Patient
Engagement:
The New Blockbuster Drug
2013 NHS Scotland Event
11 June to 12 June, 2013
Glasgow
Maureen Bisognano
Pr...
The New “Blockbuster” Drug
Patient Engagement
The New Blockbuster Drug
Large body of scientific literature on clinical inertia and
failure to intensi...
Patient Engagement
Moving from “what‟s the matter?” medicine
to “what matters to you?” medicine
– Susan Edgman-Levitan and...
How can we make
this move to “What
matters to you?”
Exercise
Read “Return of the Hero”
Discuss with your colleagues at your tables.
Talk about and make a plan to visit a pati...
Patient Engagement Has the Potential to:
Improve health outcomes
Expand our definition of “the health care
workforce”
Lowe...
Lesson: Will-building
Will-building at the Senior Level
Colones‟ rounds
Walk of shame
O‟Brien‟s breakfast meeting
Transpar...
Will-building
Ginny‟s Story:
http://www.youtube.com/watch?v=
s5x1f3_NJX8
Serious Safety Event Rate: One View
0.00
0.25
0.50
0.75
1.00 Jul-05
Aug-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
Mar-0...
John L.
4/27/2008
HAI
Baby C.
4/13/2008
Delay in Tx
Ralph H.
3/12/2008
Fall
Harold C.
8/5/2008
Fall
George P.
5/07/2008
Fa...
Patient and Family Engagement
An Alarming Disconnect
70 percent of Americans want to die at home…but 70
percent die in institutional settings1
80 percen...
Two Complementary Initiatives
Everyone‟s end-of-life wishes
will be expressed and
respected
Every one has a story to tell
...
The Conversation Project
A grassroots movement to encourage everyone to have
conversations about end-of-life wishes with l...
Early Enthusiasm
Over 86,000 visits to website
(theconversationproject.org)
Over 43,000 downloads of
the Conversation Star...
Conversation Ready
IHI initiative: 10 Pioneer organizations committed to
being “conversation ready” within one year
Requir...
Patient Engagement
Redesigned processes in acute care
New ways to think about teamwork
Lean Visits at ThedaCare
“Encircle Health”
– Anticipate and structures to meet all needs in
one visit
– Lab designed to ge...
Collaborative Care at ThedaCare
• Collaborative
rounding on your
admission
• Evidence-based
care
• The nurse as
manager of...
Minimally disruptive medicine
Health care delivery designed to
reduce the burden of treatment on
patients
while pursuing p...
Work of being a chronic patient
Sense-making work Organizing work and enrolling others
Doing the work Reflection, monitori...
5000
Hours
Source: Asch DA, et al. “Automated Hovering in Health Care – Watching Over the
5000 Hours.” New England Journal...
Medication Choice Cards
Other Cards
Low Blood Sugar
(hypoglycemia)
Blood Sugar
(A1c Reduction)
Side Effects
Daily Routine
...
Diabetes Visit Cards
Developed in England by the Design Council to
improve the effectiveness of chronic care visits
at phy...
Diabetes Visit Cards
Redesigning Care with Patients
Think:
– Dose
– Place
– Tempo
Dose
Better Health Greater Cleveland:
– In-person educational sessions for the community led by respected
clinicians; and ...
44 Pediatric GI Centers
Purpose of ImproveCareNow
Transform health, care and costs for all children
and adolescents with Crohn’s and ulcerative co...
30%
40%
50%
60%
70%
80%
90%
04/01/2007n=132…
05/01/2007n=184…
06/01/2007n=255…
07/01/2007n=298…
08/01/2007n=353…
09/01/200...
How do you create network–based
production for health?
1. Focus on outcome
2. Build community
3. Effective use of technolo...
Place
George Halvorson‟s 4 sites of care:
– Hospital beds
– Face-to-face
– Home
– Electronic
Place
Source: Landro L. “Hospitals Try House Calls to Cut Costs, Admissions.” The Wall Street Journal. Feb. 4, 2013. Avail...
