Patient and Family Engagement in the Surgical Environment Module - PowerPoint Presentation

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Patient and Family Engagement in the Surgical Environment Module

AHRQ Safety Program for Ambulatory Surgery

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Learning Objectives

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Defining patient and family engagement

Recognizing the importance of patient and family engagement for the ambulatory surgery center (ASC)

Understanding

e

ngagement in your facilityIdentifying barriers, facilitators, and motivatorsCommunicating with patients and family membersUtilizing patient advisersFinding opportunities for patient and family engagement in your facility

Overview

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Involves “…collaborating with patients and families of all ages, at all levels of care and in all health care settings…acknowledges that families, however they are defined, are essential to patients’ health and well-being

…”

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1

Conway J, Johnston B, Edgman-Levitan S, et al. Institute for Patient- and Family-Centered Care. Partnering with Patients and Families To Design a Patient- and Family-Centered Health Care System. A Roadmap for the Future. A Work in Progress. June 2006. http://www.ipfcc.org/pdf/Roadmap.pdf.

Patient- and Family-Centered Care

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Patient and family engagement2

—

Is an important component of patient- and family-centered care

Creates an environment where patients, families, clinicians, and hospital staff all work together as partners to improve the quality and safety of health care

Involves patients and family as—Members of the health care teamAdvisers who work with clinicians and leaders to improve policies and procedures

2Patient and Family Engagement. June 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://

www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/modules/patfamilyengagement/index.html.

What Is Patient and Family Engagement?

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Improve quality, patient safety, satisfaction, and optimal patient outcomes

Reduce institutional and individual cost

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C

omply with patient-centered policies and legislationIncrease adherence to treatment regimens, reducing complications2Report on engagement as a metric for successIncrease rapport between patient and staffBuild community relationships

2Patient and Family Engagement. June 2015. Agency for Healthcare Research and Quality, Rockville, MD.

http://

www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/modules/patfamilyengagement/index.html

.

3

A

Leadership Resource for Patient and Family Engagement Strategies.

Health Research & Educational Trust. Chicago: July 2013. http://www.hpoe.org/resources/hpoehretaha-guides/1407.

Benefits for ASC Providers and Facilities

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Benefits of Participation in Care

Patient Participation

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Improves

safety and awarenessBrings important perspectives about care, including cultural and religious preferencesProvides timely feedback Provides access

to patient’s historyBuilds trusting relationship with provider

Family Participation

Improves

safety and awareness

Offers familiarity

with patient medical history, normal behaviors of patient

Gives opportunity

to teach family members about postoperative care

Provides

timely feedback

Builds trusting relationship with provider

4

Advancing

the Practice of Patient- and-Family-Centered Care in Primary Care and Other Ambulatory Settings. How to Get Started…Institute for Patient-and Family-Centered Care.

2011.

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Patients and their family members

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—

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enerally assume that most care is safe and that there are system checks to prevent medical errorsBlame provider, not system, for medical errorsUnderestimate medical errorsPatient and family engagement in health care may decrease medical errors by allowing patients and family to—Be informed, asking questions about and participating in their careHelp prevent specific safety events and/or medical errorsReport on safety events after the fact

5Maurer M, Dardess P, Carman, KL, et al. Guide to Patient and Family Engagement: Environmental Scan Report. (Prepared by American Institutes for Research under contract HHSA 290-200-600019). AHRQ Publication No. 12-0042-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2012.

Patient and Family Roles in Engagement

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Patients and their family members expect the following to occur when it comes to their health care

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:

To be listened to, taken seriously, and respected as a care partner

To be told the truthTo have information communicated to their entire care teamTo have coordination among all members of the health care team across settingsTo be supported emotionally as well as physicallyTo receive high-quality, safe care1Conway J, Johnston B, Edgman-Levitan S, et al. Institutes for Patient- and Family-Centered Care. Partnering with Patients and Families To Design a Patient- and Family-Centered Health Care System. A Roadmap for the Future. A Work in Progress. June 2006.

