Patient and family engagement is an area of increasing importance for hospitals and sets the foundation for supporting a high reliability organization. This session covers multiple ways to approach the development of a Patient and Family Advisory Council.
Good morning, everyone. My name is Brandy Beilsmith. I'm the Director of Patient Safety and Quality for Washington University. Um I have the pleasure of introducing our next speakers, Jessica Stoltz and uh Jennifer Karen. So Jessica Stoltz is the Director of Clinical Quality for Missouri Hospital Association. Jessica became a registered nurse in 2007. She's currently the Director of Clinical Quality at MH A. In this role. She specializes in assisting hospitals and improving patient outcomes through process improvement, data collection, teamwork, and communication, and project management. She began her nursing career in a surgery burn trauma intensive care unit. She was part of a chapter team to open a specialized burn and wound intensive care unit and was a nursing supervisor in the unit for the next five years. Jessica obtained her master's degree in health administration and secured a position as a medical surgical unit manager. In 2014, Jessica joined Mh A and her for her focus has been quality leading, managing and executing grants and contracts as she assists hospitals with improvement processes leading to better patient outcomes. She is a certified professional in healthcare quality, a certified professional in patient safety and holds a lean six Sigma Green Belt. She's also team steps master trainer. She's the MH A liaison for Missouri Association for Healthcare Quality and the Heart of America Chapter for Healthcare Consumer Advocates, professional membership groups. Jennifer Karen is the executive director and patient experience officer for BJC Health Care. She's an industry leader in health care and experience strategy. As the patient experience officer for BJC. She serves as a subject matter expert for consumer and patient experience with contemporary thinking towards innovative programs to deliver a personalized equitable, high value, low friction experience. Having over 25 years of leadership experience, she's an active member of state and national and international organizations and boards including co-chair of the Missouri Association, Patient and Family Advisory Council. She's a professor of healthcare informatics, a public speaker, a communication coach and a fire starter, inspiring a culture of service, excellence, hospitality ownership and results across the globe. Please welcome Jennifer and Jessica is there. Is there, Mr? All right. Sure. OK. So thank you all for joining us this morning. I know everyone has full plates, full schedules, um full agendas. So we are honored to be here and to share your time. Um This morning, I'm Jessica Stol and I'm Jan Karen. Um If I would have known they were going to read my bio, I definitely would have made it a little bit shorter. I apologize for that. Uh And we're here to say that we have no disclosures this morning and to get started with our presentation, we're gonna have a very fun activity. Uh But before we start that activity, there is one rule and that rule is that when you hear me clap, I need you to stop talking. Let me put down my clicker. How are you? Uh when you hear me clap, I need you to stop what you're doing and clap along with me. Can we all do that? OK. Let's try it out. Awesome. We have a whole room of high performers. I love it. All right. So grab your cell phones again and find a picture of your loved one. And when you find a picture of your loved one, introduce your loved one to your neighbor. How are you? Yes, you talk to a lot more. Depends on the kids. She has no. Oh, what's your son's name? Oh my God. What a sweet, your left leg. That's so awesome. She's cute. Look at Net Flex and he's got a gun show. Nice. What's your husband's name? A Las? OK. Who's mother level one? What's her name? I love it. I love it. Awesome. So this is a picture of my loved one. This is AJ. And uh when AJ was younger, him and his older brother would go back to Iowa and spend their summers with our family. We were a military family. So I thought it was important that they would uh get to know their extended family. And this particular summer he was diagnosed with strep throat on multiple occasions the night before he was supposed to come back to us. My mom called and said he's starting to get fevers again. So I think you need to get him in to see the doctor. So we went into the doctor and how many of you have Children? Raise your hand? Ok. So we know the routine, take antibiotics come back and see me in 10 days if they're not better. And so I began to log his symptoms and they weren't typical strep throat syndrome, uh symptoms. He had uh swollen joints and complaining of joint pain and a fever that we could not knock down. So, on Friday, I went back into the doctor, a mi a military pediatrician and he came in and before he even talked to my son or talked to us, he said, Miss Karen, I told you to give it 10 days. You need to go home. That was my response as well. I was shocked and I was scared for my son and I thought it was the only option that I had. So I was compliant. Uh we went home and it was Sunday night and I remember it to this day, it was around six o'clock and I called him up to the table for dinner and he didn't show and I called him again and I didn't hear from him. So I found him on the couch weeping saying mama it hurts. I can't walk. I told this story a million times that I get emotional every time. So thank you for being