In the fictional country of PeoplePower, citizens and healthcare professionals work together to redesign the healthcare system based on the principle of "nothing about me without me".
Key aspects of the new system include:
1) Electronic medical records and communication technologies that enhance the patient-clinician relationship and shared decision-making.
2) Patients actively contributing to their own records and receiving education materials from clinicians.
3) Patients and clinicians jointly measuring quality of care through individual "quality contracts" and a national database that fuels research while protecting privacy.
The summary focuses on the high-level vision of patient empowerment and partnership between patients and clinicians in PeoplePower's healthcare system.
Nursing has undergone many changes and will continue to change with trends in healthcare. As healthcare shifts from hospitals to homes and focuses more on prevention, nurses will take on more essential public health and patient-centered roles. Nurses must adapt to this changing environment through lifelong learning and a broad knowledge base to address challenges around ethics, costs, and quality of care. Globalization will further impact nursing through increased mobility and standardization across borders.
The document describes a pilot program called Better Health Conversations that was developed to improve doctor-patient communication. The program's centerpiece is the Care Card, which patients fill out with their health concerns before seeing their doctor. Survey results found that the program improved agenda setting and patient satisfaction. Physicians also generally felt the program improved their interactions with patients. The program was successful due to its focus on an important issue, addressing communication in a practical way, and incorporating feedback to refine the materials. Effective communication builds better relationships that can positively impact clinical outcomes and satisfaction for both doctors and patients.
The document discusses key aspects of patient-centered care. It notes that the top 3 concerns of patients are dismissal of their voice, lack of caring attitudes from providers, and lack of continuity in care. It then discusses realities around the limited time providers spend with patients and factors that intimidate patients from asking questions. The document proposes meeting patients with empathy, plain language, access, inclusion in decisions, respect for preferences, and caring attitudes. It emphasizes implementing patient-centered care for every patient every time.
This document discusses the growing recognition of integrating patients and families into healthcare planning and delivery through a model of patient- and family-centered care. It provides examples from individual hospitals and healthcare systems that are partnering with patients at all levels from direct care to policy-making and education. The key aspects of patient- and family-centered care involve dignity and respect, information sharing, participation in decision-making, and collaboration between patients, families and healthcare providers.
Overview and history of home health careSUNITA SINGH
The document provides an overview of home health care in the United States, including its history and the Medicare home health care program. It discusses how care shifted from the home to hospitals in the early 20th century due to advances in medicine and technology. It also summarizes how the Medicare home health care benefit expanded in the 1980s-1990s but was curtailed by the Balanced Budget Act of 1997 which focused the program on post-acute care and set limits on spending. The document outlines the eligibility requirements and covered services under Medicare home health care.
Nursing practice is impacted by community involvement in several ways. Community health is affected by factors like culture, diversity, and access to care. With shorter hospital stays, nurses must find ways to educate and support patients outside of the hospital to improve health. This involves developing chronic care models, conducting outreach programs, and using telemedicine. It is important for nursing practice to understand community needs through data collection and train on diverse cultural beliefs to provide patient-centered care. Higher nursing education is needed to allow nurses to better coordinate care across settings and help patients manage chronic conditions in the community.
The document discusses trends and issues in nursing that nurses need to study. It covers topics like nursing education, research, management, and services and how trends globally, regionally, and nationally affect them. Other areas discussed include ethics, legal aspects, health advocacy, technology use, emerging nursing roles, and the future direction of healthcare systems and nursing education. The document emphasizes the importance of studying trends and issues for sound decision making and navigating possible future scenarios in nursing.
Home health care involves providing medical care and services to individuals in their homes. It allows patients to receive skilled care while maintaining independence. The nursing process is used to assess patients' needs, develop care plans, implement care, and evaluate outcomes. Services typically include skilled nursing, therapy, and home health aide visits. Home health care allows patients to heal in a comfortable environment and reduces health care costs. It is a growing sector both in the US and India due to aging populations and increased chronic conditions.
Nursing has undergone many changes and will continue to change with trends in healthcare. As healthcare shifts from hospitals to homes and focuses more on prevention, nurses will take on more essential public health and patient-centered roles. Nurses must adapt to this changing environment through lifelong learning and a broad knowledge base to address challenges around ethics, costs, and quality of care. Globalization will further impact nursing through increased mobility and standardization across borders.
The document describes a pilot program called Better Health Conversations that was developed to improve doctor-patient communication. The program's centerpiece is the Care Card, which patients fill out with their health concerns before seeing their doctor. Survey results found that the program improved agenda setting and patient satisfaction. Physicians also generally felt the program improved their interactions with patients. The program was successful due to its focus on an important issue, addressing communication in a practical way, and incorporating feedback to refine the materials. Effective communication builds better relationships that can positively impact clinical outcomes and satisfaction for both doctors and patients.
The document discusses key aspects of patient-centered care. It notes that the top 3 concerns of patients are dismissal of their voice, lack of caring attitudes from providers, and lack of continuity in care. It then discusses realities around the limited time providers spend with patients and factors that intimidate patients from asking questions. The document proposes meeting patients with empathy, plain language, access, inclusion in decisions, respect for preferences, and caring attitudes. It emphasizes implementing patient-centered care for every patient every time.
This document discusses the growing recognition of integrating patients and families into healthcare planning and delivery through a model of patient- and family-centered care. It provides examples from individual hospitals and healthcare systems that are partnering with patients at all levels from direct care to policy-making and education. The key aspects of patient- and family-centered care involve dignity and respect, information sharing, participation in decision-making, and collaboration between patients, families and healthcare providers.
Overview and history of home health careSUNITA SINGH
The document provides an overview of home health care in the United States, including its history and the Medicare home health care program. It discusses how care shifted from the home to hospitals in the early 20th century due to advances in medicine and technology. It also summarizes how the Medicare home health care benefit expanded in the 1980s-1990s but was curtailed by the Balanced Budget Act of 1997 which focused the program on post-acute care and set limits on spending. The document outlines the eligibility requirements and covered services under Medicare home health care.
Nursing practice is impacted by community involvement in several ways. Community health is affected by factors like culture, diversity, and access to care. With shorter hospital stays, nurses must find ways to educate and support patients outside of the hospital to improve health. This involves developing chronic care models, conducting outreach programs, and using telemedicine. It is important for nursing practice to understand community needs through data collection and train on diverse cultural beliefs to provide patient-centered care. Higher nursing education is needed to allow nurses to better coordinate care across settings and help patients manage chronic conditions in the community.
The document discusses trends and issues in nursing that nurses need to study. It covers topics like nursing education, research, management, and services and how trends globally, regionally, and nationally affect them. Other areas discussed include ethics, legal aspects, health advocacy, technology use, emerging nursing roles, and the future direction of healthcare systems and nursing education. The document emphasizes the importance of studying trends and issues for sound decision making and navigating possible future scenarios in nursing.
