Kaufman j (2008). Patients as partners


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Kaufman j (2008). Patients as partners

  1. 1. PATIENTS AS PARTNERS There’s growing recognition of the he concept of patients as partners in their own need to integrate patients and families into care planning and delivery. By Joanna Kaufman, RN, MS T care isn’t new. Adopting the guiding principle of “nothing about me without me,” participants at a 1998 Salzburg Seminar reached consensus that care would improve significantly if patients worked as full partners with health professionals to redesign and imple- ment change within the healthcare delivery system. InN i c h o l a s Wi l t o n March 2001, the Institute of Medicine (IOM) Committee on the Quality of Health Care in America published its land- mark report Crossing the Quality Chasm: A New Health Sys- tem for the 21st Century, which also called for fundamental change and redesign of the American healthcare system. The report provides specific direction for policymakers, healthcare leaders, clinicians, regulators, purchasers, and others, and defines six aims: Care should be safe, effective, patient-centered, timely, efficient, and equitable.1 Thanks to the Internet, consumers have equal access to the knowledge bases of medicine. Today, hospitals are increas- ingly recognizing the importance of moving away from the traditional medical model of care to more collaborative mod- els that integrate patients and families into healthcare’s plan- ning and delivery. In 2006 The Joint Commission published www.nursingmanagement.com Nursing Management August 2008 45
  2. 2. Patients as partnersPatients As Partners: How to Involve concepts: dignity and respect; infor- Hospitals balance the risk of dis-Patients and Families, and in 2007 mation sharing; participation; and closures of protected health informa-promulgated National Patient Safety collaboration. (See “Core concepts of tion against the improved quality ofGoals that require “the active in- patient- and family-centered care.”) care that emerges from patient andvolvement of patients and their fami- family participation in rounds. Theselies in the patient’s own care as a Examples from the individual level hospitals realize that informed andpatient safety strategy.”2 With growing understanding of engaged patients and families can be patient- and family-centered prac- allies in ensuring patient safety. TheLong-term commitment tices in care planning and decision concept of “nothing about me with-The new healthcare paradigm de- making, more and more hospitals are out me” truly becomes a realitymands fundamental changes and a inviting patient and family participa- when patients, their families, andredesign of the American health sys- tion in rounds. The key difference others on the healthcare team worktem to close the quality gap, as out- between family-centered rounds and together in the rounding process.lined in the IOM report. Partnership traditional bedside teaching is the Examples of ways to facilitaterequires an open relationship between active participation of the patient partnerships include online accessprofessional and patient. Advancing and family in the discussion. to shared care plans, allowingpatients to a level of partnership For 10 years, Children’s Hospital patients to collect all of their dataimplies that health providers have to of Philadelphia (CHOP) has included about providers and pharmaceuti-give up an amount of power and rec- family members as key members of cals in one place, and providing Nurse leaders committed to collaborating with families will tie patient- and family- centered care to other priorities, such as patient safety and quality improvement.ognize that their roles are evolving the interdisciplinary team; their par- physicians with all of their criticaland changing. This necessitates trans- ticipation in rounds isn’t only wel- information about specialists beingforming the organizational culture. come—it’s essential. Daily rounds seen and prescriptions being used. Patient- and family-centered care are one of many opportunities for the Planetree Hospitals have an openfosters mutually respectful partner- family to work directly with the chart policy that enables patients toships in which there’s open and hon- healthcare team to develop the most read and write in their medicalest communication. This approach optimally beneficial therapeutic plan records. In their self-medicationleads to an informed patient who for their child. Participation in program, Planetree patients whoassumes control of his or her care. rounds is one of the ways through are able can keep their medicationsThe practitioner, instead of imparting which family members can become at the bedside and assume responsi-facts and information to the patient knowledgeable about medications, bility for their administration.and family, engages in a dialogue treatments, and early signs of prob- The Medical College of Georgia hasand welcomes the patient’s active lems or changes in health status. received funding to initiate a patientinvolvement in decision making. Bedside rounds usually take place portal for their patients who haveOne expert described the true physi- outside the room; the parents are hypertension. Traditionally, patientcian/patient partnership as this: invited to join the team as they care documentation