lunes, 21 de septiembre de 2015

Statewide Association Creates Nation’s First Statewide Patient and Family Engagement Advisory Council, Increasing Adoption of Leading Practices by Member Hospitals

AHRQ Innovations Exchange: Innovations and Tools to Improve Quality and Reduce Disparities
The Agency for Healthcare Research and Quality (AHRQ) announces the September 16issue of the Health Care Innovations Exchange (https://innovations.ahrq.gov/node/8323).

Statewide Association Creates Nation’s First Statewide Patient and Family Engagement Advisory Council, Increasing Adoption of Leading Practices by Member Hospitals

Contact the Innovator


Janette Bisbee, MSN, RN-BC, NHA


Mary Marshall

Look for Similar Items by Subject

Patient-centeredness
Organizational culture change
Quality improvement strategies
Pennsylvania

Funding Sources

Centers for Medicare and Medicaid Services

Developers


Snapshot

Summary

The Hospital & Healthsystem Association of Pennsylvania created the Nation’s first statewide Patient and Family Engagement Advisory Council. Made up of roughly 30 volunteers from across Pennsylvania (divided almost evenly between patients/family members and providers), the council as a whole and individual council members provide guidance to and support the association’s multifaceted efforts to promote patient and family engagement and the provision of patient- and family-centered care. A separate subcommittee made up of only patients/family members brings formal recommendations to the full council for consideration. The council has been a major catalyst behind the increased adoption and use of practices to promote patient and family engagement by Pennsylvania hospitals. In addition, council-initiated activities have generated positive feedback from attendees. 

Evidence Rating(What is this?)

Moderate
The evidence consists of pre- and post-implementation comparisons of survey data on use of specific operational practices to promote patient and family engagement among Pennsylvania hospitals, along with anecdotal reports on trends in adoption of other practices and feedback from attendees on the value of workshops initiated and planned by the Patient and Family Engagement Advisory Council.  

Date First Implemented

2013
The council convened for the first time in August 2013.

Problem Addressed

Health care is often organized around the needs of physicians and staff rather than patients and families. This approach can have a negative impact on the patient experience and patient outcomes. The adoption of strategies and practices to promote patient and family engagement (PFE) and patient- and family-centered care (PFCC) can help address these problems, but many providers struggle in doing so.  Associations and other collaborative organizations are in a good position to assist, but most do not have formal programs and structures in place to promote PFE and PFCC.
  • Negative impact of physician- and staff-centric approach: Most systems and processes today are organized around the needs of physicians and staff rather than the patient and family members. This approach can have an adverse effect on the patient experience and on patient outcomes.1,2
  • Challenges in promoting PFE and PFCC: The Institute of Medicine has singled out PFCC as one of six critical quality aims for improving the Nation’s health care system.1 The Institute for Patient- and Family-Centered Care (IPFCC) stresses the importance of giving patients and family members a meaningful role in the health system and incorporating patient and family perspectives into efforts to improve care processes.3,4 A recent survey found that a number of organizationwide and bedside-level  practices to promote PFE appear to have a positive impact on the patient experience and outcomes.5,6 However, many providers face challenges in trying to adopt these and other practices intended to promote PFCC.  
  • Unrealized potential of statewide associations and collaboratives:Statewide associations and other collaborative organizations are in a good position to assist member organizations in promoting PFE and PFCC, but relatively few have put in place formal programs and structures for doing so. 

