The MetroHealth System is an integrated health system with an acute care hospital housing the area's only Level I Adult Trauma and Burn Center in Cleveland, Ohio. MetroHealth operates a skilled nursing facility and a network of 20 locations throughout the community, with more on the way. More than one million patients visit MetroHealth every year. The Emergency Department sees more than 100,000 patients annually. All MetroHealth active physicians are faculty of Case Western Reserve University School of Medicine, an affiliation that began in 1914.
Beginning the Patient- and Family-Centered Care Journey
In 2013, MetroHealth established an Office of Patient Experience (OPX), including a new Patient- and Family-Centered Care (PFCC) program. Within a year, the OPX implemented Pathways to Patient Experience, a four-hour training program for MetroHealth's 6700 medical providers and staff. It was the power of patient stories featured in patient videos at this training that spurred MetroHealth to establish a Patient and Family Advisory (PFA) task force in 2014.
The mission of MetroHealth's PFA task force is to bring the voice of patients and families to hospital operations. The task force includes two patient and family volunteer advisors, and employees from multiple disciplines including physicians and nurses and representatives from the following departments: Quality, Social Work, Marketing, Inclusion & Diversity, Trauma Survivors Network, and Community Relations.
In 2014, one of the PFA task force members, using funding from the Better Health Greater Cleveland Grant, arranged for Bev Johnson, IPFCC President and CEO, to consult with MetroHealth. Bev visited three times:
- Spring 2014, Bev conducted a walk-through, offering feedback on ways to make areas and signage more patient- and family-centered.
- July 2014, Bev met with the PFA task force to discuss how to implement the Patient and Family Advisor Program and establish a Patient and Family Advisory Council (PFAC).
- March 2015, Bev met with a group of Patient and Family Advisors who shared updates about their involvement as PFAs. Bev also gave an educational talk, Moving Forward with Patient- and Family-Centered Care: Partnering with Patients and Families, open to all MetroHealth employees and members of Better Health Greater Cleveland.
Patient and Family Advisory Program
In July 2014, OPX recruited Jennifer Lastic as the Program Coordinator for the Patient and Family Advisor program. Jennifer was responsible for launching all aspects of the PFA program. To jumpstart the program in the fall of 2014, Jennifer attended IPFCC's intensive training seminar, Moving Forward with Patient-and Family-Centered Care: Partnerships for Quality & Safety. According to Jennifer, the seminar "was an amazing educational opportunity. The small group sessions were especially helpful. I was able to share ideas with colleagues from other institutions and complete a project action plan to establish a PFA program and a PFAC at MetroHealth."
Back at MetroHealth, Jennifer worked with the task force—a partnership of patient and family advisors and health care providers—to develop the Patient and Family Advisor (PFA) program: planning and developing the recruitment of PFAs, marketing the program, and developing the PFA role description, application process, and program brochure.
According to Sara Laskey, MD, Chief Experience Officer, the goal is "to tap into the experience of former patients and their family members to understand how we can create positive transformation that focuses on patient- and family-centered care." Community volunteers who have patient experience or are family members of patients serve as Patient and Family Advisors (PFAs) by being members of hospital improvement teams and standing committees.
By the fall of 2014, MetroHealth held multiple information sessions to recruit potential advisors. In addition, as the PFA program rolled out, MetroHealth's Director of Patient Centered Care, Mary Linda Rivera, RN, and Jennifer, as Program Coordinator, embarked on an educational and recruitment campaign within MetroHealth. They took their message to the Executive Committee, monthly manager meetings, and departmental faculty meetings. Attendees learned about the program and were encouraged to provide referrals for potential PFAs. A staffed informational table at MetroHealth community events also provided an opportunity to educate the community and recruit potential PFAs.
Shortly thereafter, MetroHealth began to place Patient and Family Advisors on committees and projects. Before placing a PFA on a committee, Jennifer attends the committee meeting to educate staff on partnering with a PFA and provides tips for effective meetings with PFAs. Jennifer accompanies the PFA to the first meeting to provide introductions and ensure a smooth transition for the new member.