systems have“The patient provides the individual openly discuss the child’s condition been predominantly provider driven.information and the doctor the gen- and any concerns or questions from The shift is toward shared informa-eral information, and both are neces- family members or the patient. In tion systems with patients and fami-sary for effective management.”3 academic medical centers (such as lies that contain patient portals, which In a patient- and family-centered those affiliated with CHOP) where facilitates the ability to schedule theircare model, patients and families rounds have an important teaching own appointments, request prescrip-are viewed as essential allies and function, the active participation of tion refills, and review laboratory andtreated as true partners. Successful patients and families provides an X-ray reports and enhances partner-practice of patient- and family- opportunity to model effective com- ships with their healthcare providerscentered care is based on four core munication for students and trainees. by accessing information.46 August 2008 Nursing Management www.nursingmanagement.com
  3. 3. Susan Edgman-Levitan, a pioneer leader at the John Family Faculty participants offer students the opportunityStoeckle Center for Primary Care Innovations, Boston, to learn how patients and their families live with life-alter-Mass., stresses that patient- and family-centered care ing medical challenges and how their illness impacts theirdoesn’t mean forcing patients to make decisions or throw- daily lives.ing information at them, but rather working with patients Families have been part of physician education at theto ensure that they understand the information they University of Vermont College of Medicine since 1985.receive and how to use it, and educating them on their Born out of the need to ensure that all individuals receiverights and responsibilities as patients. Patient-centered care care that’s respectful, compassionate, and empowering,means meeting people where they are and customizing families together with physicians designed the Medicalcare, with the hope that over time their confidence will Education Project. Each session, co-taught by Parent-to-increase and they’ll be better able and willing to make Parent staff, is required for all third-year medical studentsdecisions. during their pediatric clerkship.Examples from all levels SafetyPatient- and family-centered care involves true partner- Over the past decade, Dana-Farber Cancer Institute,ships with patients and families at all levels of care, not Boston, Mass., worked to create an organizational cultureonly involving them in decisions about their care. Patients that places a high priority on patient safety and on patient-and their families provide valuable insights to better plan and family-centered care. Dana-Farber currently has twoand deliver care, improve the experience of care, and eval- patient advisory councils: one for adult care and one foruate that care. Hospitals, clinics, and other healthcare pediatrics. Patients provide input on organizational poli-agencies that make an explicit commitment to patient- and cies, participate on search committees, and develop educa-family-centered care are increasing their efforts to partner tional programming for staff. Members of the councils alsowith patients and families in policy and program develop- sit on the Joint Committee on Quality Improvement andment, patient safety, quality improvement, healthcareredesign, professional education, facility design planning,and research and evaluation. Healthcare providers are ask-ing patients and families to serve on patient and familyadvisory councils and on committees, task forces, andproject teams. At the University of Washington Medical Center, Seat-tle, Wash., patients and families serve in a 1- to 2-yearposition working in partnership with staff, nurses, andphysicians as advisors in inpatient cancer, perinatal/neonatal ICU, rehabilitation, and the ED. Others serve onvarious committees, including Patient Safety, Patient andFamily Education, American Disabilities Act, Aesthetics,Customer Service and Satisfaction Integration, and theService League Board.EducationIncreased involvement of patients and families in fullpartnership with medical educators is a logical out-growth of changes in relationships between patientsand healthcare providers. Teaching family-centeredhealthcare is an important facet of medical education,and involving experienced patients and families aspartners in education brings a unique perspective.4 Students at the Medical College of Georgia have theopportunity to learn about issues related to caring forpatients with various medical conditions, chronic illnesses,and disabilities. The Family Faculty Program was devel-oped to share unique patient and family experiences toillustrate family-centered care concepts in an academic set-ting as well as within the families’ home environment.www.nursingmanagement.com 47
