Category Archives: What’s New

Join Picker Institute at the 24th IHI Forum

Special ½ Day Session
Monday, December 10
1:00 PM – 4:30 PM

Picker Institute Special Session on Advancing Patient-Centered Care

Join Don Berwick, former CEO and President of IHI, Lucile Hanscom, Executive Director of the Picker Institute, Jeff Selberg, COO of IHI, Dale Shaller, Principal of Shaller Consulting, and Madge Kaplan, Director of Communications at IHI, to celebrate the Picker Institute’s quarter century of leadership in advancing patient-centered care. Six Picker grantees will inspire participants to address vexing healthcare challenges using Always Events®, an innovative improvement strategy that helps providers focus on consistently delivering excellent patient-centered care, to all patients all the time. Don Berwick will lead a provocative discussion with several distinguished Picker Awards recipients about the current and future state of patient-centered care. Don’t miss the session that is sure to be the talk of the 2012 Forum!

Always Events Grantee Panelists: Huntington, J., MD, PhD , Dartmouth-Hitchcock Medical Center; Parkosewich, J., RN, DNSc, FAHA, Nurse Researcher, Co-director Women’s Heart Health, Yale-New Haven Hospital; Rieke, C.C., DNP, RN, University of Minnesota Amplatz; Rockey, W., RN, MBA, Exempla; Shatz, R., DO , Director of Behavioral Neurology, Henry Ford Health System; Perkins, S., PhD, RN, Chief Nurse Executive, Anne Arundel Health System.

Picker Awards Recipients Panelists: Cleary, P. Ph.D., Dean, Yale School of Public Health; Gawande, A., MD (invited), Brigham and Women’s Hospital, O’Kane, P. President, National Committee for Quality Assurance; Wagner, E., MD, Director, MacColl Institute for Healthcare Innovation at Group Health.

Click the IHI Icon for the 24th Annual National Forum on Quality Improvement in Health Care Agenda

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A Conversation about Yale-New Haven Hospital’s Premature Life Transitions Program

 
Janet Parkosewich, DNSc, RN, CCRN, FAHA (left); Julia Bishop-Hahlo, RN, BSN (middle) and Laurie Jonason, RN, BSNC (right)

 

A Conversation with Janet Parkosewich, DNSc, RN, CCRN, FAHA:
Premature Life Transitions program at Yale-New Haven Hospital

 

 

 

Janet Parkosewich is the principal investigator for the Premature Life Transitions project, which supports families in the Yale-New Haven Hospital’s Newborn Special Care Unit through the transition from curative care to palliative care, infant demise, and bereavement.  Janet describes how this project has not only improved care for patients and families, but has created an opportunity for two dedicated staff nurses, Julia Bishop-Hahlo, RN, BSN and Laurie Jonason, RN, BSNC, to translate their passion into leadership and action.

Your project relates to an intensely emotional experience, not only for families, but for staff.  How do you support staff members in learning not only how to support families, but how to care for themselves while providing palliative care for an infant and coping with infant demise? 

As part of this project, we asked staff to complete an end of life bereavement care survey.  We discovered that many of the staff members did not feel comfortable with the responsibility of caring for a dying infant and supporting families through that process.  We are building a select cadre of Transitions mentor nurses who can support other staff through this experience.  We are building staff skills, providing training, and implementing a step by step guide and checklist that walks staff through every step of the process.  In general, hospitals don’t do a lot to support staff through these events, but we know that this is a loss for staff too.  There is sometimes a perception that when an infant’s life support system is withdrawn, the nurse can take another baby right away because “you’re not doing anything.”  The nurses need time to care for the family and to grieve themselves.  Many times they have cared for these babies for weeks or months and have gotten to know the baby and the family well.  We need to support them.

What have you learned from the parents involved in this program? 

