Moderator:

Judith Schaefer, MPH, MacColl Institute for Healthcare Innovation at Group Health

Speakers:

Betsy Stapleton, FNP, Consumer Engagement Leader, and Jessica Osborne-Stafsnes, Program

Manager - Patient Engagement, Aligning Forces Humboldt at The California Center for Rural

Policy, Humboldt State University

Humboldt Consumer Engagement Across the Spectrum

8 Change Concepts for Practice Transformation 1. Foundational Changes

Engaged Leadership

QI Strategy

Empanelment

2. Changing Care Delivery Continuous, Team-based Healing Relationships

Patient-Centered Interactions Organized, Evidence-based Care

3. Changing Patient Experience

Enhanced Access

Care Coordination

HUMBOLDT CONSUMER ENGAGEMENT ACROSS THE SPECTRUM

Betsy Stapleton, FNP & Jessica Osborne-Stafsnes

Hi There!

Jessica Osborne-Stafsnes

Program Manager- Patient Engagement

Aligning Forces Humboldt at The California Center for Rural Policy

At Humboldt State University

Fun fact: I once won a hula-hoop contest!

Betsy Stapleton

Retired FNP; Consumer Engagement Leader Aligning Forces Humboldt at

The California Center for Rural Policy At Humboldt State University

Fun fact: I love to drive tractors!

Special Guest

Mary Romaidis

Patient Partner Eureka Community Health Center

Opendoor Health System Fun Fact: I like to line dance!

Humboldt County AF4Q Alliance; Part of RWJF’s “Aligning Forces for Quality”

1 of 16 communities across the United States. AF4Q Aim: convene patients, providers, and payers to improve

the quality of healthcare at local, regional, and national levels.

AFH Focus: to generate meaningful opportunities for patient engagement in healthcare improvement, delivery, and design.

www.aligningforceshumboldt.org

About Aligning Forces Humboldt

Now, a little about you….

What 3 words come to mind when you think about involving patients in your quality improvement efforts?

(Type in your answers

in the chat box)

Today’s webinar

Present a model for involving patients in quality improvement

Present tools for engaging patients in improving the experience of care

Will address two components of PCMH: Patient Self-Management Support Patient Communication

A Definition of Patient Engagement

“ [Patient Engagement is]…

giving voice to the public and

involving them in shaping

health care delivery.”

-Picker Institute Europe

Patient Engagement in Humboldt County, Ca

HDNIPA participates in the IHI

“Quality Allies” Project 2005-2006

2007 AF4Q initiative begins,

citing patient engagement as a key driver of

quality improvement

Implementation of the Chronic Disease

Self-Management Program (CDSMP)

2008

2009 HDNIPA adopts

collaborative model to improve primary

care called: Primary Care Renewal

(PCR); 10 PCP practices

participate

CDSMP leaders act as faculty at PCR meeting to discuss the patient perspective of living with a chronic health

condition 2009

2011 PCR 2.0 launches with an emphasis on PCMH.

Recruitment of a “patient partner” team

member is a requirement of participation.

Significant infrastructure is built to support this

effort.

PCR 3.0 kicks-off. Practices must recruit

two patient partners to participate. Patients

participate in collaborative and office improvement meetings.

2012

2012 Community Response

To Surgical Variation

Patient Core Function Levels

Recommended Patient Role Key Patient Characteristics Necessary Support Practice Readiness

1. Help individual patients better manage their own health

Partner in care • Willing to develop self-awareness about personal role in managing health •Receptivity to initiate better health care behaviors • The ability to communicate with care team

Offer peer-support resources, such as referrals to community-based chronic disease self-management programs (often available both in-person or online), group visits, etc.

Starting to engage in viewing patients as partners in chronic condition management. Beginning practice redesign efforts. Willingness to explore new models of care. Leadership support

2. Becoming a leader beyond personal health. Support others in better managing their own health. Using health information to make informed decisions.

Partner in care • Desire to seek information about specific health issues • The ability to discuss information with provider (ask questions, seek clarification, etc.) • Desire to become peer leader and provide support to others.

Access to training for peer leader roles. Access to personal health information, resources on specific disease states, decision support is available, etc.

Starting to implement internal self-management support. Documenting and tracking self-management goals. Practice open and receptive to chronic disease peer leaders. Developing systems to direct patients to decision support material. Leadership support

3. Assist individuals to weigh in on patient experience (resulting in weighing in on quality improvement efforts, office workflows, and patient experience).