Home health care involves providing medical care and services to individuals in their homes. It allows patients to receive skilled care while maintaining independence. The nursing process is used to assess patients' needs, develop care plans, implement care, and evaluate outcomes. Services typically include skilled nursing, therapy, and home health aide visits. Home health care allows patients to heal in a comfortable environment and reduces health care costs. It is a growing sector both in the US and India due to aging populations and increased chronic conditions.
The document discusses the need for palliative care and argues that more people should demand it. Palliative care provides relief from symptoms of serious illness and improves quality of life, yet there is only 1 palliative care physician for every 1,200 seriously ill patients. The document notes that palliative care can reduce healthcare costs and result in better quality end-of-life care aligned with patient goals. It promotes increasing access to and availability of palliative care services.
Ebola primary health care system survey in focus countriesFolahan Johnson
The document reviews primary healthcare (PHC) systems in countries affected by Ebola in order to investigate the capacity of PHC to support disease control strategies. It discusses seven key principles that PHCs should uphold: serving as first contact, providing continuous care, coordinated care, comprehensive care, family-centered care, community-oriented care, and culturally competent care. Adhering to these principles can help PHCs strengthen disease prevention, detection, and response efforts in their communities.
The document discusses the nursing process in community health nursing. It describes the steps of the nursing process - assessment, diagnosis, planning, implementation, and evaluation. It provides details on how community health nurses assess communities to identify health needs, formulate nursing diagnoses for communities and populations, plan interventions, implement plans through activities like health teaching, and evaluate the impact of nursing care. The nursing process provides structure for community health nurses to systematically address the health needs of communities.
This document provides background information and context for a case study about implementing lean principles at HomeCare, a large Canadian home health care organization. It summarizes that HomeCare was facing issues like poor service, long scheduling times, and low employee satisfaction due to siloed processes and lack of coordination. HomeCare leadership brought in consultants to redesign the entire service process from a lean perspective. The consultants conducted interviews and surveys, and recommended piloting redesigned processes in two districts before expanding organization-wide. The pilots were very successful, dramatically improving key metrics like scheduling times. This provided proof and momentum to redesign additional districts using the lean methodology.
This document discusses community health needs assessment and the nursing process. It provides an overview of the steps in assessing a community's health needs which include collecting demographic data, identifying major health issues, planning programs, implementing activities, and evaluating outcomes. The nursing process is also summarized as a systematic method used in nursing practice with the main components being assessment, nursing diagnosis, planning, implementation, and evaluation. Methods of collecting and analyzing health data from communities are also outlined.
1) Family medicine involves providing comprehensive healthcare services to patients in their own homes to promote health, minimize illness effects, and restore function.
2) It serves patients with chronic conditions, acute episodic illnesses, or who need medical supervision after being discharged from the hospital or who are terminally ill.
3) Care includes medical treatment, nursing, rehabilitation, counseling, and coordinating community resources to support patients.
This document discusses medical nutrition therapy (MNT), which is the application of nutrition assessment, intervention, and counseling to manage disease and improve health outcomes. MNT is provided by registered dietitian nutritionists and involves a standardized process called the nutrition care process. This includes nutrition assessment, diagnosis, intervention, and monitoring. The nutrition assessment involves collecting information on diet, anthropometrics, labs, physical findings, and medical history. This information is used to determine a nutrition diagnosis and develop an individualized nutrition intervention plan to address any identified dietary contributors to disease. MNT has been shown to improve clinical outcomes and lower healthcare costs for many chronic conditions.
Exploring the potential for using predictive modelling in identifying end of life care needs - 15 February 2013 - National End of Life Care Programme / Whole Systems Partnership
This report, produced in partnership with Whole Systems Partnership, is based on a project which reviewed the literature on predictive modelling, canvassed views and engaged with interested parties to formulate an initial response to the opportunities presented by predictive modelling approaches in identifying people likely to be nearing the end of life.
Predictive modelling involves the interrogation of datasets to inform professional judgement about potential needs. It is hoped that the findings of this report will be used to enable commissioners and providers of services to better understand and meet people's end of life care preferences and wishes, supporting more people to live and die well in their preferred place.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
The document outlines an alignment matrix between program outcomes, course outcomes, learning outcomes, and content for a nursing course on caring for at-risk and sick adult clients. It maps concepts related to oxygenation, fluids, electrolytes, infectious and inflammatory disorders, immunologic disorders, cellular aberrations, and more. It also maps relevant principles including evidence-based practice, ethics, collaboration, lifelong learning, advocacy, culture and technology. The purpose is to ensure alignment between the broader program outcomes and what is covered specifically within this course.
Home health nursing services allow individuals to receive healthcare in their own homes, providing comfort and dignity. Services may include skilled nursing, physical therapy, occupational therapy, social services, and more. Care is provided through developing a treatment plan with the patient's physician, making regular visits to work towards goals, and documenting progress for quality assessment.
Master's prepared role electronic presentation dassVinitaRajiv Dass
A family nurse practitioner (FNP) is an advanced practice registered nurse who has completed 500 clinical hours and has a minimum of two years clinical experience as a registered nurse. FNPs assist with all aspects of patient care including diagnosis, treatment, consultations, performing physical exams, and prescribing medications. They educate patients on preventative care and prescribed treatments. FNPs function as primary healthcare providers for patients across the lifespan in settings such as primary care, pediatrics, geriatrics, and other specialties.
The Anna Westin Act of 2015 is the first eating disorder legislation to receive bipartisan support at introduction in the past decade. However, further support is needed for the Anna Westin Act to become a law. Find out how Veritas Collaborative, an eating disorder treatment center in NC, is not only passionate about “Anna’s Law” but is also reaching out for others to join the support. Find out how you can show your support and learn more about The Anna Westin Act at http://veritascollaborative.com/blog/2015/07/a-call-to-action.
Currents trends and issues in management in nursingAnzuBista1
This document discusses current trends and issues in nursing management. It begins by providing historical context on the evolution of nursing. Key points discussed include:
1. Nursing has expanded beyond hospitals to include roles like school nurses, nurse practitioners, and home care nurses.
2. Issues in nursing management include lack of authority, accountability to non-nursing duties, and poor working conditions.
3. Current challenges include staffing shortages, budget constraints, and maintaining staff morale to prevent burnout.
The document provides an overview of trends, issues, and challenges in the nursing management field.
This document summarizes several grants related to children's health, including grants to:
1) Fund eight community coalitions through the Children's Health Care Allies Against Asthma Program to improve asthma care for children.
