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PFCC - Janice bell - Keynote - Getting to The Heart of The Matter


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PFCC - Janice bell - Keynote - Getting to The Heart of The Matter

  1. 1. Janice M. Bell, RN, PhD Author, Speaker, Educator, & Researcher of Family-Focused Practice Editor, Journal of Family Nursing Member, Board of Directors, International Family Nursing Association http://janicembell.comJanice M. Bell, RN,
  2. 2. metamorphosis verb: |ch ānj| transform health care with individuals and familiesJanice M. Bell, RN,
  3. 3. Family Systems Care Family Centered Care Family-focused Care Relational practice Patient Centered Care Patient and FamilyJanice M. Bell, RN,
  4. 4. The Institute for Family-Centered Care: An Approach to Care “Family centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families.” Institute of Family Centered CareJanice M. Bell, RN, PhD
  5. 5. Elements of Patient and Family-Centered Care Information Sharing Respect and Honoring Differences Partnership and Collaboration Negotiation Care in the Context of Family and CommunityJanice M. Bell,, RN, PhD (Kuo et al., 2012}
  6. 6. Many Ideas about how to Implement Patient and Family Centered Care • Shift from “allowing” to welcoming family presence and involvement. • Partnering with individuals and families to involve them in care giving and decision making, and inviting participation in the development of organizational policy.Janice M. Bell, RN,
  7. 7. Example: Family Medication Awareness Project “I would like you to know that I believe in FCC, which means I believe in working with you as a partner in caring for your child. Please ask me questions about your child’s medication(s) any time you wish. I care about your child’s safety and encourage your participation and questions.”Janice M. Bell, RN,
  8. 8. “Despite widespread endorsement, Patient and Family Centered Care continues to be insufficiently implemented into clinical practice.” (Kuo et al., 2012; Shields, 2010)Janice M. Bell, RN,
  9. 9. A Paradigm Shift: If partners in care… then what does this mean for the patient-family-health care provider relationship?Janice M. Bell,, RN,
  10. 10. at the heart of the matter… health health professionals illness beliefs individuals larger systems familiesJanice M. Bell, RN, relationships
  11. 11. THE ILLNESS BELIEFS MODEL ™ Wright, L.M., & Bell, J.M. (2009). Beliefs and Illness: A Model for Healing. Calgary, Alberta, Canada: 4th Floor Press. http: //www.illnessbeliefsmodel.comJanice M. Bell, RN,
  12. 12. Intersection of Beliefs Beliefs of Society/Culture Beliefs Beliefs of of the Family Patient Members Beliefs of Health Care ProvidersJanice M. Bell, RN, PhD (Wright & Bell, 2009)
  13. 13. at the heart of the matter… Our beliefs often constrain our relationships with patients and familiesJanice M. Bell, RN,
  14. 14. Sample Constraining Belief “If I talk to patients and family members, I will not have time to complete my other responsibilities.” “I have more knowledge and expertise and I am usually right.”Janice M. Bell, RN,
  15. 15. at the heart of the matter… Patients and Families want to know: Do you hear me? Do you see me? Does what I say mean anything to you? (quote from Oprah, 2011)Dr. Janice M.
  16. 16. E Empathy exercise from Daniel Pink, 2013Janice M. Bell, RN,
  17. 17. Tips for Perspective-taking • Increase your power by reducing it. • Use your head as much as your heart. • Mimic strategically. (Daniel Pink, 2013)Janice M. Bell, RN,
  18. 18. Sample Facilitating BeliefsHealth and illness is a family affair.I am willing to “open space” to ideas and preferences that are different than my own.Janice M. Bell, RN, PhD (Wright & Bell, 2009)
  19. 19. Sample Constraining Beliefs: •“If I talk to patients and families I may open up a can of worms, and I will have no time or skills to deal with it.” •“I cannot possibly be helpful families in the brief time that I will be caring for them.”Janice M. Bell, RN,
  20. 20. Relationships are made visible within a therapeutic conversationJanice M. Bell, RN, PhD (Wright & Bell, 2009)
  21. 21. therapeutic conversations The importance of the first 3 seconds (Wright & Bell, 2009) Janice M. Bell, RN, PhD
  22. 22. therapeutic conversations“Goodness of fit conversations” • Take the temperature of the relationship frequently (Wright & Bell, 2009) Janice M. Bell, RN, PhD
  23. 23. therapeutic conversations • In what ways was our discussion useful to each of you, or not useful? • On a scale of 1-10 how well do you think I understood your situation? • Is there anything I can to do improve my care of your family? • Is there anything you were hoping for in this meeting that did not happen? (Wright & Bell, 2009) Janice M. Bell , RN, PhD
  24. 24. The skills of therapeutic conversation with patients and families can be LEARNED, MODELED, and COACHEDJanice M. Bell, RN,
  25. 25. Sample Facilitating Beliefs Talking can be healing. (Wright & Bell, 2009) The quality of the relationship between patient-family-health-care- provider influences quality care and safetyJanice M. Bell, RN,
  26. 26. EVIDENCE: Landspitali University Hospital Implementation Project, Reykjavik, Iceland Erla Svavarsdottir, RN, PhDJanice M. Bell, RN,