It is important to make sure we focus on what families themselves say they want and not what we think they need.  We are working closely with the Newborn Special Care Unit Aadvisory Committee and the parents on that committee have validated that this project is the right thing to do.  The parents on the committee represent a variety of perspectives and experiences, from infants that have died to infants that have been in special care, gone home and are thriving.  For all families, it is an emotionally charged situation.  What we say and do has a lasting impact.  One of the parents expressed it this way, “Do clinicians realize that we will never forget their names, their faces, and what they said to us about our dying child?”  We have used these words and other parent perspectives to reinforce the importance of the program to staff.   Less than humane interactions, such as “kidneys down, game over” are not acceptable.  Families will remember those words forever.  We also have learned how to have different types of conversations.  For example, in family meetings, we ask about the family’s goals instead of just giving the family information.  This dialogue brings everyone onto the same team.

Many organizations are interested in starting their own Always Events projects and could learn from your experience. What would you say are the secrets to your success? 

There are several factors that have been essential to our success:

  • Administrative Support – Everyone has recognized the value of the project and warmly welcomed the team.
  • Nurse Champions – Laurie and Julia are driven and don’t take “no” for an answer.
  • A Shared Vision and Common Purpose – The department heads of all involved departments were able to garner support for the project across the staff.
  • Data – Both qualitative and quantitative metrics demonstrated we had lots of room for improvement.

The role of frontline leaders can’t be underestimated.  For families to receive the level of care we want, we have to give staff nurses these skills and experiences.  Often projects such as this involve nurse educators, but this project is being run by frontline staff.  The project has helped Julia and Laurie to flourish as leaders.  They are doing something they are passionate about and are being given dedicated time in the schedule to do it.  The Magnet program requires the involvement of frontline staff in improvement work and this project demonstrates the powerful impact that frontline nurses can have.

What’s next?

We are finishing our behavioral observations and will soon start with our educational intervention.  The Yale-New Haven Hospital pediatric intensive care unit will be joining the program and we also are expanding to other hospitals in the health system.  I am grateful to the Picker Institute for helping me realize my dreams.  This program has enriched my life. 

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Always Events White Papers

Always Events® White Paper:
Creating an Optimal Patient Experience

Picker Institute has embarked on a new initiative aimed at significantly elevating the standard for the optimal patient experience in healthcare organizations throughout the United States. The new standard establishes an expectation that certain elements of the patient experience should happen for all patients all of the time. Always Events refer to aspects of the patient experience that are so important to patients and families that healthcare providers should always get them right. This refreshing focus on the positive is one of the program’s greatest strengths.

This paper describes the rapid evolution of the Always Events initiative, highlights the unique features that distinguish this program, and provides guidance on how organizations can begin using Always Events today to improve the patient experience and to support a culture that continuously views care through the patient’s eyes.



Click here to read the first Always Events® White Paper: Creating an
Optimal Patient Experience.

Always Events® White Paper: Always Events for Communication and Care Transitions- Idea Guide.

The healthcare system is beginning to return to its roots in patient- and family-centered care. The vast majority of today’s healthcare leaders recognize patient-centered care as a priority, but a sincere desire to improve is often thwarted by seemingly insurmountable barriers, not the least of which is deciding where to start. Innovations occur every day, but dissemination of these practices is limited. Patient-centered care is undoubtedly improving, but far too slowly. A new approach is necessary to galvanize rapid widespread improvement.

This idea guide is one of those resources. It highlights some of the tools developed and preliminary lessons learned by the organizations that have received grants to implement one or more Always Events. It also describes ways that any organization with an interest in improving the patient experience can get involved. A companion paper, Always Events®: Creating an Optimal Patient Experience‛ describes the evolution of the program.



Click HERE to read the Second Always Events® White Paper: Always Events for Communication and Care Transitions- Idea Guide.

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Always Events® Challenge Grant Recipients

  

 

2011/2012 Always Event® Challenge Grant Recipient Project Overviews

Organization/Institution: Quality Partners of Rhode Island Principal Investigator(s): Stefan Gravenstein, MD, MPH Project Title: Enhancing medication safety through PictureRx

Always Event(s): The family-patient team will always receive medication education using the teach-back method and then prior to discharge the patient will receive a visual medication schedule.

Organization/Institution: Massachusetts General Hospital
Principal Investigator(s): Richard H. L. Corder MHA, FACHE
Project Title: Always Know Your Caregiver/Always Responsive

 Always Event(s): Ensure that our patients always know who is in charge of their care, and that providers are always responsive to the needs of our patients and their families and that our patients always get help when they need it.

