Transcript PATIENT- AND FAMILY

PATIENT- AND FAMILY-CENTERED CARE:
Partnerships for Safety & Quality
All Employee Learning Modules
Our Time Together
▼ Review your understanding of patient- and family-
centered care and how it complements the VA’s
strategic goals and priorities.
▼ Review the progress that has been made throughout
VISN 7 in the last two years.
▼ Explore ways that everyone can actively contribute as
team members to support Veterans and their families as
essential partners in their health care.
You Should Be Able To…
▼ Restate/define the core concepts of patient- and family-
centered care.
▼ Connect VISN 7’s goals to patient- and family-centered
best practices.
▼ Describe how patient- and family-centered care is being
implemented in the workplace.
▼ Describe patient- and family-centered behaviors and their
impact on the Veteran’s and family experience of care.
▼ Identify ways to positively influence Veterans’ and
families’ experience of care using patient- and familycentered communication skills and strategies.
VISN 7
Aligning With VA Priorities
▼ VHA Mission Statement
▼ VHA Vision
▼ VHA Office of Patient-Centered Care–2010
▼ VHA national patient-centered pilot of four Field-based
Implementation Teams (FIT): Birmingham VAMC
Veterans Health Administration (VHA)
Mission Statement
Honor America's Veterans by
providing exceptional health care
that improves their health and well-being.
Veterans Health Administration (VHA) Mission Statement
Veterans Health Administration (VHA)
Vision Statement
VHA will continue to be the benchmark of excellence
and value in health care and benefits by
providing exemplary services that are both
patient-centered and evidence-based.
VISN 7
Three Promises to Veterans
PROMISE ONE:
To provide care, second to none–
the best care anywhere!
PROMISE TWO:
To maintain and expand health
services wherever possible.
PROMISE THREE: To ensure that every Veteran will be
personally satisfied with the care that
they receive based on the highest
quality of outcomes.
Office of Patient Centered Care and
Cultural Transformation
Office of Patient-Centered Care and
Cultural Transformation
▼ Contract to implement PCC
nationally awarded to
Planetree.
▼ New Director – Tracy Gaudet
M.D., formerly the Director for
the Duke Center for
Integrated Medicine.
FY11 VHA Patient-Centered Care
Implementation Plan
▼
Establish Regional Centers of Innovations
(COI)
 Four
Regional Host sites for Field-based
Implementation Teams
•
•
•
•
Region 1 – West: Greater Los Angeles HCS (VISN 22)
Region 2 – Central: North Texas HCS (VISN 17)
Region 3 – South: Birmingham VAMC (VISN 7)
Region 4 – Northeast: New Jersey HCS (VISN 3)
 Washington
▼
DCVAMC selected as 5th COI
COIs selected based on their advanced PCC
practices and culture
FY11 VHA Patient-Centered Care
Implementation Plan
▼Recruit
and hire Field-based Implementation Team (FIT)
members, responsible for PCC implementation in
respective region
▼Conduct intense 10-week PCC Certification training of FIT
Consultants
▼Determine staging of implementation rollout of remaining
VISNs
▼Begin PCC implementation rollout simultaneously within
each region.
The VA’s 12
Patient Centered Care Principles
The VA’s 12 Principles
Principle 1. Honor the Veteran's expectation of safe, high
quality, and accessible care.
Principle 2. Enhance the quality of human interactions
and therapeutic alliances.
Principle 3. Solicit and respect the Veteran's values,
preferences, and needs.
Principle 4. Systematize the coordination, continuity, and
integration of care
The VA’s 12 Principles
Principle 5. Empower Veterans through information
and education.
Principle 6. Incorporate the nutritional, cultural, and
nurturing aspects of food.
Principle 7. Provide for physical comfort, and
management of pain.
Principle 8. Ensure emotional and spiritual support.
The VA’s 12 Principles
Principle 9. Encourage involvement of family and friends.
Principle 10. Provide an architectural layout and design
conducive to health and healing.
Principle 11. Introduce creative arts into the healing
environment.
Principle 12. Support and sustain an engaged workforce
as key to providing patient-centered care.
What Does It Mean To Be
Patient- And Family-Centered?
Actively striving to see the
experience of care through
the patient’s eyes so that
delivery of health care is
centered around the choices
and priorities of Veterans
and their families.
Patient- and Family-Centered
Experience of Care Goals
in the Veterans Health Administration
A fully engaged partnership of Veteran,
family, and health care team.
Established through continuous healing
relationships.
Provided in optimal healing environments.
In order to improve health outcomes and the
Veteran’s experience of care.