Currently, MetroHealth has 44 Patient and Family Advisors. The on-boarding process for PFAs is through the Volunteer Department, which is organizationally within the OPX. New PFAs attend the general volunteer orientation and a PFA-specific orientation with the Program Coordinator, who then provides ongoing support for the PFAs.
Here is a sampling of the committees on which the PFAs participate:
- Patient and Family Advisory Council (PFAC);
- Quality Board of Trustees subcommittee;
- Patient Experience Board of Trustees subcommittee;
- Inpatient Patient Experience Committee;
- Emergency Department Patient Experience Committee;
- Language Access Communication Services Center;
- TeamSTEPPS Action Councils;
- Inclusion & Diversity Council; and
- Arts in Medicine Advisory Committee.
PFAs partner with staff on a variety of other projects, such as sharing their stories at the general orientation for new employees and participating on the Critical Care Pavilion/ICU expansion project.
Another example of partnership includes the Campus Transformation Advisory Committee, composed of 14 PFAs with various experiences at MetroHealth. At the kick-off meeting, Walter Jones, Senior Vice President, Campus Transformation, and the Executive Architect from HKS met to give an overview of the campus transformation and the role of PFAs in phase one, experiential planning. Walter Jones would like the patient perspective to be the "fishbone" of the experiential planning. The committee will meet periodically with HKS for brainstorming workshops, which will include visionary exercises, as well as process flow planning.
MetroHealth's PFA task force transitioned into the PFA Committee in order to oversee the planning and implementation of the PFAC. The role of the PFA Committee is to oversee and sustain the Patient and Family Advisor program and to ensure the viability, sustainability, and effectiveness of the PFAC.
Patient and Family Advisory Council
In January 2015, Jennifer, as Program Coordinator, with the guidance of the Patient and Family Advisor task force (now the PFA Committee)—created a charter for the creation of the MetroHealth Patient and Family Advisory Council (PFAC). The role of the PFAC is to advise MetroHealth on programs and policies to meet the needs of patients and family members. The PFAC is committed to ensuring the provision of safe, high quality, patient- and-family centered care at MetroHealth.
Members of the PFAC serve two-year terms renewable for one term. Two co-chairs, one clinical and one PFA, lead the PFAC. The Council began to meet monthly, with its first meeting in May 2015.
PFAC Recruitment and Leadership
The Program Coordinator recruited and screened the PFAs from MetroHealth's existing cadre of PFAs, and recruited some new PFAs to serve on the PFAC. Nine PFAs serve on the PFAC.
In February 2015, the Office of Patient Experience posted on MetroHealth's internal website openings for employee PFAC members. Almost 100 employees expressed interest. Potential employee advisors submitted applications, and the PFA Committee selected 25 employees to be interviewed by the Director, Patient Centered Care, and two PFAs. They selected six MetroHealth employees to serve on the PFAC, representing multiple disciplines, including Nursing, Compliance, Administration, and Protective Services.
The Clinical co-chair is a staff physician. The PFA co-chair is selected through a self-nomination and election process. The election was scheduled to take place several months into the future, to enable PFAs to garner some experience before the vote.
The Work of the PFAC
Here is a sample of the types of projects the PFAC is working on:
- Partnering with Family Medicine to improve the After Visiting Summary (AVS);
- Reviewing educational brochures/guides for patients and families
- Providing input on new communication boards for patient rooms.
Sharing MetroHealth's Success
In 2016, Jennifer Lastic, along with the Director of MetroHealth TeamSTEPPS Regional Training Center, and a PFA will present at the Beryl Institute Conference. The same group also submitted to present at IPFCC's 2016 International Conference, invitation pending. The presentation is titled: Patient and Family Advisors and TeamSTEPPS: A Cultural Transformation.