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The Beryl Institute invites members to submit posts on patient experience related topics. For guidelines and information on submitting a post for consideration, please contact us at info@theberylinstitute.org.

 

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Patient and Family Engagement to Improve Patient Safety

Posted By Tejal K. Gandhi, MD, MPH, CPPS, Monday, March 7, 2016
Updated: Monday, March 7, 2016

Patient engagement is an essential component of safe, appropriate, high quality healthcare. But what do we mean by patient engagement and how does it relate to patients’ experience of care?

A recent report published by the National Patient Safety Foundation (NPSF) notes that most definitions of patient engagement include the common themes of "partnership, communication, information exchange and respect.”

The Beryl Institute defines patient experience as "the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”

There are overlaps between patient experience of care and patient engagement. If patients are not respected as partners in their care and if clinicians do communicate with patients effectively, then it is highly unlikely that the patient’s experience will be a positive one. Moreover, research has linked patient experience to clinical outcomes, with a 2013 paper finding "patient experience is positively associated with clinical effectiveness and patient safety and [data] support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare.”

The NPSF report, Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human, makes a number of recommendations for improving patient engagement to improve patient safety:

  • Training and education: Clinicians and health professionals need to be educated about concepts such as shared decision making, health literacy, cultural sensitivity and respect.
  • Ease of access to information: Patients and families need timely access to medical records, test results and tools and resources that help them understand complex medical information.
  • Patient representation: Members of the community served by a healthcare organization should be represented on the governing bodies and committees of those organizations. Only by such representation can we ensure that safety and quality initiatives and care processes that affect patient experience are designed with patients in mind.
  • Tools and strategies: From including families in bedside rounding to the use of tools like the Ask Me 3 program, which encourages patients to ask key questions about their health and care plans, there are tools and strategies that can help engage patients and improve their experience of care.
  • Reporting and measuring: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) serves to measure, to a degree, a patient’s experience of care while hospitalized. We also need ways to measure patient engagement, including ways to capture patient reports of safety lapses.

Arguing for greater patient and family engagement is not new to NPSF, and is in fact an issue that we and others have been advocating for some time now. While educational efforts such as the Agency for Healthcare Research and Quality’s Questions are the Answer campaign are useful for patients and consumers, we also know that even experienced health professionals sometimes have trouble speaking up when put in the vulnerable position of patient.

While patients should be encouraged to be full partners in their care, their clinicians are the ones who really hold the key to making that possible.

Improving patient and family engagement is one of eight recommendations in the new NPSF report, which is a focal point of Patient Safety Awareness Week, March 13-19, 2016. The theme of the week this year is United for Patient Safety, a reflection of the belief that clinicians, patients, policy makers, researchers and everyone involved in healthcare must be part of making care safer for everyone.

 

Tejal K. Gandhi, MD, MPH, CPPS, is President and Chief Executive Officer of the National Patient Safety Foundation, the NPSF Lucian Leape Institute and the Certification Board for Professionals in Patient Safety. She is advocating for patient safety at the national level, driving educational and professional certification efforts, and helping to create and spread innovative new safety ideas.

Tags:  healthcare  patient and family engagement  patient engagement  patient safety  research  service excellence 

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Universal Children’s Day Reminds Us of Our Impact on Pediatric Patient Experience

Posted By Martie L. Moore, Sunday, November 1, 2015
Updated: Monday, November 2, 2015

"The one thing all children have in common is their rights. Every child has the right to survive and thrive, to be educated, to be free from violence and abuse, to participate and to be heard.”1 - Secretary-General Ban Ki-moon

As a former pediatric nurse and expert witness for child protection services, I’ve spent a lot of time caring for children in the hospital and home setting. I know one of the greatest things I’ve learned is that we as caregivers can empower children during difficult situations. The need to support the wellbeing of children extends beyond healthcare: It is a universal initiative.

Universal Children’s Day on Nov. 20—unlike the traditional Mother’s Day or Father’s Day recognized in the United States— was established by the United Nations General Assembly in 1954. All countries are encouraged to promote not only mutual exchange and understanding among children, but also to initiate action to benefit and uphold the wellbeing of children around the world.