  4. 4. Patients as partners Core concepts of patient- and family-centered careRisk Management, a board-level com- ♦ Dignity and respect. Healthcare practitioners listen to and honor patient and familymittee that approves the Institute’s perspectives and choices. Patient and family knowledge, values, beliefs, and culturalquality improvement plan, evaluates backgrounds are incorporated into the planning and delivery of care.outcomes of quality improvement ♦ Information sharing. Healthcare practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful.activities, and reviews reports regard- Patients and families receive timely, complete, and accurate information in order toing sentinel events. effectively participate in care and decision making. The Patient Safety Rounds Pro- ♦ Participation. Patients and families are encouraged and supported in participating ingram began in 2001 when the risk care and decision making at the level they choose.manager and other staff members ♦ Collaboration. Patients and families are also included on an institution-wide basis.made rounds in clinical areas to Healthcare leaders collaborate with patients and families in policy and program devel-obtain staff input on safety issues. In opment, implementation, and evaluation; in healthcare facility design; and in profes-2004, the program expanded to in- sional education, as well as in the delivery of care.clude patient volunteers recruited to Source: Institute for Family-Centered Care. What are the core concepts of patient- and family-centered care?interview other patients and to ob- Available at: http://www.familycenteredcare.org/faq.html. Accessed May 6, 2008.tain their input on safety concerns.This model, in which both staff and and traditions (including alterna- important guideline for involvingpatients are engaged in identifying tive/folk remedies). Leaders commu- families and patients is to believeactual and potential safety problems, nicate in a language and at a level that their participation is essential tocontinues at the Institute today. that the patient understands and the design and delivery of optimum emphasize physical comfort, privacy, care and services. Without sustainedImplications for nurse leaders emotional support, and involvement patient participation in all aspects ofNurse leaders are in a unique posi- of family and friends. policy and program developmenttion to shape healthcare by helping Nurse leaders should insist on and evaluation, we as healthcareto integrate the concepts of patient- receiving feedback about patients’ providers fail to respond to the realand family-centered care into pro- experience of care. Leadership in needs and concerns of those our sys-gram and institutional visions. nursing is demonstrated by insisting tem is intended to serve.”5 NMThese include shared decision mak- that new employee orientation REFERENCESing by consumers, ensuring health- teaches the essentials of patient- and 1. Institute of Medicine. Crossing the Qualitycare professionals are trained in family-centered care. Endorsing Chasm: A New Health System for the 21stsupporting active patients, antici- staff to be part of patient- and Century. Washington, DC: National Acad-pating health and long-term care family-centered care teams and emies Press; 2001. 2. The Joint Commission. 2007 Nationalneeds for individuals, adopting the rewarding staff members who Patient Safety Goals. Available at: http://IOM’s simple rules for healthcare, demonstrate patient-centered care is www.jointcommission.org/NR/rdonlyres/and making the patient perspective one method of illustrating a leader’s 44D4E740-7385-4666-B9E4-9EA7F769FB43/a priority in policy and planning. commitment to this concept. Time 0/07_ahc_npsgs.pdf. Accessed July 16, An effective patient-centered must be set aside weekly to listen to 2008. 3. Holman H, Lorig K. Patients as partners inmodel can’t be designed or imple- patients’ stories and create opportu- managing chronic disease: partnership ismented unless the executive leading nities to teach staff how to partner, a prerequisite for effective and efficientthese disciplines shows the way. interact, and build relationships health care. BMJ. 2000;320(7234):526-527.Working in partnership presents with patients, with a variety of 4. Hanson JL, Randall VF. Advancing a part-challenges for all involved; it re- “miniworkshops” conducted on a nership: patients, families, and medical educators. Teach Learn Med. 2007;19(2):quires trust, confidence, and risks regular basis during staff meetings. 191-197.on the part of everyone concerned. Nurse leaders who are committed 5. Sodomka P. Engaging patients and fami- Leadership sets the tone for part- to collaborating with families will tie lies: a high leverage tool for health carenering with patients and their fami- patient- and family-centered care to leaders. Available at: http://www.hhnlies by providing a physical space other priorities, such as patient safety mag.com/hhnmag_app/jsp/articledisplay. jspdcrpath=HHNMAG/PubsNewsArticle/and personal interactions that are and quality improvement, and incor- data/2006August/0608HHN_FEA_Qualitywelcoming and not threatening. porate patient-centered practices into Update&domain=HHNMAG. AccessedLeaders will create an environment daily operations and culture. July 21, 2008.of understanding and consideration According to Pat Sodomka, direc- ABOUT THE AUTHORof cultural distinctions, economic tor of the Center for Patient and Joanna Kaufman is an information special-and educational status, health liter- Family Centered Care, Medical Col- ist at the Institute for Family-Centered Care,acy level, family patterns/situation, lege of Georgia, “the single most Bethesda, Md.48 August 2008 Nursing Management www.nursingmanagement.com