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How Patient and Family Advisors Can Improve Quality |
| , 15 2008 |
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| A new movement is spreading in the health care industryone in which hospitals are
giving patients and their families a more powerful voice in the patient care
experience. Hospital leaders are enlisting patients and families to serve on
advisory councils that provide input into a multitude of hospital areas, from safety
and quality measures, as well as hospital design, building and expansion projects,
to the hiring of hospital leaders, the hospital admission process, clinical trial
design and medical resident training.
Take Hollis Ryan, who has had her share of experiences with the health care system.
She had become accustomed to accepting doctors and nurses as the authorities, and
herself as merely a bystander in her own careto listen and do as she was told. |
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| So when her son was admitted to H. Lee Moffitt Cancer Center and Research Institute
in Tampa, Fla., for brain cancer, she was not prepared for the experience that was
about to unfold. The doctors and nurses engaged her in the care process. They asked
her questions, they listened to her opinions and they discussed the treatment
options openly and thoroughly throughout her sons treatment.
In the past, I felt like I was always standing on the outside, looking in, she
says. Suddenly, I was a part of the care process. They removed that veil of mystery
that had shrouded my health care experiences for most of my life.
But Ryans positive experience did not stop there. She was later asked to share her
experiences at Moffitt and to provide suggestions for improving the patient and
family experience by serving on a Patient and Family Advisory Council. What amazed
me was that this was a committee that was made up of a broad perspective of leaders
at the hospital that could get things done, she says. It was very apparent to me
that they cared about my opinions and that they were serious about making changes.
The Institute for Family-Centered Care in Bethesda, Md., a not-for-profit group that
has created many key principles behind patient- and family-centered care, is
encouraging hospitals nationwide to create such patient and family advisory groups
to help them improve patient outcomes.
Increasingly, the voice of patients and families is being recognized by hospital
leaders and trustees as a valuable tool to help hospitals bolster patient
satisfaction, improve safety and quality, prevent malpractice litigation and reduce
costs by streamlining care delivery.
It gives leadership a chance to hear firsthand, the good and the bad, says Dick
Scheumann, an 18-year board member of the University of Washington Medical Center
(UWMC), in Seattle, and a four-year member of its Patient and Family Advisory
Council Steering Committee. [Health care delivery] is a very competitive business
and this is a way to maintain your bottom line and develop satisfied customers, he
says.
The Joint Commission and the Society for Critical Care Medicine endorse the model,
and the American Hospital Association has partnered with the Institute for
Healthcare Improvement to develop tools to help health care providers accelerate
their efforts to provide more patient- and family-centered care. In addition, the
Centers for Medicare & Medicaid Services (CMS) recently announced that it plans to
condition full payment updates in part on hospitals disclosure of patient
satisfaction datayet another impetus for hospitals to look for new ways to boost
patient satisfaction.
The creation of patient and family advisory groups is a first and critical
component for implementing the total concept of patient- and family-centered care,
says Beverly Johnson, president and CEO of the Institute for Family-Centered Care.
Its how you will move it forward.
Patient- and family-centered care involves integrating patients and their families
into medical care by supporting them in becoming active participants in their own
health care experience. The model is grounded in several key principles for
providers that include: dignity and respect toward patients and families; open and
timely information-sharing; active patient and family participation in care and
decision-making; and collaboration with patients and families on an institution-wide
basis in areas such as policy and program development, facility design, professional
education and the delivery of care.
Improving Patient Safety and Quality
Every hospital of the future should be orienting its board as to what
patient-centered care is and how it should be implemented in their organization,
Johnson says. Patients and families bring an essential perspective about care that
is critical to ensuring safety and quality and to ensuring that a hospitals finite
resources are being used wisely.
She adds that hospitals that invite the input and perspectives of patients and
families can help curb the tide of medical errors. Sometimes, when you get so close
to a problem and become so invested in the system, you lose perspective, Johnson
says. We need the voice of patients together with health care professionals to
understand current practices and tap into patient insights to find solutions on how
to fix it.