2) Support surveys of how managed care initiatives affect child welfare services.
3) Fund three studies examining health care financing and delivery problems affecting adolescents.
4) Create a new fellowship program in environmental pediatrics.
Implementation important steps of nursing processRathkalyani123
This document discusses nursing intervention, which is defined as any treatment performed by a nurse to enhance patient outcomes. There are different types of nursing intervention such as direct care through patient interaction, indirect care away from the patient, and community intervention to promote population health. The document outlines the nursing process for implementing intervention, which includes assessing the patient, planning care, organizing resources, preventing complications, documenting, and reassessing the patient and care plan. Key aspects of nursing intervention discussed are guidelines, standards, skills required, and examples of direct care activities.
Community health nursing involves providing care to populations in the communities where they live and work. It encompasses public health nursing and focuses on health promotion, disease prevention, and addressing health issues at a population level. Home visits are an important nursing intervention that allow nurses to gain insight into clients' lives and environments. The referral process involves identifying client needs, locating appropriate resources, and facilitating the connection between clients and services to promote wellness and self-care. Community health nurses take on various roles including direct client care, care coordination, and population-level roles like community assessment and health promotion.
Obstetric Fistula Post Repair Follow Up: An Outreach Worker’s Perspectivepaperpublications3
Abstract: Obstetric Fistula is a childbirth injury caused by prolonged obstructed labour leaving a woman incontinent of urine or faeces or both. The stigma associated with the condition keeps many women hidden away. A woman with obstetric fistula is too often rejected by her husband and pushed out of her village due to her foul smell. Without treatment, fistula often leads to social, physical, emotional and economic decline. Although some women with fistula display amazing courage and resilience, many others succumb to illness and despair. Kenya is estimated to have 1000-3000 new fistula cases every year where as the national treatment capacity is only 500 clients per year. With the understanding of the impact this condition has not only to the affected clients but also to the community at large, several local and international organizations are currently supporting the fistula repairs in Kenya. Review of relevant literature reveals inconsistent findings about the need for the post repair follow up for this client. This leaves program designers and their funding partners to handle the issue according to their discretion. Most projects focus on identifying fistula clients supporting them to get the surgery document the number repaired but do very little to follow up on this client. This paper gives the perspective on an outreach worker who has supported fistula clients for the last 11 years. The author looks at what is currently happening in Kenya and brings out the need for establishing post repair follow up in the programs. The paper gives case studies in the client either benefited from post repair follow up to show an amazing outcome or lost life in unclear circumstances. The paper demonstrates the effect of this follow up to the client their significant other, the community and the effectiveness of the project. It finally gives recommendation on how this can be integrated in fistula management.
This document discusses trends and issues in medical-surgical nursing that nurses need to study. It identifies several key trends and issues, including a growing need for ethical decision making in health care, concerns over human rights, and a more educated and mobile health workforce. Nurses must understand these trends and issues to effectively adapt nursing education, research, management, and services to the changing health care environment.
This document proposes a designated case worker position within a hospital setting to improve outcomes for homeless patients who overutilize the emergency department. The case worker would conduct assessments, develop individualized action plans, connect patients to community resources, and provide follow-up to ensure needs are being met. The goals are to improve patients' knowledge of and access to services, thereby reducing emergency department usage and costs while improving health outcomes for vulnerable homeless populations. Citizenship theory provides the framework to address individual needs within the larger community context.
This document discusses the importance of public relations for community health nurses. It defines public relations as understanding public expectations and communicating how an institution meets those needs. Good public relations are essential for hospitals and health centers to function effectively and provide high quality care. The document outlines various operative and communicative methods that can be used to promote good public relations, including ensuring polite staff behavior, efficient services, and communicating information to communities through media and other outlets. It also discusses qualities needed in public relations staff and how to assess public relations through indicators like community feedback and health outcomes.
The TAP project is developing a program at UCSF to facilitate the transition of adolescent patients with chronic health needs from pediatric to adult care. This includes resident training in transitional care competencies and a transition handbook for patients to teach self-management skills.
The IPR project at the Medical College of Georgia will initiate patient- and family-centered rounds on adult medical and surgical units, initially evaluating one team for satisfaction, costs, efficiency and quality/safety.
The Resident Performance project at Carilion Clinic intends to adapt an evaluation tool for patients to assess resident performance on ACGME competencies, comparing feedback and coaching to attending-only feedback.
This document provides an overview of the Picker Institute's Always Events initiative. The initiative aims to promote patient-centered care by identifying aspects of the patient experience, called Always Events, that should always occur when patients interact with the healthcare system. Picker is providing grants to support demonstration projects that develop and implement strategies to achieve specific Always Events related to communication and care transitions. The projects will form a learning network, and Picker will produce a compendium of best practices and tools derived from the projects.
The document discusses the need for palliative care and argues that more people should demand it. Palliative care provides relief from symptoms of serious illness and improves quality of life, yet there is only 1 palliative care physician for every 1,200 seriously ill patients. The document notes that palliative care can reduce healthcare costs and result in better quality end-of-life care aligned with patient goals. It promotes increasing access to and availability of palliative care services.
Ebola primary health care system survey in focus countriesFolahan Johnson
The document reviews primary healthcare (PHC) systems in countries affected by Ebola in order to investigate the capacity of PHC to support disease control strategies. It discusses seven key principles that PHCs should uphold: serving as first contact, providing continuous care, coordinated care, comprehensive care, family-centered care, community-oriented care, and culturally competent care. Adhering to these principles can help PHCs strengthen disease prevention, detection, and response efforts in their communities.
The document discusses the nursing process in community health nursing. It describes the steps of the nursing process - assessment, diagnosis, planning, implementation, and evaluation. It provides details on how community health nurses assess communities to identify health needs, formulate nursing diagnoses for communities and populations, plan interventions, implement plans through activities like health teaching, and evaluate the impact of nursing care. The nursing process provides structure for community health nurses to systematically address the health needs of communities.
This document provides background information and context for a case study about implementing lean principles at HomeCare, a large Canadian home health care organization. It summarizes that HomeCare was facing issues like poor service, long scheduling times, and low employee satisfaction due to siloed processes and lack of coordination. HomeCare leadership brought in consultants to redesign the entire service process from a lean perspective. The consultants conducted interviews and surveys, and recommended piloting redesigned processes in two districts before expanding organization-wide. The pilots were very successful, dramatically improving key metrics like scheduling times. This provided proof and momentum to redesign additional districts using the lean methodology.
This document discusses community health needs assessment and the nursing process. It provides an overview of the steps in assessing a community's health needs which include collecting demographic data, identifying major health issues, planning programs, implementing activities, and evaluating outcomes. The nursing process is also summarized as a systematic method used in nursing practice with the main components being assessment, nursing diagnosis, planning, implementation, and evaluation. Methods of collecting and analyzing health data from communities are also outlined.