Place – New Health Communities
NORCs (Naturally Occurring Retirement
Communities)
– Strong trend in the US for better elde...
Place – Schools (site visit)
NHS Tayside and Perth & Kinross Council:
– Developing improvement methods by working across
a...
Tempo
Moving from “2 per year” to “2 per week”
“A year of care”
Technology and MIT‟s “15 minutes a
quarter”
Dose, Place, and Tempo: Self-Dialysis
The Old Way
Ryhov Hospital in Jönköping had traditional hemodialysis
and peritoneal ...
The New Way
Christian taught a 73-yr-old woman how to do it…
…and they started to teach others how to do it.
The New Way
Now they aim to have 75% of patients to be on
self-dialysis
They currently have 60% of patients
Lessons to Date
From Christian (patient):
– “I have a new definition of health.”
– “I want to live a full life. I have mor...
Lessons to Date
From Anette (nurse leader):
– Surprised at design differences between
patients, family, and staff
– Managi...
Update
Now calculated costs at 50% of costs in other
hemo-dialysis units
Complications dramatically reduced and
subsequent...
Jonkoping Visit, October 2011
In 3 Years, Our Model of Care Will Be:
Assisted
HD
Home HD
Self care
on HD
We believe that a culture of
Sharing the care o...
Exercise
At your tables, brainstorm 5 things patients and
families can do for themselves…
…to get better outcomes
…to get ...
Thank You!
Maureen Bisognano
President and CEO
Institute for Healthcare Improvement
20 University Road, 7th Floor
Cambridg...
Parallel Session: Engaging Patients: The New Blockbuster Drug
Parallel Session: Engaging Patients: The New Blockbuster Drug
Parallel Session: Engaging Patients: The New Blockbuster Drug
Parallel Session: Engaging Patients: The New Blockbuster Drug
Parallel Session: Engaging Patients: The New Blockbuster Drug
Parallel Session: Engaging Patients: The New Blockbuster Drug
Upcoming SlideShare
Loading in …5
×

Parallel Session: Engaging Patients: The New Blockbuster Drug

5,096 views

Published on

In this session, Maureen Bisognano, President and CEO of the Institute for Healthcare Improvement (IHI), shares the latest tools to engage patients and families in the care system. Many are calling person-centred care/patient engagement ‘the next blockbuster drug’ because of its powerful potential to produce the best outcomes while learning best practices.

See more on the 2013 NHSScotland Event website http://www.nhsscotlandevent.com/resources/resources2013/resources

Published in: Health & Medicine, Business
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
5,096
On SlideShare
0
From Embeds
0
Number of Embeds
3,037
Actions
Shares
0
Downloads
74
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide
  • Use data and stories equally to build willCan we take the trend line out?
  • Kinds of patient work according to the normalization process theory approach we are using to understand patient work (see more on this theory at http://normalizationprocess.org – we are currently conducting patient interviews and review of consultations to further understand this domain and develop a psychometrically sound measure of treatment burden.
  • This slide shows the impact on the rate of remission among the first 15 teams to join the network. This is an annotated control chart showing, on the Y-axis, the % of patients in remission. Time is on the X-axis. The various interventions are noted on the slide. These data are from last August when the rate of remission reached about 73%. We are now up to about 77%.How are they doing it – sharing. Sharing data, know how and knowledge
  • Parallel Session: Engaging Patients: The New Blockbuster Drug

    1. 1. Patient Engagement: The New Blockbuster Drug 2013 NHS Scotland Event 11 June to 12 June, 2013 Glasgow Maureen Bisognano President and CEO
    2. 2. The New “Blockbuster” Drug
    3. 3. Patient Engagement The New Blockbuster Drug Large body of scientific literature on clinical inertia and failure to intensify treatment, especially in diabetes and hypertension management Label patients who can‟t or don‟t manage all as “non compliant” No research of de-intensification of unnecessary, ineffective treatment
    4. 4. Patient Engagement Moving from “what‟s the matter?” medicine to “what matters to you?” medicine – Susan Edgman-Levitan and Michael Barry The patient is the team captain; the clinicians are the team‟s coaches – Fred Southwick
    5. 5. How can we make this move to “What matters to you?”
