Southwest Pediatric PTN: Transforming Pediatric Care

 

Two and a half years ago, the Southwest Pediatric Practice Transformation Network (PTN) received funding through the Transforming Clinical Practice Initiative (TCPi) to develop collaboration between Children’s Hospital of Orange County (CHOC) and Rady Children’s Hospital in Southern California. The goal was to provide support to over 230 pediatric practices (more than 1500 clinicians) to transform the way they deliver care. Part of this transformation included engaging parents to improve patient health. Both hospitals had been working effectively with parents on Advisory Councils (PFACs) and hospital committees for more than seven years. So, it was only natural that those partnerships would be extended to the TCPi work.

Many of the practices participating in TCPi included community physicians who had not previously experienced the power of partnerships. To introduce them to this approach to practice transformation, a parent panel was included as part of a Learning Collaborative offered to physicians and staff.

A key transformation strategy across all the pediatric practices was the implementation of Pediatric Clinical Guidelines. A Physician Advisory Council was established to develop the guidelines, ensure buy-in from clinicians, and support implementation. A simple tool was created that met the needs of busy clinicians while still emphasizing evidence-based best practice.

Two PFACs (a newly established TCPi-specific PFAC at CHOC and the existing PFAC at Rady Children’s) were instrumental in enhancing the process to ensure that the voice of parents also informed the practice guidelines. Parent members of the PFACs reminded clinicians that a mechanism for sharing the guidelines with patients and families was a missing part of the transformation process so far. As a result of this powerful feedback, a companion tool was created by and for parents to engage them effectively.

Recently, the PFAC and the Physician Advisory Council met jointly. The response from physicians was tremendously positive. One remarked, “I’ve been in practice for years. I am shocked at how much I am learning from having parents in the room.” This sentiment was shared by many participants. As a result, the TCPi Lead, Dr. Weiss decided to combine the physician and parent groups into the Joint Advisory Council. In the future, all perspectives will be shared at the same time and, together, address the TCPi goals.

With the implementation of established Clinical Practice Guidelines, pediatric patients are now being treated consistently with best practices, leading to strong patient/parent satisfaction. As different guidelines are implemented, results are measured to demonstrate improvement. For example, new guidelines for the appropriate use of CT and MRI procedures for headaches have led to a significant reduction in unnecessary radiology testing.

During this process, three key enablers led to effective Patient Family Engagement:

• Physician leadership set expectations that parents are partners in transformation and demonstrated that commitment.
• An experienced staff liaison supported successful parent participation and coached individual practices.
• The actual experience of parents and physicians working together on shared goals excited and energized the transformation process!

With these successes at the PTN level, many practices are now establishing mechanisms to support meaningful parent participation in their local offices.