here in this moment with me. So the next morning, I was in the pediatrician's office demanding a referral to somebody who gives a who cares. And so by the grace of God, we had a referral to the Moose's Children's clinic with a pediatric rheumatology, pediatric rheumatologist for swollen joints. And so the rheumatologist goes through the exam and he re diagnosed him with strep throat and puts him on 30 days of antibiotics. We go through the care plan, he says, pick up your meds on the way out, which was very convenient and make an appointment with Mary to come back and see me in 30 days and he walks out. So I'm gathering up my things and AJ and he comes back in and he's like, you know, I have this box, I have to check. I'm gonna need you to go down and get an echo. Don't worry, I don't think we're gonna find anything but it's this quality thing and it's a step that we need to do again, pick up your meds on the way out and we see in 30 days. And so the sonographer at the end of the um uh echo, she said, let's get you a room. And I'm like, no, I think we're good. The doctor told us where we need to go. And she said, no, they're gonna wanna talk to you. And for those of us who have experienced this type of um uh uh uh procedure before we know that that is not good when the sonographer find something. So, uh the rheumatologist came in and he was visibly shaking. He had tears in his eyes and he said, I almost missed it extremely apologetic. And then he said your son would not have made it. He has bacteria on his heart valve. He is very sick for direct admitting him to the hospital to which my son said, do you mean I'm not getting ice cream? But in that moment, my vision of what ideal care completely changed, I would have been that mama bear at visits at the hospital that was at the nurses station when the nurses were 10 minutes late for medication. I would have been that mom who was questioning everything that the care team was doing because I did not feel that they had the best interests of my family. But on the contrary, the compassion and communication that I felt I was fully invested as a partner in his care and trusted the care team. So that's my story. The the ideal care to us is compassionate. It is communicative and it is very patient because we ask a lot of questions now. And so I'd like you to think back to your loved ones. I'd like you to think about a health care experience that you've had. Maybe it was ideal, maybe it wasn't. But think about what made that experience ideal for you and your loved one and then share that experience with your neighbor. OK. Thank you for being vulnerable and sharing your story with your neighbor. Everyone's story is as equally important and valuable as mine. But unfortunately, we don't have time for everybody to share their story. What we do have is some runners with mics and what we'd like you to do is to summarize in three words, what your ideal care looks like. So this is AJ he's fully recovered living his best college life. Um You are routine visits to the cardiologist, but everything is going very well for him. But to him, ideal care again is compassionate. It's patient and it's communicative. So if you could raise your hand and share in three adjectives or less, what ideal care looks like for you and your family? Listening, empathy, collaborative, honesty, empowered. I love that we don't need mics and runners, respectful, efficient, transparent. Two more equitable. OK. Three more. What, what time time take time? What is a key factor in ideal care? But none of us said it make me better heal me. Why did none of us include that in ideal care? It's the expectation patients expect that they're going to receive safe high quality care because of the name on our building and the credentials on our badge. But how they want, it is the same way that we want for our patients and families. And so when we think about wanting high quality uh safe care, it's not just a want, it really is a necessity because research shows that collaboration, communication, empathy, compassion, it all leads to higher quality and safety outcomes. So for an organization, it really is a must have. And for us as practitioners of health care, it is a must have in our um own individual interactions with patients and families. And what we're talking about, what we're describing is patient, family centered care, patient and family centered care isn't intentionally designing, delivering and evaluating health care in mutual partnership with patients, families and providers. All of us are in that bucket of health care providers. And our goal and emphasis is patients of all ages individuals from all demographics working in again, in partnership with an a goal of high uh health care and wellness that the individual seeker owns and is responsible for. Oh, that's an ugly slide. There are four core concepts and they're gonna sound very familiar because it's what we've been describing. It's respect and dignity, respect for the patient and family's preference and their choices. It's information sharing. So making sure that patients and families have timely information that is free from bias to help them make their health care decisions in participation with joint decision making. And the last one, I wanna talk a little bit more about and that's collaboration and it's not just collaboration with the patient and family individually but collaboration from a health care organization. So inviting the patient and family into policy setting um program development, it could be research, it could be training um safety initiatives uh P I projects. And by not including