Patient- and Family-Centered Care
Core Concepts
▼ People are treated with respect and dignity.
▼ Health care providers communicate and share complete
and unbiased information with patients and families in
ways that are affirming and useful.
▼ Individuals and families build on their strengths through
participation in experiences that enhance control and
independence.
▼ Collaboration among patients, families, and providers
occurs in policy and program development and
professional education, as well as in the delivery of care.
VHA Patient- and
Patient- and FamilyFamily-Centered Care Centered Care Core Concepts
A.
A fully engaged
partnership of Veteran,
family, and health care
team.
B.
Established through
continuous healing
relationships.
C.
Provided in optimal
healing environments.
D.
In order to improve
health outcomes and
the Veteran's experience
of care.
A. People are treated with respect
and dignity.
B. Health care providers communicate
and share complete and unbiased
information with patients and families
in ways that are affirming and useful.
C. Individuals and families build on
their strengths through participation
in experiences that enhance control
and independence.
D. Collaboration among patients,
families, and providers occurs in
policy and program development and
professional education, as well as in
the delivery of care.
Patient–Family Story
Who is family?
“Families” – Broadly Defined
The term “family” has many
meanings and includes not only
traditional bonds created by
marriages and common
ancestry, but also bonds
created by close friendships,
Families are the
commitments, shared
patient’s primary support
households, shared childpersons…the individuals
on whom they rely for
rearing responsibilities and
support in difficult
romantic attachments.
situations…relatives,
friends, neighbors…
Hollywood, Florida
Who is
Your “Family?”
Why Patient- and Family-Centered Care?
Families–or the Veterans’ “supportive networks”–are
often the constant across transitions and settings.
Families are important to the patient’s health and
wellbeing, and the management of chronic conditions.
Identifying and building on
strengths of patients and
families is an essential aspect
of professional practice in 21st
century health care.
Dignity and Respect
Courtesy, Sensitivity,
Empathy, and Compassion
Dignity and Respect
Dignity and Respect
Courtesy, Sensitivity, Empathy, and Compassion
▼ Explain your roles in our care, as
well as the role of the team.
▼ Be sensitive to the difficulties of
our situation.
▼ Maintain concern for our privacy
and personal dignity.
▼ Respond to our concerns.
▼ Accommodate our special needs.
Dignity and Respect
Courtesy, Sensitivity, Empathy, and Compassion
▼ Include us in treatment
decisions.
▼ Listen to and respect our
perspectives and choices.
▼ Include our values,
beliefs, and cultural
backgrounds in care
planning and decisionmaking.
▼ Address our emotional
needs.
Dignity and Respect
Courtesy, Sensitivity, Empathy, and Compassion
Listen To Me.
Trust Me.
Respect Me As A
Partner In Care.
Dignity and Respect in Action
▼Interdisciplinary Team (IDT) Care
Plans.
▼Written in the first person “I-Care”
format.
▼Veteran Resident directed–choices for
wake-up time, bathing, spiritual
preferences in the community living
centers.
Resident Care Plan
▼ Social History:
I am Frankfort Fox. My friends call me “Frank”. I was
born in Fargo, North Dakota way back in 1910. My
parents were farmers. They raised my six older
brothers and worked very hard. My parents valued a
good education. All of us boys graduated from
Washington High School in Fargo. Shortly after
graduation, I hopped a train to Colorado. I got off in a
town called Marble, way up in the Rockies…
Information Sharing
Information Sharing
Providers communicate
and share complete and
unbiased information with
patients and families, doing
so in ways that are
affirming and useful.
Patients and families
receive timely, complete,
accurate information in
order to effectively
participate in care and
decision-making.
Information Sharing
My Health E-Vet
William Jennings Bryan Dorn VA
Medical Center, Columbia, SC
Patient and Family Resources
Carl Vinson VA
Medical Center Dublin, GA
Participation
Participation
Nothing About Me…
Without Me.
Patients and families
are encouraged and
supported in
participating in care and
decision-making at the
level they choose.
Participation
“The fundamental shift in my understanding has been
how care changes when the plan is discussed and
formulated WITH a family as opposed to simply being
told TO a family.”
