ANCC National Magnet Conference Oct. 2010


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How facilitated conversations can improve compassionate patient and family centered care.
Bridge Mudge RN, MS, CNS-BC, Dartmouth-Hitchcock Medical Center, Lebanon, NH
Marjorie Stanzler, Senior Director of Programs, The Kenneth B. Schwartz Center, Boston, MA

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ANCC National Magnet Conference Oct. 2010

  1. 1. Professional Model of Care: Patient and Family-Centered Care Enhanced by Schwartz Center Rounds® C504 2010 ANCC National Magnet Conference® October 13, 2010 2:30 p.m. - 3:30 p.m. Bridget Mudge RN, MS, CNS-BC Dartmouth-Hitchcock Medical Center, Lebanon, NH Marjorie Stanzler, Senior Director of Programs The Kenneth B. Schwartz Center, Boston, MA
  2. 2. Objectives  State the value of facilitated conversations to express caregivers' thoughts and feelings about difficult situations  Apply an innovative model for improving compassionate patient and family-centered care
  3. 3. Dartmouth-Hitchcock Medical Center
  4. 4. Ken Schwartz  40-year-old father and husband from Boston, MA  Diagnosed with lung cancer, non-smoker  Died in September, 1995
  5. 5.  Published in Boston Globe Magazine July, 1995  Ken believed that his care represented the best that the system could offer: caregivers that are  Compassionate  Engaged  Willing and able to spend the necessary time  All patients should get the same quality of care  Financial pressures may take the humanity and empathy out of health care A Patient’s Story
  6. 6. “I’ve been touched by the smallest gestures – a squeeze of the hand, a gentle touch, a reassuring word. In some ways these quiet acts of humanity have felt more healing than the high-dose radiation and chemotherapy that hold the hope of a cure.” -Kenneth B. Schwartz A Patient’s Story
  7. 7.  Established in 1996 by family, friends, and caregivers to promote Ken’s vision  Provide a strong and active voice for promoting and preserving a healthcare system that values compassion and effective communication for every patient The Kenneth B. Schwartz Center
  8. 8. Relationships, “whole person” knowledge of patients and effective communication are associated with:  Improved clinical and functional status  Enhanced patient and physician satisfaction  Increased adherence to recommended treatments  Patient trust  Reduced malpractice claims Studies by Safran, Stewart, Novack, Beckman, and others Why are relationships and communication important?
  9. 9.  There are few opportunities for healthcare providers to enhance relationships, to learn the advanced communication skills needed in our complex healthcare environments, and to provide support for each other. The gap between need and opportunity
  10. 10.  To provide a forum and “level playing field” where caregivers from diverse disciplines discuss difficult emotional and social issues that arise in caring for patients  To explore the human and emotional side of clinical medicine – but with the focus on the patient-caregiver relationship rather than solely the patient Goals of the Schwartz Center Rounds
  11. 11.  Started at Mass General Hospital in Boston in 1997 as a pilot  Currently in nearly 200 sites in 31 states  Mostly hospitals, including 33 Magnet hospitals  Some nursing homes and outpatient practices  Schwartz Center responding to calls from all over the US  Targeting hospitals as part of strategic plan in specific geographic areas where we have “clusters” of Rounds hospitals  MA, ME, NH, VT, RI, CT, NY, NJ, PA, FL, MI, IL, DC area  National Cancer Institute (NCI) sites or (NCI) Community Cancer Center Program sites  Also targeting prestigious academic medical centers across the country  Piloting Rounds in 2 hospitals in the U.K. – 1st international site Expansion
  12. 12.  Buy-in from senior administration, senior physician and nursing leadership  Physician leader  Facilitator  Administrative support for logistics  Evaluations and quality control Key Features
  13. 13. Planning Committee at CHaD Pano Rodis, PhD; George Little, MD; Bridget Mudge, RN; Toni LaMonica, MSW; Patrick McCoy, Chaplain; Kyleigh Mercier, RN (not shown) Schwartz Center Rounds
  14. 14.  Multidisciplinary caregivers ( typically 8-10)  Publicize Rounds  Schedule and assign presentations for the year  Adjust presentation schedule with timely topics  Program evaluation  Budget planning Planning Committee
  15. 15.  Based on specific patient case  Panel of multidisciplinary caregivers describe their experience with patient (10-15 minutes)  Remainder of hour devoted to discussion among attendees  Share experiences, thoughts and feelings  Confidential, safe environment Rounds Format
