NLC 7 October 4-5, 2012 Transplant Track NLC 7 Transplant Track Optimizing Patient and Family Centered Care Friday, October 5, 2012

NLC 7 October 4-5, 2012 Transplant Track Transplant Center Growth and Management Best Practices 1. Institutional Vision and Commitment 2. Dedicated Team 3. Aggressive Clinical Style 4. Patient and “Family” Centered Care 5. Financial Intelligence 6. Aggressive Management of Performance Outcomes

NLC 7 October 4-5, 2012 Transplant Track Optimizing Patient and Family Centered Care Bring Patients and Staff Together – Linda Munro Patient and Family Advocacy Council – Patty Geerdes Effective Change Management – Katie McKee

NLC 7 October 4-5, 2012 Transplant Track Henry Ford Transplant Institute Detroit, Michigan Bringing Patients and Staff Together: Patient Centered Care Committee Linda Munro, RN, MSN Manager-Quality and Regulatory Compliance Elizabeth Rubinstein TLC Volunteer Coordinator October 5, :30 am

NLC 7 October 4-5, 2012 Transplant Track

Patient Centered Care IOM 2001 Health Care System Mandate – Respect patient’s values, preferences and needs – Coordinate/integrate care beyond system boundaries – Provide information, communication, education that people need and request – Guarantee physical comfort, emotional support, and involvement of family and friends

NLC 7 October 4-5, 2012 Transplant Track Patient Centered Care Evolution Incorporate patient/family perspectives into organizational policies Incorporate patient/family perspectives into quality improvement initiatives Innovations that improve patient satisfaction while reducing waste and cost Sourcing of reliable patient/family feedback Sustaining patient/family partnerships

NLC 7 October 4-5, 2012 Transplant Track Establishing Henry Ford Patient Centered Care Committee Incorporation of Successful Patient Initiative -Transplant Living Community (TLC) established On site volunteer mentorship program -Framework for engaging patients/families in total transplant experience from pre to post -Educational support and tools for transplant success -TLC “ACES” platform to compliment medical goals -Training Curriculum: HIPAA, patient safety, lifestyle versus medical, patient referral, empathic listening skills

NLC 7 October 4-5, 2012 Transplant Track Establishing Henry Ford Patient Centered Care Committee TLC Program Prime Candidate for PCCC Linkage – Favorable feedback from patients/families on TLC mentorship, PHR hardcopy tools, healthy living platform – Ability to collect real time patient feedback consistently both in clinic and bedside – Ability to conduct random pulse point/process surveys – Able to provide volume patient experience reporting – Provided services to compliment/reinforce medical staff goals – Established transplant team member – TLC life style education kits GOLF grant funded

NLC 7 October 4-5, 2012 Transplant Track Henry Ford Patient Centered Care Committee Committee Established January 2010 Membership – Designated physician chairperson – Representatives across all discipline/clinical areas – Transplant administration representatives – TLC Ambassador volunteers – Open invitation to patients, families, caregivers

NLC 7 October 4-5, 2012 Transplant Track Henry Ford Patient Centered Care Committee Rules of Conduct – Show up and choose to be present – Pay attention to what has heart and meaning – Speak truthfully without blame or judgment – Be open to change and innovation – Patient safety and respect are foremost – Engagement aligned from both healthcare members and patient perspectives

NLC 7 October 4-5, 2012 Transplant Track Engage, Empower, Improve Educational component to each meeting Structured agenda to give voice to all Actions driven with 3 tier integrated approach – Treatment Plan, Care Pathway, Patient Goals – Quality and patient safety priorities – Patient compliance/ownership emphasis Consistent education platform through out continuum Improvement initiatives instilled in care culture Collaborative responsibility for success

NLC 7 October 4-5, 2012 Transplant Track PCCC Accomplishments Kidney/Liver patient education handbooks Patient responsibilities as care team partners – Inpatient kidney/liver goals immediate post transplant Lifestyle discharge curriculum to compliment medical Staff satisfaction/trust with TLC Ambassador care team partners

