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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
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 ProgramVision
Physicians fully integrate and value the unique contributions that the family and
community bring to children’s health.
Community
Health Providers
Family
Boyle Program: 1998-2007Services & 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)
80 inpatient beds Pedi/adolescent unit PICU ICN 95,461 outpatient visits in 2006
Why Evaluate? Why Now?
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
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
DiscoveryAppreciating
DreamEnvisioning
Results
DesignCo-constructing
DestinySustaining
Goals of the Evaluation:Addressing the First Two Components of AI
To Discover: Which aspects of the
program were most meaningful?
What are the opportunities for improvements?
Are we making a difference?
To Dream Where should we be
heading over the next five years?
Design and Destiny:
The 3-5 year plan
Study Design
Selection of 21 stakeholders for interviews5 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 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? 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
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 doto affect future practice?
Content Analysis
Identified major themes related to analytic framework.
Examined similarities and differences between teachers and learners.
Participant quotations to illustrate themes.
Themes – these and more
Advocacy Altruism Communication Community Compassion Continuity Education Family-centered care (FCC)
Holistic Improve care Partnerships Relationships Real world impact Reflection Resources
Top 10 of 30 Themes88
82
69 67
50 48 46 44 40 39
0102030405060708090
100
Education
RelationshipsImprove Care
Real-worldImpact
Understandpatients
Community
FCC
Models ofcare
LeadershipResources
Quotes
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 doto affect future practice?
Most Common Themes:“What I Value”
1. Improve care
2. Education
3. Relationships
4. Altruism
5. Real-world impact
5. Understand patients
81%
67%62%
48%
38% 38%
0%
25%
50%
75%
100%
Improve care
Education
Relationships
AltruismReal-world
impact
Understandpatients
% of Participants
What I Value
CommunityContinuityExposure
FCCHolistic
AdvocacyCommunication
InterestPartnershipsResources
AltruismEducate
Improve CareReal-world impact
RelationshipSupport
Understand patients
Teachers Only
Both Learners Only
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?
LearnersPatient Partnership is a
DMS voluntary program.
Community Pediatrics & Family Faculty are requirements of the pediatric residency curriculum.
TeachersFamilies & Community
Partners are invited by the Boyle Program.
Most Common Themes:“What I Brought”
1. Interest
2. Energy
2. Education
4. Clinical Complexity
5. Relationships
5. Real-world impact
5. Improve care
45%40% 40%
30%25% 25% 25%
0%
25%
50%
75%
100%
InterestEnergy
EducationComplex
Relationships
Real-worldimpact
Improve care
% of Participants
What I Brought
InterestUnderstand patients
Clinical ComplexityImprove care
Real-world impactEducateEnergy
Teachers Only
Both Learners Only
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 doto 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 doto affect future practice?
Most Common Themes:“What’s at the Heart of the Experience”
1. Education
2. Understand patients
3. Real-world impact
4. Relationships
5. FCC5. Exposure
86%
76%71%
67%
52% 52%
0%
25%
50%
75%
100%
EducationUnderstand
patientsReal-worldimpact
Relationships
FCC
Exposure
% of Participants
What’s at the Heart of the Experience?
Common Themes
Teachers Only Both: Teachers & Learners
EducationExposure
FCCHolistic
LeadershipPartnerships
Real-world impactRelationships
ResourcesUnderstand patients
AltruismCommunication
CompassionContinuity
Improve careReflection
School
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?”
1. Leadership
2. Relationships
3. Education
4. Dedicated time
5. Community
63%
53%
37%32%
26%
0%
25%
50%
75%
100%
LeadershipRelationships
Education
Time
Community
% of Participants
What Makes the Program Work?
AltruismCommunityUnderstand
patients
CommunicationContinuityEducation
FCCFlexibility
Improve careResources
Sustainability
Educate RelationshipsDedicated time
Teachers Only
Both Learners Only
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 doto 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& DestinyPlanning & Prioritizing
DiscoveryAppreciating
DreamEnvisioning
Results
DesignCo-constructing
DestinySustaining
Most Common Themes:“Opportunities for Improvement and Continued Attention”
1. Continuity
2. Education
3. Advocacy
4. FCC
5. Resources
38%33%
29%24%
19%
0%
25%
50%
75%
100%
ContinuityEducationAdvocacy
FCC
Resources
% of Participants
Opportunities for Improvement and Continued Attention
Community
EducationFCC
PartnershipsSchool
Sustainability
Continuity
Teachers Only
Both Learners Only
Using the Evaluation to Improve Education and Care
Improve the Boyle Program
Disseminate knowledge to other educational settings
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
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
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
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 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
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