1) Family medicine involves providing comprehensive healthcare services to patients in their own homes to promote health, minimize illness effects, and restore function.
2) It serves patients with chronic conditions, acute episodic illnesses, or who need medical supervision after being discharged from the hospital or who are terminally ill.
3) Care includes medical treatment, nursing, rehabilitation, counseling, and coordinating community resources to support patients.
This document discusses medical nutrition therapy (MNT), which is the application of nutrition assessment, intervention, and counseling to manage disease and improve health outcomes. MNT is provided by registered dietitian nutritionists and involves a standardized process called the nutrition care process. This includes nutrition assessment, diagnosis, intervention, and monitoring. The nutrition assessment involves collecting information on diet, anthropometrics, labs, physical findings, and medical history. This information is used to determine a nutrition diagnosis and develop an individualized nutrition intervention plan to address any identified dietary contributors to disease. MNT has been shown to improve clinical outcomes and lower healthcare costs for many chronic conditions.
Exploring the potential for using predictive modelling in identifying end of life care needs - 15 February 2013 - National End of Life Care Programme / Whole Systems Partnership
This report, produced in partnership with Whole Systems Partnership, is based on a project which reviewed the literature on predictive modelling, canvassed views and engaged with interested parties to formulate an initial response to the opportunities presented by predictive modelling approaches in identifying people likely to be nearing the end of life.
Predictive modelling involves the interrogation of datasets to inform professional judgement about potential needs. It is hoped that the findings of this report will be used to enable commissioners and providers of services to better understand and meet people's end of life care preferences and wishes, supporting more people to live and die well in their preferred place.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
The document outlines an alignment matrix between program outcomes, course outcomes, learning outcomes, and content for a nursing course on caring for at-risk and sick adult clients. It maps concepts related to oxygenation, fluids, electrolytes, infectious and inflammatory disorders, immunologic disorders, cellular aberrations, and more. It also maps relevant principles including evidence-based practice, ethics, collaboration, lifelong learning, advocacy, culture and technology. The purpose is to ensure alignment between the broader program outcomes and what is covered specifically within this course.
Home health nursing services allow individuals to receive healthcare in their own homes, providing comfort and dignity. Services may include skilled nursing, physical therapy, occupational therapy, social services, and more. Care is provided through developing a treatment plan with the patient's physician, making regular visits to work towards goals, and documenting progress for quality assessment.
Master's prepared role electronic presentation dassVinitaRajiv Dass
A family nurse practitioner (FNP) is an advanced practice registered nurse who has completed 500 clinical hours and has a minimum of two years clinical experience as a registered nurse. FNPs assist with all aspects of patient care including diagnosis, treatment, consultations, performing physical exams, and prescribing medications. They educate patients on preventative care and prescribed treatments. FNPs function as primary healthcare providers for patients across the lifespan in settings such as primary care, pediatrics, geriatrics, and other specialties.
The Anna Westin Act of 2015 is the first eating disorder legislation to receive bipartisan support at introduction in the past decade. However, further support is needed for the Anna Westin Act to become a law. Find out how Veritas Collaborative, an eating disorder treatment center in NC, is not only passionate about “Anna’s Law” but is also reaching out for others to join the support. Find out how you can show your support and learn more about The Anna Westin Act at http://veritascollaborative.com/blog/2015/07/a-call-to-action.
Currents trends and issues in management in nursingAnzuBista1
This document discusses current trends and issues in nursing management. It begins by providing historical context on the evolution of nursing. Key points discussed include:
1. Nursing has expanded beyond hospitals to include roles like school nurses, nurse practitioners, and home care nurses.
2. Issues in nursing management include lack of authority, accountability to non-nursing duties, and poor working conditions.
3. Current challenges include staffing shortages, budget constraints, and maintaining staff morale to prevent burnout.
The document provides an overview of trends, issues, and challenges in the nursing management field.
This document summarizes several grants related to children's health, including grants to:
1) Fund eight community coalitions through the Children's Health Care Allies Against Asthma Program to improve asthma care for children.
2) Support surveys of how managed care initiatives affect child welfare services.
3) Fund three studies examining health care financing and delivery problems affecting adolescents.
4) Create a new fellowship program in environmental pediatrics.
Implementation important steps of nursing processRathkalyani123
This document discusses nursing intervention, which is defined as any treatment performed by a nurse to enhance patient outcomes. There are different types of nursing intervention such as direct care through patient interaction, indirect care away from the patient, and community intervention to promote population health. The document outlines the nursing process for implementing intervention, which includes assessing the patient, planning care, organizing resources, preventing complications, documenting, and reassessing the patient and care plan. Key aspects of nursing intervention discussed are guidelines, standards, skills required, and examples of direct care activities.
Community health nursing involves providing care to populations in the communities where they live and work. It encompasses public health nursing and focuses on health promotion, disease prevention, and addressing health issues at a population level. Home visits are an important nursing intervention that allow nurses to gain insight into clients' lives and environments. The referral process involves identifying client needs, locating appropriate resources, and facilitating the connection between clients and services to promote wellness and self-care. Community health nurses take on various roles including direct client care, care coordination, and population-level roles like community assessment and health promotion.
Obstetric Fistula Post Repair Follow Up: An Outreach Worker’s Perspectivepaperpublications3
Abstract: Obstetric Fistula is a childbirth injury caused by prolonged obstructed labour leaving a woman incontinent of urine or faeces or both. The stigma associated with the condition keeps many women hidden away. A woman with obstetric fistula is too often rejected by her husband and pushed out of her village due to her foul smell. Without treatment, fistula often leads to social, physical, emotional and economic decline. Although some women with fistula display amazing courage and resilience, many others succumb to illness and despair. Kenya is estimated to have 1000-3000 new fistula cases every year where as the national treatment capacity is only 500 clients per year. With the understanding of the impact this condition has not only to the affected clients but also to the community at large, several local and international organizations are currently supporting the fistula repairs in Kenya. Review of relevant literature reveals inconsistent findings about the need for the post repair follow up for this client. This leaves program designers and their funding partners to handle the issue according to their discretion. Most projects focus on identifying fistula clients supporting them to get the surgery document the number repaired but do very little to follow up on this client. This paper gives the perspective on an outreach worker who has supported fistula clients for the last 11 years. The author looks at what is currently happening in Kenya and brings out the need for establishing post repair follow up in the programs. The paper gives case studies in the client either benefited from post repair follow up to show an amazing outcome or lost life in unclear circumstances. The paper demonstrates the effect of this follow up to the client their significant other, the community and the effectiveness of the project. It finally gives recommendation on how this can be integrated in fistula management.