NLC 7 October 4-5, 2012 Transplant Track PCCC Accomplishments Tools for patient home charting PHR hardcopy tools and education Transplant class curriculum for caregivers and patients Laboratory services survey for patient wait times Higher patient satisfaction equaling higher scores

NLC 7 October 4-5, 2012 Transplant Track PCCC Next Steps Quality (LEAN) initiative to address laboratory wait time PHR hardcopy conversion to electronic applications – “My Chart” super user TLC mentors Commencement of IRB approved TLC research Patient transition focus in all care phases Continued empowerment of patient health ownership Living donor healthy pathways TLC/PCCC mentorship

NLC 7 October 4-5, 2012 Transplant Track The Henry Ford Experience: Listening From All Directions “Patients have power to make choices that will have a positive impact on their body, mind, and spirit. Patients choose to discover ways to live their best lifestyle yet and live it in ways that are truly healthy, smart, and inspired. The Patient Centered Care Committee and TLC can help guide individuals in this process.” 1985 Heart Transplant Recipient and TLC Ambassador

NLC 7 October 4-5, 2012 Transplant Track Henry Ford Transplant Institute THANK YOU For Further Information Contact: Linda Munro, RN, MSNElizabeth Rubinstein

NLC 7 October 4-5, 2012 Transplant Track The Importance of Change Management in Optimizing Patient & Family Centered Care Katie McKee National Learning Congress October 5, :30 a.m.

NLC 7 October 4-5, 2012 Transplant Track

Implemented Patient Online Services to: Improve patient satisfaction Enhance availability of health information Enable electronic communication between patient and care-team Increase Transplant Center efficiency

NLC 7 October 4-5, 2012 Transplant Track Achieved through Patient Online Services: Inbound messages received – Kidney2496 – Liver608 – Heart & Lung367 – BMT240 Strong patient and staff satisfaction

NLC 7 October 4-5, 2012 Transplant Track One definition of change management “The process, tools and techniques used to manage the ‘people side’ of change in order to successfully achieve the required business outcomes.” Prosci 2011

NLC 7 October 4-5, 2012 Transplant Track 23 What do you consider the main obstacles to successful change?

NLC 7 October 4-5, 2012 Transplant Track Corporate Culture Changing Mindsets and Attitudes Underestimating Project Complexity 3 most common obstacles to project success (based on industry research) Budget constraints Legal barriers Approval process

NLC 7 October 4-5, 2012 Transplant Track 1 st communication or 1 st rumor Comfort/security Worry/uncertainty Flight/risk Increasing fear and resistance Decreasing productivity Time Dept D Dept A Dept B Dept C Normal work environment Productivity loss Employee dissatisfaction Passive resistance Turnover of valued employees Tangible customer impact Active resistance Change Comfort / Risk Model

NLC 7 October 4-5, 2012 Transplant Track 26 1.Active and visible executive sponsors 2.Structured change management approach and plan 3.Engaged mid-level managers and supervisors 4.Involved front-line staff 5.Frequent and open communications Top Five Contributors to Successful Change

NLC 7 October 4-5, 2012 Transplant Track 27 A wareness of the need to change D esire to participate and support the change K nowledge about how to change A bility to implement new skills and behaviors R einforcement to keep the change in place  Nature of the change  Drivers for change (internal-external)  Risks of not changing  What is changing  Impact of the change  Nature of the change  Drivers for change (internal-external)  Risks of not changing  What is changing  Impact of the change  WIIFM (What’s in it for me)  Willingness to support change  Personal choice, influenced by nature of change  Personal situation  Intrinsic motivators  WIIFM (What’s in it for me)  Willingness to support change  Personal choice, influenced by nature of change  Personal situation  Intrinsic motivators  Training & Education of skills and expected behavior  Detail on how to use new processes, systems & tools  Understanding new roles & responsibilities  Training & Education of skills and expected behavior  Detail on how to use new processes, systems & tools  Understanding new roles & responsibilities  Putting knowledge into action  Individual or group demonstrates capability to implement change at the required performance level  Putting knowledge into action  Individual or group demonstrates capability to implement change at the required performance level  Sustains change, prevents relapses  Builds momentum  Creates a history (Absence of negative consequences Recognition, Accountability)  Sustains change, prevents relapses  Builds momentum  Creates a history (Absence of negative consequences Recognition, Accountability) ADKAR

