Transcript patient engagement - Administrators in Medicine

Engaging Patients, Providers & the
Community for Safer, Better Care
Certified Medical Board Executive Institute
October 26, 2016
Marie Dotseth, MHA
Executive Director
Minnesota Alliance for Patient Safety
Overview
• What/Who is MAPS?
• Why focus on patient & family engagement?
• MAPS current work to engage patients
• How can we support culture change?
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The Minnesota Alliance for Patient Safety
• Originally formed in 2000
– All volunteer, in-kind support
• Incorporated as a 501c3 in 2012
– First staff hired
– VISION: SAFE CARE EVERYWHERE
• Over 100 member organizations
– Across the continuum of care, across the state, public &
private
• Board of Directors
– 5 Founding partners: MHA, MMA, MMIC, MDH, Stratis
– 6 Strategic Partners: Mayo, MNA, DHS, CareProviders,
Leading Age, M Health
– 1 patient
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MAPS Early Work
• Provided expertise and advocacy to pave the way
for the groundbreaking and “first of its kind”
Minnesota Adverse Health Care Event Reporting
Act.
• Transformed the Informed Consent Form to be
more consumer-friendly.
• Led the way to develop the framework for a safe,
accountable and Just Culture. Received the John
M. Eisenberg Patient Safety and Quality Award
(2006) for Innovation recognizing its work in
creating a Culture of Safety.
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Engagement is Safety
• MAPS Strategic Priority: Engaging patients,
providers and the community for better, safer
health care across the continuum
– Evidence is clear – Engaged patients get safer care
& have better outcomes
– Safety is a necessary condition for patient
engagement
• Lack of safety erodes trust
• Without trust, meaningful engagement is nearly
impossible
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NPSF Report, Safety is Personal
“Engaging Patients and families in improving health
care safety means creating effective partnerships
between those who provide care and those who
receive it – at every level...”
• Why Engage Patients for safety?
–
–
–
–
–
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Extra set of eyes,
Know their symptoms
Highly invested
Always “present”
Provide insights about care and care processes
Patient resilience inspires caregivers
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Safety is Personal
“This should not be seen simply as a new initiative
or program; it is rather an effort to inspire
strategic alignment across the communities of
health care consumers and advocates, policy
makers, researchers, and health care leaders and
clinicians to commit to increasing patient
engagement in order to reduce harm.”
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Patient Safety Developments
• Gordon & Betty Moore Foundation
– Almost half of U.S. patients report that their
physicians do not always tell them about their
treatment options or involve them ... And, 26 percent
of hospitalized patients report that clinicians fail to
explain medication use... Not only does this lack of
engagement lead to clinical harm, but it also results
in a loss of respect and dignity
• Consumer Reports
– Those who said they rarely received respect from the
medical staff were two and a half times as likely to
experience a medical error as those who thought
they were usually treated well.
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Start at the End – Call to Action
• “The panel feels strongly that we have failed to
make substantial, measureable, system-wide
strides in improving patient safety. Other
priorities have overshadowed the agenda of
keeping patients safe from harm related to
care. Insufficient collaboration and perhaps
lack of will have stalled progress...”
• Preventable harm remains unacceptably
frequent—in all settings of care and among all
patient populations.
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Free From Harm Report
• …a fundamental finding from the past 15
years is that patient safety initiatives can
advance only by making teamwork, culture,
and patient engagement a key focus…
• Meaningful advancement in patient safety can
occur only when a total systems approach
underpins improvement initiatives.
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NPSF Recommendations
“At its core, patient
engagement is about the
free flow of information
to and from the patient”
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IOM Report on Diagnostic Error
• Estimated that 5 percent of U.S. adults who seek
outpatient care each year experience a diagnostic
error.
• Postmortem examination research… has shown that
diagnostic errors contribute to approximately 10
percent of patient deaths, and
• Medical record reviews suggest that they account for
6 to 17 percent of adverse events in hospitals.
Recommendations
• Health care professionals and organizations should
partner with patients and their families as diagnostic
team members …To accomplish this, they should…
– Ensure patient access to electronic health records
(EHRs), including clinical notes and diagnostic testing
results, to facilitate patient engagement in the
diagnostic process and patient review of health
records for accuracy
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MAPS Grant funded Project
• Engaging Patients to
Improve Safety at
Transitions: Lessons
from Consumer
Research and Pilot
Testing
Transitions, the Problem
• Confusion – lack of follow through, over,
under and misuse, inconsistent monitoring
• Cost – failures of care coordination,
overtreatment, poor quality care cost $Billions
annually
• Harm – medication errors, missed lab test
results, misdiagnoses
• Prevalent – communication between
providers/settings routinely not completed
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MAPS Approach
• MAPS decided to focus on the patient side of
the equation
• Can the transitions process be simplified, made
actionable for patients and consistent for any
transition of care?
– Average hospital discharge instructions = 70 pages1
– We can provide consumers actionable tools to
better engage and stay safe
1. Hanson, Candy RN, Julie Jacobs MS, RN. StratisHealth HIT PAC (Health Information Technology – Post Acute Care) Environmental Scan. January
2013
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Safe Transitions of Care – Best Practices
• Successful safety improvement at transitions
centers on a plan that routinely includes the
following elements:
– Medication reconciliation,
– Communicating test results,
– Understanding the warning signs that a medical
condition is worsening, and
– Completing next steps or follow-up appointments.