Click HERE to view the MGH Always Events video.

Organization/Institution: Planetree/Griffin Hospital
Principal Investigator(s): Michael Lepore, PhD
Project Title: Same Page Transitional Care: Creating a Template for Optimal Transitions

Always Event(s): Patients will always have the opportunity across healthcare settings to utilize a portable personal health record embedded with actionable patient-driven information, to ensure patients, their healthcare providers and their family members are on the same page with regard to the patient’s healthcare needs, priorities, and lifestyle.

Organization/Institution: St. Jude Children’s Research Hospital Principal Investigator(s): Kathryn Berry-Carter
Project Title: Parent Mentor Program

Always Event(s): The  Always Eventis proposed as having four goals: 1) to offer each newly diagnosed family at St. Jude a trained parent-mentor, offering support and encouragement throughout the trajectory of the child’s treatment including the transition into survivorship or bereavement, 2) to provide the family the opportunity of acceptance, while facilitating coping mechanisms and hope, 3) empowering providers and the family as a partner and in their communication with St. Jude staff in their child’s treatment, and 4) providing a resource of services offered by St. Jude and the community.

Click HERE to view the St. Jude Children’s Research Hospital Always Events video.

Organization/Institution: Iowa Health System Principal Investigator(s): Gail A. Nielsen
Project Title: Always Use Teach Back!

Always Event(s): The Always Event is to always listen to the patient during hand-offs by encouraging teach-back opportunities—during hospitalization and upon arrival in the next care setting. Always use the Teach-back method.

Click HERE to view the Iowa Health System Always Events video.

Organization/Institution: University of Pittsburgh Medical  Center Innovation Center
Principal Investigator(s): Anthony DiGioia, III, M.D.
Project Title: Trauma Team Texting and Guardian Angels

Always Event(s): 1) Always let the patient be the center of the care team… Care Team Twittering, 2) Always keep patients and family members informed… “Guardian Angels,” 3) Always know the discharge plan and beyond… Transitions in Care Experiences.

Click HERE to view UPMC’s ‘Guardian Angels’ Always Events video.

Click HERE to view UPMC’s ‘Trauma Team Texting’ Always Events video.

Organization/Institution: Lahey Clinic
Principal Investigator(s): Elizabeth Collins, M.D.
Project Title: Transitions of Care Partnership Project

Always Event(s): Always listen to and involve the patient in their care transitions. This community partnership project ensures that patient-provider communication occurs and will improve the delivery of patient-centered care at each step in the discharge or transfer process from one setting to another.

Organization/Institution: Anne Arundel Health System Principal Investigator(s): Sherry B. Perkins, PhD, RN and Mitchell Schwartz, MD
Project Title: The SMART Discharge Protocol

Always Event(s): Always provide the patient with a SMART discharge process.  With the involvement of patients and families providers will develop a simple, universal, 5 item checklist as a SMART Discharge ProtocolSM. (SMART is an acronym for: Signs, Medications, Appointments, Results, and Talk with me.) Providers will build on current evidence; create urgency and expectation for use with patients, families, and caregivers; disseminate findings, and promote as a national standard.

Organization/Institution: Saint Joseph Hospital Foundation Principal Investigator(s): Wendy Rockey
Project Title: Comfort & Pain Relief Menu

Always Event(s): Patients will ALWAYS be offered every option and/or combination of options for pain control and comfort. Nurses will ALWAYS have a more comprehensive conversation about pain & comfort with every patient.

Organization/Institution: Inova Health System
Principal Investigator(s): Mary Ann Friesen, PhD, RN, CPHQ
Project Title: Developing a Patient-Centered Approach to Handoffs

Always Event(s): Patients will always be included in the ISHAPED handoff shift-to-shift hand-off process at the bedside as this will add an additional layer of safety by allowing the patient to communicate potential safety concerns.

Click HERE to video Inova Health System’s Always Events video.