NLC 7 October 4-5, 2012 Transplant Track In absence of:You will see: Awareness and Desire More resistance from employees. Employees asking the same questions over and over. Lower productivity. Higher turnover. Hoarding of resources and information. Delays in implementation. Knowledge and Ability Lower utilization or incorrect usage of new processes, systems and tools. Employees worry if they are prepared to be successful in future state. Greater impact on customers and partners. Sustained reduction in productivity. ReinforcementEmployees revert back to old ways of doing work. Ultimate utilization is less than anticipated. The organization creates a history of poorly managed change. Without ADKAR

NLC 7 October 4-5, 2012 Transplant Track Barrier Point ADKAR Profile

NLC 7 October 4-5, 2012 Transplant Track Engaged physician champion Formed cross-functional project team Performed stakeholder analysis (ARCIVD) Established weekly meetings for workflow mapping, process integration, and identification of concerns Engaged Patient and Family Advisory Council Patient Portal Implementation: Awareness

NLC 7 October 4-5, 2012 Transplant Track Identified key messages linked to personal motivators What’s in it for patients? – Connect with their care-team – Communicate on their schedule – Reference previous messages to avoid misunderstanding instructions – Request appointments What’s in it for the Transplant team? – Connect with your patients – Stop playing phone tag – Manage tasks on your schedule – Automatic creation of a clinical note – Clear, concise, documented communication Patient Portal Implementation: Desire

NLC 7 October 4-5, 2012 Transplant Track Staff education developed to – Activate patient portal accounts – Triage messages – Respond to messages – Effectively educate patients Patient Portal Implementation: Knowledge

NLC 7 October 4-5, 2012 Transplant Track ABILITY to succeed was achieved through preparation Onsite support during go-live Resources such as reference guides and FAQs Availability of subject matter experts for support Patient Portal Implementation: Ability

NLC 7 October 4-5, 2012 Transplant Track Recognition of “outbound messaging champions” Regular progress communications, sharing of results Data monitoring to identify and assist specific areas Celebrating success stories Patient Portal Implementation: Reinforcement

NLC 7 October 4-5, 2012 Transplant Track

36 Adopted from Prosci 2011 Middle managers & supervisors Executives & senior managers Project resources / team Employees impacted by change Change management team Change Management Roles

NLC 7 October 4-5, 2012 Transplant Track 37 Change Management Process for Leaders

NLC 7 October 4-5, 2012 Transplant Track 38 Establishing guidelines for managing resistance BEFORE resistance is encountered … …increases the likelihood of a successful transition from current to future states. Resistance is the norm, not the exception

NLC 7 October 4-5, 2012 Transplant Track 39 Lack of participation Openly expressing negativity Lack of attendance and absenteeism Reverting to old ways A decrease in productivity and missed deadlines Persistent challenging of specific components of change What does resistance look like?

NLC 7 October 4-5, 2012 Transplant Track 40 Prosci’s 2011 Best Practices in Change Management benchmarking study Executive Sponsor/Owner Why are we changing? What will happen if we don’t change? How does this fit our vision/strategic plan? Manager/ Supervisor Translates change for employees: How will the change impact me and the way I do my work? What support are you providing to me to make the change? Communicate directly

NLC 7 October 4-5, 2012 Transplant Track 41 Communication Checklist

NLC 7 October 4-5, 2012 Transplant Track 42 A AWARENESSAWARENESS List the reasons you believe this change is necessary Review these reasons and ask yourself the degree to which staff are aware of these reasons. Rank on a 1 to 5 scale. D DESIREDESIRE List the factors or consequences (good and bad) for this group that create a desire to change Consider these motivating factors. Assess the desire of the staff to change. Rank on a 1 to 5 scale. 1 Not aware of the reasons 5 Fully aware of the reasons 1 Little desire to change 5 Strong desire to change Assessing your current state