Jeffrey Simmons, MD, The Hospitalist, 2006
Participation
▼ My Daily Plan–Charleston
▼ Next Steps in Care–Dublin
▼ Nursing Post-Discharge Call–Dublin
▼ Just Ask–Atlanta
▼ Family Initiated Rapid Response Team–Atlanta
Participation
Collaboration
Veterans and
Families as Advisors
Collaboration
Veteran and Family Advisors
▼ Policies and Procedures
▼ Patient Information and Education
▼ Facilities Design
▼ Systems and Processes
▼ New Initiatives and Programs
▼ Peer Support
▼ Staff Development and Education
Patient and Family Collaboration
Staff Education
New Programs
and Services
My Health E-Vet
Ralph H. Johnson Medical Center Charleston, SC
Examples of
Veteran and Family Advisor Involvement
▼ Female Veteran
participating in design of
Women’s Wellness project
▼ Veterans on special task
forces, “Timely Reporting
of Test Results”
▼ Parking Committee
▼ Environment of Care
Rounds Committee
▼ Daily Plan Implementation
Committee
▼ CLC Patient and Family
Council
▼ Inpatient Pain Program
▼ Subcommittee on
Admission and Discharge
Process Improvement
▼ Patient Handbook
Committee
▼ Pet Therapy Program
▼ Ethics Committee
▼ Visiting Hours Team
▼ My Health E-Vet
Education Program
Join
the
Family–
We NEED
everybody’s
point of view
Family–Veteran Centered Care
Your Can Become a Veteran Family Advisor
For Information Contact laDonna Golden
At (334) 272-4670 x4439
Misconceptions About
Patient- and Family-Centered Care
▼ Patient- and family-centered care is not just “being
nice.”
▼ Patient- and family-centered care does not mean the
staff give up all decision-making to patients and families.
▼ Patient- and family-centered care does not mean there
are “no boundaries.”
▼ Patient- and family-centered care does not mean that
patients and their families may be rude or abusive to
staff.
HIPAA—Complying with the Law and
the Intent of the Law
▼ Health information can be disclosed for:
 Treatment
 Health care operations
 Payment
▼ HIPAA acknowledges incidental disclosures may occur. This
is not a HIPAA violation as long as you:
 Take reasonable safeguards to protect privacy
 Only disclose or use the minimum information necessary
▼ Information about HIPAA is shared with patients and families
and asking for their cooperation in respecting the privacy of
others, conveying that staff and physicians are making the
same commitment…mutuality.
New Ways of Working
1. After reviewing patient and family
satisfaction surveys, the cafeteria increases
it options of food for differing cultures.
4. A multidisciplinary clinic committee
purchases new patient and family cardiac
health education models and materials to
place in individual provider rooms and
Patient Health Education Room.
5. In the Plan of Care/Next Step in Care
each patient is provided current information
on condition, treatment, and the next step in
plan of care.
6. In nursing post-discharge calls patients
are asked if their family members received
information at discharge for continuing their
care at home.
8. The staff link a patient, newly diagnosed
with behavioral health concerns, to a peer
mentor.
9. A nurse teaches a young Veteran and his
the mother how to manipulate the prosthetic
device after his amputation. They are
provided a staff member name and phone
number to call with specific questions, as
well as a list of orthopaedic related
community resources.
10. The cardiac critical care unit states that
visitors may visit for 10 minutes each hour.
New Ways of Working
Patient- and Family-Centered Care
What’s In It For Us?
What’s In It For Us?
Benefits to Staff
▼ Physicians, nurses, and other health
professionals reconnect with their real
purpose…taking caring of human beings, in this
case Veterans and their families.
▼ Patient- and family-centered care approaches to
care save time in the long run.
▼ Patient and family involvement and participation
reduces risks for all.
▼ Patient- and family-centered
care enhances teamwork,
reduces conflict, and
enhances safety.
Patient Satisfaction Outcomes
FY2009
Best
Trend continues in FY2010 – 3% above the Peer Index
What’s In It For Us?
Break
Where Are We On The Journey:
Applying Best Practices In
Your Workplace
Advancing the Practices of Patient- and
Family-Centered Care in VISN 7
Emerging Best Practices at
VISN 7 Facilities
How Can You Support Moving
Forward in Patient- and FamilyCentered Care?
Recognize the Expectations
Is it Patient- and Family-Centered…
or NOT?
Veterans and Families Expect
That You Will…
▼ Introduce yourself and describe your role on the
care team.
▼ Connect and engage with them in a welcoming and
positive way.
▼ Show respect and appreciation for the Veteran’s
military service.
▼ Show empathy for the Veteran and family.
▼ Respect their social, cultural, and spiritual diversity
and values.
Veterans and Families Expect
That You Will…
▼ Respect their perspectives and include their needs
and preferences in the plan of care.
▼ Identify the ways they prefer to learn and their
priorities for education and information about their
health, medications, and treatment choices.