  27. 27. EVIDENCE: Providence Health Care Peggy Simpson RN, PhD Clinical Nurse Specialist Psychiatric Consultation Liaison Mental Health HIV/AIDS Programs and Addiction Services Providence Health Care - St. Pauls Hospital Vancouver, B.C. CANADAJanice M. Bell, RN,
  28. 28. Physician Coaching Program at the University of Rochester: A Pilot Study Susan H. McDaniel, PhD University of Rochester School of Medicine & Dentistry, Rochester, NY 2012 ELAM Leaders Forum Purpose Methods Outcomes To develop and determine feasibility of a physician • PFCC Leader Council meets monthly, advises medical coaching program with the following objectives: center leadership, receives training, shares wisdom and • establishment of sustainable learning community experience. of physicians to improve patient- and family- • Leaders articulated key PFCC behaviors that I distilled centered care (PFCC) into : • improved quality, safety, team communication, I (Introduce yourself and your role), patient/family experience of care, and physician C (ask for patient/family Concerns), satisfaction and retention. U (check for Understanding). These behaviors top the observational checklist in the coaching program. URMC Physician Coaching Program • I directly observed a broad sampling of 12 physicians with 78 patients, coding each encounter. Feedback “What it did was alleviate my concerns regarding my patient interactions. She showed me all the things I was doing • Physicians received post-session verbal feedback, written reports on ICU and other PFCC behaviors, He on the… correctly and pinpointed some areas that could be tweaked in the future. I think Ve every provider in our department should improvement. Outcomes highlighting strengths and specific suggestions for lpf meet with her if we are truly going to make PFCC a global buy-in behavioral ry initiative.“ ul… Table. Physician characteristics by ICU. Introduce Concern Understand “…I believe this type of experience is valuable since habits (good or bad) h… Characteristic creep into communication…Very Background Sex Male 70.8% (17) 70.4% (38) 13.0% (7) professional and insightful. I would like to do this again…” Female 100.0% (12) 76.2% (16) 47.6% (10) “She made me realize that I did a lot of• In 2009, the Vice President of Health Affairs at Physician Status teaching, but did not always elicit URMC articulated a commitment to PFCC in response to his experiences as a patient in the Surgeon Non-surgeon 70.8% (17) 100.0% (12) 64.4% (29) 24.4% (11) 83.3% (25) 20.0% (6) Next Steps patients’ concerns.” wake of a traumatic bicycle accident. HCAHPS Score• Newly-announced Centers for Medicare & Low 76.5% (13) 55.8% (24) 14.0% (6) • Scale up the Physician Coaching Program Medicaid Services (CMS) enhanced High 84.2% (16) 93.7% (30) 34.4% (11) • Prioritize next groups: MD’s close to reimbursement reimbursements partially based on consumer •Non-surgeons and females introduced themselves 100% threshold, new faculty, disruptive/low scoring MDs, satisfaction with interpersonal care (Hospital of the time to new patients. everyone at reappointment Consumer Assessment of Healthcare Providers •Physicians with higher HCAHPS scores 10.6x more likely • Conduct larger descriptive study and Systems, or HCAHPS) to ask about patient concerns than those with lower scores. • Study coaching intervention and patient •Female physicians 6x more likely to check for satisfaction, quality, safety, and physicianThank you to collaborators Jacqueline Beckerman MSW, Jean Joseph MD,Tziporah Rosenberg PhD, and Paul Winters MS, and mentors Ronald Epstein understanding. satisfaction.MD, Elizabeth McAnarney MD, and Yeates Conwell MD, for their support of this •Physicians with higher HCAHPS scores and males tookproject.
  29. 29. at the heart of the matter…Changing our beliefs about and skills to create healing relationships with patients and families affects the quality of care and satisfactionJanice M. Bell, RN,
  30. 30. a particular PATIENT AND FAMILY CENTERED CARE kind of practice (Bell & Wright, 2011; Wright & Bell, 2009) Janice M. Bell, RN, PhD
  31. 31. a particular kind of practiceoffered by a PATIENT AND FAMILY CENTERED CARE particular kind of health care provider (Bell & Wright, 2011; Wright & Bell, Janice M. Bell, RN, PhD 2009)
  32. 32. at the heart of the matter… health health professionals illness beliefs individuals larger systems familiesJanice M. Bell, RN, relationships
  33. 33. Useful Resources Wright, L.M., & Bell, J.M. (2009). Beliefs and Illness: A Model for Healing. Calgary, Alberta, Canada: 4th Floor Press. Wright, L.M. (2005). Spirituality, Suffering, and Illness: Ideas for Healing. Philadelphia, PA: F.A. Davis. Wright, L.M., & Leahey, M. (2013). Nurses and Families: A Guide to Family Assessment and Intervention (6th ed.). Philadelphia, PA: F.A. Davis.Janice M. Bell, RN,
  34. 34. THE ILLNESS BELIEFS MODEL ™ Wright, L.M., & Bell, J.M. (2009). Beliefs and Illness: A Model for Healing. Calgary, Alberta, Canada: 4th Floor Press. http: //www.illnessbeliefsmodel.comJanice M. Bell, RN,
  35. 35. Journal of Family Nursing 5 year average Impact Factor: 1.25 Janice M. Bell, RN, PhD, Founding EditorJanice M. Bell, RN,