It was, in part, this goal of stemming potential medical errors, that motivated UWMC
to begin employing patient and family advisors in 2002. The hospital now has some 60
to 70 advisors serving on more than 25 operational committees, including patient
safety, education, ethics, grievance and hospital aesthetics. Stephen Zieniewicz,
UWMCs executive director, believes the advisors are having an impact.
Patient and family involvement in their health care has been shown to greatly
increase patient safety, Zieniewicz says, adding that such involvement has helped
reduce the number of falls, ensures that patients understand care plan instructions
and has contributed to reduced medical errors. Advisory councils are firmly
implanted at UWMC, he says. The councils report to the patient- and
family-centered care steering committee and receive guidance and suggestions from
the committee. The steering committee, in turn, is part of the medical centers
quality improvement structure and includes members from all areas of the
hospitalfrom the medical director to the chief nursing officer to department heads
and nurse managers. This ensures that the work and philosophy of the councils is
disseminated and embraced on a hospitalwide basis.
The advisory councils include patients and family members as well as a mix of
clinical and administrative representatives. A physician is represented on each
committee and a board member sits on the patient- and family-centered care steering
committee. While advisory groups are empowered to make departmental changes that
evolve from their councils, the steering committee can approve larger, hospital-wide
initiatives and provide support for implementation.
Patients and families are important stakeholders that have been missing from the
discussion on how to improve quality of care, explains Cezanne Garcia, associate
director of the Department of Patient and Family-Centered Care and Education at
UWMC. We have found that they can help us identify issues and needs and develop
appropriate solutions. Suggestions and insights provided by patient and family
advisors go beyond safety, and can also contribute greatly to the care experience
and ease of navigating the care process, Garcia says.
For instance, at the urging of several patient advisors, UWMC recently rolled out
hospital-wide meal room service, which allows patients to order their meals from a
daily menu whenever they are ready to eat. Garcia says previously, the hospital
would receive frequent complaints about menu choices and timing of meals, as well as
reports that meals arrived cold. Unless you have never been a patient at a
hospital, you might not understand how important these issues are, he says. What
[patients] eat and when [they] eat can vary greatly depending on the patient, their
treatment protocol and how he or she is feeling on that particular day, Garcia
explains.
Based on another advisory council recommendation, the hospital developed a
peer-to-peer mentor program that pairs families of infants previously hospitalized
in UWMCs neonatal ICU with new families to orient and support them during a
stressful, emotional and uncertain time. Other patient advisory councils have helped
develop a patient and visitor navigation guide to the medical centers services;
helped change the waiting room procedure for expectant mothers who had often
previously shared the room with mothers who had decided to terminate their
pregnancies because of genetic problems; and are helping to expand the use of rapid
response teams at UWMC. Patient and family advisors on the hospitals ethics and
grievance committees are also supporting creative solutions to offer restitution to
families who have complaints against the hospital.
During a time when many academic medical centers are seeing an increase in lawsuits,
MCG Health System in Augusta, Ga., has seen a steady drop over the past five years,
due in large part to working more closely with its patients and families. MCG, which
is now noted as the most cost-efficient hospital in the University HealthSystem
Consortium (an alliance of 97 academic medical centers and 153 affiliated hospitals,
representing approximately 90 percent of the nations not-for-profit academic
medical centers), decided to introduce the patient- and family-centered model in
conjunction with the remodeling and redesign of its neuro-ICU in 2003.
The hospital started by consulting with former patients and families as well as
staff members for recommendations on how to provide the best patient and family
experience in its facility.
After the physical expansion was completed, the hospital soon began to see a
transformation in the quality of care as well. Patient satisfaction increased from
the 10th to the 99th percentile; length of stay decreased by 50 percent; discharge
volume increased by 15.5 percent; medical errors were reduced by 62 percent; and
staff vacancy rates dropped from 7 percent to zero.
Improving the Patient Experience
Before instituting patient and family advisors at H. Lee Moffitt Cancer Center,
Nancy Newman, Moffitts director of patient support services, sought the approval of
senior leadership and the board of directors. They thought it was a great idea that
supported our mission of providing compassionate care and really embraced it, she
says.
