January 2013, Issue 58

Moving Forward with

Patient- and Family-Centered Care

Partnerships for Quality and Safety

An Intensive Training Seminar

April 15-18, 2013

Loews Annapolis Hotel

Annapolis, MD

Early Bird Registration Through February 13, 2013!

Registration Now Open

Thanks to AAMC, DFMC, MHA, & MPSC ~ Sponsors for the Spring Seminar
Physician Describes Urgent Need for Health Care System to Actively Partner with Patients and Families to Reduce Medical Errors
The Aligning Forces for Quality Initiative: The Importance of Collaboration
Emergency Physicians Advocate for Partnering with Patients
Compassionate Care Video Embraces Patient- and Family-Centered Care
Institute for Patient- and
Family-Centered Care
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Thanks to AAMC, DFMC, MHA, & MPSC ~ Sponsors for the Spring Seminar

Many thanks to the four Maryland organizations, described below, for partnering with the Institute for Patient- and Family-Centered Care to bring the Moving Forward with Patient- and Family-Centered Care Intensive Training Seminar to Annapolis, Maryland. The seminar will be held at the Loews Annapolis Hotel, April 15-18, 2013. Registration is now open. Take advantage of the Early Bird pricing by February 13, 2013. Learn more about the Institute's Seminars and read the Seminar Brochure.

Anne Arundel Medical Center (AAMC), based in Annapolis, Maryland, is a regional health system that includes a 100-acre medical park, a freestanding substance abuse treatment facility, outpatient clinics in underserved neighborhoods, medical office pavilions in surrounding communities, a research institute, physician practices, and a foundation. AAMC serves more than one million residents.

Three years ago, with the adoption of its new strategic Vision 2020, AAMC embraced patient- and family-centered care. With a core mission of "Living Healthier Together," staff invited patient and family advisors to partner with them on such important initiatives as family presence, a newly expanded patient safety council, peer review, hospital wayfinding, bedside shift report, patient electronic access to the inpatient medical record, and executive recruitment.

Each year, AAMC's Patient and Family Advisory Council (PFAC) and Board of Trustees, approve two patient- and family-centered goals to ensure tangible progress towards improving the quality of care. This year's goals include providing direct electronic medical record access to all patients discharged from the Emergency Department, and advancing palliative care and the promotion of advance directives.

The PFAC is responsible for providing strategic insight to ensure decisions are made through the lens of patients and families. AAMC's teams have become true believers in the importance of having the patient and family perspective. They continue to lead by example with the phrase their advisors reference, "Nothing about me without me."

AAMC is a proud recipient of a Picker Institute Always Event® grant, featuring the SMART discharge protocol. Designed by staff and advisors and led by Sherry Perkins, PhD, RN, CNO, COO, and Mitch Schwartz, MD, CMO, the tool ensures that patients and their families always have the most important information available to them at the time of discharge.

For the past two years, AAMC has achieved top hospital distinction by the LeapFrog Group for exceeding benchmarks in quality and patient safety.

Delmarva Foundation for Medical Care (DFMC) is a not-for-profit organization in Maryland dedicated to monitoring and improving the quality and delivery of health care services. As the federally-designated quality improvement organization (QIO) for Maryland, DFMC is a contractor to the Centers for Medicare & Medicaid Services (CMS) working to ensure better patient care, better population health, and lower health care costs through improvement for Medicare beneficiaries.

DFMC works with providers, local organizations, patients, their families, and other stakeholders to spread best health care practices and facilitate rapid, large-scale change, helping communities learn from one another and create solutions to improve how care is delivered. DFMC provides leadership and consulting services to ensure that care is safe, effective, efficient, equitable, timely, and patient-centered.

The Maryland Hospital Association (MHA) is the advocate for Maryland hospitals, health systems, and their patients before legislative and regulatory bodies. Its membership is comprised of community and teaching hospitals, health systems, specialty hospitals, veterans' hospitals, and long-term care facilities. In 2013, MHA is committed to the Institute for Healthcare Improvement's "Triple Aim" for health care: improving the experience of care, improving the health of populations, and reducing the cost of health care.