NLC 7 October 4-5, 2012 Transplant Track 43 Barrier point (1 st area scoring 3 or below) Potential response(s) / Action items AwarenessCommunicate the reasons the change is necessary. Emphasize patient value. Consider Sender/Receiver concept. Think 5-7 times … multiple channels … DesireAddress their inherent desire to change. Desire may come from negative or positive consequences. KnowledgeProvide the needed education including day-to-day work changes and new performance measures. AbilityTime is required to develop new abilities. Provide visible ongoing coaching and support. ReinforcementWhat is preventing staff from reverting back to old behaviors. Address the incentives or consequences for not adopting the change. What Now?

NLC 7 October 4-5, 2012 Transplant Track 44 Not everyone changes at the same pace ADKAR Person A ADKAR Person B ADKAR Person C ADKAR Person D ADKAR Person E ADKAR Person F ADKAR Person G ADKAR Person H ADKAR Person I

NLC 7 October 4-5, 2012 Transplant Track 45 Successful aggregate change requires individual change A structured approach to managing change will significantly increase our success Successful change begins with each of us Achieving patient & family centered care depends on us all doing this well! Points to Remember

NLC 7 October 4-5, 2012 Transplant Track 46 Books Best Practices in Change Management, Prosci Benchmarking Report Change Management: The People Side of Change. ADKAR: A Model for Change in Business, Government and Our Community. (also available in Mayo library) Kotter, John. Leading Change Harvard Business School Press Articles Kotter, John. Leading Change: Why Transformation Efforts Fail. March – April, Harvard Business Review Web sites Prosci Quality Academy EPMO References

NLC 7 October 4-5, 2012 Transplant Track 47 Katie McKee

NLC 7 October 4-5, 2012 Transplant Track Integrating A Partnership In Healthcare to Optimize Patient & Family Centered Care Patricia Geerdes, RN, MSN Manager – Quality & Informatics National Learning Congress October 5, :30 a.m.

NLC 7 October 4-5, 2012 Transplant Track Mayo Clinic Rochester Mission & Vision Mission: Provide the best care to Every patient every day through Integrated clinical practice, Education and Research. Vision: The NEEDS of the patient come first.

NLC 7 October 4-5, 2012 Transplant Track Patient Centered Care IOM Health Care Recommendation Payer Initiatives Future of Health Care: D. Berwick – Secret to health care reform is to focus on the family as partners in their care. – Build facilities and processes around the people who get the care rather than those who give the care. – Allow patients to be the drivers of their healthcare, not passengers – “Not from the bedside, but rather from the bed” J. Conway

NLC 7 October 4-5, 2012 Transplant Track Goal: Improve Overall Patient Satisfaction

NLC 7 October 4-5, 2012 Transplant Track Concept Background A venue to focus on the voice of the patient, family members and caregivers Increase patient satisfaction with the transplant experience Patient Family Advisory Councils are established multiple areas: – Cardiovascular Diseases – Gastroenterology and Hepatology – ENT – Mayo Health System

NLC 7 October 4-5, 2012 Transplant Track Drinking from the Fire hose…

NLC 7 October 4-5, 2012 Transplant Track Transplant Patient and Family Advisory Council (PFAC) Charge: – Patient and family advisory council (PFAC) is dedicated to building on Mayo’s tradition that “the needs of the patient come first.” Patients, family, caregivers and Mayo employees work as a team to develop changes through improved processes and outcomes in the Transplant Center

NLC 7 October 4-5, 2012 Transplant Track Transplant Patient and Family Advisory Council (PFAC) Goals: – Collaboration between patients & families with Mayo employees of the Transplant Center to improve the quality of service provided – Assisting in the identification of opportunities that will improve patient and family satisfaction – Offering input to leadership in the planning and evaluation of services – Serving as a vital link between the Transplant Center and the community