    6. 6. Exercise Read “Return of the Hero” Discuss with your colleagues at your tables. Talk about and make a plan to visit a patient person, without any medical equipment, and learn who they are and what they hope for.
    7. 7. Patient Engagement Has the Potential to: Improve health outcomes Expand our definition of “the health care workforce” Lower costs Improve patient satisfaction
    8. 8. Lesson: Will-building Will-building at the Senior Level Colones‟ rounds Walk of shame O‟Brien‟s breakfast meeting Transparency Sharp end knowledge
    9. 9. Will-building Ginny‟s Story: http://www.youtube.com/watch?v= s5x1f3_NJX8
    10. 10. Serious Safety Event Rate: One View 0.00 0.25 0.50 0.75 1.00 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 EventRate 0 1 2 3 4 5 6 7 8 9 10 NumberofEvents Rolling 12-month Serious Safety Events expressed per 10,000 adjusted patient days SSER August 2008: 0.41 Average Days between events: 14 days (CY08 Sept YTD) 19 days (CY07) 37 days (CY06) Safety Behavior Training Begins Employee Training Ends Medical Staff Training Ends
    11. 11. John L. 4/27/2008 HAI Baby C. 4/13/2008 Delay in Tx Ralph H. 3/12/2008 Fall Harold C. 8/5/2008 Fall George P. 5/07/2008 Fall Roberta A. 10/13/2008 Fall Tom D. 1/29/08 Delay in Tx Tammy F. 1/17/2008 Post Procedure Death Jaunita D. 8/25/2008 Fall Baby D. 8/1/2008 Wrong Pt. Procedure Donald C. 6/26/2008 Delay in Tx James A. 9/06/2008 Delay in Dx Frank H. 6/03/2008 Delay in Tx Joe E. 9/23/2008 Wrong Site Surgery Johnny R. 9/08/2008 Delay in Dx. Another View of the Same Data for the Last 3 Months Herman D. 3/17/2008 Retained Foreign Obj. Mark G. 8/17/2008 Fall John G. 1/03/2008 Delay in Tx Nick S. 1/4/2008 Delay in Dx
    12. 12. Patient and Family Engagement
    13. 13. An Alarming Disconnect 70 percent of Americans want to die at home…but 70 percent die in institutional settings1 80 percent of Californians want to speak to a doctor about end-of-life wishes…but only 7 percent have done so2 82 percent of Californians say it‟s important to put their wishes in writing…but only 23 percent have done so2 1CDC. Worktable 309: deaths by place of death, age, race, and sex: United States, 2005. 2California HealthCare Foundation. Final chapter: Californians‟ attitudes and experiences with death and dying. CHCF, 2012.
