Advancing the Practice of Patient- and Family-Centered Care in Hospitals Learning Community: September 2015 Update | AHRQ Health Care Innovations Exchange

Advancing the Practice of Patient- and Family-Centered Care in Hospitals Learning Community: September 2015 Update

Introduction

The primary goal of the Patient- and Family-Centered Care (PFCC) Learning Community (LC) is to support member hospitals in adopting and implementing strategies from a “cluster” of innovations, selected from the AHRQ Health Care Innovations Exchange, to advance the practice of PFCC. This LC is comprised of eleven Florida-based hospitals that have committed to developing a new (or enhancing an existing) patient and family advisor program. In addition, LC members are working to implement one or more other PFCC strategies identified in the cluster, based upon each hospital’s specific needs and unique contexts.

In collaboration with the Institute for Patient- and Family-Centered Care (IPFCC) and the Florida Hospital Association (FHA), the work of the LC is based upon an evidence-based PFCC framework that addresses hospital leadership, patient and family partnerships, staff engagement, and performance improvement.

Teams from member hospitals receive guidance and technical assistance from monthly one-on-one coaching calls, as well as monthly Web-based seminars. Each seminar offers participants an opportunity to hear from both a nationally-recognized subject matter expert on specific hospital-based PFCC strategies, and an innovator/PFCC “champion” who offers insights from his or her own personal experience in successfully implementing strategies described in the profile cluster.

Learning Community Aims

While helping hospitals implement these innovations, the PFCC LC seeks to identify and disseminate to its members best practices around patient and family engagement, a key strategy that hospitals using to improve patient outcomes. By offering technical assistance to health care providers that enhances their understanding and uptake of evidence-based innovations, the LC operationalizes AHRQ’s mission of producing evidence to make health care safer, higher quality, more accessible, equitable, and affordable.

The LC’s specific aims are as follows:

Aim #1: Engage stakeholders using an evidence-based patient- and family-centered framework that addresses a) leadership, b) patient and family partnerships, c) staff engagement, and d) performance improvement.
Aim #2: Assist hospitals in tailoring and implementing strategies from the Innovations Exchange to advance the practice of PFCC within their own organizational culture and context.
Aim #3: Achieve and document improvement in process and outcome measures tailored to the specific strategies/interventions.

Progress on these aims is discussed below.

Activities to Date

The PFCC Learning Community was launched in October 2014. During the past year, the LC held monthly all-member Web-based seminars, core team meetings, individual hospital team coaching calls, and in-person meeting in Orlando. It also produced monthly newsletters, each profiling individual member hospitals (Aim 1) and highlighting other helpful resources. Members were all required to adopt one specific innovation—the formation or enhancement of a patient advisor program—based on the Georgia Regents Medical Center’s work described in the Innovation Profile, Patient Advisors Participate in Hospital Councils, Committees, Staff Training, and Other Activities, Contributing to Improved Patient Satisfaction and Better Organizational Performance. To aid in this effort, the LC amassed and posted on an online collaborative site with “helpful documents,” or tools and articles related to tailoring and implementing the selected PFCC strategies to individual member hospitals (Aim 2). At the outset, 4 of the 11 participating hospitals had some form of a patient advisor program, involving an aggregate total of 56 patient advisors. As of September 1, 2015, all 11 member hospitals have patient and family advisor councils (PFACs) with an aggregate total of 111 active advisors (Aim 3).

Preliminary Outcomes

Patient advisors have become involved in a range of activities at the member hospitals. As of September 1, 2015:

Six hospitals have patient advisors participating in patient rounding.
Eight hospitals have patient advisors serving on patient safety committees or workgroups.
Seven hospitals have patient advisors serving on committees or workgroups about discharge or transition planning.

In addition to these accomplishments, LC members have made significant progress adopting other patient- and family-centered care strategies:

Four hospitals have a 24-hour patient access policy and five hospitals are in the planning phase.
Five hospitals implemented an evaluation of hospital processes or protocols and five more hospitals are in the planning phase.
Five hospitals have developed staff training on patient- and family-centered care and five more hospitals are in the planning phase.

Below is a brief description of each participating hospital’s progress towards developing or enhancing their patient advisor programs, along with a snapshot of an activity or activities that demonstrate how the hospital has advanced patient- and family-centered care in their unique organizational context.