Maryland Patient Safety Center (MPSC)—established by the Maryland legislature in 2003—is one of the first 25 organizations in the nation to be listed as a federal patient safety organization. The Center is engaged in a number of initiatives focused on reducing harm to patients throughout the health care continuum and maintains a relentless pursuit of innovative approaches to make medical errors a thing of the past. Realizing that patients and families who are actively involved in their care makes for a safer patient, the Center stresses and promotes patient/family participation. Through education, program coordination and outreach, the MPSC is committed to incorporating patient- and family-centered care as part of making health care in Maryland the safest in the nation.

Physician Describes Urgent Need for Health Care System to Actively Partner with Patients and Families to Reduce Medical Errors

Dr. Jonathan R. Welch's first experience with medical error, in which he played the unexpected role of the adult son trying to save his mom's life, changed the way he practices medicine. He tells of his experience, and its aftermath, in his recent article, As She Lay Dying: How I Fought To Stop Medical Errors From Killing My Mom, published in the December 2012 issue of Health Affairs.

Read the moving story of how—despite Dr. Welch's multiple efforts to save his mother's life—she died in the hospital after not receiving the appropriate treatment for systemic infections. There was no system in place to alert the hospital that crucial protocols had not been ordered. Dr. Welch describes, in detail, his and his family's reactions during and after these events, and what system-wide changes could prevent such medical errors in the future.

Dr. Welch, an emergency room physician, imagines an alternative scenario to his mother's experience. He describes how patients and families can and should actively participate in quality and safety improvements, and he provides examples from several hospitals. Some hospital systems already have a policy to communicate openly and directly with patients and families after medical errors or complaints, using their input to make improvements in clinical care. Additionally, routinely interviewing patients and families following hospitalizations, especially after bad outcomes, and using the information provided, would "add new perspectives and important information that could drive opportunities for improvement."

Dr. Welch states, "Hospitals—and those of us who work in them—often fall short of understanding the experiences of hospitalized patients and their families and the perspectives they have that might improve care. Integrating patients and families into a hospital's quality and safety culture needs to become one of the important elements of patient-centered care." Dr. Welch stated that in his current practice, "I attend patient and family advisory councils, and I'm working to incorporate patient input in all aspects of my work, using best practices from the Institute for Healthcare Improvement as well as the Institute for Patient- and Family-Centered Care. The need for those of us working in health care to thoughtfully and decisively incorporate patient and family voices into care is urgent."

Some hospitals have implemented the program Condition H, or a similar rapid response program, which provides patients and families direct access to a hotline when they feel that they are not receiving the care they need, resulting in the immediate contact with an interdisciplinary rapid response team to address their concerns. Many hospitals have—and the state of Massachusetts requires that all hospitals have—patient and family advisory councils. Such councils routinely lead to policy and program improvements, including in the safety arena.

Read the entire article or listen to it in a podcast on iTunes.

The Aligning Forces for Quality Initiative: The Importance of Collaboration

Check out The Imperative to Promote Collaborative Consumer Engagement: Lessons From the Aligning Forces for Quality Initiative, by Debra L. Ness, MS, one of several articles in the supplement to The American Journal of Managed Care, which discusses the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) initiative, the largest privately funded community-based quality improvement initiative to date. AF4Q provides funds and technical assistance to 16 multi-stakeholder alliances located throughout the United States, with the goal of improving patient health and healthcare. The supplement, guest edited by David Blumenthal, MD, MPP, includes articles that describe the AF4Q initiative, results to date, and perspective from nationally recognized thought leaders.

In her article, Debra Ness, President, National Partnership for Women & Families, states that the work of AF4Q has advanced the work to define consumer engagement. Debra notes that, "True collaborative consumer engagement...would amount to nothing less than culture change for our health care system...It engages consumers at all levels—from policy to governance, to redesign of care practices, to individual/family engagement, to community involvement." Read the article to learn what Debra says about the four lessons learned:

  • You can't achieve what you can't define;
  • Put real consumers at the table;
  • Change doesn't happen without accountability and rewards; and
  • Real people need real, meaningful work.

In conclusion, Ms. Ness says, "patients and consumers can be a game-changing force if they are equal partners when new care delivery models are implemented and operationalized."

The Institute for Patient- and Family-Centered Care has been pleased to work with several of the AF4Q communities (Maine, Oregon, and Minnesota) in advancing the practice of patient- and family-centered care, as part of the Foundation's AF4Q Development Fund.

