The Patient Journey
The Guided CarePath, as part of a multi-modal strategy, helps create a
single streamlined patient expe...
Guided CarePath

Smart
Checklists for
Patients

Delivered online
and available 24/7
from home
Patient & Family Education:
A Multi-Modal Approach to
Improve the Experience

Jack Davis, MSN, RN, ONC
Manager, Patient Ed...
HSS background
• Musculoskeletal
Specialty hospital
est 1863
• No. 1 ranking
orthopaedics
• Magnet Recognition
• Academic ...
Conflict of Interest
• No financial affiliation with products
discussed
• My current role as Manager Pt
Education Programs...
Objectives
• Describe methods used to educate
orthopaedic patients and families
across the continuum
• Recognize factors t...
Poll Question #1
• Do you routinely use a preop
education class to teach patients?
1. Yes
2. No

RS Laskin MD
Educational Methods &
Strategies
–
–
–
–
–
–

Preop class group learning
Written materials
Web-based
Individual learning
U...
Poll Question #2
• Do you routinely use internet or web based technology to teach patients?
1. Yes
2. No

RS Laskin MD
Organization’s Culture
• Identify models or theoretical frameworks
– Transpersonal Caring
– Relationship Centered Care
– P...
Poll Question #3
• Do you routinely include family in the
education of patients?
1. Yes
2. No

RS Laskin MD
What metrics are used to
evaluate the education
experience?
–
–
–
–
–
–

Volume stats
Cost to educate
Outcomes associated?...
Hospital Consumer Assessment of
Healthcare Providers and Systems
(HCAHPS)
• Publicly reported survey of patients’
percepti...
Poll Question #4
• Are you modifying teaching
strategies to improve HCAHPS
scores?
1. Yes
2. No

RS Laskin MD
Is the education of
Patient/Family relevant?
Patient education is critical to
helping patients successfully cope
with and ...
Is education relevant to
the organization?
• Sets expectations for experience
– Nursing & MD Care
• Courtesy, listen, teac...
So is preop class best
practice?
• Pre-op program shows mixed results
– Anxiety, LOS, Pain, Expectations

• Joint Commissi...
Patient Education Framework
• Provide health information
• Facilitate knowledge & understanding
• Engage patients to take ...
Patient Education
“ …is more than just having the nurse
review discharge instructions prior to
leaving the hospital, it is...
Increased responsibility to
educate the patient’s family
members and caregivers d/t
shorter hospital stays and
earlier tra...
Is there a best or most
effective method to teach
orthopaedic patients?
•
•
•
•

Combined teaching strategies
Repeated/rei...
Transpersonal Caring
•
•
•
•

Watson’s 10 Carative Factors
Deep caring spiritual connection
Provides comfort & Pain contro...
Watson’s 7th Carative
Factor…
• Promotion of transpersonal teachinglearning
– Interpersonal approach nurse to patient
and ...
Relationship Centered Care
Respectful of and responsive to
individual patient preferences, needs
and values and ensuring t...
Healing Relationships
• A two-way sharing of info patient &
provider
• Explore values & preferences
• Help patient & famil...
Similar to self-management
• Model used in chronic disease
• Problem solving and decision making
• Patients engage in dail...
Poll Question #5
• Do you routinely use Clinical
guidelines or pathways?
1. Yes
2. No

RS Laskin MD
Patient & Family Centered
Care
• More popular approach
• Patient & Family Partnership
• Supports family presence and
parti...
Outcomes?
• Better adherence to medications
• Improved disease management,
problem solving and decision making
• Improve s...
Transitional Care
• Ensure health care continuity
• Avoid preventable poor outcomes
• Promote safe and timely transfer
– O...
Helps identify the best
time to teach
• Before surgery
• Access to information after consults?
• During the hospital when ...
Orthopaedic Transitions
•Out Patient office
consult
•Operating Room
•Post op follow up

•Primary care
•Internist
•Anesthes...
Transitional Care
Interventions
•
•
•
•
•

Discharge planning
Patient and family teaching
Home visits
Calls or surveys aft...
Magnet Model of Nursing
Excellence
•
•
•
•
•
•

Nurse as teacher concept
Patient education program
Interdisciplinary team ...
Interdisciplinary Patient/Family Centered Education Committee
Revise content
Condition & process

Office practice
Service ...
A Challenge
Research shows that patients
remember and understand less than
half of what clinicians explain to them.