This document discusses trends and issues in medical-surgical nursing that nurses need to study. It identifies several key trends and issues, including a growing need for ethical decision making in health care, concerns over human rights, and a more educated and mobile health workforce. Nurses must understand these trends and issues to effectively adapt nursing education, research, management, and services to the changing health care environment.
This document proposes a designated case worker position within a hospital setting to improve outcomes for homeless patients who overutilize the emergency department. The case worker would conduct assessments, develop individualized action plans, connect patients to community resources, and provide follow-up to ensure needs are being met. The goals are to improve patients' knowledge of and access to services, thereby reducing emergency department usage and costs while improving health outcomes for vulnerable homeless populations. Citizenship theory provides the framework to address individual needs within the larger community context.
This document discusses the importance of public relations for community health nurses. It defines public relations as understanding public expectations and communicating how an institution meets those needs. Good public relations are essential for hospitals and health centers to function effectively and provide high quality care. The document outlines various operative and communicative methods that can be used to promote good public relations, including ensuring polite staff behavior, efficient services, and communicating information to communities through media and other outlets. It also discusses qualities needed in public relations staff and how to assess public relations through indicators like community feedback and health outcomes.
The TAP project is developing a program at UCSF to facilitate the transition of adolescent patients with chronic health needs from pediatric to adult care. This includes resident training in transitional care competencies and a transition handbook for patients to teach self-management skills.
The IPR project at the Medical College of Georgia will initiate patient- and family-centered rounds on adult medical and surgical units, initially evaluating one team for satisfaction, costs, efficiency and quality/safety.
The Resident Performance project at Carilion Clinic intends to adapt an evaluation tool for patients to assess resident performance on ACGME competencies, comparing feedback and coaching to attending-only feedback.
This document provides an overview of the Picker Institute's Always Events initiative. The initiative aims to promote patient-centered care by identifying aspects of the patient experience, called Always Events, that should always occur when patients interact with the healthcare system. Picker is providing grants to support demonstration projects that develop and implement strategies to achieve specific Always Events related to communication and care transitions. The projects will form a learning network, and Picker will produce a compendium of best practices and tools derived from the projects.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
The document discusses strategies for improving patient-centered care. It focuses on ensuring patients feel oriented, informed, and involved in their care. This includes introducing all medical staff, explaining plans in plain language, checking for understanding, keeping patients updated on delays, allowing them to explain concerns, and setting clear expectations for next steps. The goal is for patients to understand their care and feel their needs, preferences, and questions are being addressed.
This document provides information about discussing goals of care with family members of patients with dementia. It begins with an introduction and outlines the session goals. It then discusses the natural history and progression of Alzheimer's disease using the FAST scale. Data on the clinical course of advanced dementia is presented showing high rates of infections, eating problems, and burdensome interventions in the last months of life. Evidence is discussed regarding treating or not treating pneumonia and tube feeding. The role play provides an example case of a patient with advanced dementia to discuss goals of care.
Integrating Patient- and Family-Centered Care Principles into a Simulation-Ba...Picker Institute, Inc.
This document provides guidance on effectively sharing bad news with patients. It introduces the SPIKES protocol, a 6-step model for delivering bad news. The steps are: Setting, Perception, Invitation, Knowledge, Emotions, and Strategy/Summary. The document emphasizes creating the right environment, understanding the patient's perspective, delivering the news with empathy, assessing the patient's emotional response, and creating a follow-up plan. The goal is to share information in a supportive, compassionate manner that meets the patient's needs and preferences.
Improving Patient Rounds (IPR): Medical College of Georgia/Georgia HealthPicker Institute, Inc.
This document summarizes a quality improvement project to implement patient- and family-centered care (PFCC) rounds at a hospital. The project aims to engage patients and families as partners in care, decision-making, and discharge planning. Outcomes included improved communication and satisfaction for patients, families, and nurses. Challenges included patient advisor training and coordinating interdisciplinary teams. Strategies to overcome challenges included designating consistent patient observers, establishing a PFCC rounds schedule, and providing team building. The document describes using an observation checklist to assess communications and provide feedback to improve PFCC rounds.
What is Global Health?: Miguel Ángel González BlockUWGlobalHealth
As proposed by the Declarations of the Alma Ata and challenged by the Millennium
Development Goals, action by players and stakeholders of diverse specialties and
backgrounds is required to achieve health for all. This assembled expert panel
drawn from different backgrounds will enrich the discussion with their own experiences.
S28 September-October 2016HASTINGS CENTER REPORTUndispu.docxWilheminaRossi174
S28 September-October 2016/HASTINGS CENTER REPORT
Undisputedly, the United States’ health care sys-
tem is in the midst of unprecedented complexi-
ty and transformation. In 2014 alone there were
well over thirty-five million admissions to hospitals in
the nation,1 indicating that there was an extraordinary
number of very sick and frail people requiring highly
skilled clinicians to manage and coordinate their com-
plex care across multiple care settings. Medical advances
give us the ability to send patients home more efficiently
than ever before and simultaneously create ethical ques-
tions about the balance of benefits and burdens associ-
ated with these advances. New treatments for cancer or
complex heart disease may prolong life until the disease
becomes irreversible while causing significant morbidity
that undermines functional status, independence, and
quality of life in ways that patients find unacceptable.
Some patients and families voice concerns about access
to treatments and about the quality and safety of the care
they or their loved ones receive.
Every day on every shift, nurses at the bedside feel
these pressures and the intense array of ethical issues that
they raise. A staggering 17.5 percent of trained nurses are
leaving their roles or the profession after less than one
year of service,2 and increasing levels of moral distress
and burnout contribute to their decisions.3 Meanwhile,
research supports the common-sense understanding that
patients and health care organizations fare better when
nurses are not harried, are supported in their work en-
vironments, and are able to practice high-quality, ethical
care.
At the same time, administrators, policy-makers, and
regulators struggle to balance commitments to patients,
families, staff members, and governing boards. Health
care organizations are compelled by laws, regulations,
and accrediting bodies to pursue externally reported
measures of effectiveness that can put their mission and
values at risk. While health care systems declare their
commitment to core ethical values, many clinicians
struggle to understand institutional priorities, budgets,
policies, and decisions seemingly inconsistent with their
values as professionals.
Increasingly clinicians find their ability to provide
compassionate care at odds with the intensifying focus
on matters such as clinical pathways aimed at standard-
izing care, cost-cutting efficiencies, electronic medical
records, and hospital policies and procedures.4 Arguably,
each of these have merit in the current system, but what
is not accounted for are the unintended consequences
of diverting attention from the core ethical values of the
professions. For example, the advent of the EMR requires
clinicians to focus on documentation rather than being
fully present during patient encounters. An emphasis on
clinical pathways increases the risk of reducing patient
symptoms and diseases to what fits a rote app.