What They DidBack to Top

Description of the Innovative Activity

The Hospital & Healthsystem Association of Pennsylvania (more commonly referred to as HAP) created the Nation’s first statewide PFE Advisory Council. Made up of roughly 30 volunteers (divided almost evenly between patients/family members and providers), the council as a whole and individual members provide guidance to and support HAP’s multifaceted efforts to promote PFE and PFCC. A separate subcommittee made up of only patients/family members often brings formal recommendations to the full council. Key components of the council and its activities are described in more detail below:
  • Full council of volunteer members, subcommittee of patients/family members: As detailed below, the full council is made up of volunteer members with roughly equal representation from the patient/family and provider communities, while a separate subcommittee includes only patient/family representatives.
    • Full council: As noted, the full PFE Advisory Council consists of approximately 30 volunteer members, roughly evenly divided between patients/family members and providers. Membership remains fluid, with new members being invited to join on an ongoing basis. Examples of current patient/family representatives on the council include several members of hospital-based patient and family advisory councils (PFACs), a local high school teacher, a college professor, an inner-city pastor, and lay trustees who serve on the HAP board. Provider representatives hold a broad array of positions in member hospitals and health systems from across Pennsylvania.
    • Subcommittee: A separate subcommittee is made up of all patient/family representatives from the full council. The subcommittee meets periodically in advance of full council meetings to discuss issues and form recommendations for consideration by the larger group. This structure helps to ensure that the voice of the patient and family member is heard, thus eliminating potential concerns about providers dominating the conversation or agenda.
  • Ad hoc meetings to discuss issues, provide guidance and feedback: To keep them purposeful and effective, meetings of both the subcommittee and the full council are held on an as-needed basis. Program leaders originally considered having a formal schedule of quarterly face-to-face meetings but instead decided on this ad hoc approach as a way to respect the time of volunteer members, who tend to be quite busy.  Since forming, the council has held roughly four face-to-face meetings per year; as noted, the subcommittee periodically meets in advance of the full council meetings. Meetings focus on one or more specific issues that have arisen or action items that need to be taken, such as the following:
    •  Identifying goals and priority areas: The initial face-to-face meeting focused on developing formal goals and objectives for the group. Other meetings have focused on identifying priority areas for member hospitals; for example, effective clinician–patient communication emerged as an early priority after the council reviewed the results of a hospital needs assessment survey.
    • Recommending key initiatives and activities to pursue: The PFE Advisory Council regularly provides guidance to HAP on the kinds of programs it should consider to promote PFE. Past recommendations have included the following: hosting regional workshops focused on improving doctor–patient communication and instilling a culture of patient-centered engagement; developing video vignettes on the value of taking a proactive stance related to one’s health care; incorporating the patient voice into the HAP Web site and strategic plan; and adding a patient/family member to the HAP board of directors. 
    • Reviewing and providing guidance on activities: The PFE Advisory Council regularly reviews and provides feedback on HAP initiatives and resources related to PFE and PFCC. For example, the council has provided guidance on the following: the aforementioned video vignettes, a hospital assessment tool to help identify areas of strength and weakness with respect to PFE, a guidebook for hospitals on developing PFE programs (developed in partnership with IPFCC), and a training program that teaches consumers to take responsibility for their own health care (developed in partnership with the Pennsylvania Library Association).
  • “Offline” communication through conference calls, webinars, and e-mail: As necessary, program leaders keep council members informed about key HAP activities related to PFE and PFCC through webinars, conference calls, and e-mail communications. Council members often provide guidance, feedback, and other support related to these activities as part of these communications.
  • Individual council member support of specific HAP initiatives: Outside of formal  meetings, individual council members routinely lend their time and expertise to specific activities related to PFE, including those led by HAP, the HAP-led Pennsylvania Hospital Engagement Network (PA-HEN), and other organizations, as outlined below:
    • HAP activities: Council members have developed the format and agenda for PFE-related events sponsored by HAP, such as the regional workshops on effective communication.  They have also given presentations and led discussions at numerous PFE events sponsored by HAP and its partner organizations, including the regional workshops and the annual meeting of the Pennsylvania Library Association. They have also developed blogs and other materials related to PFE for HAP’s Web site and other HAP communication/social media programs
    • PA-HEN activities: Council members regularly supported a wide array of events, webinars, and other activities sponsored by the PA-HEN as part of its participation in the Centers for Medicare & Medicaid Services (CMS) Partnership for Patients (PfP) campaign. PA-HEN incorporated PFE into its overall leadership/culture program and its individual projects. (More information about PA-HEN can be found in the Context section.)
    • National activities: Council members have attended national PFE conferences sponsored by IPFCC, the Institute for Healthcare Improvement, and the American Hospital Association

Context of the Innovation

HAP is a statewide member services organization that advocates for and serves nearly 240 Pennsylvania acute care, specialty care, primary care, subacute care, long-term care, home care, and hospice providers, along with the patients and communities they serve.
The impetus for the PFE Advisory Council came from two concurrent major HAP initiatives that each highlighted the critically important need to support member hospitals and health systems in promoting PFE and PFCC. The first initiative, launched in 2010, focused on helping members improve their HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, which historically had been lagging. Much of the work thus far has concentrated on improving physician and staff communications and interactions with patients and family members. The second initiative, launched a few years later, was HAP’s work as a HEN in Pennsylvania for the PfP campaign. In this role, HAP worked with 109 acute care hospitals throughout the State, with the goal of achieving PfP targets for reducing preventable hospital-acquired conditions and readmissions.
Overseeing these two major initiatives at the same time, HAP leaders quickly realized that their ability to promote PFE and PFCC in HEN hospitals would be critical to improving HCAHPS scores and achieving PfP campaign goals, since patients and family members who are fully engaged and participating in their inpatient and followup care are much less likely to experience hospital-acquired conditions or readmissions. Recognizing this common need to promote PFE and PFCC in member hospitals and health systems, HAP leaders began looking for a formal way to bring their work on HCAHPS and PfP together. Aware of the growing movement to create PFACs at the hospital level, they felt that creating a similar mechanism at a statewide level could be a highly effective way to ensure that patient and family members had a strong voice in guiding HAP’s efforts across Pennsylvania. 

