Module 1: Patient/Family Partnership

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The focus of this module is to explore patient/family centered care and how it links to incident analysis and management to will help to make care safer. Guest speakers and patient representatives will highlight what the patient needs are at different points during the incident analysis and management process. During small group discussions, participants will tap in to their own experiences and apply the “Checklist for Effective Meetings with Patients/ Families”.

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Module 1: Patient/Family Partnership

  1. 1. Incident Analysis Learning ProgramModule OnePatient/Family PartnershipThursday, November 8, 2012
  2. 2. WelcomeSandi Kossey Ioana Popescu Carrie-Lynn Haines Tina Cullimore
  3. 3. The Virtual Classroom Be prepared to use: - Chat - Pen - Raise Hand - Other 39-Nov-12 3
  4. 4. Where are you from? Use to place your name on the map International: (type here)
  5. 5. About You0 Familiarity with incident analysis / management 100 Familiarity with the Canadian Incident Analysis Framework 10
  6. 6. Agenda1. Invited guests will share how they were included in the incident analysis & management process - highlighting the overall outcome of their lived experience.2. Theory - practice leader/knowledge expert.3. Facilitated discussion and virtual group exercise.
  7. 7. Learning ObjectivesThe knowledge elements include an understandingof the following:• What is patient engagement?• What are the expectations of patients/families following an unexpected situation?• Why is patient/family involvement an important part of incident analysis and making care safer?
  8. 8. Learning ObjectivesThe performance elements include the ability to:• Use the checklist to plan a meeting with patients/ families .• Describe ways in which patients/families can partner in the incident analysis process in order to build trusting relationships.
  9. 9. Sections of the Canadian Incident Analysis Frameworkwere written by a group of patients and families,members of Patients for Patient Safety Canada (PFPSC).These sections provide the basis for this module, thus,the content is delivered from their perspective.It is the voice of the patient/family.
  10. 10. Canadian Incident Analysis Framework Sections: • Claire‟s story (John Lewis) (p. 5) • 1.4 Incident analysis and management from a patient/family perspective (p. 14) • Appendix F – Checklist for Effective Meetings with Patient(s)/Families (p. 87)“Patients and families have important insights,information and experiences to share. There are manydifferent ways that we can help. We are patients andfamilies. We are committed partners in the safetyand quality of our care.”
  11. 11. Patient / Family Partnerships inIncidents and Incident Analysis Patient / Family Partnerships in Incident Analysis & Management Raeline McGrath Sharon Nettleton
  12. 12. Patient/Family PartnershipThe Lived Experience – Claire’s Story Raeline McGrath
  13. 13. Claire’s StoryTo nurses, doctors and health care professionalswho give their all each day to improve and savelives, and who feel humbled and privileged to bepart of life and death, but most of all to Claire.
  14. 14. A lifetime of happiness -that is our wish
  15. 15. ChallengesSeptember 2006 - 12° October 2007 - 46°
  16. 16. The Big Day! Feb 27, 2008 - PICU Day 1• Transferred to the PICU after surgery …peaceful, settled, chest sounds good, Dad playing with and fixing Claire, child awoke…• Successful posterior fossa decompression• Intensivist and neurosurgeons are pleased… Perfect!
  17. 17. “It Is Time” March 14, 2008 - PICU Day 16• Oscillator withdrawn and placed on conventional mode of ventilation at 10:10.• Claire died 50 minutes later at 11:00. “Catastrophe” …devastation - us and the PICU
  18. 18. Claire was gone… Now what?• Devastation, desperation, a parent‟s guilt• Return to nursing in the same division in which Claire died – no book to guide me or the organization• After the dust settled Confusion & questions Instinct and intuition Connecting the dots…duty to Claire
  19. 19. Incident Analysis Process• Preliminary file review – no findings• Parents pose questions – internal case review completed• External review - specialized area and parent an employee• Worst possible outcome…the edge of the cliff
  20. 20. Preventable Death…Claire’s picture is removed from the „Memory Wall‟ in the PICU…shock, anger, overwhelming for everyone
  21. 21. Important First Steps• Apology and disclosure to family first – unexpected and appreciated• Disclosure – candor and openness from reviewers and organization startling• Disclosure to staff and physicians immediately following• Action Plan developed to implement recommendations – given to us• Commitment made to family to keep them engaged in the implementation process… Silence from the PICU – devastating and antagonizing
  22. 22. Process Challenges Review shared with Family before staff from PICU Review read to everyone – no hard copy sharing pushback from PICU – indignation and denial no blame translates into no accountability…devastation, isolation, anger
  23. 23. Rewriting the Literature• New CEO arrives• A new attitude to disclosure, quality reviews, patient safety – not fearing our motives… relieved to move forward and to be included
  24. 24. What Works: CONNECT AND COMMIT• Families must be given the information necessary to identify what happened, how it happened, and what is being done to ensure that it doesn’t happen again.• Information to staff and families must be clear, factual, and above all, shared.• Honesty and openness are crucial.• Uniqueness of situations - flexibility.