Clinical interactions and communication are key factors for improving chronic disease self-management for Aboriginal and Torres Strait Islander peoples with rheumatic heart disease. Improving communication requires effective two-way and cross-cultural communication between patients, community members, and healthcare providers. Strategies like clinical yarning and developing cultural health capital can help build rapport and understanding between patients and providers to support self-management. Addressing social and cultural factors is important for meaningful patient-provider interactions and successful self-management.
Palliative care in the United States has experienced tremendous growth and visibility over the past decade. Integrating palliative care principles into mainstream health care systems is becoming increasingly common in both acute care and community-based programs. The Center to Advance Palliative Care (CAPC) has played a key role in advancing this field by providing resources, education and training to healthcare providers.
Advancing Effective Communicationcommunication, Cultural...Beth Johnson
The document discusses advancing effective communication, cultural competence, and patient- and family-centered care in hospitals. It provides a roadmap for hospitals to improve in these areas. The roadmap includes recommended issues to address during patient admission, such as informing patients of their rights, identifying language and communication needs, and collecting demographic data. Overall, the document aims to help hospitals evaluate their compliance with relevant laws and inform policies to better serve patient needs and experiences.
The Kaiser Permanente Homeless Navigator Pilot Program in Woodland Hills, California connects homeless patients with community resources to help them find housing and other services, placing over 576 homeless patients in shelters and programs since 2012. The program uses a team approach involving medical, social work, and community staff. It has been successful in transforming lives and ending homelessness for many patients.
This document profiles 7 exemplary interprofessional primary care training programs across the United States that focus on developing competencies for team-based primary care. The programs highlighted train professionals such as family physicians, nurses, pharmacists, psychologists, social workers and more. They share common elements like a focus on patient-centered care, cultural sensitivity, quality improvement, effective team practice, dispersed leadership and integrating behavioral health. The profiles describe the programs' educational levels, elements, organization types, professions trained and competencies developed for team-based primary care. Interprofessional education is seen as key to achieving the goals of better health, better care and lower costs through the patient-centered medical home model.
- The document discusses ensuring community care is provided in close collaboration with citizens and communities. It emphasizes the importance of patient empowerment, health literacy, digital health, patient involvement, and inclusiveness.
- Patient empowerment in community settings requires a shift towards seeing patients as equal partners in their care. This involves improving health literacy, self-management support, and shared decision-making between patients and healthcare professionals.
- Digital technologies can help facilitate chronic disease management and patient-centered care if designed and implemented in a way that strengthens patient empowerment and health literacy. Meaningful patient involvement in healthcare, research, and policy is also critical.
Week 1 Case Study Foundations of U.S. Health Care Delivery nicolleszkyj
Week 1 Case Study: Foundations of U.S. Health Care Delivery
The coordination of care through integrated delivery systems is at the foundation of health care delivery in the United States. Often a primary goal of government officials, public health professionals, and health care administrators, measuring care coordination is a key performance indicator that directly correlates with the overall success of the health system (Johnson & Stokopf, 2010).
Northwestern Hospital first opened its doors back 1882 in Minneapolis, Minnesota. Early hospitals were small, often with fewer than 50 beds, unsanitary, and nonscientific compared to their modern counterparts (Allina Health). Moreover, they mainly served the poorest members of the community or patients who were mentally ill or facing life-threating illnesses. Northwestern Hospital was an early pioneer in the establishment of what would eventually become an evidence-based medicine (EBM) practice and featured one of the first schools of nursing in the United States (Allina Health).
Introduction
For over a century Northwestern Hospital’s use of EBM has enabled clinicians and practitioners to incorporate best treatment practices at the point of patient care in both their hospital and ambulatory organizations. For example, Northwestern’s goal to enhance quality delivery and overall patient care hastened the formation of a new entity, Minneapolis Medical Center Incorporated (MMCI). In 1966, Northwestern Hospital, along with other health care facilities in the Minneapolis area, formed the nucleus of an organization that would significantly master care coordination and delivery in the ensuing decades. Ultimately, an EBM environment created a standard of patient care that enabled MMCI to advance care delivery and medical education and lay the foundations of a modern health care delivery system.
Case Report
MMCI established a culture of continuous quality improvement (CQI). Wenke, Jongwha, LaClair, and Paz (2013) have linked CQI to better clinical quality and improved patient satisfaction. The best practice in EBM methodology is to ensure that patient care is coordinated and of high quality through the use of objective clinical data from credible sources and references. By the 1980s, a desire to add resources and support services for the coordinated care of patients such as physical rehabilitation helped lead an evolution from Northwestern Hospital to MMCI and then formation of Abbott Northwestern Hospital. Since that time, the hospital’s health services offerings have grown into a primary health system, supporting cardiovascular care, medical education, and health plans.
Conclusion
MMCI recently went through a merger and is now part of a larger health system called Allina Health that serves patients in locations across the Midwest. It has significantly expanded its portfolio of EBM to include mental health services, neuroscience, orthopedic care, and cancer treatment. Additionally, decision makers ...
This document discusses a student's weekly reflective journal entries for their capstone practicum course. The journal covers several topics, including identifying health disparities in the community, creating objectives for a proposed negative pressure wound therapy project, discussing new approaches like telehealth nursing, and understanding how health policy and clinical systems work. The student demonstrates several competencies, including identifying health disparities, setting measurable objectives, considering the role of technology, and understanding how new practices are implemented in healthcare organizations.
assessment skills to clarify and identify the person’s health problem, birthing/parenting
support and related needs. The needs might relate to care while an inpatient or it
might relate to their needs when they go home.
It is essential that an interprofessional collaborative approach is used to plan care
that is person-centred. Communicating effectively together (and with the person
receiving care) enables healthcare team members to support and complement one
another’s services and avoid duplications and omissions in planning and coordinating
care. Nurses and midwives in their various roles can advocate for that person’s
holistic needs to be met through effectively documenting needs, making referrals
through face-to-face meetings and consultation with other professionals. This chapter
discusses the different ways nurses and midwives properly document care, report
care and how they formally confer with others to ensure people’s continuity of care
needs are met.
In Australia and New Zealand, the current healthcare system requires that all
nurses and midwives are competent in documenting their client’s care to ensure
continuity of care, that legal records are kept about the care given so that the
documentation can also provide a trail and evidence for evaluating and auditing the
effectiveness of the care given (Blair & Smith, 2012). Documentation of care is
therefore an important source of reference and communication between all health
professionals including nurses and midwives, with implications for continuity of care
and interprofessional collaborative practice. The health standards set by government
accrediting bodies in Australia and New Zealand has specific guidelines for
documenting clinical data and care. Nurses and midwives need to document
concisely, and have a system of non-duplication and evidence-based care to ensure
quality and safety. The following section explores documentation and some of the
different ways and systems of documenting care that are used in our healthcare
services.