    14. 14. Two Complementary Initiatives Everyone‟s end-of-life wishes will be expressed and respected Every one has a story to tell The conversations are personal, not medical The power of storytelling Develop a culture of shared decision making with patients Improve processes to reliably prompt, store, and access end-of-life care wishes http://theconversationproject.org/ http://www.ihi.org/offerings/Initiatives/C onversationProject/Pages/Conversation Ready.aspx
    15. 15. The Conversation Project A grassroots movement to encourage everyone to have conversations about end-of-life wishes with loved ones “at the kitchen table” Bringing about change “from the outside in” Leveraging media, including social media, to bring messages and tools to all Targeting specific geographic regions and segments of the population
    16. 16. Early Enthusiasm Over 86,000 visits to website (theconversationproject.org) Over 43,000 downloads of the Conversation Starter Kit (also available in Spanish)
    17. 17. Conversation Ready IHI initiative: 10 Pioneer organizations committed to being “conversation ready” within one year Requires a new perspective – moving beyond the current “rescue culture” of US health care Leveraging the lessons of exemplar organizations such as Gundersen-Lutheran in La Crosse, WI, and Dana- Farber Cancer Institute in Boston, MA
    18. 18. Patient Engagement Redesigned processes in acute care New ways to think about teamwork
    19. 19. Lean Visits at ThedaCare “Encircle Health” – Anticipate and structures to meet all needs in one visit – Lab designed to get results to patient record within 15 minutes – Patients leave with one plan, all results
    20. 20. Collaborative Care at ThedaCare • Collaborative rounding on your admission • Evidence-based care • The nurse as manager of care • Electronic Records • Design of physical space
    21. 21. Minimally disruptive medicine Health care delivery designed to reduce the burden of treatment on patients while pursuing patient goals
    22. 22. Work of being a chronic patient Sense-making work Organizing work and enrolling others Doing the work Reflection, monitoring, appraisal
    23. 23. 5000 Hours Source: Asch DA, et al. “Automated Hovering in Health Care – Watching Over the 5000 Hours.” New England Journal of Medicine. July 2012: 367(1).
    24. 24. Medication Choice Cards Other Cards Low Blood Sugar (hypoglycemia) Blood Sugar (A1c Reduction) Side Effects Daily Routine Daily Sugar Testing
    25. 25. Diabetes Visit Cards Developed in England by the Design Council to improve the effectiveness of chronic care visits at physicians‟ offices The patient sorts the cards to select issues that form the agenda for the visit Satisfaction is improved and patients report more control of their disease
    26. 26. Diabetes Visit Cards
    27. 27. Redesigning Care with Patients Think: – Dose – Place – Tempo
    28. 28. Dose Better Health Greater Cleveland: – In-person educational sessions for the community led by respected clinicians; and digital education for clinicians, medical students, and residents Texas Medical Association: – County medical societies promoting Choosing WiselyTM recommendations to 47,000 physicians and medical students – State-wide patient campaign – Collaborative to share best practices for implementation American Society of Echocardiology, MA Medical Society, and American Society of Nuclear Cardiology – Apps to allow for easy search for criteria – Websites for patients and clinicians to use in shared decision making
    29. 29. 44 Pediatric GI Centers
    30. 30. Purpose of ImproveCareNow Transform health, care and costs for all children and adolescents with Crohn’s and ulcerative colitis sustainable collaborative chronic care network, enabling patients, families, clinicians and researchers to work together in a learning health care system accelerate innovation, discovery and the application of new knowledge
