Monday, 25 April 2016 06:11

Family and Patient Engagement Critical to Improving Care

Written by Robert Fortini, PNP, and Patti Lipes

r fortinip lipesThe patient experience of care domain is every bit as important in the ambulatory care sitting as it is in the hospital. While information gathered through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys is invaluable, nothing can replace in-depth, face-to-face meetings with patients to really get at the heart of what they want from their providers and practice staff. How do you tailor care delivery to meet the needs of individual patients without asking? 

According to a recent article by Mike Miliard for Heathcare IT News, healthcare organizations looking to move past meaningful use and toward value-based purchasing are investing capital in platforms that better support patient engagement. In fact, population health and patient engagement topped projected purchasing plans for 2016. Patient experience was also identified as a top priority across all healthcare settings, from physician practices to hospitals to long-term facilities, by a benchmarking study, State of Patient Experience 2015: A Global Perspective on the Patient Experience Movement, released by The Beryl Institute in August 2015.

Bon Secours Medical Group (BSMG) uses many methods to advance patient-centered medical home care and facilitate the move from fee-for-service to fee-for-value within its practices. One of the newest, the formation of patient and family engagement councils within practice locations, is being used to provide a forum for improved information-sharing between patients, providers, and staff, hopefully improving both the delivery of care and the patients’ satisfaction with the delivery system.  

The participating practices within BSMG optimize the care model by facilitating two-way communication between patients and providers through quarterly meetings held at the applicable practices. Meetings follow a pre-published agenda and include a verbal survey of membership about specific practice administrative and clinical concerns and experiences. Patient feedback is recorded in summary for review by the project team and all members of the applicable practice. The information then is prioritized and used by the practice members and project teams to establish action plans to address top concerns through appropriate remedial activities.

Objectives include improved communication between patients and practice staff, the correction of deficiencies within a practice, increased patient knowledge regarding available resources (both within the practice and within the community), and increased patient knowledge about specific disease management through ongoing education, if appropriate. It is hoped that meeting these objectives will improve patient satisfaction scores on surveys by 5 to 10 percent over a two-year period. 

Patient and family engagement council membership is seen as an honor by the participants, who are personally invited to serve by their primary care physician and the administrator of their medical home. Members serve a one-year term, with an option of remaining on the council as advisors after that term expires. Several councils are working to improve the care delivery system for patients with chronic conditions such as diabetes and obesity. Just understanding and having access to auxiliary clinical services has been seen by patient members as sufficient reason to participate. Members leave the councils with a greater knowledge of the role played in their care by their physician, nurse navigator, registered dietician, and/or pharmacist. They also share with fellow members and learn and grow from the experiences and insights of their peers. Their suggestions are then shared across the practice, allowing all the patients of the applicable practice to benefit from the experience of the representative sample. 

Skilled facilitation is provided at each meeting to ensure that all voices are heard and that passionate discussions remain respectful. Staffers are encouraged to remain neutral while receiving constructive feedback regarding possible deficiencies within the practice. All participants, patients and staff members alike, approach the sessions as an opportunity to improve service. What staff may see as adherence to compliance or just good procedure, patients may view as rude. One example was discussed early in the formation of a new council at a very large, very busy practice. Staff had posted a stop sign near the check-in desk in an attempt to have those in line stand back while the patient being served was registered. The staff’s only desire was to provide privacy. However, many patients of the practice found the sign offensive and suggested a simple wording and location change for signage that would accomplish the same desired outcome – privacy for all those checking in for an appointment. 

The physicians within the Bon Secours Medical Group who participate in patient and family engagement councils welcome the opportunity to spend quality time with patients outside of the typical visit. The councils provide physicians an opportunity to focus on an issue or disease state with a core group of eager participants. One physician recently developed a council for patients with a diagnosis of obesity. Not only will this group meet and share treatment options in addition to general clinical and administrative concerns, but the physician champion has set up “walks with the doc” to promote healthy, safe exercise among her patients. Registered dieticians will discuss and share healthy cooking tips, and all meals served during meetings will be appropriate to support good nutrition and weight loss.

One of the newer councils at Bon Secours is in formation at a large, rural pediatric practice. The payor mix for those served at this practice is 75 percent Medicaid, 25 percent private insurance. A large number of these pediatric patients are cared for by extended family, particularly grandparents. Providers and staff are anxious to learn better ways to serve this population. One physician recently discussed the need for extended access. Her concern will be addressed at a patient family council meeting – when do extended hours make sense? For example, if many primary caregivers do not wish to drive after dark, do evening hours make sense? Is this an issue in a rural environment with dark country roads? Perhaps more so than in a city or suburban area? The benefit of having councils specific to each practice is highlighted by this simple example.    

Whether at the practice level or at the system level, the voice of the customer will continue to help drive change within medical practices. Healthcare is no longer the top-down, “physician-only” controlled organization it may have been in the times of the horse and buggy. Today’s healthcare teams are complicated organizations made up of many members, all focused on providing patients with the best possible experience while improving health and controlling cost. A true challenge of the triple aim is and will continue to be achieving the ability to detect and appreciate the small but significant changes that patient and family engagement councils bring to the table. Patient-centered care must allow for the voice of the patient in all its possible forms to be heard, and councils are just one of many very important components.  


About the Authors

Robert Fortini, PNP, VP and chief clinical officer for Bon Secours Virginia Medical Group Home Health and Hospice, is responsible for facilitating provider adoption of electronic medical records (EMRs), plus coordinating clinical transformation and facilitating advances in population health initiatives. Robert has extensive experience in operations and clinical policy development, and experience in workflow reengineering and CQI in ambulatory care. He recently advanced Bon Secours’ efforts in “Good Help for Life” by leading efforts in advance care planning and behavioral health integration into primary care, promoted access via expansion into the retail clinic and telehealth arenas, and developing a workforce equal to the task. 

Patti B. Lipes is a graduate of Averett University with a bachelor’s in business administration degree. Prior to joining Bon Secours, she served in leadership roles at HA-LO Branded Solutions and Reynolds Metals Company. Her areas of expertise are market development and business operations. As senior clinical operations project administrator for Bon Secours Virginia Medical Group, Patti is responsible for coordinating and facilitating project plans within the knowledge areas of analytics, patient-centered medical home care, population health, and quality. Patti holds the Project Management Professional (PMP) certification and is a Lean Six Sigma Green Belt. She is certified in mass care, disaster services, and shelter management through the Red Cross and worked in Mississippi and Louisiana with City Impact following Hurricane Katrina.   

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Last modified on Monday, 25 April 2016 07:54