Patient and Family Expectations

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In the ASC setting, patients and their family members should expect to—

Be educated about preoperative, operative, and postoperative care in person and through take-home written materials

Have family, caregivers, and advocates included at the patient’s desired or age- or condition-appropriate level

Be respected as an individual and not be identified as a surgical name or number

Be given the opportunity to have all of their questions answeredBe able to stop the process if they believe there are questions or problemsPatient and Family Expectations Specific to Surgical Environments

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Factors preventing successful engagement for patients and family include

3,4

—

3

A Leadership Resource for Patient and Family Engagement Strategies. Health Research & Educational Trust, Chicago: July 2013. http://www.hpoe.org/resources/hpoehretaha-guides/1407.4Advancing the Practice of Patient- and-Family-Centered Care in Primary Care and Other Ambulatory Settings. How to Get Started…Institute for Patient-and Family-Centered Care. 2011.

Barriers to Engagement for Patients and Family

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Patients in an ASC facility may not—Understand the system or culture

Know who different staff are and what they do

Want to bother busy ASC staff

Have a chance to have their questions answered, because they are only in the facility for a short time

Additionally, they may be—Afraid or uncomfortable about their surgery/procedureCared for post-surgery by their family members and caregivers after they leave the ASC settingThe Patient’s Ambulatory Surgery Center Experience

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Perceived level of time and effort4

Communication challenges

Culture, language, power

d

ynamics, navigating patient and family preferencesProfessional norms and experiencesHealth care workers’ understanding and knowledge of engagement, workplace culture, patient and family engagement skills (lack of skills or negative experiences)Patient situation upon discharge Patient sedation, rapid discharge (less than 24 hours)Fear of litigation Transparency and adverse events, compliance with patient privacy laws

4Advancing the Practice of Patient- and-Family-Centered Care in Primary Care and Other Ambulatory Settings. How to Get Started…Institute for Patient-and Family-Centered Care.

2011.

Barriers to Engagement for Health Care Personnel

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The Health Insurance Portability and Accountability Act (HIPAA) aims to protect patient health information, but may present unique challenges for patient and family engagement. However, HIPAA and Patient and Family Engagement share the following objectives

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:

5

Institute for Patient-and Family-Centered Care. HIPAA – Providing New Opportunities for Collaboration. Oct 2010. http://www.ipfcc.org/advance/hipaa.pdf.Privacy Barriers – HIPAA

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Privacy Barriers – HIPAA

Continued

6

Institute

for Patient-and Family-Centered Care. HIPAA – Providing New Opportunities for Collaboration.

October

2010.

http://

www.ipfcc.org/advance/hipaa.pdf

.

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Measuring baseline culture assessmentWhat is your patient and family engagement level?

What are your personal attitudes about patient and family involvement in their own health care?

Understanding Patient Engagement in Your Facility

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Participating in patient and family engagement can be made easier by—

Facilitation of Engagement for Health Care Personnel

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Facilitators of Patient and Family Engagement

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Ask patient first, in private, what matters most to them

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Determine level of family engagement based on patient’s desires and wishes for their care

No one size fits all

Patient and family engagement and engagement incentives will look different for practice specialty and patient demographics (i.e., age)Find individual case studies and strategies for engaging health care users in Engaging Health Care Users: A Framework for Healthy Individuals and Communities87Scholle SH, Torda P, Peikes D, et al. Engaging Patients and Families in the Medical Home. (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO2.) AHRQ Publication No. 10-0083-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2010

.

8

American Hospital Association. Engaging Health Care Users: A Framework for Healthy Individuals and Communities. Chicago: American Hospital Association, Committee on Research; 2012.

http://

www.aha.org/research/cor/content/engaging_health_care_users.pdf

.