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Consumer Research - Findings
• Conducted Online Digital Bulletin Boards (ODBBs)
with 100 Minnesotans
– Allowed us to recruit participants statewide
– Allowed us to capture reactions to communication themes
on an individual basis prior to group discussion
– Took place over 5 days  5 hours of input x ~100
respondents
• Discussion guide could evolve as we learned
– Separating boards by gender  similarities and differences
between women and men could be observed
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Word clouds of respondents’ descriptions of their health conditions’
effects on their lives also revealed differences between genders
•
Women were more likely to express
regret, loneliness, and concern
about how others viewed them
I feel as though things
are happening to me
and I have no control
over them and what
they are doing to my
life.
I pretend that I'm
feeling well when
really I'm not, so I
feel like I have to put
a different "face" on
•
Men tended to accentuate the positive
and focus on their determination to
continue life as usual
My daily thoughts always
focus on the future and if I
am strong, I will be able to
be here to enjoy those
days.
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Tested a “To do” List & Graphics
• “To Do” List was derived from evidence-based
best practices
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Patient Feedback
• Number of items on “To Do” list about right
– VERY few wanted MORE items on the list
• Most likely to say they would act on next steps
& watch for warning signs
• Least likely to bring lists and results
– Polarized feedback on medication lists
– Many expect the “system” to keep track of
medicines and test results
It's too much work to bring
with to your Dr appt no
matter what your ailment
is…It's not gonna get done.
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Patient’s Accepted Responsibility Scale
o My responsibility only
o Mostly my responsibility, but also someone
else's
o Split Responsibility; half mine half someone
else's
o Mostly someone else’s responsibility, but also
mine
o Someone else’s responsibility only
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Patients’ Accepted Responsibilities – Rank Order
1. Immediately reporting to my doctor when
something happens that is associated with
warnings signs
2. Filling and re-filling prescriptions for all
recommended medications
3. Keeping a list of all major warning signs
associated with all of my conditions
4. Asking for written copies of major medical
tests
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Patients’ Accepted Responsibilities –
Rank Order (cont’d)
5. Making appointments for all examinations,
consultations, tests recommended
6. Keeping a complete list of all follow-up steps
recommended (examinations, medications,
tests)
7. Keeping an up-to-date list of medications
8. Bringing written copies of all major medical
tests to all medical appointments
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The Solution; Campaign Materials
• Patients under-engaged
– Assume “the system” has everything covered
– Rarely told they matter in the caregiving process
• So, care providers end up under-informed
– Misdiagnoses, mistreatments, delayed
treatments, medicine interactions
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MAPS
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MAPS action to advance patient engagement
across all care settings
Primary Care
Pediatrics/Parents
Long-term Care
Families/Mental
Health System
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MAPS Patient Engagement work and objectives
• Purpose: to provide both patients and healthcare professionals with a
valuable, interactive resource for patient and family engagement best
practices, guidelines, resources, and contacts.
– How can we efficiently spread effective patient engagement practices, across all settings
of care in Minnesota, for purpose of improving safety and quality?
• Start with definitions
o Numerous definitions, appears to be evolving over time
o A handful are widely accepted
 “Patients, families, their representatives, and health professionals working
in active partnership at various levels across the health care system—direct
care, organizational design and governance, and policy making—to improve
health and health care.”
•
K. Carman et al, Patient and family engagement: A framework for understanding the elements and developing interventions and policies. Health Affairs 32, No.
2(2013): 223-231. Definition of patient and family engagement.
o Contention point: patient engagement vs. patient experience vs. service excellence vs.
patient-and-family centered care
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MAPS Patient Engagement work and objectives
• Built Virtual Community
• Dynamic, real-time, “living/breathing” tool vs. a
publication that could become dated soon after
printing
• Where best practices, challenges, and ideas are
shared and spread
• Heart of a virtual community to be an “open source
guidebook”
– “open source gives everyone access to the blueprint, then access to universal
redistribution of that design or blueprint, including subsequent improvements
to it by anyone”
• Utilizing and Building Upon “Include Always”
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Include Always Mission
Include Always. That’s what we aim to do.
Include patients and families at every level throughout the
health care system. Through conversations, sharing ideas,
and inviting the patient in, the outcome will be better
health care for everyone. We’re not launching a campaign
that begins and ends. Together, we’re creating a cultural
shift, a unified mindset where the patient is truly one of
us. It’s a whole new health care approach. It takes a whole
lot of change. It takes courage. It takes all of us working
together to make our system the best it can be.
We will listen more, engage often, and Include Always.
3
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How can we support Culture Change?
The problem, oversimplified
How to shift
• Physicians from problem detectives…
• Patients from passive recipients of care…
Patient has
health problem
they can’t solve
Physician
determines
problem
Physician
prescribes
treatment
Patient acts to
follow up
Patient achieves
“health”
• …To co-creators of health
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