  16. 16.  Healthcare professionals: physicians, nurses, social workers, psychologists, physical therapists, care managers  Hospital administrators, clergy  CHaD average attendance 40 (20-60 range)  National average 50 ( 20-100 + range) Rounds Participants
  17. 17.  Nurses  Residents  Security  Child Abuse Team  Social Workers  Physicians  Palliative Care  Chaplain  Nursing Ethics  Child Life Groups Assigned for Topic Selection
  18. 18.  Respect and Dignity  Information Sharing  Participation  Collaboration Source: Institute for Family-Centered Care 2010 Principles of Patient and Family- Centered Care
  19. 19.  Providing compassionate care when a family complains  Welcome to CHaD: When the unit doors are locked  My patient’s mom looks sick. Is it my job to ask about it?  Complex child with simple parents  Family centered care in child abuse Sample Topics
  20. 20.  Biting, swearing, screaming, and hitting: How do you provide compassionate care?  Separating twins: When a pre-adoptive family decides against adoption of a disabled twin  Staying overnight: How to provide safe but family centered care  Hurricane Katrina: Our reaction and lessons learned Sample Topics
  21. 21. “Provides a forum for all the disciplines to discuss some complex and often difficult cases. It’s great to get everyone’s different perspectives based on their professional discipline. It is a supportive place especially when dealing with morally and ethically complex topics.” “I especially appreciate the safe and confidential place to self disclose our feelings.” Testimonials from Dartmouth- Hitchcock Medical Center
  22. 22.  Getting nursing staff to the meetings  Confidentiality  Avoiding problem solving  Allowing discussion of emotions Challenges
  23. 23.  Building a Magnet® culture  Creating a culture change  Team building  Improve interdisciplinary communication  Increased insight into non-clinical aspects of care  Decreased stress Benefits
  24. 24. “Voices of Caregivers” Schwartz Center Rounds Video “Voices of Caregivers”
  25. 25. Hired outside firm to conduct comprehensive quantitative and qualitative evaluation After attending the Schwartz Center Rounds, do caregivers report:  Increased insight into the non-clinical aspects of patient care?  Improved teamwork?  Increased support?  Providing more compassionate care? Evaluation Questions
  26. 26. Evaluation Methods  Retrospective Study  Web-based survey of 256 providers at 6 experienced sites (Rounds ongoing > 3 years)  44 interviews with providers, Rounds leaders and facilitators, hospital administrators  Prospective pre-post study  Web-based surveys of 222 providers at 10 hospitals newly implementing Rounds (pre) and after > 7 Rounds (post)  Supplementary interviews
  27. 27. Slightly, somewhat or strongly agree:  87% new ideas/strategies for patient situations  84% more compassion for patients and families  86% more likely to consider effects of illness on personal life of patient  84% more energized about work with patients Caregivers report impact on patient care:
  28. 28. Some or a great deal of improvement in teamwork:  93% appreciation for the roles/contributions of colleagues from other disciplines  88% sense of belonging to a caregiving team  76% less alone in work with patients Caregivers report impact on teamwork:
  29. 29.  Caregivers in retrospective study reported feeling less stressed, better able to cope with non-clinical demands and less overwhelmed by emotions  For both new and experienced sites:  The more Rounds attended, the greater the impact  Attending with co-workers associated with greater improvement in teamwork Other Key Findings:
  30. 30. Approximately 50% of respondents observed changes in practices or policies within the department or in the hospital at large, as a result of Rounds discussions  Unique and profound contribution/changing culture  fills a hole in the clinical community  a philosophy that [Rounds set] the standard for care  Greater use of palliative care/new palliative care services  Change in nursing care in ICU Study subject of article published in Academic Medicine in June, 2010 Perceived institutional outcomes
  31. 31. "Rounds are a place where people…are willing to share…their vulnerability, to question themselves. Rounds are an opportunity for dialogue that doesn’t happen anywhere else in the hospital.” “There is more heart in what we do with patients…the connections are deeper, we are less afraid of difficult topics. Since we know there is support for us in the institution, we’re willing to take more risks.” In caregivers’ own words…
  32. 32. Bridget Mudge, RN, MS, CNS-BC Dartmouth-Hitchcock Medical Center, Lebanon, NH (603) 650-7029 Marjorie Stanzler, Senior Director of Programs The Kenneth B. Schwartz Center, Boston, MA (617) 726-0914 Professional Model of Care: Patient and Family-Centered Care Enhanced by Schwartz Center Rounds