Transcript Family-Centered Care Education: Evaluation of the Boyle

Family-Centered
Care Education:
Evaluation of the
Boyle Community Pediatrics Program
William E. Boyle, Jr. MD
Toni LaMonica, MSW
Learning Objectives
(1) Understand a successful strategy for
implementing a qualitative evaluation.
(2) Understand how community partners
improve patient and family centered
medical education.
(3) Apply components of a successful
program to your own setting.
Boyle Community Pediatrics Program
Mission
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To recognize and reduce the burden of
illness on families of children with
serious health issues by creating
educational experiences for medical
learners.
To enhance patient and family-centered
care throughout CHaD/Dartmouth
Hitchcock Medical Center.
Boyle Community Pediatrics Program
Vision
Physicians fully
integrate and value the
unique contributions
that the family and
community bring to
children’s health.
Community
Health Providers
Family
Boyle Program: 1998-2007
Services & Initiatives
Patient Partnerships
Family Faculty
Community Pediatrics Residency Training
CHaD Family Center
CHaD Family Advisory Board
Schwartz Center Rounds
… and more
(A Children’s Hospital within a Hospital)
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80 inpatient beds
Pedi/adolescent unit
PICU
ICN
95,461 outpatient visits in 2006
Why Evaluate? Why Now?
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Fresh, unbiased review to guide
decisions about the future.
Obligation to medical center leadership
and program funders.
Anticipated leadership changes in the
next 3 years.
First Steps
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Develop a partnership
with Dartmouth Medical
School, Center for the
Evaluative Clinical
Sciences
Hired Aricca Van Citters,
MS
Decided on qualitative
research methodology Appreciative Inquiry (AI)
Appreciative Inquiry (AI)
Developed by David Cooperrider of Case
Western Reserve University in 1980.
Basic idea

Focuses on existing capabilities and
successful experiences, as a foundation for
creating more of what is desired.

Builds upon the strengths of a program.
Appreciate Inquiry 4-D Cycle
Discovery
Appreciating
Dream
Destiny
Envisioning
Results
Sustaining
Design
Co-constructing
Goals of the Evaluation:
Addressing the First Two Components of
To Discover:
 Which aspects of the
program were most
meaningful?
 What are the
opportunities for
improvements?
 Are we making a
difference?
AI
To Dream
 Where should we be
heading over the
next five years?
Design and Destiny:
The 3-5 year plan
Study Design
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Selection of 21 stakeholders for interviews
5 Parents
• 14 Parents in Parent Task Force
• 26 Families in Family Faculty
• 9 Parents in the CHaD Family Advisory Board
6 Community Members (n of 17)*
4 Medical Students (n of 24)
6 Pediatric Residents (n of 39)
*Including 2 DHMC staff
Interview Questions
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How did you get connected to the program and what
have your experiences been?
Can you think of a special time that you were most
engaged?
- What really mattered to you?
- How did this special time relate to or reinforce your own
values?
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What is the heart of the experience you had with the
Boyle Program?
What do you wish might be strengthened or built into
the Program?
Interview Data
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17 interviews conducted in person
4 interviews by telephone
Interviews lasted from 35-80 minutes
Interviews audiotaped and transcribed
Analysis Process

Responses were combined into groups
- Teachers: family members, community and
staff partners
- Learners: medical students, pediatric residents