  25. 25. What Works: CONNECT AND COMMIT• Ongoing discussions with program staff and physicians.• “Big Picture Thinking” - challenging the status quo.• Working together with the family is much better than working around them - inclusiveness.• Use of outside consultants for support and to effect change.
  26. 26. Follow-UpFamilies must feel and observe a commitment andacceptance of responsibility, accountability and ofsteps being taken to prevent a reoccurrence.
  27. 27. Theory Burst – Patient/Family Partnerships in Incident Analysis & ManagementSharon Nettleton
  28. 28. Patient Engagement• Thank you Raeline and so many other patients/families for staying engaged and for your work as partners in helping to make care safer.
  29. 29. Patient Engagement• What is it?• Why is it important?• Why is it even more important when unexpected things happen?
  30. 30. EngagementWhat is it?“ The feeling of being involved in a particular activity.” Macmillian Dictionary (English)
  31. 31. Patient Engagement What it feels like• I‟m able to share what I know, how I feel• Someone is listening to me• I‟m able to talk openly• Someone understands me• I‟m treated with respect• Someone cares about me• I‟m included in the team• I feel safe• I feel I have a partner(s) in my care
  32. 32. Patient Engagement• An exchange of ideas, experiences and expertise• Different perspectives / new thinking / other possibilities, actions and solutions• Innovations, improvements are possible
  33. 33. Patient Engagement A relationship between Person requiring health care (patient, client and/or family or loved one) ANDPerson(s) who can provide health care services (providers, clinicians, staff, administrators)
  34. 34. Patient Engagement When patients or family feel disengaged• Left out, isolated, betrayed• Unacknowledged, not listened to• Not respected• Unimportant• Knowledge or expertise wasn‟t valued• Not cared for• Not safe
  35. 35. Patient/Family Centred CareThe provider or health organization perspective: Dignity & respect Access to information Open communication Involved in decision-making
  36. 36. Patient Patient/FamilyEngagement Centred CareWhat it feels like to the What it feels like tothe patient/family the providerI feel heard I listenI feel understood I try and understandI feel cared for I show I careI am helped I provide helpI feel safe I provide safe care
  37. 37. Patient Patient/FamilyEngagement Centred CarePartnerships or relationships between the patient/family & care providers and principles of: Involvement Respect Honesty Trust Safety
  38. 38. Patient Engagement & IncidentsWhen unexpected things occur during our care,these principles are even more important: Involvement Respect Honesty Trust Safety Healing/Learning/Improving
  39. 39. Words and Actions MatterFrom OUR perspective…• We often see you (care providers) for only minutes at a time• But we remember our encounters (what you say, what you do, how you treat us, how you make us feel) it has a lasting impact
  40. 40. When Unexpected ThingsOccur Being unprepared Being (somewhat) prepared
  41. 41. When Something Unexpected OccursFirst minutes, first words, first actionsreally matter Often set the stage for everything that happens nextOngoing connection
  42. 42. Framework
  43. 43. When Something Unexpected OccursNormal Human Reactions • Surprise, shock • Guilt, feeling „let down‟ • Feeling frozen (not knowing what to say & how to act, who to turn to, what happens next) • Fear • Avoidance • Anger • Name, blame, shame • “Get past it”, “Move on” • Grief
  44. 44. When Something Unexpected OccursReflective & Emerging Questions • What happened? • How/why did it happen? • What (if anything) can be done to prevent this from happening again? • What happens next? Learning, improving, rebuilding trust & relationships, healing
  45. 45. When Something Unexpected Occurs1. Being (somewhat) prepared for the unexpected.2. Knowing immediately what to do. (Care & empathy for the patient/family AND the providers directly involved).3. Knowing where to access resources and people to help.
  46. 46. Framework
  47. 47. Three Essential Questions1. Who is going to look after the patient/family?2. Who is going to look after the providers/staff directly involved?3. Who is going to coordinate/be accountable for the management of the incident? This is engagement!