NLC 7 October 4-5, 2012 Transplant Track Transplant Patient and Family Advisory Council (PFAC) Council Composition – Approximately 30 members (2/3 membership patient/family) – All programs represented BMT (Blood and Marrow Transplant), Heart, Lung, Liver, Kidney, and Pancreas Live Donor

NLC 7 October 4-5, 2012 Transplant Track Council Ideas – Wellness coaching (create energies, decrease fear, increase support) – Mentoring, peer networking with people in a similar situation (BMT InfoNet, peers have credibility, validity) – Importance of Support groups – Caregiver component of transplant (support and potential manual) – Mental health support (pre- transplant, transplant, post-transplant, PTSD implications analogy – Patient education (medically oriented, family education) – Compassion in healthcare and among family members – Spirituality, human touch and defining moments – Finance implications of transplantation (pay for meds, counseling) – Gift of Life Transplant House (value of experience, local patients miss out )

NLC 7 October 4-5, 2012 Transplant Track Evolution from Concept to Expectation Theory of Change – Set the Stage Communication plan – Decide What to Do Determine goals – Make it Happen Identify barriers Evaluate effectiveness – Make it Stick Review lessons learned Celebrate successes

NLC 7 October 4-5, 2012 Transplant Track Outcomes: Improve Patient Satisfaction

NLC 7 October 4-5, 2012 Transplant Track Goal: Improved Efficiency

NLC 7 October 4-5, 2012 Transplant Track Next Steps Quality initiative in updating educational materials across the transplant continuum Patient focus in the transition from inpatient to outpatient activity Assist with the development of health literacy initiatives Empower the collaboration of patient’s in their health care Mentorship program

NLC 7 October 4-5, 2012 Transplant Track Showcasing the Patient Family Advisory Council Patient and family centered care is an approach to health care that shapes policies, programs, facility design and staff day-to-day interactions. It leads to better health outcomes and wiser allocations of resources, and greater patient and family satisfaction.

NLC 7 October 4-5, 2012 Transplant Track Mayo Clinic Rochester Transplant Center THANK YOU For Further Information Contact: Patty Geerdes, RN, MSN

NLC 7 October 4-5, 2012 Transplant Track NLC 7 Transplant Track Discussion

NLC 7 October 4-5, 2012 Transplant Track Increasing Organ Acceptance

NLC 7 October 4-5, 2012 Transplant Track Speakers Kidney Turndown Review- Linda Munro Increasing Kidney Transplants By Reducing Cold Ischemic Time- Kathy Hogan

NLC 7 October 4-5, 2012 Transplant Track Kidney Turndown Review Linda Munro, RN, MSN Transplant Institute Henry Ford Hospital October 5 th, 2012, 10:30 am

NLC 7 October 4-5, 2012 Transplant Track Outline Our Experience with Kidney Offer Reviews Tools/Resources Improvements Challenges

NLC 7 October 4-5, 2012 Transplant Track History of Organ Offer Reviews HRSA (2007) Key Change Concept 3.1 “Create high threshold for rejecting organ offers and potential recipients” Action Items Take steps to push the envelope on organ acceptance criteria, including ECD and DCD organs Use data on whether organs that were rejected by the center were accepted for transplant elsewhere

NLC 7 October 4-5, 2012 Transplant Track Henry Ford Hospital (HFH) Detroit, MI

NLC 7 October 4-5, 2012 Transplant Track HFH Experience June 2009 started monthly meetings Review previous month’s offers:  Discuss organ offers where organs were accepted after we turned down  Decide whether to track for 1 year graft function  Discuss revising clinical practices or deceased donor criteria

NLC 7 October 4-5, 2012 Transplant Track Tools Organ Offer Report in DonorNet® shows all electronic offers for a given month HFH Organ Offer Sheets completed by coordinator HFH Spreadsheet with pertinent donor/recipient data Review of Organs Offered and Transplanted (ROOT) Report on Secure Enterprise Homepage under ‘Data Reports’ (tracking 1 year graft survival) HFH Experience

