Modern medicine has expanded the range of possible treatments that can prolong life without necessarily providing a quality of life that may be acceptable to a patient and her family. They are often confronted by the need to make a series of complicated and even overwhelming decisions. The kinds of decisions that have to be made are especially difficult when the patient suffers from advanced dementia and cannot communicate for him or herself. These decisions are extremely stressful and burdensome for families. These are conversations that should always occur in the setting of advanced dementia and we strive to have these conversations led by the outpatient physician before moments of crisis. Unfortunately, trainees are not encouraged to have these discussions nor are they taught how to carry them out. This project will develop a video and curriculum to teach residents how to discuss goals of care with family members of patients with dementia (Module I) and to develop a video and teaching module so that interns can better understand what they can expect while they are helping their patients to complete a living will (Module II).
In the Department of Anesthesiology and Perioperative Care at UC Irvine, they have developed a standardized program and curriculum focusing on training anesthesiology residents on the patient experience. The program titled “Humanism in the Perioperative Environment program” will train Anesthesiology residents in compassion, communication and empathetic care, in addition to technical care. In order to assess efficacy of the program, residents will be assessed in their non-technical skills prior to and after curriculum implementation. The curriculum centers on the patient’s entire Perioperative experience, with close attention to the patient’s fears, pain, and anxiety. The goal is for residents to develop Perioperative “always events” that integrate and promote patient-centered medicine, resulting in a personalized patient Perioperative experience. Key to the vision for this program is multimodal learning opportunities, including classroom didactics, video analysis, role-playing, simulation activities, immersion sessions and evaluative feedback. This program includes weekly 1-hour sessions for the first-year anesthesiology residents.
The Making the Most of Your Visit (MMV) tool is designed to be completed by patients in the waiting room prior to each visit, asking, 1) “how am I managing my health?” and 2) “What do I want to ask my doctor today?” The tool is then brought into the exam room with the patient and discussed with the provider. 3 NEVHC staff members are certified to facilitate 4 hour workshops that will teach providers and support staff communication skills and techniques that have been proven to increase positive patient behavior change. Combined with the utilization of the MMV tool, these skills and techniques have demonstrated to greatly assist providers in initiating a conversation with patients regarding their health, thus helping lay the foundation for a true patient-provider partnership. In order to ensure the Always Event is properly executed, this initiative will implement 8 four-hour Choice and Change workshops. These workshops will give providers and staff the skills necessary to effectively listen and communicate with their patients, as well as how to fully utilize the MMV tool. Patient surveys will be distributed to 70 randomly selected adult patients, 18+ years of age, per quarter across our six targeted sites. Surveys will assess effectiveness of the intervention program, including the effectiveness of the MMV tool.
Development and implementation of a multifaceted intervention, MyStory, to have all care interactions with children begin with a meaningful conversation between care providers, patients, and families. MyStory will capture the patients’ values, preferences, and expressed needs, and document it where it can be viewed and used by all care team members. Implementing MyStory as an Always Event as children are admitted to the hospital will ensure we capture the “story” of each child and use the information to involve children in care decisions and care planning. The MyStory application will be built into the electronic medical record that is used throughout our system of hospitals and clinics. It will be designed by a project team that includes nurse managers, a bedside nurse, the organizational development manager, child family life staff, a member of the Patient and Family Centered Care Task Force, a child from the Kids Council, and parents from the Parent Advisory Board. Adaptation will be lead by MyStory Champions, chosen from each of the inpatient departments. A MyStory kick-off event will be held to gain buy-in and excitement. Education will be developed and delivered to more than 500 direct care interprofessional staff.
This initiative proposes to utilize their Patient Safety Training Center to deliver two simulation-based educational modules focused on improving the quality of physician-patient communication. The specific topics addressed by these modules are Sharing Bad News and Informed Patient Choice. Patient Family Advisors will be intimately involved in the development process, delivery and evaluation of each module. The curriculum will be based on the key principles of PFCC and “always events”- observable behaviors that ensure all patient care experiences are firmly grounded in dignity, respect, and information sharing. The educational program for each of the two modules will include: focused advanced reading related to the topic, a small group session moderated by a faculty member and a patient family advisor, a videotaped simulated patient (SP) encounter, observation of each SP encounter by a patient family advisor and faculty member, a group debriefing led by faculty and patient family advisors, as well as an evaluation component.
This project implements and tests a novel approach to teach pediatric residents about patient and family-centered care (PFCC). The approach calls for a supervised meeting between a family member of a previously hospitalized child and a resident in the context of a pediatric residency rotation (behavioral and developmental pediatrics). For this “proof-of-concept” phase, meetings are being conducted with all the pediatric residents in the institution. The meeting is standardized and is supplemented by a discussion with a faculty member. PFCC will be discussed using predefined, manual-driven guidance. This meeting is followed by a discussion with the faculty member to identify core components of family-centered care as exemplified in the parent interview. This standardized encounter lends itself to a targeted evaluation of outcome.