Endorsement of patient and family advisory councils by the board of directors and
senior managers is key to shaping the organizational structure of health care
organizations, Johnson says. If senior leaders dont encourage and support the
practice, its not going to happen in a sustained and effective way.
With the boards blessing, patient and family advisors have been integrated into 12
major hospital committees at Moffitt that include service excellence, quality and
performance improvement, hospital operations, the clinical steering committee, a
hiring committee and the quality committee of the board.
Advisors are also asked to serve on other hospital committees as needed. Patient and
family advisory committee progress and patient satisfaction scores are reported to
the board on a quarterly basis.
This is one of the most important reports we receive, says Beth Houghton, board
chair at Moffitt. Patient assessment as to how we are doing is very important and
is something we watch very closely. From a boards perspective, the greater
inclusion of patients and families into the care process and operations of the
hospital was a natural. This is a group whose feedback we highly value.
Patient and family advisors are selected carefully after a series of interviews and
an eye for specific qualities and competencies to find the right fit, Newman says.
The hospital considers race, ethnicity, age, employment background and other factors
to create a diverse group. Advisors also are screened for competencies such as the
ability to see beyond the problem and to work in a group, good judgment, the ability
to represent the views of others, and problem-solving skills.
All patient and family advisors participate in a hospital orientation to ensure they
are HIPAA-compliant and trained in important hospital policies and procedures. We
want people who can provide a balanced perspective and constructive input, Newman
explains.
In some cases, Moffitt has benefited from patient advisors with specific
professional backgrounds. For instance, Ron Giovannelli, a civil engineer, is a
former patient at Moffitt who often provides input into hospital expansion and
remodeling projects. After receiving treatment in the radiation therapy department,
he was able to provide feedback about improving its layout and design to make it
more patient-friendly.
Moffitt has made many important changes since enlisting the support of patient and
family advisors. Some of these include: developing portals that allow patients and
families to manage their own appointments and view lab test results, medication
orders, etc., via a protected Internet site; redesigning hospital signage to improve
accessibility; increasing valet parking hours to accommodate patients with late
infusion treatments; changing the process of shift changes to occur in patients
rooms instead of at the nurses station so that patients and families understand
care plans and changes; training former patients to provide counseling to other
patients; counseling medical students on how to deliver bad news to patients and
their families; and providing input from patients and families into clinical trial
design to encourage greater participation by patients.
We had so many early successes that we started getting more requests from all areas
of the hospital than we had advisors, Newman says. This has been a very positive
movement that really articulates our values and brings our patients to the table.
Mark Pizzo, a U.S. Federal Magistrate for the middle district of Florida, as well as
a patient advisor and member of Moffitts board, is used to commanding the floor.
But when he was asked to provide his opinion in a room full of health care leaders
and clinicians at one of his early safety committee meetings, in which he serves as
a family advisor, he at first froze briefly. What insight could I provide that they
didnt already know? he asked himself.
As it turns outquite a lot. When you bring someone to the table whos had a
personal experience, that experience brings a reality to the situation, Pizzo says.
Everyone listened intently. It was comforting to know that these people actually
cared about what I had to say.
Since implementing the patient advisory groups, Moffitt has seen its patient
satisfaction scores climb from 95 percent to 98 percent in the last three years.
We believe that we can learn tremendous things by listening to patients and
families, says Nick Porter, executive vice president for Institutional Advancement
and Corporate Relations at Moffitt. Their insights and perceptions are very
important to us. They are the authorities as to how well we are accomplishing our
vision of providing compassionate care and improving safety and quality of care.
This is certainly the wave of the future, Giovannelli agrees. Wouldnt you rather
go to a hospital where your point of view is taken into consideration? It just makes
sense.
Susan Meyers is a writer based in Omaha, Neb.
This article 1st appeared in the April 2008 issue of Trustee Magazine. |
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| : Susan Meyers |
| : 1909 |
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