the patient and family perspective, we are unintentionally building in bias and engineering bias into health care. And what I mean by that is all of us, we want the best for our patients and families. We show up every day and do we wanna do a great job, but our lens is our daily experience delivering health care. And so that's the bias that we bring. And by including the patient and family perspective, then we can create an ecosystem where all patients, families and practitioners are represented so that we can achieve um our high performing goals. How do we find these patients and families to join us? And we find them through patient family advisory councils often referred to as PFAS A PAC is a formal council that is embedded in the organization. And their goal is to bring the perspective of the communities that we serve and they have four roles. The first one is process improvement. They can bring us ideas that we didn't even think about. They also advise on policies. Many of us probably experienced a visitor policy change in the last couple of years. And so they can not only advise on our policy but also help us understand how to best communicate this with the community. So when they show up, they have the same expectation that we have um also inform and strategies and I'm having the same problem that uh I can do a little uh uh inform and strategies and then cosigning the experience again, an ecosystem that works in harmony with everyone who is practicing and receiving care. There's four types of the councils. The top two really gained a lot of speed, post COVID, our digital councils and virtual as well as the ons sites. Uh Those council members are starting to come back in many of our hospitals and they can um uh focus on multiple programs. You can have a PAC that is solely focused on the hospital or one that's across the service line. Women and infants is a great example of that when we look at care across the continuum uh and the help of our, our mothers and babies uh also uh community pac. So BJCBJH had a wonderful community PAC that was made up of community members who were uh represented the minority voice in the community. So they served as an amplifier for uh a voice that is uh sometimes muted by the broader population. And so it really served as a way that we could better understand the community and reach everyone that we serve. The last thing that I wanna share is PAC visibility to serve as your force multiplier for highly reliable patient family centered care. So, sharing with the community and internally with their staff and providers that we're not only designing health care for patients and families, but with patients and families. And the Missouri Hospital Association has done a great job of helping organizations to um uh create pacs and to help develop pfas, not only in the state of Missouri, but also nationally. So speaking from uh a little bit more of a macro level, um uh I'm gonna talk a little bit about MH A S PFA. Um and kind of what we do what we have to offer our hospitals. So our council was formed in 2017 and it came, it came to fruition under a one of the supporting arms and some of the quality improvement grants and contracts that we were working on. Um And our, our board, um along with us, we decided that this is definitely gonna be worth our time, our attention and our energy. And at the time, we were one of only a handful of states that had a statewide PFA. So we were kind of um along with these other few states kind of engineering, the, the path that others are going to join. Um And now about 25 states have a statewide PF and um we're able to jump on calls with this group and learn collectively what other states are doing across our nation and bring that back to our hospitals. Um So, our PAC is comprised of patients, families, patient advocates and hospital staff. We have extraordinary expertise on our PAC. Um We're really blessed with such a great, a wonderful group. We have about 25 council members um and they are energetic and willing to share and willing to roll up their sleeves and get in and help our hospitals grow a PFA um from the ground up or come in and help kind of reshape things and strengthen PFAS that may already be um e established. Um And we provide support and advocate for PFA across the continuum of care, right? We need to take care of our patients before they come in and then after they leave our hospitals. Um I'm really happy to be here in person. Um It's really exciting to be able to get back together and see people face to face. Um Our council meets mostly virtually um just given people's um where they are in the, in the state and the regions. Um And to be a good steward of time, but we meet quarterly uh mostly virtually um as many pacs in our hospitals do. Um And then of course, we call ad hoc meetings. If we need something um in a time limited fashion, we have a wonderful web, web page. And on our very last slide on our resources, there's a link that you guys can uh can visit our web page, but it's a, a wonderful repository of resources that we have spent several years uh building compiling to hopefully take some of the some of the stress and work off of our hospitals instead of doing your own research, spending time scouring the internet, building your templates, building a patient, welcome letter or a family welcome letter that's already been done. We have fully customizable templates, letters, um anything you might need. Um It's probably on our web page. Um We have a customizable getting started kit. So everything you would need to start, maybe you already have a PFA. Um And you're