Methods of Engaging Patients and Family Members

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Communication techniques

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M

ake eye contact, smile, introduce yourself and others

Ask how the patient would like to be addressedInclude the patient and family as members of the health care teamAsk about and listen to the patient and family’s needs and concernsHelp the patient and family understand the health condition, procedure, and next steps in their careWork with patients to ensure that they fully understand health information and use that knowledge to make informed decisions themselves

Tool: Communicating to Improve Quality (Tool 5 AHRQ)9

9

Strategy

2: Communicating to Improve Quality (Tool 5).

Implementation

Handbook. Overview of Communication Competencies.

Guide

to Patient and Family Engagement. Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy2/index.html. Accessed July 2013.

Communication Guide for Providers

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Question prompt

s

heets, such as AHRQ’s “Questions Are the Answer”

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Includes questions for patient and family to ask their health care providers before, during, and after a procedurePreoperative and postoperative materials for preparation, such as “Helpful Information for the Day of Your Surgery” Explains how to prepare for surgery and what to expect the day of surgeryDescribes health care provider rolesInformed consent materialsDetails risks of procedures/benefits of procedures

10Questions

To Ask Your Doctor. September 2012. Agency for Healthcare Research and Quality, Rockville, MD.

http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html

. Accessed July 2013.

Communication Guides for Patients and Families

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Opportunities for Patient and Family Engagement in Your

Facility

–

Introducing Health Care Personnel

Select to play video: https://youtu.be/X3KGKqFChi8

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Encourage

patient and family engagement in the use of the safe surgical

checklist:

Patient identifies surgery site

Patient verbally lists medication allergiesPatient is active in own surgery preparednessPatient and family are active in discharge process

Opportunities for Patient and Family Engagement in Your Facility

– Checklist

Select to play preoperative video:

https://youtu.be/8gmMfZ__ibw

Select to play recovery video:

https://youtu.be/GpsdM9-Hi6s

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Fully disclose risks using simple, slow, clear languageCheck understanding of risk and procedure

Offer opportunity for questions

Opportunities for Patient and Family Engagement in Your Facility –

Informed Consent

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IDEAL discharge planning11

I

nclude the patient and family

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iscuss with the patient and family five key areas to prevent problems at homeEducate the patient and family throughout their time in the ASC facilityAssess how well health care providers explain the diagnosis, condition, and next steps in their care — use Teach BackListen to and honor the patient and family’s goals, preferences, observations, and concerns11Care

Transitions from Hospital to Home: IDEAL Discharge Planning Training. Guide to Patient & Family Engagement. Strategy 4: IDEAL Discharge Planning (Tool 4).

Agency for Healthcare Research and Quality.

http://

www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy4/index.html

. Accessed

July 2013.

Opportunities for Patient and Family Engagement in Your Facility

– Discharge

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Disclosure and apology for unexpected adverse outcomes12

Opportunities for Patient and Family Engagement in Your Facility

12

Federico F, Frankel A, Huber S, et al. PS 105: Patient

Safety and Communicating with Patients After an Adverse

Event (updated August 15, 2016, to Responding to Adverse Events). Open School. Institute for Healthcare Improvement. August

2010.

http://

app.ihi.org

.

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Advisers are collaborative partners in developing and revising facility policies, procedures, and practices.

How might that look in the ASC

setting?

Patient and

family advisory boardsAre patients and family members currently playing an advisory role at your facility? If not, is there an opportunity for patient advisers?Improving Engagement at Organizational Level – Patient Advisers

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Effective engagement and communication among patients, family members, and other members of the health care team impacts health outcomes and patient, family, and staff satisfaction.

Although barriers to engagement exist for both patients and families and health care personnel, creating a patient-centered environment that encourages open communication from all parties can facilitate engagement.

Opportunities for engagement exist throughout the ambulatory surgery center experience.

Organizations should be prepared to respond and communicate proactively when adverse events occur.

Summary

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For

patients

and

families

:Getting Ready for Your Ambulatory SurgeryQuestions Are the Answer10For providers:Advancing the Practice of Patient- and-Family-Centered Care in Primary Care and

Other Ambulatory Settings. How to Get Started…

13

Readiness for Advisers

Senior Leader Checklist

IDEAL

Discharge

Planning

11For more support tools and free downloads, please refer to the Patient- and

Family-Centered Care

Web site at

http://www.ipfcc.org

.