Broward Health North Hospital− Deerfield Beach, FL

Patient Advisor Program

Broward Health North formed its new Patient and Family Advisory Council in fall 2014 and held its first meeting in November 2014. Today, the PFAC includes 8 advisors who meet monthly with hospital leadership and provide input on a wide range of topics. Patient advisors participate on various quality committees; serve as speakers for new hire staff orientations; and have provided input on written patient materials including the admissions folder, the patient discharge packet, and various forms and flyers.

Advancing Patient- and Family-Centered Care: A Snapshot of LC Member Accomplishments (2014-15)

Broward Health North recently integrated patient advisor storytelling into its new staff hire orientation. Attendees have reported that the patient advisor message is powerful and provides a “back to purpose” moment as they are introduced to a new working environment. A patient advisor also recently spoke to hospital administrators, physicians, and staff at the Leadership Development Institute, a two-day training for hospital administrators. During these talks, the advisor shared his experiences, good and bad, to help participants understand how patients perceive actions of caregivers and staff. In doing so, the advisor serves almost as a coach, helping hospital staff and executives understand how their actions and comments are perceived by patients.

Health Central Hospital, Orlando Health− Ocoee, FL

Patient Advisor Program

Health Central implemented its PFAC in 2012. Since joining the LC, the hospital recruited nine new advisors to the Council and expanded the roles of advisors significantly. Today, Health Central’s patient and family advisors engage in many activities, such as conducting patient experience rounding, enhancing patient white boards, updating hospital signage, participating in new employee orientation, and serving on seven different hospital improvement committees at which they help share the patient perspective.

Advancing Patient- and Family-Centered Care: A Snapshot of LC Member Accomplishments (2014-15)

Health Central is focused on providing high quality PFCC through a cohesive team approach. As a result of its participation in the LC, this approach now integrates patient advisors into the rounding process. Patient advisors begin their day by checking in with unit staff about patients’ needs. Staff provide information to help guide the advisor’s rounding process, often suggesting that advisors focus on specific patients who may need additional attention. While advisors interact with patients in various ways, their core activities include visiting every patient room to verify that the patient’s white board has complete and current information and reviewing the care plan to remove medical jargon. With leadership support, the Health Central team hopes to roll out the pilot patient rounding program across the entire hospital.

Health First System: Cape Canaveral Hospital—Cocoa Beach, FL and Palm Bay Hospital—Palm Bay, FL

Patient Advisor Program

Palm Bay Hospital and Cape Canaveral Hospital are both part of Health First, a not-for-profit, fully integrated, health care delivery network in Central Florida. Palm Bay launched its inaugural PFAC in July 2015; Cape Canaveral’s began in August 2015. The Councils’ initial activities include reviewing hospital policies and procedures, providing input on patient handbooks and facility wayfinding signage, and developing patient notepads to improve patient-provider communication. The two hospitals co-developed standard patient advisor program materials that they each used to develop their PFACs. Using these jointly-developed materials and leveraging lessons learned, Health First plans to replicate Palm Bay’s and Cape Canaveral’s success by creating PFACs throughout the system.

Advancing Patient- and Family-Centered Care: A Snapshot of LC Member Accomplishments (2014-15)

Palm Bay and Cape Canaveral have collaborated not only with each other, but also with other hospitals in the LC. For example, prior to its PFAC launch, a delegation from Palm Bay reached out to and visited another LC member hospital to observe a more mature PFAC in session. The experience allowed Palm Bay’s team to see an effective PFAC meeting first-hand, learn about productive meeting structure options, and absorb key lessons about member engagement, meeting tone, and advisor/patient interactions.

Jupiter Medical Center− Jupiter, FL

Patient Advisor Program

Jupiter Medical Center, an independent, not-for-profit hospital, formed its new 9-member PFAC in May 2015. Since then, advisors have been involved with small projects across a broad range of issues, including patient-clinician communication, facility improvements, and hospital culture. Advisors are also sharing patient experience stories and identifying areas of potential improvement, updating the patient handbook, and reviewing the pre-admission process. The Council has also created a PFAC “Seal of Approval” to help promote the work of the Council and to indicate that specific materials were reviewed and approved by patient advisors.

