November 2009 E-zine

Quality Tip: PATIENT & FAMILY CENTERED CARE

Patients and their families are truly at the heart of quality health care, and all that we do at TIPQC. However for most hospitals, parents remain our greatest untapped resource as quality and safety partners. When surveyed, 95% of our NICUs said that their hospitals encouraged patient & family centered care, however less than 30% of the hospitals involved families as advisors and less than 20% involved families on quality improvement teams. How do we move patients and families from being customers to our powerful new partners, engaged in the dance of providing quality health care?

It might be helpful first to understand what patient & family-centered care means. Patient and family centered care is defined by the Institute for Family Centered Care as, “an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families.” Patient and Family Centered Care involves four aspects: dignity and respect, meaningful information sharing, participation, and collaboration.

There is great evidence that patient & family centered care is a “best practice” ensuring a culture of accountability and transparency with an increasing demand for greater communication and disclosure as healthcare organizations and individuals advance their performance. In a project in North Carolina NICUs called “How’s Your Baby,” the state collaborative found: shorter lengths of stay, higher satisfaction with care, fewer re-admissions, improved rates of breastfeeding, reduced parental stress, improved parental comfort, and greater competence with post-discharge care. Other similar NICU studies have shown improved weight gain for preemies, lower need for breathing and feeding tubes, and result in early discharge, fewer re-hospitalizations, and better staff satisfaction. Other hospitals have found additional benefits including: higher patient satisfaction, lower lengths of stay, lower medical errors, higher discharge volume, lower staff vacancy, higher perception of the unit, greater framework and strategies to achieve quality and safety goals, enhanced market share, lower costs, and strengthened staff satisfaction.

According to the Institute for Family Centered Care, involving patients and families as partners & advisors will: bring important perspectives about the experience of care, teach how systems really work, inspire and energize staff, keep staff grounded in reality, provide timely feedback and ideas, lessen the burden on staff to fix the problems (not required to have all the answers), bring connections with the community, and offer an opportunity for patients & families to “give back.”

There are many perceived barriers to involving families from the healthcare side including, transparency, perceived risk, parent’s unreasonable expectations, staff concerns, and HIPAA limitations. All of these are indeed concerns and may need to be met with creative solutions to reap the benefit of collaboration.

According to the Institute for Healthcare Improvement, “We have observed that in a growing number of instances where truly stunning levels of improvement have been achieved, organizations have asked patients and their families to be directly involved in the process. And those organizations’ leaders often site this change—putting patients in a position of real power and influence, using their wisdom and experience to redesign and improve care systems—as being the single most powerful transformational change in their history. Clearly this is a leverage point where a small change can make a huge difference.” Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care (Second Edition). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2008. (Available on the IHI website)

In order to successfully implement patients and families as partners, a culture shift may be necessary, family selection and training will be required, and a belief that family participation will be essential. In order for TIPQC to have a strong patient and family centered focus, all of our hospitals and practices will need to embrace family centered care. (For more on being a patient friendly hospital, please see the complete Hospital Self-Assessment inventory)

As we look closer at our involvement of families and patients as “partners,” we will see an exciting engagement and collaborative exchange which will be well worth the hard work of forging new ground for some, and a distinct culture shift for others.

Shall we join together in this journey?

Resources

• Patients As Partners: Toolkit for Implementing the National Patient Safety Goal, Joint Commission
• Strategies for Leadership: Patient & Family Centered Care, Joint Commission Resources, Advisory Board Company, Presented by the American Hospital Association in partnership with the Institute for Family-Centered Care
• Developing and Sustaining a Patient and Family Advisory Council
• Institute for Family Centered Care
• Center for Medical Home Improvement

Project Highlights

NICU–Admission Temperature Project

The 21 NICU hospital teams (One more hospital is joining the project, giving us 22 teams!) have had five phone huddles and three learning sessions. The last phone huddle was the mid-way point for this project, and the state aggregate preliminary data showed that the temperature project is having a positive impact on temperature of babies in Tennessee. The next huddle will be on November 18, 2009. We look forward to each hospital sharing. Upcoming family member & family champion training on November 12, 2009.