(Ley,...
Barriers to learning
•
•
•
•
•

Patient health status
Medications
Anxiety
Teaching environment
Learning styles

RS Laskin ...
Individualistic learning &
retention
•
•
•
•
•
•

10% of what is read
26% of what is heard
30% of what is seen
50% of what...
Engagement and
Evaluation of Learning
•
•
•
•
•
•

Is content provided?
Is it effective?
Knowledge gained?
Ability to mana...
Teach-Back: Closing the Loop

Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bin...
Teach-back – Using it Well:
Elements of Competence
●
●
●
●

Responsibility is on the provider.
Use a caring tone of voice ...
Even if teaching is good,
will it influence behavior?
Education occurs if learning takes place
with a resultant change in ...
Providers should understand
learning principles
• Active involvement
• Readiness to learn
• Conducive
environment
• Percei...
Ortho Patient Education
Best Practice Summary
• Multi-modal approach
• Reinforced across practice settings
• Pre-op to dis...
Identify & link to models
•
•
•
•
•
•

Transpersonal Caring
Relationship Centered Care
Patient & Family Centered Care
Tran...
More than the preop class
• It is about the nurse-patient
relationship
• It is about how we include the family
and convey ...
Improving the experience
•
•
•
•
•
•

Monitor HCAHPS & other metrics?
Feed form focus groups?
Engage the participants in p...
Educational Methods &
Strategies case study
–
–
–
–
–
–

Written materials
Web-based
Classroom group learning
Individual l...
Thank you!

Questions?
Jack Davis, MSN, RN, ONC
Manager, Patient Education Programs
Hospital for Special Surgery
davisj@hs...
References
•
•
•

•

•

ANCC Commission on Magnet Recognition. (2008). Application
manual magnet recognition program (2008...
The Patient Journey
The Guided CarePath, as part of a multi-modal strategy, helps create a
single streamlined patient expe...
Guided CarePath

Smart
Checklists for
Patients

Delivered online
and available 24/7
from home
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Patient & Family Education: A Multi-modal approach to improve the experience

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This session will describe educational concepts to enhance the orthopaedic patient experience. The elective nature of orthopedic surgery creates an opportunity to intervene with patients and family early and often throughout the episode of care. Multimodal teaching strategies (individual, group learning, written materials and web based tools) delivered prior to surgery and reinforced multiple times across care transitions can reduce anxiety, increase satisfaction, improve ability to manage pain and help patients feel more prepared for surgery.

Improving the patient experience is increasingly important as quality and satisfaction metrics are becoming linked to reimbursement. Transitional care interventions, such as discharge planning, follow up calls with emphasis on participation in self care have shown to improve continuity of care, reduce readmissions and prevent poor health outcomes.

About the Speaker:
Jack Davis MSN, RN, ONC is the Manager of Patient Education Programs at Hospital for Special Surgery in NYC. Jack has over 30 years experience in orthopaedic nursing. He has been an active member of the National Association of Orthopaedic Nurses (NAON) since 1991. Jack currently serves as Director of the Orthopaedic Nurses Certification Board (ONCB). He is passionate about preparing patients and family for surgery and seeks to improve nursing practice through research, promoting specialty certification and nursing continuing education.

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Patient & Family Education: A Multi-modal approach to improve the experience