▼ Actively promote their right to make choices about
their plan of care.
Veterans and Families Expect
That You Will…
▼ Work collaboratively with other staff and with Veterans
and families to move toward a more patient- and
family-centered environment of care.
▼ Continue learning about patient- and family-centered
practices and developing collaboration and
communication skills.
As Staff, How Do We Meet
These Expectations?
Patient- and Family-Centered Care
You are at the reception desk of the specialty clinic. At
11:00 am you realize that three patients are still waiting to
be seen in the clinic. You inquire and find out the doctor
has been called away, but no one told the Veterans and
their families in the waiting room. What should you do?
a) Announce to the people in the waiting room that Dr. D.
is gone and they will need to re-schedule through the
automated system.
b) Call each person up to the desk, apologize, and offer to
re-schedule them.
c) Tell the Clinic staff they have to tell the patients about
the SNAFU.
d) Apologize to the patients, offer them a choice to see
another physician or re-schedule, and facilitate
whichever option they choose.
A patient’s wife and two adult sons came with the
patient to his appointment. They have now been told
he has to be admitted immediately. However, they did
not bring either a change of clothing or money for food.
What should you do?
a) Tell them there is nothing you can do. They need to
go home, get money and clothing, and come back.
b) Tell them to go to the Social Worker’s office.
c) Express empathy and tell them where they can find
an ATM and a computer to check for hotels.
d) Take the family to the Social Work office, introduce
them and their situation to the Social Worker;
express confidence that the Social Worker can help
them. Make sure they know how to contact you so
you can follow up with the patient.
A patient’s wife waits for 6 hours outside the Intensive
Care Unit (ICU) in a cramped vending machine area. The
surgeon has told her the surgery was successful and the
patient is recovering in the ICU. The ICU nurse sees the
very anxious woman, who asks if she may come in to see
her husband. If you were that nurse, what should you do?
a) Explain that the ICU is not private and she will need
to wait until the patient is moved to a room.
b) Explain that visitors are an infection risk and she will
needs to go to the official waiting room until called.
c) Express empathy with her feelings and bring her in
for a few minutes to hold her husband’s hand.
d) Tell her you are sorry, but you really can’t break
the rules.
The nurse comes into the room to educate the patient
about chemotherapy medications. The patient’s husband,
who is present, wants to wait until later in the day so their
daughter can also be there. If you were the nurse, what
should you do?
a) Tell the husband that you will explain everything to him and
when the daughter comes she can call you with questions.
b) Find out when the daughter is coming; make a commitment to
return then; or, if your shift is ending, bring in the oncoming
nurse and explain the family’s request to her at the bedside.
c) Express empathy with her feelings and encourage her to come
and be at her husband's side for as long as she wishes.
d) Review the basics of the information with the husband, give
him a notepad to write down questions.
The wife of a Veteran with heart disease asks the
clinic staff to print out her husband’s latest lab
results and send them to their home. What should
you do?
a) Tell the wife that only the physician can share results
and that the patient will have to call the doctor.
b) Check the patient’s record for a consent/surrogate
form; then print the results and send them.
c) Tell the wife you will call the physician for the ok and
then send the results to their home.
d) Tell the wife you will call the physician for the ok but
you can only send the results to the referring
community clinic.
A Veteran with chronic obstructive pulmonary and heart
disease is told that he must have several more tests at the
VAMC. He lives in a community some hours away from the
clinic. He asks if the tests could be scheduled at the same
time so that he only has to make one trip. What should you
tell him?
a) Agree that it would be the best for him, but explain
that the tests are in different departments and they
schedule individually.
b) Tell him only his community based outpatient clinic
(CBOC) physician can make those arrangements.
c) Offer to contact each department and make the
arrangements for tests over two days so he can come
and stay overnight.
d) Call the various departments and make the
arrangements before the patient returns home.
A Veteran is resting comfortably after a particularly difficult
outpatient procedure. His wife is in the hallway, and has
been told she cannot come into the small recovery room to
be with him. When the physician comes to tell him the
results, she follows the physician into the room. What
should you do?
a) Nothing.
b) Apologize to the physician and ask the wife to leave
the room.
c) Ask the physician’s permission to allow her to stay.
d) Introduce the wife to the physician and support her
desire to be with her husband while the results are
discussed.
The partner of a Veteran hospitalized for abdominal
surgery wants to spend the night in the patient’s
(private) room. Visiting hours are officially over at 8 pm.