Transcriptions analyzed for common and
unique themes within and across the
teacher and learner groups.
Analytic Framework
Participants
-What I value?
-How I got connected
-What I brought
Experiences
-What I did?
Looking Back
-What is at the heart or core
of this experience?
-What makes the Boyle Program
work?
-How has the program reduced
the burden of illness for
children and their families?
Looking Forward
-What do I take from this program?
-What can this program do
to affect future practice?
Content Analysis
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Identified major themes related to
analytic framework.
Examined similarities and differences
between teachers and learners.
Participant quotations to illustrate
themes.
Themes – these and more
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Advocacy
 Holistic
Altruism
 Improve care
Communication
 Partnerships
Community
 Relationships
Compassion
 Real world impact
Continuity
 Reflection
Education
 Resources
Family-centered care (FCC)
50
46
44
40
39
Models of
care
Leadership
Resources
48
FCC
Community
Understand
patients
69
Real-world
Impact
Improve Care
88
Relationships
100
90
80
70
60
50
40
30
20
10
0
Education
Quotes
Top 10 of 30 Themes
82
67
Analytic Framework
Participants
-What I value?
-How I got connected
-What I brought
Experiences
-What I did?
Looking Back
-What is at the heart or core
of this experience?
-What makes the Boyle Program
work?
-How has the program reduced
the burden of illness for
children and their families?
Looking Forward
-What do I take from this program?
-What can this program do
to affect future practice?
Most Common Themes:
“What I Value”
38%
38%
Understand
patients
48%
50%
Real-world
impact
5.
62%
25%
0%
Altruism
5.
67%
Relationships
4.
75%
Education
3.
81%
Improve care
2.
Improve care
Education
Relationships
Altruism
Real-world impact
Understand patients
% of Participants
1.
100%
What I Value
Teachers
Only
Advocacy
Communication
Interest
Partnerships
Resources
Both
Altruism
Educate
Improve Care
Real-world impact
Relationship
Support
Understand
patients
Learners
Only
Community
Continuity
Exposure
FCC
Holistic
Participants – What I value?
“Med school just runs you down.
You come home after being in
class for 6 hours …, you have to
make dinner, you have to make
time for your husband, you have
to do the laundry. It is just an
overwhelming cycle. Then I take
some time out of my day and call
[my Patient Partner] and I get
this happy inner feeling like I
connected with somebody…”
Medical student
How I Got Connected?
Learners
Patient Partnership is a
DMS voluntary
program.
Community Pediatrics &
Family Faculty are
requirements of the
pediatric residency
curriculum.
Teachers
Families & Community
Partners are invited by
the Boyle Program.
Most Common Themes:
“What I Brought”
25%
25%
25%
Improve care
30%
Real-world
impact
5.
40%
Relationships
5.
40%
25%
0%
Complex
5.
45%
Education
4.
50%
Energy
2.
75%
Interest
2.
Interest
Energy
Education
Clinical Complexity
Relationships
Real-world impact
Improve care
% of Participants
1.
100%
What I Brought
Teachers
Only
Clinical Complexity
Improve care
Real-world impact
Both
Educate
Energy
Learners
Only
Interest
Understand patients
What I Brought?
“[We brought] a dedication and
a real desire to have some sort
of impact… to be able to really
have somebody understand. I
think that is what it comes
down to, you just really want
somebody out there to
understand the goods and the
bads and that life with a child
with chronic illness and/or
disabilities is not all awful and
it is not all wonderful. There
are right ways to handle
things.” ~ Family member
Analytic Framework
Participants
-What I value?
-How I got connected
-What I brought
Experiences
-What I did?
Looking Back
-What is at the heart or core
of this experience?
-What makes the Boyle Program
work?
-How has the program reduced
the burden of illness for
children and their families?
Looking Forward
-What do I take from this program?
-What can this program do
to affect future practice?
Examples of Experiences
Learners
 Meetings with partners
 Reflections with peers
and MD facilitators
 Visits to community
organizations
 Working in community
practice setting
 Family Faculty home
and school visits
Teachers
 Parent Task Force
 Develop and Advise
CHaD Family Center
 Family Faculty members
 Community mentors
Experiences
“I meet with [the residents] at a school and then I
show them around the school, introduce them to
some of the people, the guidance people and
special ed people, kind of give them a tour of the
school, and then I would bring them around to
the different schools. ... From there I would drive
them around to show them some of the
neighborhoods, … just to give them an idea of
where these kids are coming from.”
~ Community member
Analytic Framework
Participants
-What I value?
-How I got connected
-What I brought
Experiences
-What I did?
Looking Back
-What is at the heart or core
of this experience?
-What makes the Boyle Program
work?
-How has the program reduced
the burden of illness for
children and their families?
Looking Forward
-What do I take from this program?
-What can this program do
to affect future practice?
Most Common Themes:
“What’s at the Heart of the Experience”
100%
52%
52%
FCC
Exposure
5.
67%
50%
25%
0%
Relationships
5.
71%
75%
Real-world
impact
4.
76%
Understand
patients
3.
86%
Education
2.
Education
Understand patients
Real-world impact
Relationships
FCC
Exposure
% of Participants
1.
What’s at the Heart of the
Experience?
Common Themes
Teachers Only
Altruism
Communication
Compassion
Continuity
Improve care
Reflection
School
Both: Teachers
& Learners
Education
Exposure
FCC
Holistic
Leadership
Partnerships
Real-world impact
Relationships
Resources
Understand patients
What’s at the heart of the
experience?
“The absolute heart of this is
putting the family’s view of their
child’s healthcare first and then
supporting it and figuring out a way
for our view of healthcare and the
family’s view of their child’s
healthcare to integrate. … Let
them tell their story and then tell
our story and integrate them into
the best possible combination of
stories.” ~ Staff member
Most Common Themes:
