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A11/B11:Partnering with “Familiar Faces” 

Embracing Diversity of ExpectationTiffany Christensen

Trevor Torres

Session Objectives

• Examine the variety of expectations held by chronically ill patients and their families

• Explore and discuss a variety of tools for improving communication and engaging patients in safety efforts

• Write action plans for personal and organizational improvement based on the information shared

The presenters in this session have nothing to disclose

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Where we’re going…

Today’s demands for culture change takes your skill set to the next level.

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Why the culture change?

*Pts with more access to information* Competitive markets* Questions about boundaries

And yet…Providers asked to do more with less money

So how do we keep up with shifting expectations? 

How do we improve the patient experience while attending to so many other demands?

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The What:Person‐ and Family‐Centered Care is putting the patient and the family at the heart of every decision and empowering them to be genuine partners in their care

~Institute for 

Healthcare Improvement

Trevor Torres

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You should getDiabetes!

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My story, and things I’venoticed as a patient

Just ask me!

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Great teachers adapt

Practicing PFCC

THE PLATINUM RULE

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I like to know what’shappening.

Allow me to now narrate my care…

My Upper Endoscopy

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Patient and Family Centered Care Guiding Principle:

Information Sharing

The “it’s cold outside”problem

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Trying to get an A1C

ChronicInconvenience 

A.K.A.Red tapeoverdose

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Patient and Family Centered Care Guiding

Principle:

Dignity and Respect

I can haz video?

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Patient and Family Centered Care Guiding Principle:

Participation

My style:

The CEO metaphor

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Patient and Family Centered Care Guiding Principle:

Collaboration

Here come the

Millennials!

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Thank you.

It’s your turn!

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Group Exercise

Betty’s story…

Examine this story from

the perspective of PFCC.

Using the 4 Guiding Principles discuss:• How safe is if for Betty to go home today?

• How might the conversation have gone differently?

4 PFCC Guiding Principles

• Respect and dignity. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.

• Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decision-making.

• Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.

• Collaboration. Patients and families are also included on an institution-wide basis. Health care leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in health care facility design; and in professional education, as well as in the delivery of care.

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Another patient perspective

Diagnosed at 6 months old with the

gift of cystic fibrosis

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I had a relatively normal childhood

I had my first hospital stay at

Age 12

I had three weeks of intravenous

antibiotics and got my first taste for

the need to be an advocate

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This was just the beginning…

There would be countless more days spent in the hospital during my

lifetime

By age 21, I was sick almost all of the time.

I was attending the North Carolina School of the Arts and

I just couldn’t keep up.

I had to give up my Hollywood dreams and drop out.

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I was on oxygen getting tube feedings.

The doctors put me on the

list for a bilateral lung transplant.

I waited 4 years for my “call”

I was 95 pounds and my lung function was

25% of capacity

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Facing Medical Error

Surgical Error:

“Wet Run” and an apology

Ripple Effect of Reactions:

In the OR

In the Transplant Protocols

In Safety Procedures Hospital Wide

Patient and Family Centered Care Guiding Principle:

Information Sharing

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I waited 1 more year for my first set of donor lungs

Now, due largely to the surgical error,

I was 87 pounds and my lung function was

18% of capacity

April 4th, 2000

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Patient and Family Centered Care Guiding Principle:

Participation

I was healthier and puffier than ever before!

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In June of 2002, my lung function started to drop.

I was diagnosed with my second

terminal illness 6 months later. I had Chronic

Rejection.

Within two years, my lung function had dropped to 10% of

capacity.

I was 73 pounds.

I was dying and the doctors gave me 6 more months to live.

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Loss of Purpose and Worth

I asked my doctors if I

could have a second lung transplant.

They said no.

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After the stages of grief…the soft arms of acceptance

We got a new transplant

coordinator.

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Only 4 months after I was listed,I got “the call”

My fear was overwhelmingGoing into the OR, I was looking

for comfort

Patient and Family Centered Care Guiding

Principle:

Dignity and Respect

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On March 28, 2004

Despite my team’s

concern, the recovery was easier than

the first time.

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Unlike after the first time, I was not confused about what to do

with my life.

I felt a strong calling to reach out to others touched by illness.

I wanted to share what I had learned…

• Author• Public Speaker• Workshop Leader• Hospice Volunteer• TeamSTEPPS Master Trainer• Respecting Choices Instructor/Facilitator• Duke Patient Advocate

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I fell in love

love…again

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And…again

And…again

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Sister, Daughter, Friend

And working on that other thing...

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Collaboration: Duke PAC

Established in 2005 by Dr. Victor Dzau, Chancellor of Health Affairs. Used to advise DUHS on patient centered care initiatives and culture at Duke University Health System  

Expansion/sustainability program:

Local Councils providing feedback to specific clinical specialties

Standardized Training for all staff and advisors

Strategic structure and implementation

Rigorous interview/approval process

A different kind of feedback!

Patient and Family Centered Care Guiding Principle:

Collaboration

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Duke PAC Collaboration: Safety

2009 to date:

12+ Duke Health System PAC members trained as TeamSTEPPS Master Trainers

The result:

Partnership with Patients to reduce Medical Errors using

TeamSTEPPS

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TeamSTEPPS• An evidence-based teamwork system to improve

communication and teamwork skills among health care professionals. (Based on the aviation model of safety)

• Scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles.

• Developed by Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality.

• Increases team awareness and clarifies team roles and responsibilities.

• Resolves conflicts and improves information sharing.

• Eliminates barriers to quality and safety.

Yes and….

Where is the patient?

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Sharing Tools

• SBAR (Partnering for time and clarity)

• CUS(S) (Partnering through frustration)

Partnering through Preparation

Symptoms

Background (relevant)

Assessment

Request (immediate)

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Partnering for Safety

Concerned

Uncomfortable

Scared

Safety

Every interaction is an opportunity to build a partnership

One Step at a Time Patient: One simple “job” at a time

Eager Patient and Family: Track own data and medicines

Expert Patient and Family: Trained in SBAR

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And sometimes, no matter what, people will be dissatisfied…

Thank You!

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It’s your turn!

Giving Your Patient a “Job”

Remember our lack of purpose and worth?

Help us by helping you! Give us a job to do to be proactive and safeguard our own health.

• Example: Next Slide

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Ed Johnson from TeamSTEPPS• Setting: Clinic

Ed Johnson, a 41-year-old patient with a history of hypertension, is seen in the Cardiology Clinic for a follow-up after his recent admission to rule out a myocardial infarction. His vital signs are normal except for a BP of 170/110. An EKG shows NSR without evidence of ischemic changes. He states that he has been having episodic chest pain since his release, so the physician decides to repeat his cardiac enzymes. His CPK is 201, and a Troponin I level is pending.

• Mr. Johnson's pain resolves, and he insists on going home. The Troponin I level is still pending when Mr. Johnson is discharged with instructions to call the office the next day if he is still having problems. Shortly after Mr. Johnson is discharged, the Troponin I level of 0.22 (normal <0.03), indicating myocardial ischemia, is called in to the nurse in the clinic. The nurse notifies the physician of the result. No attempt is made to contact Mr. Johnson. Later, he is found unresponsive and having difficulty breathing. His friend calls 911, and when the ambulance crew arrives, they find him apneic and they cannot detect a pulse.

Action PlanUsing the 4 guiding principles, the TeamSTEPPS tools and other key messages you heard today:

Write out 1 way in which

you plan to improve

the patient experience

within your practice

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Questions?

Contact us!

sickgirlspeaks.com

diabetesevangelist.com