1. Rhonda Dickman, RN, MSN, CPHQ
Rhonda Dickman is a Quality Improvement Specialist with the Tennessee Hospital Association’s Tennessee Center for Patient Safety, supporting hospitals in their quality improvement work, particularly in the area of readmissions. She is also the clinical manager of the Tennessee Center for Patient Safety’s PSO (patient safety organization).
Rhonda has worked in the field of hospital quality management since 2006 and has a clinical background in trauma, critical care, oncology, and organ donation.

2. THA Webinar Series
Exclusive program for clinical leaders in hospitals that are part of the Tennessee Hospital Association Hospital Engagement Network (HEN)
Focused on supporting clinical leaders who supervise front-line staff
18 webinars in total
1.5 contact hours for each webinar
Transitioned to new webinar platform

3. Objectives Participants will be able to:
Describe the benefits of involving patients and families as partners
Recognize the valuable role of family caregivers in high quality care transitions
Share tips on getting patients and family members involved and removing barriers to effective partnerships
Use a self-assessment tool on readiness for patient engagement

4. Kathy Duncan, RN
Kathy D. Duncan, RN, Director, Institute for Healthcare Improvement (IHI), oversees multiple areas of content, directs multiple virtual multiple learning webinar series. Currently she serves as Faculty for the AHA/HRET Hospital Engagement Network (HEN) 2.0 Improvement Leadership Fellowship Ms. Duncan also directed content development and spread expertise for IHI’s Project JOINTS, an initiative funded by the Federal Government to study adoption of evidenced-based practices. In 10 US States, Project JOINTS spread three evidence-based pre-and perioperative practices to reduce the risk of surgical site infections in patients undergoing total hip or knee replacement. Previously, she co-led the 5 Million Lives Campaign National Field Team and was faculty for the Improving Outcomes for High Risk and Critically Ill Patients Innovation Community. She has also served as a member of the Scientific Advisory Board for the American Heart Association’s Get with the Guidelines Resuscitation, NQF’s Coordination of Care Advisory Panel and NDNQI’s Pressure Ulcer Advisory Committee. Prior to joining IHI, Ms. Duncan led initiatives to decrease ICU mortality and morbidity as the Director of Critical Care, Orthopedics and Neuro for a large community hospital.

5. Peg Bradke, RN, MA
Peg M. Bradke, RN, MA, has held various administrative positions in her 25-year career in heart care services. Currently she is Vice President of Post-Acute Care at St. Luke's Hospital in Cedar Rapids, Iowa, where she oversees a long-term acute care hospital and two skilled nursing and intermediate care facilities, with responsibility for home care, hospice, palliative care, and home medical equipment. In her previous role as Director of Heart Care Services at St. Luke's, she managed two intensive care units, two step-down telemetry units, several cardiac-related labs, and heart failure and Coumadin clinics. Ms. Bradke also serves as faculty for the Institute for Healthcare Improvement on the Transforming Care at the Bedside (TCAB) initiative and the STAAR (STate Action on Avoidable Rehospitalizations) initiative.

6. Gail A. Nielson, BSHCA, RT(R), FAHRA
Fellow and Faculty of the Institute for Healthcare Improvement (IHI). Nielsen is the former system-wide Director of Learning and Innovation for UnityPoint Health (formerly Iowa Health System). Her current work as faculty for IHI includes reducing avoidable readmissions and improving transitions in care, leading 2-day Reducing Readmissions seminars, improving the quality of care in nursing facilities, and other assignments. Nielsen’s ten years of experience in improving care transitions and reducing avoidable readmissions began during her 1-year IHI Fellowship. Her most recent experience includes system-wide work in Iowa; four years in the STAAR initiative across three states: Massachusetts, Michigan, and Washington; and support to Hospital Engagement Networks in multiple states. Additional past areas of expertise and work with IHI includes six years on the Patient Safety faculty; four years on the faculty for Transforming Care at the Bedside; engagement and patient-centered care; reducing falls and related injuries; spread and scale-up of innovations; and ACOs-Post Acute Care.

7. Amy Thorn and Melissa Robertson
Assignment Options
Follow a patient as they transition to a SNF facility, or go with Home Care on a home care visit.
Do an observation of a discharge process
Interview a Primary Care Office to determine if we they are receiving the appropriate information to receive the patient back in the clinic
Do a random chart review and determine percentage of time post hospital appointments are made for the patient prior to discharge.
Amy Thorn and Melissa Robertson
: Tiffany Crews, MRCM chart review and Lisa chambers chart review for MD visits
Jackie Wyatt – DC Observation
Amy Thorn and Melissa Robertson – Navigator SNF Process