Emergency Physicians Advocate for Partnering with Patients

When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests (St. Martin's Press, January 2013) advocates for every patient to become an active participant in his/her own health care. The book provides a practical guide for how patients can establish partnerships with their health care providers, which will help to avoid misdiagnoses and unnecessary tests. This resource provides a practical guide for patients and their doctors to use narrative history and common sense to reach the right diagnosis.

The authors—Dr. Josh Kosowsky and Dr. Leana Wen—are both emergency doctors at Brigham & Women's Hospital in Boston, MA. In addition to being the Clinical Director of the Emergency Department at Brigham & Women's Hospital, Dr. Kosowsky is an Assistant Professor of Emergency Medicine at Harvard Medical School. According to Dr. Kosowsky, "what's needed...is open and thoughtful communication between patients and doctors."

Dr. Wen, who is also an emergency physician at Massachusetts General Hospital and clinical fellow at Harvard Medical School, was inspired after her mother's long battle with cancer. Dr. Wen "saw how out of control patients can feel, and how disempowering our health system often is." It is her goal to bridge the disconnect between patients and health care providers.

Dr. Wen also writes a blog, The Doctor Is Listening, in which she offers positive insights on what patients and health care providers can do to change "long-entrenched systems." According to Dr. Wen, hospital systems "are recognizing that in order to deliver first-rate care, they must value the patient's experience." She provides the following example, "Dr. David Feinberg, CEO of the UCLA health system, talks about how he spent the first several months on the job listening to patients. What he heard was so shocking, so imperative, that he challenged his 18,000-member staff to redesign their entire vision of care delivery." He ensured that patients were part of every committee. "How can we deliver patient-centered care if patients aren't part of the process?"

In another post, Dr. Wen applauds shared decision-making, and stresses the importance of this process during diagnosis: "My patients are surprised when I tell them that, actually, they are key to their diagnosis. At first, they don't believe me. With time, they understand what I mean that only you can convey to your doctor the symptoms you're having and the story of your illness. Only you can help your doctors narrow down the possibilities and arrive at the answer. Only you can be sure that your doctor listens to you and focuses on getting you to your diagnosis. Only you can really advocate for your health care."

Compassionate Care Video Embraces Patient- and Family-Centered Care

Check out the TouchStones of Compassionate Care Video, produced by the Family Advisory Council at the Children's Hospital of Orange County (CHOC). This video is based on the "Dear Future Physician" letter written by Ann Schrooten, a mom who started TouchStones for Compassionate Care, a program of The Willow Tree Foundation—an organization dedicated to enhancing the lives of parents of medically fragile children. This five-minute video features family partners and a physician champion who articulate the expectations of patients and families, which align with the core concepts of patient- and family-centered care. The video is shown within CHOC hospital in multiple education settings, including the residency program and physician grand rounds.

Institute for Patient- and Family-Centered Care Celebrates 100th Webinar

The Institute for Patient- and Family-Centered Care celebrated its 100th webinar, with the January 8, 2013 presentation of its new topic, Responding to Medical Errors in a Patient- and Family-Centered Environment. Congratulations to the Special Projects Team! Learn more about the Institute's Webinar programs.



Advancing Patient- and Family-Centered Care is a Collective Pursuit—Share Your Knowledge and Experience!

For more than 20 years, the Institute for Patient- and Family-Centered Care has collaborated with health care organizations, patient and family advisors, and leaders. Strong partnerships don't just happen—they are created by people working together, learning together, and sharing ideas about what works well and what doesn't. Chances are that you, or your organizations, have resources to support partnerships with patients and families. We are inviting you to share these resources to help the field continue to advance. The Institute would like to celebrate your success and inspire others with what is possible. Here are some examples:
  • The Institute's new website page with links to patient- and family-centered videos is getting great feedback, but we want to make it even better! So, if you know of other relevant videos that your organization is willing to share, or that are in the public domain, consider sending the links to the Institute.
  • The Institute provides access to position descriptions for staff liaisons and directors, and coordinators for patient- and family-centered care from a variety of organizations. If your organization has position descriptions for these or other types of such positions to share, please forward them to us.
  • If your organization sent a team to one or more previous Institute intensive training seminars, the Institute is interested in updates to your action plans to advance patient and family engagement. Send us an update in a few paragraphs of how patient- and family-centered care is successfully moving forward, and lessons learned. The Institute will share a sampling of these in future Pinwheel Pages e-newsletters.
  • Join the PFACnetwork to share ideas and strategies.
Please send relevant links or documents to institute@ipfcc.org. Thanks!