Organization/Institution: University of California San Francisco Principal Investigator(s): Carla Graf, RN, MS, PhD
Project Title: Improving Patient and Family Centered Care  for Hospitalized Persons with Dementia

Always Event(s): The Always Event will be that patients with dementia and their families receive care that is targeted to the patient’s type and stage of dementia.

Click HERE to view UCSF’s Always Events video.

Organization/Institution: Northeast Valley Health Corporation Principal Investigator(s): Ursula Baffigo, MD
Project Title: Team Up for Health

Click HERE to view the Northeast Valley Health Corporation’s Always Events video

Always Event(s): Always help prepare our patients for their office visits through the Making the Most of Your Visit form. Spread utilization of the MMV tool from the pilot site to all 7 of their primary health clinics. Patients complete the form while in the waiting room prior to each visit. The 2 questions are: 1) How am I managing my health; 2) What do I want to ask my doctor .

Organization/Institution: Yale-New Haven Children’s Hospital Principal Investigator(s): Janet Parkosewich, DNSc, RN, CCRN, FAHA
Project Title: Premature Life Transitions: A Patient- and Family- Centered End of Life Care Program for Neonates

Always Event(s): Our proposal for the Always Event TM Grant is aimed at the consistent use of an innovative, systematically applied end-of-life program by all members of our neonatal interdisciplinary team to support patients and families during the transition from curative to palliative care, infant demise, and bereavement.

Click HERE to view the YNHH Always Events video.

Click HERE for more information about the YNHH Always Events project and to view a powerpoint presentation.

Organization/Institution: University of Minnesota Amplatz Children’s  

Principal Investigator:Cheristi Cognetta-Rieke, RN
Project Title: My Story
Always Event(s): Upon every admission and transition in care a questionnaire-based interview will occur between the intake nurse, the patient and the patient’s family or friends.  The interview will specifically focus on the personality and interests of the patient, such as hobbies, nicknames, pets, and special interests.  The “story” of each individual patient will be used as a consistent approach to involving the child in the delivery of patient care.

Click HERE to view the University of Minnesota Amplatz Children’s Hospital Always Events video

Organization/Institution: Dartmouth-Hitchcock Medical Center Principal Investigator(s): Jonathan T. Huntington, MD, PhD &Suzanne C. Beyea, PhD, RN, FAAN.
Project Title: Implementation of a set of Always Events that will increase communication

Always Event(s): Always communicate with, inform and respect the patient through the following behaviors in every patient/family encounter: 1) Introducing yourself and describing the reason you are there at each encounter, 2) Addressing and referring to patients by the name that they choose; not by their disease, 3) Displaying your name badge at all times, 4) Treating those whom you serve with the same respect you would wish them to show you, 5) Encouraging patients and families involvement in decision making, 6) Welcoming and being respectful to those defined by the patient as “family.”

Click HERE to view the DHMC Always Events video.

 Organization/Institution: Vanderbilt University Medical Center Principal Investigator(s): Terrell Smith
Project Title: Effective Communication and Collaboration with Patients and Families for Falls Prevention

Always Event(s): Patients and families will always receive information and education to facilitate autonomy, self-care and health promotion. This communication strategy educates patients as to how they can partner with the health care team to prevent a fall during their stay.

Organization/Institution: Cleveland Clinic
Principal Investigator(s): Jennifer Ramsey, MD
Project Title: Unmet expectations regarding ICU patient outcomes: Identification and management of at risk families

Always Event(s): Always assure that MICU patients and families understand and participate in their care through: 1) Timely, ongoing, clear, consistent and compassionate communication, 2) Medical decision-making aligned with patient values, care goals, and treatment preferences, 3) Family care that includes liberal visiting and practical, emotional, spiritual and bereavement support.

Organization/Institution: March of Dimes
Principal Investigator(s): Liza Cooper, LMSW
Project Title: Close to Me

Always Event(s): March of Dimes considers kangaroo care, or skin‐to‐skin holding of the premature infant by the parent as an Always Event(s)™ that is discrete, affordable and measurable. It has numerous proven health benefits for mother and baby and is indicated as one of the most comforting activities by NICU families. Close To Me is the intervention program being implemented to increase the early onset and frequency of kangaroo care in NICUs.