What should you do?
a) Ask the patient if she wants her partner there, and if
so, make sure there is a sleeper chair in the room
and provide access.
b) Tell the charge nurse to make the decision.
c) Explain to the partner that visiting hours are over and
there is nothing you can do.
d) Check with the patient; if she wants her partner
there, explain to the partner that she can stay but has
to be out of the room before morning shift change.
A patient undergoing treatment for breast cancer
refuses to eat, saying that the smell of food makes her
sick. The physician’s orders are to make sure she gets
adequate nutrition. What should you do?
a) Ask the patient if there are some food options she
would find appealing to eat and contact the dietician
and/or physician to see if there are alternative
nutritional approaches for this patient.
b) Tell the patient that she may change her mind so you
will just leave the tray in the room for her.
c) Tell the patient she has to eat, and sit with her while
she does.
d) Call the physician and report that the patient is being
non-compliant.
A Veteran residing in a Community Living Center likes to sleep
until noon and then have his breakfast. He stays up late, then
asks for a “midnight” snack and walks around the building. He
gets very agitated when he is told he must eat at regular
mealtimes and observe lights-out time. What should you do to
handle this situation?
a) Hold a family conference and tell them they have to
make him understand he has to change his behavior.
b) Bring the nurse manager in to tell the Veteran resident
he has to follow the rules, period.
c) Task the Care Assistant with waking him up on time,
and putting him to bed on time.
d) Hold a team conference to individualize his care plan
and support his lifestyle.
The Power Of Words
Allow….…….Encourage
Permit…….…Support
Informed Consent….…….Informed Choice
The Power of Words
Avoid
Use
▼ Allow
▼ Permit
▼ Require
▼ Offer
▼ Choose
▼ Support
The Power of Words
Words to Eliminate
Words to Use
▼ Prohibited
▼ Chief Complaint
▼ Problem Conference
▼ Analgesic
▼ Anti-inflammatory
▼ Ambulatory Clinic
▼ Encouraged
▼ Patient/Family
Observations or
Concerns
▼ Conference for
challenging situations
▼ Medicine for Pain
▼ Reduces swelling
▼ Walk-in Clinic
The Power of Words
Words to Avoid
▼ Dysfunctional
▼ Non-Compliant
▼ Uninvolved
La Familia Medical Center
Santa Fe, New Mexico
Diabetics . . .
Take off your shoes.
With the suggestion of the patients, the poster was
changed to:
Show off your feet.
“Medical staff members also need to recognize that
families also suffer the stress of a wounded child or
spouse. They deserve answers to their questions that
they can comprehend–not medical textbook jargon
that the intern is "practicing.”
-1st Lt. Ryan Miller
The Words We Use
A Brainstorming Exercise
The Words We Use
Break
As Staff We Can!
Care Scenarios
Care Scenario 1
1. What are the issues in this scenario from a patient-
and family-centered care perspective?
2. What would have more positively influenced the
experience of care for this Veteran and his family?
3. What specifically could this nurse have said to
determine if the patient wanted his family present?
4. Assume you are the next staff person this patient
and his family interacts with. They are agitated and
upset as they tell you this story. What specifically
should you say and do now?
Care Scenario 2
1.
What do you think the Nurse said or did?
2.
What should she have done? And why?
3.
What are the issues in this scenario from a patientand family-centered care perspective?
4.
What would positively influence the experience of
care for this Veteran and his family?
What really happened next in
Care Scenario 2:
The Nurse said: “I don’t work in admissions or
surgery prep, but come with me and I will get this
straightened out.” Within minutes, the patient had a
room and lunch is ordered for him and tests and
preparations for surgery are started.
Says the Veteran who wrote this scenario:
“This is great that a Nurse goes the extra mile to be vigilant
for patients needing extra help, even patients she is not
assigned to at the moment. The patient’s anxiety is greatly
reduced, he is taken from the high risk coughing and
sneezing sick patients in emergency room waiting area,
and now feels good and comfortable that someone really
cares about him and is going to take good care of him.
Unfortunately, the patient did not get the Nurse’s name but
is going to try and find out who she is. The Nurse needs to
be immediately rewarded for this assertiveness, great
service, compassion, kindness, and attention to patients.”
Patient- and
Family-Centered Care
A Journey…Not a Destination
Personal Commitment
What Will YOU Do To Support Our
PFCC Journey???
Thank You
After the call to serve,
many Veterans
continue to pay a
high price for the
sacrifices they made
at home and abroad.
Getting to know their
stories becomes part
of the healing.
“Let us not forget.”
Adapted from: Jillian Van Ens CNE,
“Our Veteran Population”,
Spokane VAMC, June 2010