Establishing a Standard for Patient and Family Engagement Programs

Beth Daley Ullemwww.qualityandsafetyfirst.org

Evolution of the Patient’s Role in Healthcare

Paternal Care

Informed Consent

Satisfaction

Advocacy

Information Access

Expectations after ‘Harm’

Striving for Engagement

Patient’s Involvement, Expectations and Information have

Dramatically changed over the last 50 years in

medicine!

Activated Patients: Cost Less and Better Outcomes

Patients who are activated in their care have been found to have costs that are 8-21% lower than similar condition patients

who are not activated in their care.*

• Patients with low levels of activation are twice as likely to be readmitted to

hospitals within 30 days of discharge.**

*Health Affairs 32, no 2: Judith H Hibbard et. al.**JGIM: Feb 2014, Vol 29 Issue 2Mitchell et. al.

Patient Activation = Engagement

Once a patient is activated and motivated…

It does not mean that they actually can be ‘engaged’ unless the healthcare system provides the information, support, training, systems and

processes for successful engagement!

Patient Activation + Engagement

We are all searching for the Holy Grail

(often called the Triple Aim)

Patient Activation +Patient Engagment

PatientActivation

High

Low

PatientEngagement

HighLow

The Current Challenge for Patient and Family Engagement Programs

PFE has become a ‘catch all’ term for too many things.

2013-2014 AHA study of ¼ of the US hospitals PFE programs found wide variation in PFE

programs and policies.*

*BMJ Quality and Safety June 16, 2015

The Current Challenge forPatient and Family Engagement Programs

The Current Challenge for PFE Programs

What should the minimum components for a PFE program include?

What should a best-in class program include?

If you are missing some components, are you still authentically having a PFE commitment?

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1. Patient Engagement in Hospital Decision Making

2. Patient Engagement for Individual Care

3. Patient Engagement after Harm Events

PFE Roadmaps Need to Set a Minimum Standard

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1. Patient Engagement is a Priority for Hospital Decision Making

– Hospital has a PFAC and Patient representation on the Quality Committee of Board and Board of Directors

– Governing Board Reviews Safety, Quality and Patient Engagement Metrics In-Depth

– Leadership and Front-line Compensation Includes Quality and Patient Engagement metrics

– Front-line Hospital Employees Get Training Patient Engagement and Input on Improvement

Proposed PFE Minimum Standards

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2. Patient Partnership for their Individual Care– Medical records access

– Shared decision making for all parts of care and teach-back training

– Multidisciplinary coordinated care esp. for complex/ chronic conditions

– Patient access to RRT activation and grievance reporting

– Bedside rounds

– Language support

– Visitor/Family access

– Strategies to build health literacy and condition navigation

Proposed PFE Minimum Standards

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3. Engagement after harm– Transparency of and learning from harm

events– Patient input in RCA after harm event– Early Conflict Resolution after Harm Events– Training for Difficult Conversation– Regular review of distribution of grievances

and incident reporting

Proposed PFE Minimum Standards

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1. Outcomes and price transparency will become a starting point for care

• Comparative reporting and pricing of most common conditions/procedures

2. Advances in Heathcare IT will enable better patient voice and management of care

• Patient real-time bedside interface into the EMR• Significantly more interactive Push/Pull of med administration, chronic

care and scheduling• Education online/video decision making support for conditions and

procedures

3. Deeper community outreach and care coordination will improve ability to manage up and downstream of point of care

4. Patient activation assessment and scoring will become part of plan of care

Upcoming Next Phase of PFE Standards

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PFE Minimum Standard

Beth Daley Ullem

www.qualityandsafetyfirst.org