looking for something to kind of strengthen it. Um Our getting, our getting started getting started guide is there for you. Um And we're really excited um In 2022 we debuted our Compass Honor. So our Compass honor that our PFA sponsors um recognizes a Missouri Hospital who has uh shown outstanding efforts in engaging with their PAC. Um So we're in our second year and um we'll talk about the past winners and honorable mentions when we talk about some story sharing um in the next few slides. Um But we have an open application period. Typically over the summer we pull applications and we deidentify everything and our council members vote on it and then we have a winner. So um a few more things that I wanted to highlight that you could find on our web page. We have recently done a three part webinar series called healing Happens here from a patient's perspective. Um And we really wanted to take the time that we did on these webinars to really give our hospitals something tangible, something that they can turn around and, and easily implement um something that would be um simple to take to the bedside and immediately make changes. So the three topics that are here on the slide, improved communication. So what can we do um in all facets of that communication. Um When we have those talks with our patients with their families, how can we improve that? Um Engineering the environment from a patient's perspective and culture change, right? Uh We've talked about culture change already this morning and we know it takes a long time, right? We can't do it overnight. And the most important thing is we just have to start, we have to start somewhere, we have to start small and we just have to start also, there's a, a road map. So you can um visit our road map and it breaks down the framework of building a PFA and it puts it into three different tracks. And those three different tracks have metrics that you can measure, right? If you don't have data, you don't know what you're doing, right? You can't measure if you're doing the right thing. So we have metrics that you could use um that go along with each of the uh tracks on our road map. So high reliability who has heard of high reliability in here. So maybe about half. Um so great. Awesome. So essentially high reliability is performing consistently over time, right? It's failure free. Um It is decreasing to eliminating your variation, you can predict outcomes. Um And I like as a, as a bedside nurse, I like to think of it as it's, it's consistency and care no matter who's working, no matter what doc is working, no matter what day it is, no matter what shift, if it's shift change, you know, um no matter if we have downtime or not, it's consistency in, in care. And HR O is a framework for how we strive to operate. Um And I'll say a few times um it's to boil it down, it's making your work, your processes easy to do the right thing and make it hard to do the wrong thing. So, hr O is our end goal or end game. I saw somebody with a swifty bag. Uh So sorry, it was a little plug there. Um And stealing shamelessly from uh my friend Adam at De Tank. He recently gave a HR O presentation and he said, Hr O is not a project, it's not an initiative, it's not a collaboration and we've, we talk about toolboxes a lot. Hr O isn't something to put in your toolbox and it's not a thing, right? Hr O is a platform, a framework a philosophy and HR O is the toolbox and it's a mindset. So a little bit more about HR O and I apologize, it's, it might be kind of hard to read on the slide. But we developed this HR O tool kit, there's a link on the slide and we developed this wheel and you can see there's five different spokes in the wheel. Um And we're gonna start with the orange one. So you see communication and below that, you see deference to expertise. So deference to expertise is the actual HR O principle. Um And some of the hr O principles are, are a little bit fluffy like what does it actually mean? So we identified words, actionable items to attach to each Hr O principle to make it more um make resonate with us a little bit more. So the orange um deference to expertise, this means everyone is an expert, right? If you are doing the work, if you are implementing the change, if the change is happening to your work, you are the expert, no matter who you are, no matter what your credentials are and you should be included and be heard yellow improvement models or the HR O principle is reluctant to simplify and this means don't accept a band-aid, a simple fix. I gotta get back to my to my work. Let's just do this um and put a band aid on it and then blue continuous learning or the Hr O principle of sensitivity, sensitivity to operations. And this means understanding your systems and processes, understanding your outcomes, understanding your data and understanding your performance. And how do you, how do you do that? Right? You unders you have a sensitivity to your operations, you're out there, you're talking to your staff, to your patients purple accountability or the HR O principle of commitment to resiliency. This means we're adaptable, we're nimble. Um we're swift to react when unexpected events or errors occur and then read transparency. Um Hr O principle of preoccupation with failure. So regardless of the size of the event or error, um we address our failures immediately and completely. And what do you see in the middle of the wheel? It's our why, right. It's why we're here. It's, it's our purpose. Um There are some overlaps between the spokes. So the orange and red blend together, some of the orange may go into the blue. So it those