For ongoing implementation support, please refer to “

A Leadership Resource for Patient and Family Engagement

Strategies

.”

3

3

A Leadership Resource for Patient and Family Engagement Strategies. Health Research & Educational Trust, Chicago: July 2013.

http://www.hpoe.org/resources/hpoehretaha-guides/1407

.

10

Questions

To Ask Your Doctor. September 2012. Agency for Healthcare Research and Quality, Rockville, MD.

http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html

. Accessed July 2013.

11

Care

Transitions from Hospital to Home: IDEAL Discharge Planning Training. Guide to Patient & Family Engagement. Strategy 4: IDEAL Discharge Planning (Tool 4) Agency for Healthcare Research and Quality.

http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy4/index.html. Accessed July 2013

.

13

Advancing

the Practice of Patient- and-Family-Centered Care in Primary Care and Other Ambulatory Settings. How to Get Started…Institute for Patient-and Family-Centered Care. 2016.

http://

www.ipfcc.org/resources/GettingStarted-AmbulatoryCare.pdf

Tools

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References

Conway J, Johnston B, Edgman-Levitan S, et al. Institutes for Patient- and Family-Centered Care. Partnering with Patients and Families To Design a Patient- and Family-Centered Health Care System. A Roadmap for the Future. A Work in Progress. June 2006.

http://www.ipfcc.org/pdf/Roadmap.pdf

.

Patient and Family Engagement. June 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/modules/patfamilyengagement/index.html

.A Leadership Resource for Patient and Family Engagement Strategies. Chicago: Health Research & Educational Trust, July 2013.

http://www.hpoe.org/resources/hpoehretaha-guides/1407

.

Advancing

the Practice of Patient- and-Family-Centered Care in Primary Care and Other Ambulatory Settings. How to Get Started…Institute for Patient-and Family-Centered Care. 2011

.

Maurer

M, Dardess P, Carman, KL, et al. Guide to Patient and Family Engagement: Environmental Scan Report. (Prepared by American Institutes for Research under contract HHSA 290-200-600019). AHRQ Publication No. 12-0042-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2012.

Institute

for Patient-and Family-Centered Care. HIPAA – Providing New Opportunities for Collaboration.

October

2010.

http://

www.ipfcc.org/advance/hipaa.pdf

.

Scholle

SH, Torda P, Peikes D,

et al. Engaging

Patients and Families in the Medical Home. (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO2.) AHRQ Publication No. 10-0083-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2010

.

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References

American Hospital Association. Engaging Health Care Users: A Framework for Healthy Individuals and Communities. Chicago: American Hospital Association, Committee on Research; 2012.

Strategy 2: Communicating to Improve Quality (Tool 5). Implementation Handbook. Overview of Communication Competencies. Guide to Patient and Family Engagement. Agency for Healthcare Research and Quality.

http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy2/index.html

. Accessed July 2013.Questions

To Ask Your Doctor. September 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html

. Accessed July 2013.

Care Transitions from Hospital to Home: IDEAL Discharge Planning Training. Guide to Patient & Family Engagement. Strategy 4: IDEAL Discharge Planning (Tool 4) Agency for Healthcare Research and Quality.

http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy4/index.html

. Accessed July

2013.

Federico

F, Frankel A, Huber S, et al. PS 105: Patient Safety and Communicating with Patients After an Adverse Event (updated August 15, 2016, to Responding to Adverse Events). Open School.

Institute

for Healthcare Improvement. August 2010.

http://app.ihi.org

.

Advancing the Practice of Patient- and-Family-Centered Care in Primary Care and Other Ambulatory Settings. How to Get Started…Institute for Patient-and Family-Centered Care. 2016.

http://

www.ipfcc.org/resources/GettingStarted-AmbulatoryCare.pdf

.