    31. 31. 30% 40% 50% 60% 70% 80% 90% 04/01/2007n=132… 05/01/2007n=184… 06/01/2007n=255… 07/01/2007n=298… 08/01/2007n=353… 09/01/2007n=383… 10/01/2007n=411… 11/01/2007n=436… 12/01/2007n=459… 01/01/2008n=488… 02/01/2008n=495… 03/01/2008n=513… 04/01/2008n=516… 05/01/2008n=526… 06/01/2008n=522… 07/01/2008n=541… 08/01/2008n=570… 09/01/2008n=595… 10/01/2008n=631… 11/01/2008n=657… 12/01/2008n=718… 01/01/2009n=772… 02/01/2009n=785… 03/01/2009n=797… 04/01/2009n=821… 05/01/2009n=840… 06/01/2009n=891… 07/01/2009n=920… 08/01/2009n=945… 09/01/2009n=961… 10/01/2009n=970… 11/01/2009n=978… 12/01/2009n=996… 01/01/2010n=1009… 02/01/2010n=1002… 03/01/2010n=1025… 04/01/2010n=1041… 05/01/2010n=1050… 06/01/2010n=1068… 07/01/2010n=1090… 08/01/2010n=1126… 09/01/2010n=1153… 10/01/2010n=1187… 11/01/2010n=1613… 12/01/2010n=1687… 01/01/2011n=1728… 02/01/2011n=1791… 03/01/2011n=1857… 04/01/2011n=1963… 05/01/2011n=2019… 06/01/2011n=2137… 07/01/2011n=2168… 08/01/2011n=2239… 09/01/2011n=2269… 10/01/2011n=2328… 11/01/2011n=2360… 12/01/2011n=2427… 01/01/2012n=2490… 02/01/2012n=2537… 03/01/2012n=2566… 04/01/2012n=2587… 05/01/2012n=2612… 06/01/2012n=2769… 07/01/2012n=2759… 08/01/2012n=2849… 09/01/2012n=2808… % of Patients in Remission 18 care centers with > 75% of patients in registry
    32. 32. How do you create network–based production for health? 1. Focus on outcome 2. Build community 3. Effective use of technology 4. Learning system System science, QI, qualitative research, clinical research
    33. 33. Place George Halvorson‟s 4 sites of care: – Hospital beds – Face-to-face – Home – Electronic
    34. 34. Place Source: Landro L. “Hospitals Try House Calls to Cut Costs, Admissions.” The Wall Street Journal. Feb. 4, 2013. Available at: http://online.wsj.com/article/SB10001424127887324610504578278102547802848.html
    35. 35. Place – New Health Communities NORCs (Naturally Occurring Retirement Communities) – Strong trend in the US for better elder communities combines with a trend toward self care and decreased confidence in the unquestioned authority of the medical system
    36. 36. Place – Schools (site visit) NHS Tayside and Perth & Kinross Council: – Developing improvement methods by working across a wider community campus model – Designing a „strategic coalition‟ across the public sector, the voluntary sector and communities. – Almondbank House: outcome-focused improvements which have been delivered in partnership with traditionally hard-to-reach families
    37. 37. Tempo Moving from “2 per year” to “2 per week” “A year of care” Technology and MIT‟s “15 minutes a quarter”
    38. 38. Dose, Place, and Tempo: Self-Dialysis The Old Way Ryhov Hospital in Jönköping had traditional hemodialysis and peritoneal dialysis center. But in 2005, a patient, Christian, asked about doing it himself.
    39. 39. The New Way Christian taught a 73-yr-old woman how to do it… …and they started to teach others how to do it.
    40. 40. The New Way Now they aim to have 75% of patients to be on self-dialysis They currently have 60% of patients
    41. 41. Lessons to Date From Christian (patient): – “I have a new definition of health.” – “I want to live a full life. I have more energy and am complete.” – “I learned and I taught the person next to me, and next to her. The oldest patient on self-dialysis is 83 years old.” – “Of course the care is safer in my hands.”
    42. 42. Lessons to Date From Anette (nurse leader): – Surprised at design differences between patients, family, and staff – Managing at 1/2 – 1/3 less cost per patient – Evidence of better outcomes, lower costs, far fewer complications and infections – “We brought in the county‟s employment, helped the patients make or update the CVs, and trained them for a new career.”
    43. 43. Update Now calculated costs at 50% of costs in other hemo-dialysis units Complications dramatically reduced and subsequent expensive care avoided Measuring success by “number of patients working”
    44. 44. Jonkoping Visit, October 2011
    45. 45. In 3 Years, Our Model of Care Will Be: Assisted HD Home HD Self care on HD We believe that a culture of Sharing the care on Haemodialysis is the foundation for Self care on dialysis units. • We plan to initiate shared haemodialysis care in dialysis centres across Yorkshire and Humber. • We will to this by – – Setting up a course to teach dialysis nurses how to support patient to learn aspects of their own dialysis. – Supporting willing patients to learn as much of their own dialysis as they wish to.
    46. 46. Exercise At your tables, brainstorm 5 things patients and families can do for themselves… …to get better outcomes …to get better self-efficacy …to lower health care costs
    47. 47. Thank You! Maureen Bisognano President and CEO Institute for Healthcare Improvement 20 University Road, 7th Floor Cambridge, MA mbisognano@ihi.org

    ×