Did It Work?Back to Top

Results

The PFE Advisory Council has been a major catalyst behind the increased adoption and use of practices to promote PFE. In addition, council-initiated activities have generated positive feedback from attendees.
  • Increased adoption and use of practices to promote PFE: Multiple sources suggest that the PFE Advisory Council has encouraged hospitals across Pennsylvania to adopt and use various strategies designed to promote PFE.
    • Self-assessment survey: Between 2013 and 2015, the number of Pennsylvania hospitals reporting that they used several specific PFE practices increased by 26 percent; these practices include encouraging patients and families to be present for and participate in multidisciplinary rounds and bedside change-of-shift reports, and giving patients and families access to the medical record and encouraging them to document in it.
    • Statewide report: A report by the Pennsylvania Health Care Cost Containment Council found that between January 2013 and August 2014 Pennsylvania hospitals and health systems significantly reduced readmissions. These reductions were achieved in part through increased adoption of practices to promote PFE, including  the following: programs to improve patient and family understanding of postdischarge care instructions; incorporation of health literacy into discharge instructions, including providing an understandable explanation of a patient’s condition and required followup care; “teach-back” models that involve having patients repeat information related to discharge and followup care; and new methods for sharing information with a patient’s other health care providers, particularly information critical to successful transitions to other settings.7,8
  • Positive feedback on council-initiated activities: Feedback from attendees of the first three regional workshops on effective communication has been overwhelmingly positive, with a clear majority of attendees finding the information and ideas presented to be very useful and believing that the workshop will help them improve their effectiveness and results. As one attendee (the director of patient experience in a large health system) noted, “the workshop made me … remember the basics and why as providers we were called into health care—to make a difference and touch someone. To do so, we need to ask ‘what did you hope for when you were a patient or family member and how did that feel?’ Then, we can work to ensure that our patients and their families experience what we would want for ourselves.”

Evidence Rating(What is this?)

Moderate
The evidence consists of pre- and post-implementation comparisons of survey data on use of specific operational practices to promote patient and family engagement among Pennsylvania hospitals, along with anecdotal reports on trends in adoption of other practices and feedback from attendees on the value of workshops initiated and planned by the Patient and Family Engagement Advisory Council.  

How They Did ItBack to Top

Planning and Development Process

Key steps included the following:
  • Securing leadership approval: Leaders of the HCAHPS and PA-HEN initiatives at HAP approached the president, chief executive officer, and other senior leaders to discuss the idea of creating a statewide council focused on PFE. As part of these meetings, they shared relevant data and other information to make the case for the creation of an overarching mechanism to guide HAP’s efforts in this area. HAP’s leadership team fully supported the idea and encouraged them to explore it in more detail. 
  • Eliciting input from IPFCC and peers in other associations: A program leader and a patient attended IPFCC’s annual conference to network with their peers in other hospital associations and to meet with IPFCC’s president and chief executive (Beverley Johnson). During these discussions, they sought guidance on the merits of the idea and how to move forward with it. 
  • Conducting needs assessment survey: HAP developed and sent out a survey to member organizations. In addition to eliciting input about hospital needs related to PFE and PFCC, the survey described in broad terms the concept of a statewide advisory council, asking for input from members on how such a council should be structured and what roles and functions it could play in supporting them. A portion of the survey also asked whether the hospital had its own PFAC and, if so, whether any current members might be interested in being a part of the new statewide council.
  • Inviting prospective members: In addition to inquiring about prospective members through the survey, HAP engages in an ongoing, multifaceted effort to recruit prospective members to the council, including through the organization’s Web site, publications, conferences, webinars, and other activities.

Resources Used and Skills Needed

  • Staffing: Two employees co-lead the overall PFE initiative at HAP, each spending roughly one quarter of their time on it. Much of this work relates directly or indirectly to the activities of the statewide PFE Advisory Council, including facilitating meetings and developing related materials and educational events.
  • Costs: Detailed data on the costs of operating the PFE Advisory Council are not available. The primary expense consists of salary and benefits for the two co-leads who spend a portion of their time on PFE-related activities. Other costs directly associated with the PFE Advisory Council include development of video vignettes and printed materials, reimbursement for mileage for members traveling to face-to-face meetings, and minor expenses associated with conference calls and other council activities.

Funding Sources

Until December 2014, the Centers for Medicare & Medicaid Services (CMS) covered a portion of the costs associated with the PFE Advisory Council through a contract with HAP as part of the PfP campaign. Since that time, HAP has covered these costs out of its operating budget.  