This initiative creates and implement, as an Always Event, a “Comfort & Pain Relief Menu” to be offered with every pain/comfort assessment. This will include a broad list of pain relief and comfort measures for caregiver and patient to discuss together so they can create a comprehensive pain & comfort plan. The hope with this grant is to create a color, picture-aided, patient-friendly tool (resembling a restaurant menu), which will offer a widely comprehensive list of options on the menu, including: pharmacologic options, medication-combination options and/or a visit from the pain nurse, heat/cool therapies, positioning and movement, distraction, music and/or massage. In addition, comfort items like sleeping eye masks, neck pillows, warm blankets, aromatherapy, or ear plugs would be offered.
IHS will develop and implement a “Always Use Teach-back!” toolkit for the three care settings encountered by patients being discharged from the hospital: hospital discharge, primary care follow-up, and home health support. The toolkit will include training modules with videos demonstrating effective use of teach-back. IHS will train and coach physicians and nurses on the “Always Use Teach-back!” approach. The Always Events encompass Teach-Back (T-B) opportunities – during a patient’s hospitalization and upon arrival in the next care setting. Physicians and nurses will educate and discover (in a non-shaming way) what the patient or family caregiver understood using T-B. IHS has the ongoing benefit of patient and family advisors in developing appropriate T-B interventions through their HLC, partnership with the New Readers of Iowa7, and Reducing Readmissions Collaborative. IHS patient and family caregivers will be partners in developing and testing the most effective T-B learning system.
This project will build on previous research by the Inova Health System (IHS) to improve the quality and safety of patient care by enhancing communication and encouraging patient participation. Recent reviews of patient safety and satisfaction at Inova identified the shift-to-shift handoff as a process in need of improvement. Inova responded by convening a quality-improvement team to develop a new strategy for conducting the shift-to-shift handoff, one that standardizes procedures and incorporates a bedside component. Entitled “ISHAPED” (I=Introduce, S=Story, H=History, A=Assessment, P=Plan, E=Error Prevention, and D=Dialogue), this strategy also provides patients and their families the opportunity to participate in the handoff process. The proposed project aims to 1) measure patient satisfaction and perceptions regarding the ISHAPED bedside handoff process, 2) use the patient feedback to optimize and standardize the bedside handoff process, and 3) develop a training video and companion toolkit to educate nurses on how to conduct a safe, effective and patient-centered bedside hand-off across multiple settings.
The goal of Family Feedback ALWAYS! is to develop and assess a pilot program that will enhance communication strategies used by pediatric residents. The program will allow residents to gather meaningful insights and feedback from families they serve in the continuity clinic experience. The program will focus on providing residents with the resources, education and skills to implement the core components of a patient-centered medical home during a 0-2 year old well-child visit. The patient-centered medical home is an approach to providing comprehensive, continuous healthcare that is based on the foundation of a personal relationship between a patient and their family, their physician, and members of a care team. It is facilitated through mutual trust and partnerships that enable bidirectional communication. In turn, critical to this partnership is the physician’s effectiveness in eliciting feedback from patients/families as to the quality of their interactions—this information guides practice improvement as a PCMH.
The primary aim of this project is to improve residents’ ability to disclose medical errors. Disclosure, the process of bringing to light an unintended outcome, is essential to the nature of the patient-physician relationship. In this project, we are using simulated patient encounters, on-line teaching, self-assessment, and observer assessment to introduce the learners to proper disclosure.
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.
The Patient’s Voice: Institution-Wide Training for Housestaff in Patient-Centered Care
This project integrates 3 components that will 1) identify the “voice of the patient” at our institution using actual comments from patient surveys and focus groups; 2) develop and pilot with residents strategies for delivering patient-centered care that incorporates simulated patients; and, 3) design an expanded, intensive workshop on patient-centered care practices integrating the lessons learned from the first two components.
Commit To Sit
The Radiology Commit to Sit program is an innovative program that encourages radiology professionals to communicate with patients in a way that demonstrates compassion, respect, empathy and competence in order to foster a trusting relationship. By sitting eye-to-eye with patients at the initial contact and spending time engaging in open dialogue and active listening, patients will communicate critical information such as allergies, past radiology experiences, feelings of anxiety, fear or claustrophobia as well as important past medical history such as pacemaker placement or difficulty lying flat.
Seamless Care Team Communication
Always have seamless communication between members of the nursing team so all nurses on a unit are informed of the status of each patient, enabling them to support each other effectively and to address patient needs and concerns quickly and efficiently. A large body of research demonstrates the link between patient experience, communication, and care transitions. After identifying the gaps above, San Mateo Medical Center created solutions based on staff input and evidence-based practices to improve both the work environment and the experience for patients and staff.
Know Your Physician
Always ensure the entire care team and patients and families are able to identify the doctor assigned to hospitalized patient’s care each day in order to improve communication and ability to respond quickly to patient and family questions about their care. The project team set out with the aim of developing a communication process so that every caregiver involved in caring for a Med/Surg patient knows the Attending Physician and Resident responsible for the patients care.
Always build relationship between patient and staff upon admission to an inpatient unit by establishing a sacred moment. The Sacred Moment fundamentally changes the way patients are greeted upon arrival to an inpatient unit. Whereas the traditional intake process focused solely on validating patient demographics, obtaining proof of insurance, or confirming the existence of a living will, the Sacred Moment seeks to humanize the care experience. The new standard creates a lasting first impression by getting to know patients as people – identifying their preferences, fears, concerns, and most importantly what the care team can do to ease their journey.