  1. 1. The Patient Journey The Guided CarePath, as part of a multi-modal strategy, helps create a single streamlined patient experience through the entire journey of a total joint replacement.
  2. 2. Guided CarePath Smart Checklists for Patients Delivered online and available 24/7 from home
  3. 3. Patient & Family Education: A Multi-Modal Approach to Improve the Experience Jack Davis, MSN, RN, ONC Manager, Patient Education Programs Hospital for Special Surgery
  4. 4. HSS background • Musculoskeletal Specialty hospital est 1863 • No. 1 ranking orthopaedics • Magnet Recognition • Academic center • Research division RS Laskin MD
  5. 5. Conflict of Interest • No financial affiliation with products discussed • My current role as Manager Pt Education Programs for HSS influences my views on the subject on which I am presenting RS Laskin MD
  6. 6. Objectives • Describe methods used to educate orthopaedic patients and families across the continuum • Recognize factors that may improve the “experience” RS Laskin MD
  7. 7. Poll Question #1 • Do you routinely use a preop education class to teach patients? 1. Yes 2. No RS Laskin MD
  8. 8. Educational Methods & Strategies – – – – – – Preop class group learning Written materials Web-based Individual learning Use of technology Dedicated educator(s) RS Laskin MD
  9. 9. Poll Question #2 • Do you routinely use internet or web based technology to teach patients? 1. Yes 2. No RS Laskin MD
  10. 10. Organization’s Culture • Identify models or theoretical frameworks – Transpersonal Caring – Relationship Centered Care – Patient and Family Centered Care – Transitional Care – Magnet Model for Nursing Excellence RS Laskin MD
  11. 11. Poll Question #3 • Do you routinely include family in the education of patients? 1. Yes 2. No RS Laskin MD
  12. 12. What metrics are used to evaluate the education experience? – – – – – – Volume stats Cost to educate Outcomes associated? Knowledge Satisfaction HCAHPS? RS Laskin MD
  13. 13. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) • Publicly reported survey of patients’ perceptions of hospital care • Satisfaction with the Experience • Failure to report=reduced reimbursement • HCAHPS performance linked to Value-Based Purchasing incentive payments RS Laskin MD
  14. 14. Poll Question #4 • Are you modifying teaching strategies to improve HCAHPS scores? 1. Yes 2. No RS Laskin MD
  15. 15. Is the education of Patient/Family relevant? Patient education is critical to helping patients successfully cope with and recover from orthopaedic conditions and surgery RS Laskin MD
  16. 16. Is education relevant to the organization? • Sets expectations for experience – Nursing & MD Care • Courtesy, listen, teach, respond • Manage pain, new meds, toileting – Environment • Clean, quiet • Discharge disposition and transitions RS Laskin MD
  17. 17. So is preop class best practice? • Pre-op program shows mixed results – Anxiety, LOS, Pain, Expectations • Joint Commission Disease Specific Care Certification – Formalized program that provides theory & skills to manage disease • AHRQ National Guideline Clearinghouse – Pre op education program = moderate LOE RS Laskin MD
  18. 18. Patient Education Framework • Provide health information • Facilitate knowledge & understanding • Engage patients to take an active role in care management • Effect physical and mental health outcomes RS Laskin MD
  19. 19. Patient Education “ …is more than just having the nurse review discharge instructions prior to leaving the hospital, it is a means for the nurse to assist the patient in the enhancement and expansion of his ability to provide effective self-care” (Bastable, 2006). RS Laskin MD
  20. 20. Increased responsibility to educate the patient’s family members and caregivers d/t shorter hospital stays and earlier transitions to home RS Laskin MD
  21. 21. Is there a best or most effective method to teach orthopaedic patients? • • • • Combined teaching strategies Repeated/reinforced three times Patient/Family engagement Grounded in multiple theory RS Laskin MD
  22. 22. Transpersonal Caring • • • • Watson’s 10 Carative Factors Deep caring spiritual connection Provides comfort & Pain control Well being, Wholenss & Healing (Gallagher-Lepak and Kubsch, 2007) RS Laskin MD
  23. 23. Watson’s 7th Carative Factor… • Promotion of transpersonal teachinglearning – Interpersonal approach nurse to patient and not information – Assess readiness to learn – Respect pre-existing knowledge – Understand feelings about content, goals/desired outcome (Gallagher-Lepak and Kubsch, 2007) RS Laskin MD
  24. 24. Relationship Centered Care Respectful of and responsive to individual patient preferences, needs and values and ensuring that patient & family values guide all clinical decisions (Epstein, Fiscella, Lesser & Stange, 2010) RS Laskin MD
  25. 25. Healing Relationships • A two-way sharing of info patient & provider • Explore values & preferences • Help patient & family make decisions • Facilitate appropriate care • Follow through with behavioral change RS Laskin MD
  26. 26. Similar to self-management • Model used in chronic disease • Problem solving and decision making • Patients engage in daily process to manage own care • Use family, health team & community to manage consequences of health conditions (Richard & Shea, 2011) RS Laskin MD
  27. 27. Poll Question #5 • Do you routinely use Clinical guidelines or pathways? 1. Yes 2. No RS Laskin MD
  28. 28. Patient & Family Centered Care • More popular approach • Patient & Family Partnership • Supports family presence and participation • Enhance access to information • Encourage shared decision-making • Promote safety & well being RS Laskin MD
  29. 29. Outcomes? • Better adherence to medications • Improved disease management, problem solving and decision making • Improve self-efficacy and ability to navigate health system RS Laskin MD