Advancing Patient- and Family-Centered Care: A Snapshot of LC Member Accomplishments (2014-15)

Jupiter has committed to integrating the tenets of PFCC into existing policies. To accomplish this integration, executives developed and implemented an “umbrella” policy committing the hospital to the principles of delivering PFCC. This key document supplements all new and existing hospital policies. In addition, Jupiter has developed and implemented a “Family Engagement Survey” to gauge the level of inclusiveness and welcoming during pre-admission educational sessions (e.g., labor and delivery/OB classes and orthopedic pre-operative education classes). Questions probe patient and family experiences and the answers will inform how the hospital involves patients and families both before and after a hospital visit.

Lakeland Regional Medical Center− Lakeland, FL

Patient Advisor Program

Lakeland Regional Medical Center, a community, not-for-profit hospital, established a patient advisory group in 2013 with 14 members. Its goal is to expand its membership to 20 advisors. In 2015, patient advisors were actively involved in two projects at the hospital: providing input into new facility design; and participating in meetings of Lakeland’s new Patient Safety Institute. As a result of its involvement in the LC, Lakeland is engaging patient advisors to refine the hospital’s patient and family “welcoming presence” guidelines that support 24-hour patient access, and to provide input to enhance the bedside shift report.

Advancing Patient- and Family-Centered Care: A Snapshot of LC Member Accomplishments (2014-15)

Lakeland has committed to partnering with patients in the design and development process for hospital facilities, including a new patient pavilion, inpatient rehabilitation center, and expansion of its cancer center. Advisors participated early in the process by reviewing and providing input on facility design plans. They toured demonstration “mock-up” patient rooms in, for example, the Labor and Delivery Department and gave specific feedback on actual room layout and configuration to improve the patient experience.

Parrish Medical Center− Titusville, FL

Patient Advisor Program

Since joining the LC, Parrish Medical Center, a public not-for-profit acute care hospital, developed a strategic plan and charter for its patient advisor program and leveraged its employee orientation to train two new advisors. The hospital launched its new patient advisor program in August 2015 with two members, who are providing feedback on patient care performance improvement and patient safety initiatives. Parrish’s PFCC LC team is now focusing on developing an advisor recruitment plan and intends to expand its membership to five by January 2016.

Advancing Patient- and Family-Centered Care: A Snapshot of LC Member Accomplishments (2014-15)

Parrish Medical Center continuously strives to meet its mission of “Healing Experiences for Everyone All the Time” by integrating PFCC into the hospital’s culture. For the first time, advisors are providing input on employee orientation practices. Additionally, the Inter-professional Practice Council signed a commitment agreement to partner with advisors in 2015, and advisors are now serving on the Council. The Council, an interdisciplinary clinical group, focuses on care processes and plans to enhance the integration of PFCC principles into clinical communication and hourly rounding.

Sacred Heart Hospital− Pensacola, FL

Patient Advisor Program

Sacred Heart boasts two PFACs that meet on a monthly basis: an adult PFAC (established in 2013) and a pediatric PFAC (established in 2014). This year, a total of eight new advisors joined the councils’ memberships. Advisors are engaged in multiple activities, including providing consultation to hospital administration as new programs and improvements are planned; providing information to hospital visitors; and serving on 12 hospital-level committees and two health system-level committees. As a result of LC participation, Sacred Heart has undertaken a review of hospital policy and language related to Lesbian, Gay, Bisexual, and Transgender (LGBT) patients and families, implemented a patient notepad to enhance communication between patients and care teams on various units, and developed a new course to support the hospital-wide cultural and organizational focus on patient- and family-centered care.

Advancing Patient- and Family-Centered Care: A Snapshot of LC Member Accomplishments (2014-15)

In 2015, Sacred Heart implemented a mandatory class, Evidence Based Care: Patient and Family Experience, for all employees who have any patient contact (from maintenance staff to hospital-employed physicians). The course reviews the role of empathy and promotes such universal actions as making eye contact. It also outlines concrete actions for improving specific tasks, such as hourly rounding, bedside reporting, and rounding with physicians. Patient advisors played a key role in course development by reviewing and providing input on proposed content. The class begins with a video of a patient advisor sharing her experience at Sacred Heart Hospital. As of August 2015, more than half of eligible staff members had completed the class; remaining staff will complete the mandatory training through the Hospital’s “My Learning” system. The Hospital Education Department is also integrating the course into new hire orientation.