spokes overlap. But what goes into each principle is a patient family aspect. And then of course, our leadership and culture kind of hold us all together and they're our perimeter. So we've talked about higher liability, highly reliable every time. Same thing. Standard work, no variation. And we've talked about patient family engagement and that's kind of the softer side. Every patient is different and we need to treat patients the way they want to be treated. It seems a little bit counterintuitive, right? So can we really have both? Yes, and we have to have both. Um And here's just an example, the wheels back up here. Um uh an actionable actionable PFE tactics for each principal deference to expertise, starting with the orange again, actively engaging your patients and families in their care. We're taking care of them. They, it's happening to them. Why aren't we including them in their decisions in our rounds in everything that happens to them, reluctance to simplify and that all diversities are represented represented on our PFA C sensitivity to operations. Um including the patient, voice, commitment to resiliency, including patients and families and root cause analysis. That's a little bit sticky. It's a little bit tough, right? Um But studies have shown if you engage patients and families in these discussions early on how to make things better, you have a less chance of the patients, families taking legal action, transparency sharing outcomes and with patients and families, post your data on your units, post them in your, in your visitor spaces and post it post your data that is easily interpreted, not big graphs with billions and trillions of dollars like Mr Doolittle was showing us earlier but but easy, easily understandable um data that that patients and families can walk by and be like, oh great. They've committed one less infection in their central lines this week. That's great. Just an example. OK. So as, as a nurse, you know, I always wanted to figure out what that seems like something that my, our presidents or our directors need to do. What do I need to do? Right. So here are some examples of bedside, what we can do at the bedside, what we need to do at our organizational level, what we need to do at the community and policy level because we want our communities to know that we care how they perceive their care here. Um And a few more at the bedside level since I think we do have some front line care staff here. Um You can, you can read the slide but a few more things um commit to sit sitting down with your patients, knee to knee, eye to eye, um get, get down to their level wherever they're at. Um and have that empathetic communication, warm introductions and warm exits. We want the patients to feel like they matter to us and not that they're just another thing. We need to check off our list, right. Um We have make them feel like we have the time even though we have a million, a million things to do in our mind. Um We don't need them to perceive that um teach back as they plan for discharge and any kind of a care transition. Um and make sure that teach back is making sure they understand the instructions they were given. So um having that opportunity to have teach back with the patient also the family Um And you can see different organization level opportunities and community levels. So, patient as a safety champion, um patients and families, they're generally super passionate. Um they want to be involved um and willing to give feedback on how care can be improved. Um So a a great opportunity to include the patients in those discussions. And I really like this last bullet here. Um Patients that perceive their care team is working well together, tend to report better experiences and perceive their care as safe and higher quality. So that's, that's us, that's our colleagues, right? Um So it should be easy to check that one off the list, right? We may be guilty of our phones ringing while we're in patients' rooms and maybe eye rolls, maybe s maybe not. Right. So keeping that, that in check um as we're sitting at the patient's bedside talking with them. Um and again, making it easy to do the right thing and hard to do the wrong thing. And this is not just in health care, right? You probably do this at home with your, with your kids, right? Lay their clothes out, you get their backpack ready, make it hard for them to forget their homework even though they still do forget their gym shoes, right? Um But identifying ways that we can make it easy to do the right thing and make it hard to do the wrong thing. Hard stops in Emrs, right? E hr s they're there for a reason. Um OK, so now we wanted to spend ample time talking about stories, stories seem to resonate with our, with our staff, with our colleagues. Um And we wanted to give actual implement implementation ideas of what other hospitals have done. So the first story sharing that we're going to do is this one from University of Missouri Health Care. They were our compass honor, honorable mentions in 2022 and 2023. So their women's and children's PFC was established in 2017. They have about 12 members and you can see the committees that their PAC has membership on. So their clinical integration team, their skin and wound assessment team, their IPA rounding initiative and their patient portal. So some of the initiatives that they included on their past applications, integration of two campuses into one. So if you're not familiar, University of Missouri Health Care has a main campus and then they used to have a women's and children's campus kind of across town and they recently brought their