Advisor • Communication skills • Can collaborate with diverse individuals • Desire to increase knowledge • Can contribute and provide collective pt. perspective comfortably • Focused on improving care related to the team goals

Offer information and training on key focus areas. Ask specific questions. Create a culture that values patient insight. Significant investment in resources.

Link into external support that will aid your practice in working with patients in a quality improvement setting. Leadership support.

4. Foster and support champion patients as equal core members of committees that drive redesign efforts at the highest levels

Advisor and Champion •Skills listed above and: •Can articulate pt. insight and bring pt. feedback to the forefront • Functions in a fast-paced and technical setting • Problem-solves in inclusive ways

Create roles for a patient/patient advocate on committees. Solicit patient feedback. Offer educational and training opportunities. Significant investment in resources.

Link into external support that will aid your practice in working with patients in a quality improvement setting. Leadership support. (Stapleton & Osborne-Stafsnes, 2012)

CDSMP

AFH’s Patient Engagement Efforts

Patient Partners Surgical Rate Project

CDSMP Health

Information Engagement in personal

health

Engagement beyond personal health

Patient Engagement

in Patient

Experience

Fostering Patient

Champions at policy

levels

CDSMP- an introduction

Chronic Disease Self-Management Program (CDSMP)

Six week workshop series, meeting once a week for 2 ½ hours for six weeks Developed by researchers at Stanford University Patient Education Research Center Evidence based Highly interactive Trained Peers as leaders

CDSMP- Core Curriculum

Workshop Topics Goal setting Exercise Communication Nutrition Managing emotions Problem solving Symptom management

CDSMP Applied

“I am going to the doctor, getting

regular check-ups, keeping track and self-managing to stay in the good

place that I am at right now.”

CDSMP Near You

CDSMP is offered across the United States, Online and Internationally.

Find a program near you! : Http://patienteducation.stanford.edu/organ/cdsites.html

CDSMP

AFH’s Patient Engagement Efforts

Patient Partners Surgical Rate Project

CDSMP Health

Information Engagement in personal

health

Engagement beyond personal health

Patient Engagement

in Patient

Experience

Fostering Patient

Champions at policy

levels

The Patient Partner Project

“Practices often struggle with the 'fires' of the day , making it difficult to focus on larger constructs such as patient-centered care. The participation of Patient Partners on practice improvement teams keeps the importance of improving patient care at the forefront of discussion.”– Rosemary DenOuden, Chief Operating Officer, HDNIPA

Project Specifics

• Began in 2011

• Part of QI

collaborative

•Two patients/team

• Patient Partners

receive training and

support

• Ambassadors and

advocates

Share insights and feedback explicitly

focused on collaborative topics

Conceptual Framework

Patient Partner

Collaborative Meetings

Team Meetings

Patient Partner

Meetings

“The process of becoming an intelligent partner in the health process can be hard for people.”

-- Toni M.

Process Development

Steps to Engagement

1. Recruit 2. Train 3. Engage and Support

1. Meetings 2. Brainstorming

1) Recruit

Fundamentals Role clarity

Leadership Buy-in Physician and administrative leaders must actively and visibly

endorse patient engagement work Vision for partner role What is the patient’s role? What “jobs” will they do?

Job description/skill sets Time commitment Skill sets Authority Structure

1) Recruit Cont. Strategies for recruitment Provider/Staff Recommendation Partner with CDSMP organization Flier Interview Social Media

Mary’s Reflection

1. How were you recruited to this project?

2. In your experience, what was successful about the recruitment process?

3. What recommendations would you make to practices looking to recruit patients to participate in similar activities?

2) Train

Patient readiness Medical Culture QI process Methodology Theory/Philosophy

PCMH Confidentiality “Medical-ese” Chronic Care vs. Acute Money talks Group dynamic training

2) Train Cont.

Practice Readiness Identified facilitator with appropriate skills CDSMP Leader Training Loving firmness Able to remove health system hat Sense of humor Commitment to the role

Translational role Commitment to communication and feedback on patient input Transparency Communication Contingency planning

Mary’s Reflection

1. What was the most valuable part of the training process?

2. What would you do differently?

3) Engage and Support

Patient Partner

Collaborative Meetings

Team Meetings

Patient Partner

Meetings

Patient Partner Meetings

• Introduce meeting topics and curriculum • Practice updates, brainstorming, and problem-solving • Sharing of “best-practices” • Capture patient recommendations and perspective on meeting subjects.