A note from Dr. Grubb, TIPQC Medical Director

October was the halfway point for our “learning project.” Those of you who participated in the Oversight Committee meeting and Temperature Huddle #5 have seen the preliminary data. In this venue, all I am going to say is that the data was encouraging, and Tennessee still has plenty of room to improve!

A few centers have had dramatic improvement, many centers more modest improvement, and some of us are working hard to realize that first measurable change for the better. Now is not the time to let up, and begin thinking about next year’s projects. It’s half time, your QI teams are only really just warmed up, and getting the hang of this. The big opportunities for improvement lay just ahead in the next 3-4 months. Now is the time for us to look hard at our data, and even harder at our system and ask ourselves “why was that baby cold?” Now is the time to make those tough changes, adjust as needed based on data, and make our systems perform better for the mothers and infants of Tennessee.

Franklin, TN, March 3rd, 2010. We will put up a slide showing where we were, and where we’ve come to. If we each improve the part of the system that is in front of us, we will have plenty to celebrate.

Projects Being Piloted

OB–Reducing Elective Deliveries before 39 Weeks

The Davidson County pilot has completed their data training and reportable data collection will begin on November 1, 2009. Funding has also been received from the March of Dimes to help with this project.

TIPQC was represented at the March of Dimes’ Symposium on Quality Improvement to Prevent Prematurity held in Arlington, VA on October 8-9, 2009 which featured a multi-disciplinary group of health care practitioners, health insurers, policy makers, health purchasers, regulators and concerned citizens discussing quality improvement as an essential component in the strategy to prevent prematurity. The symposium especially focused on the 39 week project as well as describing model programs that have successfully improved the nature and quality of patient care.

The TIPQC State meeting this year will feature Jay Iams with the Ohio Perinatal Collaborative sharing about their 39 week project. This will be a great opportunity to learn more about this project and see how you can be involved in Reducing Elective Deliveries before 39 Weeks!

NICU–CLABSI Reduction

The CLABSI pilot has begun and all of the pilot centers will begin “live data entry” this month!  After this project has been piloted, all centers in Tennessee who want to participate will be able to join. We plan to hold the first CLABSI “KICK OFF/Learning Session” in January 2010. Watch your TIPQC e-zine for updates!

NICU–Human Milk Feeding Project

The four pilot centers will be submitting applications along with IRB documentation to begin piloting this project. This project should be ready for state-wide enrollment at the Annual Meeting in March 2010, with the first learning session and “kick off” in April 2010.

Project(s) Being Developed

OB–Breastfeeding Awareness Campaign

This group of state leaders has met five times, and is developing a state-wide project.

For more information on all projects: http://www.tipqc.org/projects.

Hospital Highlights

Multiple Centers are improving their DR and OR thermal management with changes ranging from $8 thermometers to capital expenditures to redesigning systems.

FAMILY & Patient Corner

Please invite your family member to join the Temperature team. Send all names and emails for the training on Thursday, November 12, 2009 at 2 PM CST. Please also have your hospital family champion join the call. For additional resources for encouraging family centered care, please see the power point “The Value of Families” at our Meetings page.

Oversight Committee Nominations

The TIPQC Oversight Committee still has a few positions to fill. We are looking for dedicated, committed volunteers who would be able to provide leadership and direction to TIPQC. Ann Duncan has recently resigned from the Committee and we would like to fill her position with another nurse. Two positions are also open for Families or Patients. Please send your nominations to Brenda.Barker@TIPQC.org.

Upcoming Conferences

Mark your calendar now for the Annual State TIPQC Meeting on March 3-4, 2010.

Please note that we have added a calendar feature to our website, where these dates and others can be found at http://www.tipqc.org/calendar.

As we look toward our second year, we are excited about the many possibilities and opportunities that will be afforded TIPQC & our members. One thing we know for sure is that Tennessee babies and mothers will greatly benefit from the hard work and unrelenting dedication of the TIPQC stakeholders.

Watch this site for updates throughout the month.

Sincerely,
Brenda Barker, MEd
Peter Grubb, MD
M. K. Key, PhD