women's and children's hospital onto their main campus. And I was also part of a hospital transition into a new hospital in Jefferson City a few years ago. And you could imagine all the things right, all the things you need to think about um and transferring patients, moving families into this new space um huge undertaking. So their PFA was really involved in um the transition campus map, obviously a new space. Um campus map was developed with patient and family input and advisement refinement on bedside report process and then they had their PFA help with clinical improvements. So reducing their central line infections, their skin and wound team to help heal or maintain integrity of our patient's skin. Um and then readmissions committee to uh decrease readmissions University Health um formerly known as Truman Medical Center in Kansas City. Um Their PV was established in 2019. They were our inaugural winner in 2022. So we're really excited for them um and being established in 2019 and then turned every get did so many things to be able to fill out an application and win in three years is amazing. Um So they have 15 members. The committees that there PFA sits on sdoh social determinants of Health Committee, their Cultural Food Equity Project committee, their ethics committee and their quality committee. And we include initiatives on these slides, but this is just uh just a snippet of all the wonderful things that they're doing. Um So based on their pac um input, they updated billing practices, all of their improvement project charters. So any time they're making an improvement or a change or anything, there's a spot on their charter that has a voice of the patient section. So from the very beginning, they're having those conversations with their patients um appointment, notifications, refined caregiver badge with a QR code. So if you go into the hospital in your family or, or uh uh the patient caregiver. Um You're given a caregiver badge and on the back of that badge has a QR code and you can scan and it'll give you resources that you would need either lodging or um any kind of food or a map or phone numbers that you can call or, or any kind of resources that you would need. Um They can scan it on the back of their QR code or scan the QR code on the back of their badge. And then they developed an on-site food pantry and uh discharge lounge accommodation. So after patients discharged, they may not have a AAA ride yet. Um So there's a discharge lounge and based on feedback, they made some additional accommodations to their discharge lounge. North Kansas City Hospital also was a compass honor, honorable mention in 2022 and 2023. And they established they call theirs pe ac same thing, right? Um It's a patient experience advisory council. They have 15 members and some of the committee's Quality Council readmissions committee neonatal bereavement team and their auxiliary board and one of the first bullets on their initiatives, caregiver badge. Prime example of learning together, learning collectively they took um University Health's Truman Medical Center's idea of the caregiver badge. They implemented it at it at their hospital within a year. So, um and they're having wonderful results and feed, getting feedback as well um after hours, greeting procedure, improvements of public restrooms to make them handicapped accessible. Because on their pe ac, they had, they identified that they should have a, a handicapped person on their pe ac. Had they not had that perspective. It probably would have taken them a lot longer to realize that they needed to improve their restrooms. Streamline and standardized signage. They created a public video and that's on their web page marketing their pe ac so the community can see the things that the hospital is, is uh making an effort in, right, involving the patients and families in their care. Um and discharge process updates CRE and they created a new patient information guide. Um when I was a nurse manager, um several years ago, we had a few of us managers on the committee to put together a new patient. Um the folder that everybody gets. And so it was just us in the room and thinking back now, you know, I didn't know anything about PFA thinking about now, like man, we should have had them at the table. I don't, what does the patient want to see when they come into the hospital? What should we have in these folders? Um So using their pe ac engagement, they created a new patient information guide. So Jess and I could share numerous stories with you on hospitals and organizations across Missouri. Um Many of them are compass winners. The one we're running out of time. So the one that I wanna share with you that I hope that you can all connect with is my calling in my experience with AJ. I found my calling to health care specifically in quality and safety. I served as a regional uh quality project manager for a large health system in the Midwest. And um I quickly learned that our quality program was failing or we were not seeing results because we didn't have the patient family perspective as part of our program. Once we did just one of the outcomes that we saw is we reduced our readmissions rate from 15% to 9% in less than a year. And we sustain those results. And so I was love to hear your stories. We're uh we're gonna hang out after the presentation. So I would love to hear you as fellow colleagues in quality and safety world um as well as your personal story and you have our contact information um on the slides. Um So again, thank you for letting us be here and share some of the things that we're passionate about with you.