Premise:

•Anyone who has an idea

can share it.

•No commentary during

the brainstorm.

•Ideas are clarified or

further discussed after the

activity is completed.

Brainstorming

Premise:

•Anyone who has an idea

can share it.

•No commentary during

the brainstorm.

•Ideas are clarified or

further discussed after the

activity is completed.

Brainstorming

Practice Brainstorm

Using the chat box, brainstorm responses to the following question:

What sort of quality improvement projects or activities could you engage patients in?

Brainstorming

Benefits: • Great tool to generate conversation. • Engages all members of the group. • Recurrent themes are clearly visible. • Makes evident any areas of confusion. • First step towards a topics for further discussion.

Brainstorm: What sort of challenges do you encounter with access?

Problem-Solving

1. Identify a problem

2. List ideas

3. Choose 2-3 solutions for further discussion

4. Examine these solutions from the clinical perspective

5. Revise solutions based on clinical feedback

Conceptual Framework

Patient Partner

Collaborative Meetings

Team Meetings

Patient Partner

Meetings

Collaborative Meetings

Techniques

Standing agenda item

that starts meeting and

sets tone

Prep patient for

presentation

Vary presentation mode

to keep interest

Evaluate

Conceptual Framework

Patient Partner

Collaborative Meetings

Team Meetings

Patient Partner

Meetings

Team Meetings • Patients attend one “practice improvement” meeting at their office each month.

• Some offices have standing agenda items specifically for their patient partners.

• Patients offer insight and work on projects specific to the practice.

Sample Projects:

•Practice brochure

• Patient-friendly language

• Practice ombudsman

• Testing patient portals

• Process development

Mary’s Reflection

What has your team done to engage you during team meetings?

3) Engage & Support Cont.

For Practices: Formal collaborative requirement Patient partner work aligns with pre-existing

practice goals Adequately trained patient partners Close communication with practice coaches Assistance with recruitment, patient training, etc.

Support Systems Summarized

Prac

tice

• Recruitment assistance

• Third-party support

• Patient Partner Contract

• Patient Partner training

• Recommendations for engagement

Patie

nt P

artn

ers • Orientation

• Resource Binder • Patient Partner

Meetings • “Buddy System” • Transparency • Strong structure Pr

actic

es

Addressing Challenges

• Recruitment • Transformation • Outside Opportunities

Unbalanced Engagement

• Initiate with a project in mind • Clarity and intent with requests • Sharing of ideas/best-practices

In-office Engagement

• Patient training and support • Creative solutions to meeting

coordination barriers

Clinical Culture

Whose Home Is It?

Providing Medical Care Patient Experience

Practice Home

Doing Business Quality Improvement

Practice Redesign

Medical Home

(Stapleton, 2012)

•Patient’s Home •Patient-centered

• Staff uses comprehensible

language •Ultimately, patient is

in control

• Provider/Staff home

• Office-centered • Patient Partners

learned “Medicalese” •Ultimately,

Provider/Staff are in control

Recognizing Success

Patient Partners are catalysts for transformation

Recognizing Success

4.35

4

4.19

4.1

4.35

4.04

3.88

3.79

3.98

3.5

3.6

3.7

3.8

3.9

4

4.1

4.2

4.3

4.4

February 2 March 31 May 26 August 4 September 22

Scor

e

Meeting Date

PCR 2.0 Meeting Evaluations - Scale 1 to 5

Did the Patient Partner Presentation/Skit aid your understanding of patient perspective?

Was the information shared by the keynote speaker useful?

“They keep our focus centered where it should be: on the patients.” -- Participating Clinician

Recognizing Success

“They keep our focus centered where it should be: on the patients.” -- Participating Clinician

Focus Groups Surgical Rate Project Empanelment Process Development Backlog reduction

Lessons Learned

Leadership buy-in is essential

Be prepared for learning curves

Have a highly structured and focused framework in place

Thread the value of patient involvement through out the entirety of your work

Mary’s Reflection

What final thoughts would you like to share?

Tell Us….

What next steps will you take to begin working or continue working effectively with patients?

(Type in your answers

in the chat box)

“… it is the active presence of patients, families and communities in the design, management, assessment, and

improvement of care, itself” - Dr. Donald Berwick, 2008

“Put the patient at the center- at the absolute center of your system of care…

Jessica Osborne-Stafsnes Betsy Stapleton

jessica@aligningforceshumboldt.org 5104stapleton@gmail.com

Thank you!