Tools and Resources

Relevant HAP resources that have been developed and/or refined under the guidance of the PFE Advisory Council include the following:

Adoption ConsiderationsBack to Top

Getting Started with This Innovation

  • Secure leadership commitment at association and hospital level: This program will not succeed without commitment and support from leadership teams within the association and its member organizations.
  • Conduct needs assessment: An upfront assessment of member hospital needs can help in identifying priority areas that should be the focus of early council initiatives.
  • Consider subcommittee for patients/family members: As noted, this separate subcommittee helps to ensure that patients and family members have a strong voice in discussions.

Sustaining This Innovation

  • Be purposeful in holding meetings: As volunteers, busy council members may react negatively to set schedules that result in meetings without a stated purpose or objective. By bringing the group together on an ad hoc basis only when needed, program leaders demonstrate respect for council members’ time and maximize the likelihood that they will remain committed to the effort.
  • Create opportunities for networking: Regional workshops and other council-sponsored events provide an excellent opportunity for member hospitals to showcase best practices, share ideas for overcoming challenges, and otherwise mentor and support each other.
  • Continually recruit potential council members: The various resources and activities that the PFE Advisory Council supports can also serve as a way to raise awareness about its existence and attract new members with unique perspectives and diverse educational training and professional experiences.
  • Seek partnerships with other organizations: The PFE Advisory Council encouraged HAP to partner with IPFCC, the Pennsylvania Library Association, and other organizations to develop resources and programs. These partnerships serve to maximize the reach and impact of these efforts.

Spreading This Innovation

Several other hospital associations have contacted HAP leaders to learn more about the statewide PFE Advisory Council. 

More InformationBack to Top

Contact the Innovator

Janette Bisbee, MSN, RN-BC, NHA
Education/Project Manager
Clinical Quality
The Hospital & Healthsystem Association of Pennsylvania
717-561-5372
E-mail: jbisbee@haponline.org(link sends e-mail)
Mary Marshall
Director, Workforce and Professional Development
Regulatory Advocacy
The Hospital & Healthsystem Association of Pennsylvania
717-561-5312
E-mail: mmarshall@haponline.org(link sends e-mail)
 

Innovator Disclosures

Ms. Bisbee and Ms. Marshall reported that activities of the PFE Advisory Council and PA-HEN were in part funded and performed under contract number HHSM-500-2012-00022C, entitled “Hospital Engagement Contractor for Partnership for Patients Initiative.”

Recognition

As listed below, HAP’s efforts to promote PFE and PFCC have been recognized several times in the last few years. Through its guidance and oversight, the PFE Advisory Council has been a major catalyst for the improvements generated by these efforts and hence a major reason that HAP has earned these awards. 
  • Winner of Caregiver Action Network’s 2014 award in “Advancing Excellence: Outstanding Best Practices in Patient and Family Engagement”
  • Inclusion in Caregiver Action Network’s 2014 list of “25 of the Nation’s Best Practices in Patient and Family Engagement”
  • One of seven finalists for the 2015 John Q. Sherman Award for Excellence in Patient Engagement, given by EngagingPatients.org(link is external)

Footnotes

  1. Institute of Medicine. Crossing the quality chasm. Washington, DC: National Academy Press; 2000.
  2. Shaller D. Patient-centered care: what does it take? The Commonwealth Fund; October 2007. Available at:http://www.commonwealthfund.org/publications/fund-reports/2007/oct/patient-centered-care–what-does-it-take.(link is external)
  3. Institute for Patient- and Family-Centered Care. Available at:http://www.ipfcc.org/(link is external).
  4. Johnson B, Abraham M, Conway J, et al. Partnering with patients and families to design a patient- and family-centered health care system. Institute for Patient- and Family-Centered Care; April 2008. Available at:http://www.ipfcc.org/pdf/PartneringwithPatientsandFamilies.pdf(link is external).
  5. Health Research & Educational Trust.  Patient and family engagement and patient satisfaction: Results of a national survey. Chicago, IL: Health Research & Educational Trust; April 2015. Accessed at www.hpoe.org(link is external)
  6. Herrin J, Harris KG, Kenward K, et al. Patient and family engagement: a survey of US hospital practices. BMJ Qual Saf. June 16, 2015. Available at:http://qualitysafety.bmj.com/content/early/2015/06/16/bmjqs-2015-004006.long(link is external).
  7. PA Healthcare Cost Containment Council. Readmissions for the same condition: January 2013-August 2014 data. June 2015. Available at:http://www.phc4.org/reports/readmissions/samecondition/14/default.htm(link is external).
  8. HAP. PA hospitals make statewide progress in reducing readmissions. Press release. June 17, 2015. Available at:https://www.haponline.org/Newsroom/News/ID/1099/PA-Hospitals-Make-Statewide-Progress-in-Reducing-Readmissions(link is external).
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