“What Makes the Program Work?”
100%
50%
37%
32%
26%
25%
Community
0%
Time
5.
53%
Education
4.
63%
Relationships
3.
75%
Leadership
2.
Leadership
Relationships
Education
Dedicated time
Community
% of Participants
1.
What Makes the Program Work?
Teachers
Only
Communication
Continuity
Education
FCC
Flexibility
Improve care
Resources
Sustainability
Both
Educate
Relationships
Dedicated time
Learners
Only
Altruism
Community
Understand
patients
What Makes the Program Work?
“Family members and
community members are willing
to take voluntary time to help
shape future pediatricians. I
was a resident at the time so
that is my world, but they went
out of their way to make sure we
learned this new dimension of
learning.” ~ Pediatric resident
How has the program reduced the
burden of illness for children and
their families?
Domains of interest
 Social Isolation
 Lack of personal contact and peer
relationships
 Financial issues
 Uncertainty of health outcomes
Social Isolation
“I felt privileged that he
allowed me, at least for a
time, to be his refuge from
diabetes and that I was able
to help him develop the skills
he needed to create those
social contacts that he was
so craving to have.”
~ Medical student
Lack of Peer Contact
“Right there in the Family Center there is
always somebody who can address
questions. Kids are busy playing and
parents feel welcome.”
~ Community member
Financial Issues
“For our shelter guests it was important… These are folks
that … feel like invisible people in society. Here they are with
an M.D. sitting in their living room or kitchen speaking with
them for extended periods of time, not just 5 or 10 minutes
that you get when you see a doctor, but an hour, hour and a
half, in depth discussions about their kids. So I think for our
guests it was like, ‘Wow, all of sudden I have a friend who is
a doctor’. I think it just made them feel very, very
encouraged.”
~ Community member
Uncertainty of Health Outcomes
It gives you an
understanding of living with
chronic disease and what
that means in the greater
context of the patient’s life,
and not just what
medications they take….”
~ Medical student
Analytic Framework
Participants
-What I value?
-How I got connected
-What I brought
Experiences
-What I did?
Looking Back
-What is at the heart or core
of this experience?
-What makes the Boyle Program
work?
-How has the program reduced
the burden of illness for
children and their families?
Looking Forward
-What do I take from this program?
-What can this program do
to affect future practice?
What do I take from the
program?
“I think the program
allows you to
practice medicine
the way you ideally
wanted to practice
medicine when you
started this whole
journey.”
~ Pediatric resident
What can the program do to
affect future practice?
“I realize that they [parents] know a lot about
their kids and we better listen when they come.
Often our experiences are these short little
inpatient visits and there is a huge other aspect
to the child and the family’s experiences having
this child.”
~ Pediatric resident
Next Steps: Design& Destiny
Planning & Prioritizing
Discovery
Appreciating
Dream
Destiny
Envisioning
Results
Sustaining
Design
Co-constructing
Most Common Themes:
“Opportunities for Improvement and
Continued Attention”
100%
38%
33%
29%
24%
25%
19%
Resources
0%
FCC
5.
50%
Advocacy
4.
Education
3.
75%
Continuity
2.
Continuity
Education
Advocacy
FCC
Resources
% of Participants
1.
Opportunities for Improvement
and Continued Attention
Teachers
Only
Education
FCC
Partnerships
School
Sustainability
Both
Continuity
Learners
Only
Community
Using the Evaluation to Improve
Education and Care
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Improve the Boyle Program
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Disseminate knowledge to other educational
settings
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Encourage partnerships with patients, families,
and community members to create unique
opportunities to teach patient and family
centered care. You can do this too!
Improvements for the Boyle
Program
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Increase community network
Develop closer connections among
members of Family Faculty
Support advocacy projects that build
connections and continuity
Form strategic planning council for Boyle
Program
Unexpected Findings
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Recruitment of family and community
members easier than we expected.
The community is a rich resource for
teaching - it is a vast, free classroom.
Our efforts in the community have
improved the reputation of DHMC.
Both learners and teachers want more.
Dissemination
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AI as a process for understanding
program strengths
Applications to residency programs,
medical schools, and other health
provider education programs
Successful model of achieving ACGME
general competencies
• e.g., Communication and Professionalism
Partnerships with Patients, Families,
and Community Members

Families and community members are eager to
participate in medical education – to give back
and make care better next time.

Learners and teachers understand this is a
shared journey toward the minimization of the
burden of illness in people’s lives.
In Conclusion

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AI is a successful strategy for program evaluation.
Families and community members offer unique
knowledge and experiences to medical learners.
Medical learners value “real world” exposure and
experience.
Engaging patients and families in medical education is a
natural extension of the Patient & Family Centered Care
movement in health care.
Families and community members want to be involved –
they are willing and interested and a resource available
in every community.
References and Further
Information
Boyle Program Evaluation and PowerPoint:
 www.dhmc.org/goto/boyleprogram
Appreciative Inquiry:
 www.aiconsulting.org
 www.centerforappreciativeinquiry.net
 Suresh Srivastva, David L. Cooperrider, and
associates. Appreciative management and
leadership: the power of positive thought and
action in organizations, San Francisco:
Jossey-Bass, 1990