8. Assignment Options Jackie Wyatt
Follow a patient as they transition to a SNF facility, or go with Home Care on a home care visit.
Do an observation of a discharge process
Interview a Primary Care Office to determine if we they are receiving the appropriate information to receive the patient back in the clinic
Do a random chart review and determine percentage of time post hospital appointments are made for the patient prior to discharge.
Jackie Wyatt
: Tiffany Crews, MRCM chart review and Lisa chambers chart review for MD visits
Jackie Wyatt – DC Observation
Amy Thorn and Melissa Robertson – Navigator SNF Process

9. Assignment Options Tiffany Crews, MRCM Lisa Chambers
Follow a patient as they transition to a SNF facility, or go with Home Care on a home care visit.
Do an observation of a discharge process
Interview a Primary Care Office to determine if we they are receiving the appropriate information to receive the patient back in the clinic
Do a random chart review and determine percentage of time post hospital appointments are made for the patient prior to discharge.
: Tiffany Crews, MRCM chart review and Lisa chambers chart review for MD visits
Jackie Wyatt – DC Observation
Amy Thorn and Melissa Robertson – Navigator SNF Process
Tiffany Crews, MRCM
Lisa Chambers

10. Assignment Options
Follow a patient as they transition to a SNF facility, or go with Home Care on a home care visit.
Do an observation of a discharge process
Interview a Primary Care Office to determine if we they are receiving the appropriate information to receive the patient back in the clinic
Do a random chart review and determine percentage of time post hospital appointments are made for the patient prior to discharge.
: Tiffany Crews, MRCM chart review and Lisa chambers chart review for MD visits
Jackie Wyatt – DC Observation
Amy Thorn and Melissa Robertson – Navigator SNF Process

11. Engaging Patients and Families in Improving Care Transitions
Gail Nielsen
March 16, 2016

12. Since providers and care managers do not provide the majority of care nor care coordination, WHO DOES? WHY IS THIS IMPORTANT?

13. Provocation from Don Berwick
“Are patients and their families… someone to whom we provide care? Or, Are they active partners in managing and redesigning their care?”
We are not hosts to our patients, we are guests in their lives.
Story of the Swedish engineer who does his own dialysis
Jim Lang the father helping the team at Cincinnati Children’s working on CF. Terri Schindler, a CF nutritionist at Cincinnati Children’s whose daughter drawing her own blood through the port never missed.
Taking care of oneself to the full extent of possibility is not something that we just “allow”, but support and encourage.
Donald Berwick, M.D. Plenty, 2002 IHI Forum Plenary

14. Three Levels of Engagement
Patients and family caregivers:
Participate in giving feedback and ideas on improvement or participate at the project level
Participate in shared decision-making and care processes
Are partners in improving, design, or redesign of care delivery processes or infrastructure

15. How do your patients provide feedback?
Opinion surveys? Experience surveys? Focus groups? Advisory councils? Participating on teams?

16. (c) Judith Hibbard, PhD University of Oregon
Patient Activation
Slide by Eric Coleman, MD
Judith Hibbard, PhD University of Oregon
(c) Judith Hibbard, PhD University of Oregon

17. University of Oregon’s Judith H. Hibbard and colleagues report
Adding a Measure of Patient Self-Management Capability to Risk Assessment Can Improve Prediction of High Costs
University of Oregon’s Judith H. Hibbard and colleagues report
Patients with the knowledge, skills, and confidence needed to manage their health conditions—those who are activated— are significantly less likely to visit an emergency department or be admitted to the hospital.
Activation scores can be used to accurately predict a patient’s future use of health services.
Authors say, this can help health systems better assess risk, manage costs, and address patients’ needs.
Caveat: Use of this scoring method is not free.
J. H. Hibbard, J. Greene, R. Sacks et al., “Adding a Measure of Patient Self-Management Capability to Risk Assessment Can Improve Prediction of High Costs,” Health Affairs, March (3):489–94.

18. Supporting Family Caregivers: United Hospital Fund of New York

19. Your Turn to Share Your Thoughts
Local examples? Thoughts? Surprises? Questions?

20. The Patient Engagement Evolution
“Doing to patients
Doing for patients
Doing with patients
Doing with patients and their families”
“It’s a profound paradigm shift.”
Barbara Balik, Common Fire, 2011

21. Examples from St Luke’s Staff
Doing to me:
Probing, sticking, shaking, pushing
Nurse saying, “You are doing fine.”
Physician saying, “Here is what needs to be done.”
Doing for me:
Physical Therapy
Making me move and repositioning me in bed
Hygienic measures
Doing with me and my family
Taking time to calm me and really talk with and learn about me
Asking patients what they need; asking family members as well
Sharing facts - being transparent (shared decision-making)
Always updating the care plan with patient & family

22. Chat and Discussion Share an example of partnering with patients:
Your examples of engaging patients and families
Are your examples “To”, “For”, or “With”?