  30. 30. Transitional Care • Ensure health care continuity • Avoid preventable poor outcomes • Promote safe and timely transfer – One level of care to another – One type of setting to another (Naylor et al. 2011) RS Laskin MD
  31. 31. Helps identify the best time to teach • Before surgery • Access to information after consults? • During the hospital when taking medications? • Reminders sent after discharge? • Across all transitions of care? • Who is the target audience? RS Laskin MD
  32. 32. Orthopaedic Transitions •Out Patient office consult •Operating Room •Post op follow up •Primary care •Internist •Anesthesia •Other Consultant Surgical Service Post Surgery •PACU •In-patient •Home •Rehab Medical Service Pre Surgery •Patient Education •Admission •Nutrition •Holding RS Laskin MD
  33. 33. Transitional Care Interventions • • • • • Discharge planning Patient and family teaching Home visits Calls or surveys after discharge Improve continuity of care & prevent readmission? (Coleman et al,2006) RS Laskin MD
  34. 34. Magnet Model of Nursing Excellence • • • • • • Nurse as teacher concept Patient education program Interdisciplinary team input Other members of team? Address diverse patient/family needs Communicates across the organization RS Laskin MD
  35. 35. Interdisciplinary Patient/Family Centered Education Committee Revise content Condition & process Office practice Service lines Written Classroom Patient Education Knowledge Outcomes retention Press Ganey Multimedia Web-based & other Interactive formats RS Laskin MD
  36. 36. A Challenge Research shows that patients remember and understand less than half of what clinicians explain to them. (Ley, 1988) RS Laskin MD
  37. 37. Barriers to learning • • • • • Patient health status Medications Anxiety Teaching environment Learning styles RS Laskin MD
  38. 38. Individualistic learning & retention • • • • • • 10% of what is read 26% of what is heard 30% of what is seen 50% of what is seen & heard 70% of what they say 90% of what say as do something (Felder & Silverman, 2002) RS Laskin MD
  39. 39. Engagement and Evaluation of Learning • • • • • • Is content provided? Is it effective? Knowledge gained? Ability to manage self care? How long is information retained? Target patient & family RS Laskin MD
  40. 40. Teach-Back: Closing the Loop Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman A. Closing the Loop Physician Communication With Diabetic Patients Who Have Low Health Literacy. Arch Intern Med/Vol 163, Jan 13, 2003 RS Laskin MD
  41. 41. Teach-back – Using it Well: Elements of Competence ● ● ● ● Responsibility is on the provider. Use a caring tone of voice & attitude. Use Plain Language. Ask patient to explain using their own words (not yes/no). ● Use for all important patient education, specific to the condition. ● Document use of & response to teach-back. RS Laskin MD
  42. 42. Even if teaching is good, will it influence behavior? Education occurs if learning takes place with a resultant change in behavior, skill or attitude. (Falvo, 1994) RS Laskin MD
  43. 43. Providers should understand learning principles • Active involvement • Readiness to learn • Conducive environment • Perceived relevance • Repetition • Generalize info • Pleasant experience • Begin with known topics to unknown • Present at appropriate rate (DeYoung, 2009) RS Laskin MD
  44. 44. Ortho Patient Education Best Practice Summary • Multi-modal approach • Reinforced across practice settings • Pre-op to discharge instructions & post-op calls • Nurses to use teaching principles and evidence-based strategies • Engage patients & family in the process RS Laskin MD
  45. 45. Identify & link to models • • • • • • Transpersonal Caring Relationship Centered Care Patient & Family Centered Care Transitional Care Magnet Model for Nursing Excellence Others? RS Laskin MD
  46. 46. More than the preop class • It is about the nurse-patient relationship • It is about how we include the family and convey messages • It is about assessing individual learning needs and styles • It is about reinforcing across transitions RS Laskin MD
  47. 47. Improving the experience • • • • • • Monitor HCAHPS & other metrics? Feed form focus groups? Engage the participants in process Make it convenient Expand access to info? Use technology? RS Laskin MD
  48. 48. Educational Methods & Strategies case study – – – – – – Written materials Web-based Classroom group learning Individual learning Use of technology www.hss.edu RS Laskin MD
  49. 49. Thank you! Questions? Jack Davis, MSN, RN, ONC Manager, Patient Education Programs Hospital for Special Surgery davisj@hss.edu RS Laskin MD
  50. 50. References • • • • • ANCC Commission on Magnet Recognition. (2008). Application manual magnet recognition program (2008th ed.) Bandura, A. (1977). Self-efficacy toward unifying theory of behavioral change. Psychological Review, 191-215. Kearney, M., Jennrich, M. K., Lyons, S., Robinson, R., & Berger, B. (2011). Effects of preoperative education on patient outcomes after joint replacement surgery. Orthopaedic Nursing / National Association of Orthopaedic Nurses, 30(6), 391-396 Epstein, R. M., Franks, P., Fiscella, K., Shields, C. G., Meldrum, S. C., Kravitz, R. L., et al. (2005). Measuring patient-centered communication in patient-physician consultations: Theoretical and practical issues. Social Science & Medicine (1982), 61(7), 15161528. Naylor, M. D. (2009). Transitional care model. Retrieved December 12, 2009, from www.transitionalcare.info RS Laskin MD
  51. 51. The Patient Journey The Guided CarePath, as part of a multi-modal strategy, helps create a single streamlined patient experience through the entire journey of a total joint replacement.
  52. 52. Guided CarePath Smart Checklists for Patients Delivered online and available 24/7 from home

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