Children in the U.S. may not always face the same frightening conditions as elsewhere in the world. But this day helps us to remember that we as clinicians still have a responsibility to create an atmosphere that supports the children under our care. We know that the less stress and anxiety a child has, the better their ability to cope in a stressful situation. Hospitalization is one of the stressful situations that we can do something about.

Improving patient experience is already a major target for hospitals, and hospitals are measured and paid based on HCAHPS surveys completed by adult patients. In October 2014, the Agency for Healthcare Research and Quality posted a pediatric version of the HCAHPS survey. This pediatric survey is under review this year as a possible benchmark on which to base hospitals’ Medicaid and Children’s Health Insurance Program reimbursements, leading to the expectation that this pediatric HCAHPS survey will ultimately factor into reimbursement as the adult equivalent does now for Medicare.2

Now is the time to be thinking about how to address this special population. The ways you care for children in your facility can go a long way toward producing a positive experience for both the patient and their loved ones.

Make the Hospital A Safe Place for Children

We all know hospitals can be a very scary place for anyone, let alone children. A child doesn’t know what to expect, and is constantly meeting new strangers. He or she may not understand what’s happening to them. They could be experiencing pain from their illness, the treatment, or both.

So how do we make the hospital a place where a child can feel safe, participate, and be heard? You can make a big impact with small changes: Start with what they’re wearing. Pajamas are a great source of comfort, and while the child’s personal pajamas may not be an option, your facility can still stock pediatric gowns that promote comfort and modesty, have kid-friendly prints, and feel soft like the pajamas they may wear at home. Consider pediatric gowns with MRI-safe plastic snaps that negate multiple gown changes.

While using pediatric gowns that evoke the comforts of home, also be sure that a child’s hospital bed is a safe place. Avoid performing any painful treatments while they are in their hospital beds so that it remains a haven that they can trust.

You can also help by communicating directly with your patients. Talk to them, not at or above them, so they understand what is happening. Speak at their level, both intellectually and physically, crouching or sitting down to look them in the eye.

You may even choose to draw pictures to help demonstrate what is going on inside their bodies or a treatment they are about to experience. Many children "play nurse or doctor” at home; offer to let them participate in their care by holding the stethoscope, counting with you for their pulse or heartbeat, or perhaps picking a favorite color for a bandage or cast. Your conversation may also help distract them from their pain. The fun prints on their gown featuring friendly animals or characters could be a conversation starter in itself. Ask them about pets, sports, movies, or their funniest joke. A good belly laugh does wonders for the soul!

Good communication involves good listening. Take the time to hear what a child says to you. You could learn that something as simple as a special toy or a quick trip outside for some fresh air could make him or her feel better.

Listening and observing may also help you uncover any signs of abuse. If you observe these signs, stay calm and report the suspected abuse immediately per your facility protocols.

You Make a Difference

Every day, clinicians make a big difference in the lives of the children they care for. Make yours a good difference. Delivering extraordinary care to our children can change lives, helping them grow up to be healthy and successful adults who can protect the next generation of youth around the world.

Sources
1. Universal Children’s Day. Available at: http://www.un.org/en/events/childrenday/. Accessed October 15, 2015.
2. CMS may use new child HCAHPS to adjust Medicaid hospital pay. Available at: http://www.modernhealthcare.com/article/20150108/NEWS/301089948. Accessed October 15, 2015.

Martie L. Moore is chief nursing officer of Medline Industries, Inc. based in Mundelein, Ill, a leading provider of medical products and clinical solutions across the continuum of care. In this role, Moore provides nursing leadership for solution-driven clinical programs, delivers product development to enhance bedside practice and launches quality initiatives across the continuum of care. With what she learned during the nearly 30 years of clinical experience and extensive executive leadership, Moore now develops forward-thinking solutions and programs for those in the field today.

Tags:  HCAHPS  Hospital  patient experience  patient safety  pediatric 

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