St. Anthony’s Hospital, BayCare Health System− St. Petersburg, FL

Patient Advisor Program

St. Anthony’s Hospital, part of the BayCare Health System, formed its new PFAC in June 2014. The Council, which meets quarterly with the hospital’s steering committee, added two new members in 2015 and plans to expand its membership in the coming year to a total of 12 members. Since joining the LC, St. Anthony’s has engaged the PFAC in various new activities, including: reviewing hospital signage, participating in performance improvement and hospital safety committee meetings, reviewing patient bills, and formulating recommendations upon review of HCAHPS comments. Staff are currently working with facility education services to incorporate a patient advisor in the hospital facility orientation for new patients, and plan to partner with the PFAC on improving the discharge education process.

Advancing Patient- and Family-Centered Care: A Snapshot of LC Member Accomplishments (2014-15)

One of the PFAC’s early activities was to tour the hospital admissions unit and provide input about the hospital’s upcoming redesign. Based on a patient advisor’s recommendation, the hospital moved quickly to erect partial walls between beds in the admissions unit to enable soundproofing and increase privacy, replacing curtains that previously separated beds. Patient advisors also helped select new hospital gowns and conducted tasting of patient food selections, providing feedback to improve the patients’ experience.

St. Joseph's Hospital, BayCare Health System− Tampa, FL

Patient Advisor Program

St. Joseph’s Hospital—part of the BayCare Health system—held the first meeting of its new Patient and Family Advisory Council in October 2014. Its newly-minted PFAC has provided input and feedback on a wide range of items and topics, including the patient welcome guide, educational brochures, infection control signs, patient menu offerings, and policies such as family presence during resuscitation and emergency room visitation. Advisors have also identified improvement opportunities through sharing their own past experience as patients and volunteers at St. Joseph’s; for example, the facilities department installed a new blinking “Pedestrian Crossing” sign in the hospital’s parking garage in response to the PFAC’s concerns about pedestrian safety.

Advancing Patient- and Family-Centered Care: A Snapshot of LC Member Accomplishments (2014-15)

In addition to partnering with patients through the PFAC, St. Joseph’s has identified the need to move further toward an organizational culture of empathy and is implementing policy and process changes to meet this priority. System-wide, staff are now required to complete a patient experience class. Additionally, staff teams review negative patient comments every two weeks and develop action plans to address feedback; and hospital leadership emphasizes the importance of transparency in sharing patient feedback and team member accountability.

Tallahassee Memorial Healthcare− Tallahassee, FL

Patient Advisor Program

Tallahassee Memorial HealthCare (TMH) is a private, not-for-profit health care system serving 17 counties in North Florida and South Georgia. In Spring 2015, TMH launched its pilot PFAC, which has grown to include 19 active patient and family advisors (PFAs) by mid-August (and is expected to grow to 23 by the end of September). TMH advisors are involved in a range of activities—for example, they are developing a new “welcoming” policy that will better convey partnerships with patients and families around hospital visitation. PFAs also serve on a focus group that provides input on the layout and design of the new Critical Care and Surgical Center, which is currently in the design phase. Advisors are working with Human Resources to review staff orientation and recruitment interview processes to help bring the patient perspective to TMH’s family medicine clinics. They also “act” as patients and “grade” new resident physicians on their bedside manner. Currently, advisors serve on 13 different hospital councils or committees.

Advancing Patient- and Family-Centered Care: A Snapshot of LC Member Accomplishments (2014-15)

Many advisor activities serve a dual purpose of fostering TMH’s partnership with patients and families while helping to embed PFCC into the hospital’s culture. For example, through the addition of advisors on Interdisciplinary and Nursing Shared Governance Councils, advisors can both contribute to the system’s decision making process and educate TMH clinicians and staff about core PFCC concepts. Currently, advisors serve on five different Interdisciplinary Shared Governance Councils, two Nursing Shared Governance Councils, and six Relationship-based Care Teams–which bring together nursing staff across different care settings. Currently, one PFA sits on each of the Councils. Beginning in October 2015, the Councils plan to update their bylaws to include two patient advisors as standing members.