  48. 48. Immediate ResponseEngage with the Patient/Family• Immediate Care for the people directly involved (patient/family AND providers)• Assign people to Stay Connected to those directly involved (patient/family AND providers)
  49. 49. Framework
  50. 50. Preparing for AnalysisEngage with the Patient/Family• Inquire and plan for patient/family involvement in the analysis process• Using the Checklist for Effective Meetings with Patients/Families (Appendix F, p.87)
  51. 51. Framework
  52. 52. Analysis ProcessEngage with the Patient/Family• Involve the patient/family• Begin with the patient/family perspective• Include a patient/family advisor(s) on the review team
  53. 53. Framework
  54. 54. Follow Through and Close the LoopEngage with the Patient/Family• Include (even begin) with the patient/family• Include as part of the team to re-establish trust, partnership/relationshipDemonstrates honesty, commitment, learning,improvement and helps with healing
  55. 55. When Something Unexpected HappensConnect with the people involved • Timely acknowledgement / empathy / apology • Caring about the people & relationship(s) • Includes patient/familyCommit to analysis • Includes patient/familyFollow-Up • Includes patient/family
  56. 56. Evaluating Patient Engagement• How are „we‟ engaging patients/families when incidents occur?• Ask us (patients/families) what else could be done.• Engage patients/families as advisors in helping to improve.
  57. 57. Evaluating the Incident Management ProcessWhat worked What needs improvement• Nurse‟s immediate response • Reaction of PICU (regret, empathy, apology) • Removal of Claire‟s picture from• Sharing of findings with family wall• Verbal report to family • No paper copy to family• Heartfelt apology, caring • Meeting with whole team• Opportunity to continue improvements Observations • Pushback from PICU • Leadership change • Communication & follow-up
  58. 58. Preparation Begins with Discussions & Sharing of ResourcesCanadian Incident Analysis Framework• Claire‟s Story (John Lewis)• Patient/Family Perspective• Checklist for Effective Meetings with Patients/FamiliesOther Resources• “Claire‟s Story” (Raeline McGrath) Canadian Nurse Oct. 2009 Vol. 105, No. 8• Beware the Grieving Warrier (Larry Hicock & John Lewis, 2004)• After Harm (Nancy Berlinger, 2005)• “Harm to Healing: Partnering with Patients Who Have Been Harmed” (Trew, Nettleton, Flemons) www.patientsafetyinstitute.ca• Canadian Disclosure Guidelines www.patientsafetyinstitute.ca• Literature on Patient Engagement, Grief, Healing & Forgiveness• Policies/Procedures/Practices within your own organization, other organizations
  59. 59. A Safety CultureIn healthcare settings where there is a safety culture,the people (providers, staff, administrators ANDpatients/families) are engaged, encouraged andsupported to make care safer.
  60. 60. Patient/Family Partnerships inIncident Analysis & Management –A Provider’s ExperiencePaula Beard
  61. 61. Partnering with Patients and Families• Involving patients/families in incident analysis• Engaging with patients/families as members of analysis teams• Practical examples of ways to involve patients and families in analysis
  62. 62. Applied Learning
  63. 63. Breakout Session1. The technical host has randomly assigned half of the participants to a breakout room2. If prompted, click YES to both popup screens to join
  64. 64. Learning ObjectivesPerformance ElementUse the checklist to plan a meeting withpatients/families.
  65. 65. The checklist has been developed to help preparehealthcare leaders and providers for meetings withpatients/families when a patient safety incident is beingdiscussed.The most important attributes that leaders and providerscan bring to these meetings are compassion, a willingnessto listen and understand, and the ability to be supportive.
  66. 66. •Virtual Group Exercise – ChecklistReview the “Checklist for Effective Meetings with Patient(s)/Families” on page 87 of the Canadian Incident Analysis Framework.* What are some of the barriers and enablers to meeting with patients and families?* What are some strategies to overcome the identified barriers?
  67. 67. Learning ObjectivesPerformance ElementDescribe ways in which patients/familiescan partner in this process in order to buildtrusting relationships.
  68. 68. Virtual Group Exercise – Gap AnalysisWhat would your preferred future state look like in relation tokey steps in the Canadian Incident Analysis Framework,specifically:* What are we doing well?* What do we need to improve?* What are our next steps?
  69. 69. Write a goal:“Tomorrow I/we will….”
  70. 70. Next Steps• Evaluation• Follow up surveyIncident Analysis Learning Program1. Patient/ family partnership – November 8, 20122. The essentials: principles, concepts and leading practices – November 29, 20123. Incident analysis as part of the incident management continuum – December 13, 20124. Comprehensive analysis – January 10, 20135. Concise analysis – January 31, 20136. Multi-incident analysis – February 21, 20137. Recommendations management – March 7, 20138. Follow-through and share what was learned – March 28, 2013
  71. 71. Additional CPSI Resources• “Harm to Healing: Partnering with Patients Who Have Been Harmed” (Trew, Nettleton, Flemons, 2012)• “Canadian Disclosure Guidelines: Being Open with Patients and Families” (2011)• Learning Opportunities – information about workshops, training, and learning sessions• Tools – a collection of documents, templates, guidelines, and examples www.patientsafetyinstitute.ca www.patientsforpatientsafety.ca
  72. 72. Thank you!Contact us at: analysis@cpsi-icsp.ca

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