Click HERE to video the March of Dimes Always Events video.

Organization: American Academy of Pediatrics                                            
Principal Investigator(s): Aditee Narayan, MD, MPH
Project Title: Family Feedback — Always! (FFA)

Always Event: To develop and assess a pilot program to facilitate communication strategies used by pediatric residents for eliciting feedback from the families they serve in continuity clinics — Family Feedback– Always!

 

Organization/Institution: Health Care For All                Principal Investigator(s): Deborah Wachenheim              Project Title: Patients and Families Improving Hospital Discharge

Always Event(s): This initiative will create, in partnership with the PFACs and STAAR teams at Massachusetts hospitals, a discharge process that consistently and meaningfully engages patients (and their caregivers) in identifying the patient’s needs at home. It is consistent with the criteria for selection of an Always Event and is closely aligned with the principles of the Picker Institute.

Click HERE to view the Health Care For All Always Events video.

Organization/Institution: Henry Ford Health System
Principal Investigator: Rhonna Shatz, DO
Project Title: Dementia Screening for Senior Patients

Always Event: HFHS will develop a new “Always Event” that will screen patients 70 years and older for dementia as part of their annual primary care health exams.  This initiative will use a new Web-based cognitive assessment tool developed by the National Institutes of Health and modified for use at HFHS.  Physicians will also utilize an NIH developed web-based smart survey tool to assess mood, behavior, daily living activities and review caregiver distress.  Should the patient exhibit any signs of a neurological impairment following the cognitive screen, the doctor would initiate a full dementia assessment guided by EMR templates that can be downloaded or utilized and saved on-line as an office note. 



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Always Events: Dartmouth-Hitchcock


Dartmouth-Hitchcock Medical Center

Principal Investigator(s): Jonathan T. Huntington, MD, PhD & Sandra G. Dickau, RN, MS
Project Title: Implementation of a set of Always Events that will increase communication


Always Event(s):
Always communicate with, inform and respect the patient through the following behaviors in every patient/family encounter:
• Introducing yourself and describing the reason you are there at each encounter
• Addressing and referring to patients by the name that they choose; not by their disease
• Displaying your name badge at all times
• Treating those whom you serve with the same respect you would wish them to show you
• Encouraging patients and families involvement in decision making
• Welcoming and being respectful to those defined by the patient as “family”

Overview: Develop and implement a educational practice intervention and improvement program to promote and evaluate the competency of frontline clinical nurses with a set of observable and behavioral Always Events. Intervention is based on experiential learning provided with simulation and fully integrating Patient Family Advisors who will serve as Standardized Patients in a clinical scenario. The efforts will build from a foundation of pre-existing resources and educational infrastructure. Specific Aims include: To operationally define measurable behaviors that demonstrate competence in specific PFCC Always Events involving communication. To Enhance a nationally recognized experiential education program targeting recently hired nurses to create immersive learning experiences utilizing SPs that will serve as a pilot for the evaluation and practice of these Always Events. To provide education to SPs regarding the importance of these behaviors and how to provide targeted feedback to learners. To Develop a novel evaluation method to measure the effects of this intervention on the clinical practice of recently hired nurses.

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Always Events: MGH

Massachusetts General Hospital
Principal Investigator: Gaurdia Banister, RN, PhD
Project Title: Always Know Your Caregiver/Always Responsive

Always Event(s): Ensure that our patients always know who is in charge of their care, and that providers are always responsive to the needs of our patients and their families and that our patients always get help when they need it.