NLC 7 October 4-5, 2012 Transplant Track Offers Excluded from ROOT Report Organs recovered but not transplanted Candidates with the refusal codes below (not inclusive):  802- multi-organ transplant  810- positive crossmatch  812- no sera  851- directed donation

NLC 7 October 4-5, 2012 Transplant Track HFH Experience Attendance  Transplant Surgeons and Nephrologists  Pre Transplant Coordinators  Quality and Regulatory Compliance Manager  OPO Representatives Quality Spreadsheet

NLC 7 October 4-5, 2012 Transplant Track HFH Improvements Transparency & Accountability Collaboration between Transplant Center & OPO Expanded donor acceptance criteria  Increased Cold Ischemic Time for ECD  Increased age for DCD donors  Increased maximum Creatinine Changed Clinical Practice  Nephrologist may be called to review offer  Turndowns are reviewed by second surgeon

NLC 7 October 4-5, 2012 Transplant Track Challenges At times conflicting or missing information ROOT Report- unavoidable time lag in reporting initial graft status (2 months) Depend on other transplant centers to report graft status in a timely manner

NLC 7 October 4-5, 2012 Transplant Track Looking to the Future Proposal to Update Data Release Policies would expand information on ROOT Report In the process of reviewing our ECD graft survival by Cold Ischemic Times We continue to review donor selection criteria We continue to expand our donor acceptance criteria and protocols

NLC 7 October 4-5, 2012 Transplant Track Thank You! Contact Information Linda Munro RN MSN Quality and Regulatory Compliance Manger Transplant Institute Henry Ford Hospital

NLC 7 October 4-5, 2012 Transplant Track Increasing Kidney Transplants By Reducing Cold Ischemic Time Kathy Hogan, RN, BSN, CCTC Nurse Manager Transplant Institute, Henry Ford Hospital

NLC 7 October 4-5, 2012 Transplant Track Objectives Discuss the ability to adapt concepts of a No Prospective Cross Match List as a means to reduce cold ischemic time and thereby increasing the number of decease donor organs in the donor pool

NLC 7 October 4-5, 2012 Transplant Track Criteria First transplant Male Listed for kidney transplant only No HLA Antibodies for past 6 months Commit to supplying monthly sera Compliant with all medical treatment while awaiting transplantation

NLC 7 October 4-5, 2012 Transplant Track The Team Surgical Program Director Medical Program Director Director of Transplant Immunology Lab Supervisor of Transplant Immunology Lab Quality and Regulatory Compliance Manager Medical Assistant

NLC 7 October 4-5, 2012 Transplant Track Quarterly Meetings Review each patient for: – No development of HLA Antibodys – No sensitizing events – No change in health status – Compliance with all health care requests

NLC 7 October 4-5, 2012 Transplant Track Retrospective Review Cadaveric Donors (N – 116) Ischemic time minutes (17.18 hrs) Non-Prospective Crossmatch Donors (N – 16) Ischemic time minutes (17.04 hrs)

NLC 7 October 4-5, 2012 Transplant Track Non-prospective Crossmatch Donors 18 donors UNOS wait time – 2.2 years Ischemic time minutes (17.18 hrs) – 10 SCD –Ischemic time 925 min (15 hrs) – 4 DCD – Ischemic time 1025 min (17.1 hrs) – 4 ECD – Ischemic times 1035 (17.2 hrs) 8/10 arrived on pump

NLC 7 October 4-5, 2012 Transplant Track Non-prospective Crossmatch Donors 9 patients had immediate graft function 9 patients least 1 dialysis treatment Average creatinine today = patients are re-listed – 1 primary non-function – 1 renal vein thrombosis

NLC 7 October 4-5, 2012 Transplant Track Summary 16 patients received kidneys that would have previously turned down for prolonged ischemic time if we had to wait for prospective crossmatch Even though it appears ischemic times are the same, technically they are not Greatly reduced UNOS wait list time No difference in graft function between kidneys arriving on a pump and those that did not

NLC 7 October 4-5, 2012 Transplant Track Discussion