DOCUMENTING CARE
Documentation is any written or electronically generated legal record of all pertinent
interactions with the client that describes the care and services provided to that
person. Documentation is a written record of the healthcare professional interacting
with the person on all levels of care including assessing, identifying health problems,
and planning, implementing and evaluating care. Increasingly sophisticated
management information systems (MIS) are becoming available to manage patient-
specific data and information, as well as provide access through clinical databases
for evidence-based practice. The data obtained from a MIS are used to facilitate
person care, serve as legal records, help in clinical research and support decisio.
The National Council has played a leading role in advocating for policies and practices that break down barriers to integration and collaboration, developing clinical and business models that support seamless and comprehensive healthcare, and fostering collaborative opportunities. Advocating for funds to bring primary care services to behavioral health organizations has been a National Council legislative priority. We've also been active on the practice improvement front and have helped member organizations and their primary care partners overcome clinical, cultural, and communication barriers to collaboratively provide comprehensive healthcare.
1) The document discusses a student's reflective journal entries for their capstone practicum project over 10 weeks.
2) In early weeks, the student assessed their healthcare setting's needs and identified potential project topics, focusing on reducing health disparities.
3) For one topic on implementing negative pressure wound therapy, the student created objectives to improve outcomes and safety through new approaches.
4) Later weeks discuss exploring telehealth nursing and considering new policies, technologies, and how they can ethically benefit patients while maintaining standards of care.
Shared innovations in measurement and evaluationbikandob
This document summarizes the goals and abstracts submitted to the "Global Health Metrics & Evaluation: Controversies, Innovation, Accountability" conference. Key points:
1) The conference aims to bring together different disciplines involved in global health measurement and evaluation to share knowledge and innovations.
2) Over 400 abstracts were submitted from many countries covering topics like non-communicable diseases, malaria, and health inequalities.
3) The selected abstracts illustrate the diversity of work, including new tools for priority setting, emerging evaluation methods, and approaches to measuring outcomes like maternal mortality.
The National Center for Primary Care (NCPC) is the only congressionally sanctioned center in the US dedicated to promoting optimal healthcare, especially for underserved communities. Headquartered at Morehouse School of Medicine, NCPC is committed to improving national health.
The Always Events Recognition Program aims to recognize healthcare organizations that have implemented programs meeting the criteria of an Always Event - actions that should always be performed to provide an optimal patient experience. Organizations can apply by submitting a letter describing their program and how it meets the Always Events criteria of being significant, evidence-based, measurable, and affordable. The letter must also outline how the program involves patients/families, has leadership support, engages staff, and is evaluated for effectiveness. Registered programs will be listed on the Always Events website and organizations can promote their work using the Always Events brand.
This document provides a blueprint for using Always Events to transform healthcare organizations and improve the patient experience. Always Events refer to aspects of care that are so important to patients that providers should always perform them consistently. Over 80 organizations have implemented Always Events projects to address challenges like communication, care transitions, patient and family engagement, and safety. Their results and lessons learned provide a roadmap for other organizations. The blueprint describes how healthcare leaders, educators, and other stakeholders can use Always Events to advance patient-centered care and transform the healthcare system.
The document describes Always Events, which are practices that should always occur to improve the patient experience. It then summarizes initiatives from 20 organizations to address common healthcare challenges through Always Events. One area is care transitions, where several grantees developed Always Events focusing on hospital discharge, handoffs between providers, and reducing readmissions. For example, one organization implemented a "SMART Discharge Protocol" to ensure key information is discussed at discharge. Another developed a "Patient-Centered Bedside Shift-to-Shift Handoff" process to include patients in shift changes. The document provides contact information for each program to allow other organizations to learn from their work.
The document provides an overview of a teach-back training toolkit that aims to help healthcare providers learn to use teach-back effectively when communicating with patients. The toolkit includes tools and resources like an interactive learning module, coaching materials, and videos to teach providers the 10 elements of competence for using teach-back. It also describes what teach-back is and the various sections included in the toolkit to support its use.
My Story- University of Minnesota Amplatz Children's Hospital: Always EventPicker Institute, Inc.
The MyStory project was designed to personalize care for pediatric patients at the University of Minnesota Amplatz Children's Hospital by capturing each patient's unique story. It incorporates the psychosocial needs of pediatric patients to create individualized, patient-centered care and engage children in decision making. The MyStory tool documents each patient's story in the electronic health record and is used to personalize care and involve patients in care planning. Outcomes data shows improved patient satisfaction scores related to understanding their condition, involvement in care, and feeling like the hospital feels like home. Lessons learned include the importance of patient involvement, interprofessional collaboration, and using the electronic health record to consistently deliver a personalized experience.
The document describes a simulation-based training program developed by Dartmouth-Hitchcock Medical Center to improve physician-patient communication skills. The program engaged Patient Family Advisers as subject matter experts to design, deliver, and evaluate a two-hour module focusing on sharing bad news. Residents participated in simulated patient encounters and debriefing sessions. Evaluation measures included pre-and post-training assessments of resident confidence and standardized patient evaluations of resident performance. The program aimed to better utilize the medical center's simulation center and address communication skills and professionalism training.
Transplant Guardian Angels and Trauma Team Texting is a program that connects organ donors who have registered to donate with recipients waiting for an organ transplant. Through the program, living donors can send encouraging text messages to recipients waiting on the transplant list. The program aims to provide emotional support for transplant recipients during their wait, while also raising awareness about the need for organ donation.
This document outlines a project aimed at establishing a sustainable process for patient-centered care transitions. The goals were to (1) address what matters to patients, (2) provide actionable health information, and (3) share information across care settings. Partners implemented a process using an electronic personal health record called "How's Your Health" to survey patients in the hospital and after discharge. Results showed patients were more confident after hospital discharge but less so after skilled nursing discharge. Sustainability varied by site but engaged volunteers were key. Additional funding was received to focus on diabetes patients. Lessons included tailoring health IT to settings and supporting older adults, garnering volunteer interest, and engaging designated caregivers or volunteers.
This document describes a project to develop a patient-centered handoff process called ISHAPED at a hospital system. The project team collaborated with Patient and Family Advisory Councils to gather patient perspectives on handoffs. Based on interviews, five themes emerged around introducing nurses, communication, patient engagement, education, and privacy. An educational campaign was conducted after developing videos highlighting lessons. Surveys found that introducing nurses and several other factors positively influenced patient ratings of care. The project highlighted the importance of engaging patients and a culture change to patient-centered care.