Overview: The strategy that will be adopted will be a multi-factorial one, and will consist of a variety of approaches and tactics. These strategies will be piloted on a single, or a small number of homogeneous patient care unit(s) – using a similar unit(s) as a control. The specific strategies will be developed and deployed by staff, adjusted as they are deployed and then rolled out to the entire organization over the balance of the year remaining. It is expected that these strategies will be overseen and directed by the existing Communication and Responsiveness Council that reports to the Patient Care Services Committee – and will be influenced by the newly formed centralized Patient Family Advisory Council (PFAC). Strategies will include but will not be limited to: 1) A variety of rounding strategies to support and model the importance of timely responses to patients’ needs and their requests, 2) The production of a video that will welcome the patient and their family to the MGH, explain the environment, introduce the team that will be taking care of them and explain what they can expect in terms of our commitment to their care and well being, 3) The use of “face sheets” — The sheet describes who is taking care of them, what their role is on the team and what they should expect from them. The face sheet contains actual photographs, names and pager numbers and descriptions of each team members roles and responsibilities, 4) White boards – in each patient room that detail who is taking care of the patient, their nurse, their doctor and other pertinent information that might help the patient better communicate with the right people, 5) Communication Boards – similar to the boards for patient rooms but designed for the nurse’s stations to communicate the monthly, quarterly and year to date patient satisfaction scores – especially “Staff Responsiveness.”

Click here to view the MGH Interventions

Click here to download the Whiteboard Guidelines

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Always Events® Brochure



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Always Events: Yale-New Haven Hospital

Organization/Institution: Yale-New Haven Children’s Hospital
Principal Investigator(s): Janet Parkosewich, DNSc, RN, CCRN, FAHA

Project Title: Premature Life Transitions: A Patient- and Family- Centered End of Life Care Program for Neonates

Always Event(s): Our proposal for the Always Event TM Grant is aimed at the consistent use of an innovative, systematically applied end-of-life program by all members of our neonatal interdisciplinary team to support patients and families during the transition from curative to palliative care, infant demise, and bereavement.


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Always Events: UPMC — Care Team Twittering

Organization/Institution: PFCC Innovation Center at University of Pittsburgh Medical Center
Principal Investigator(s): Anthony M. DiGioia, III, M.D.
Project Title: Trauma Team Texting and Guardian Angels

Always Event(s):

  • Always let the patient be the center of the care team… Care Team Twittering
  • Always keep patients and family members informed… “Guardian Angels”
  • Always know the discharge plan and beyond… Transitions in Care Experiences

Overview: Trauma Services and the Transplant Programs at UPMC have incorporated the PFCC Methodology and Practice (PFCC M/P) in their care delivery approach. The PFCC M/P approach enables Care Givers to deliver truly exceptional care experiences by refocusing existing resources through a six step process that brings patients and families directly into co-designing care delivery improvement. PFCC M/P will serve as the means by which the 2 always events will be incorporated, monitored, evaluated, disseminated, and accelerated locally and nationally so that accurate communication takes place in real time and transitions in care are seamless.

Guardian Angel Brochure

 Transplant Guardian Angel PickUp Sheet (Blank)

Transplant Guardian Angel Handoff Report (Blank)

Angel Hand- OFF Sheet Info

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Always Events: St. Jude

Organization/Institution: St. Jude Children’s Research Hospital
Principal Investigator(s): Alicia Huettel, MSN and Patricia Aiken
Project Title: Parent Mentor Program


Always Event(s):
The  Always Eventis proposed as having four goals: 1) to offer each newly diagnosed family at St. Jude a trained parent-mentor, offering support and encouragement throughout the trajectory of the child’s treatment including the transition into survivorship or bereavement, 2) to provide the family the opportunity of acceptance, while facilitating coping mechanisms and hope, 3) empowering providers and the family as a partner and in their communication with St. Jude staff in their child’s treatment, and 4) providing a resource of services offered by St. Jude and the community.   

Overview: Our Always Event™ proposal is the development and implementation of a parent‐mentoring program at St. Jude. During the first year we will: 1) outline the position description, recruit and train 3‐10 parent mentors with an interdisciplinary team of chaplains, social workers, psychologists, physicians, nurses, and members of the FAC and Family Centered‐Care Program, 2) formulate a program marketing plan to offer the Always Event™ to parents, 3) establish a communication process between mentors and parents, 4) create a formal documentation process, 5) establish the feedback process to interdisciplinary team including debriefing and support, 6) implement evaluation measurements, 7) assess the feasibility of program expansion within other clinics. A parent mentoring implementation team (PMIT) will be formed to assess the outlined steps and to offer feedback as the program is implemented. The PMIT will consist of members of the described interdisciplinary staff.

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