23. “Start before you are ready!”
Jim Anderson
Chairman of the Board
Cincinnati Children’s Hospital and Medical Center
James M. Anderson retired in 2009 as president and CEO of Cincinnati Children’s Hospital Medical Center, a position he had held since 1996. He was instrumental in shaping the extraordinary growth at the medical center.  Since his retirement, the James M. Anderson Center for Health Systems Excellence has been named in his honor.
His appointment as president and CEO followed 20 years of service to the Cincinnati Children’s Board of Trustees, including four years as chairman.

24. Patient and Family Advisory Council: St
Patient and Family Advisory Council: St. Luke’s Hospital Heart Care Services
Purpose:
“Dedicated to St Luke’s mission ‘Give the health care we’d like our loved ones to receive’ and to supporting the principles and practice of family-centered care.”
Provide input on:
Enhancing patient and family experience of care
On delivery of services for patients and families that support or enhance family-centered care

25. St. Luke’s Hospital: Critical Care/ Heart Care Services
Provide input and feedback on:
Educational programs, classes, written materials, and home visits
Program development
Facility design or renovation
Participate in:
Education/orientation of hospital associates
Annual review of accomplishments and goal setting
Recruiting new members

26. IPCC Patients as Partners (PasP) Provincial Steering Committee
DRAFT
Patients as Partners
INTEGRATED PRIMARY ACUTE AND COMMUNITY CARE
IPCC Integration Leadership Committee (ILC)
IPCC Patients as Partners (PasP) Provincial Steering Committee
1500 Trained Patient Partners
Caryl / Cheryl
Sustainable Measurement Strategy
Vision Awareness ...communications
Build Capacity individual / population to be meaningfully engaged
Self Management Support

27. Partnering with Patients
Toni Cordell
Patient who did not understand found her voice
Local and national health literacy advocate
Workshop co-presenter
Patient partner in health literacy programs
Faculty in medical residency programs
Keynote speaker
Turning stumbling blocks into stepping stones:

28. Assessing Readiness and Depth of Patient Engagement

29. Health Affairs 32, no 2(2013):223-31 This edition is dedicated to patient- and family-centered care.
"Health Policy Brief: Patient Engagement," Health Affairs, February 14, 2013.

30. The Guide to Patient and Family Engagement in Hospital Quality and Safety: Engaging Patients and Families to Improve the Quality and Safety of Care We Provide Information to Help Hospitals Get Started; How to select, implement, and evaluate the Guide’s strategies How patient and family engagement can benefit your hospital How senior hospital leadership can promote patient and family engagement
Handouts that accompany this presentation:
About the Guide to Patient and Family Engagement
How Patient and Family Engagement Benefits Your Hospital
Supporting Patient and Family Engagement: Best Practices for Hospital Leaders
You may also wish to have on hand:
Printouts of this PowerPoint presentation
Information to Help Hospitals Get Started
Guide to Patient and Family Engagement

31. PFAC Toolkit Detailed Toolkit to: Engage patients
Develop Advisory Councils
Available at the Colorado Hospital Association

32. Patient & Family Engagement Survey

33. Fostering Patient and Family Engagement: Does the Hospital…
1. Have a patient/family advisory committee? 2. Do bedside rounds and include patients and families? 3. Have a person who involves patients in safety design? 4. Have a board member that received care and/or experienced harm in the hospital? 5. Offer a planning checklist given to patients in the ED?
Slide by Eric Coleman, MD
AHA/HRET Survey Supported by the Gordon and Betty Moore Foundation

34. AHA/HRET Survey Supported by the Gordon and Betty Moore Foundation
Key Findings
Few hospitals have implemented majority of Patient & Family Engagement strategies (room for improvement)
Strategies occur at multiple levels:
Direct care
Organizational design and governance
Policy making
Embracing these strategies => improved HCAHPS scores
Slide by Eric Coleman, MD
AHA/HRET Survey Supported by the Gordon and Betty Moore Foundation

35. Questions and Comments?
Did your CEO filled out the Patient & Family Engagement Survey?
What are you most proud of in engaging patients and families?

36. More Information on Partnering with Patients and Families
Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: A Roadmap for the Future. Cambridge, MA: Institute for Healthcare Improvement. Available at
Tools for Advancing the Practice of Patient- and Family-Centered Care. Institute for Patient- and Family-Centered Care. Available at
Berwick D. What ‘patient-centered’ should mean: confessions of an extremist. Health Affairs (Millwod). 2009;28(4):
Taylor J, Rutherford P. The pursuit of genuine partnerships with patients and family members: the challenge and opportunity for executive leaders. Health Services Management. 2010;26(4):3-14. Available at

37. Assignments for next session
Interview 3 patients and ask them “What do we do to you?”  “What do we do for you?”  “What do we do with you?”
Or - use the same interview questions with 3 or more staff
Read the report relating findings from a survey of hospital CEOs by AHA:

38. Call Number 6
Improve Transition from Hospital to Home and Community Based Care March 30, 1-2:30 EST