This document describes Project PARIS, which aims to (1) improve medical trainees' knowledge and attitudes around family-centered care and (2) determine the ideal time for family-centered care education. The strategy involves family members teaching trainees about their child's hospitalization. Phase 1 involved 29 pediatric residents and Phase 2 involved 52 medical students. Both phases found significant improvements in attitudes but only residents' knowledge improved significantly. The lessons learned are that involving family faculty in training is a promising way to teach family-centered care principles required in pediatric training programs.
The Always Events Recognition Program aims to recognize healthcare organizations that have implemented programs meeting the criteria for an Always Event - actions that should always be performed to provide an optimal patient experience. Organizations can apply by submitting a letter describing their program and how it meets the criteria of being significant, evidence-based, measurable, and affordable for patients. The letter must also outline how the program was developed with patient partnerships, has leadership support, and staff engagement, and discuss evaluation measures and outcomes to date. Recognition provides marketing benefits and the opportunity to share best practices.
The document provides a mnemonic to help healthcare providers effectively communicate with patients and their families. The mnemonic is POTHOLEs, with each letter standing for an element of patient-centered care. These elements include listening to patients, orienting them to their treatment and care, checking their understanding, treating them with kindness and respect, providing timely care, allowing them to explain their needs and concerns, and managing their expectations of what will happen.
This document outlines ways to improve the patient experience through always events. It recommends paying attention to patients, actively listening to them, and ensuring timeliness. It also suggests introducing all team members, managing expectations through clear communication, using nice manners, and testing patient understanding.
This interim report provides updates on MyStory's progress. It includes appendices that provide additional details on key aspects of the work. The report gives a status update on where the project is to date.
University of Minnesota Amplatz Children's Hospital Always Event: My StoryPicker Institute, Inc.
The document discusses an initiative at University of Minnesota Amplatz Children's Hospital called MyStory that aims to capture personal stories and preferences of pediatric patients admitted to the hospital. MyStory recognizes children as individuals rather than just patients. The goal is to personalize care provided based on each child's unique story and needs.
University of Maryland Graduate Medical Education Always Events Poster Presen...Picker Institute, Inc.
This study aimed to empower patients and optimize medication regimens through a multidisciplinary approach involving internal medicine residents and clinical pharmacists. Residents received training on prescription plans, polypharmacy, and financial issues and worked with pharmacists and patients to address medication-related issues. Results showed residents improved their self-efficacy and competency working with patients. Patients positively rated the collaborative process and valuable changes were made to their medication regimens. The multidisciplinary model provided residents with beneficial learning experiences and tools to enhance patient care.
This document describes a project at Exempla Saint Joseph Hospital to increase patient participation in managing their comfort and pain. The project team developed a menu that nurses use during pain assessments to offer patients six different "courses" of options for pain control, including comfort items, medication options, comfort actions, personal care items, relaxation options, and ways to reduce boredom. Initial results showed higher patient satisfaction scores for pain management. The team's goal is to implement the menu hospital-wide to consistently involve patients in deciding their own comfort plans.
Wake Forest Graduate Medical Education Always Events Poster PresentationPicker Institute, Inc.
This document describes the development of a new curriculum called the Acute Care for the Elderly Transition Program (ATP) aimed at improving medical residents' education around care transitions. The program involves second-year residents conducting in-home visits with two recently discharged patients to assess medication management, follow-up care, functional status, and social support. Initial implementation is planned for July 2011. Preliminary findings indicate the program will need orientation for residents and dedicated time on their rotation. Lessons learned so far show importance of resident buy-in, direct supervision, and evaluating impact on patient outcomes and learning.
The document outlines a plan by Henry Ford Health System to implement routine dementia screening for senior patients aged 70 and older using online cognitive and behavioral assessments, with positive screens receiving further evaluation, diagnosis if appropriate, treatment, and referral to social services for patient and caregiver support. The goal is to test this screening program in two primary care clinics over 6 months before evaluating outcomes and potential expansion to other primary care practices.
This document provides guidance and reminders for an educational session on informed consent. It instructs participants to turn off electronics and participate in a debriefing session. It outlines learning objectives around shared decision-making, the informed consent conversation, and obtaining consent consistent with standards. Key elements of the informed consent conversation are described, including setting the environment, discussing options and patient preferences, and documenting the discussion and patient decision. Potential challenges like incapacitated patients, treatment refusal, language barriers, and consent for minors are also addressed.
1. Viewpoint
Healthcare in a land called PeoplePower:
nothing about me without me
Tom Delbanco MD1, Donald M. Berwick MD2, Jo Ivey Boufford MD3,
S. Edgman-Levitan PA4, Gunter Ollenschlager MD5, Diane Plamping PhD6
È È
7
and Richard G. Rockefeller MD
1
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA, 2Institute for Healthcare Improvement,
Boston, USA, 3Robert F. Wagner School of Public Service, New York University, New York, USA, 4The Picker Institute,
Boston, USA, 5Agency for Quality in Medicine, Cologne, Germany, 6Tower Hamlets Community Healthcare NHS Trust,
Mile End Hospital, London, UK, 7Health Commons Institute, Falmouth, ME, US
Abstract
Correspondence In a 5-day retreat at a Salzburg Seminar attended by 64 individuals
Tom Delbanco
from 29 countries, teams of health professionals, patient advocates,
Harvard Medical School
Beth Israel Deaconess Medical Center artists, reporters and social scientists adopted the guiding principle
330 Brookline Avenue, LY 310 of `nothing about me without me' and created the country of
Boston PeoplePower. Designed to shift health care from `biomedicine' to
MA 02215
USA `infomedicine', patients and health workers throughout People-
E-mail: tdelbanc@caregroup. Power join in informed, shared decision-making and govern-
harvard.edu ance. Drawing, where possible, on computer-based guidance and
Accepted for publication communication technologies, patients and clinicians contribute
29 September 2000 actively to the patient record, transcripts of clinical encounters are
Keywords: electronic medical records, shared, and patient education occurs primarily in the home, school
employee satisfaction, patient
and community-based organizations. Patients and clinicians jointly
satisfaction, shared decision-making,
volunteerism develop individual `quality contracts', serving as building blocks for
quality measurement and improvement systems that aggregate data,
while re¯ecting unique attributes of individual patients and clini-
cians. Patients donate process and outcome data to national data
banks that fuel epidemiological research and evidence-based
improvement systems. In PeoplePower hospitals, constant patient
and employee feedback informs quality improvement work teams of
patients and health professionals. Volunteers work actively in all
units, patient rooms are information centres that transform their
shape and decor as needs and individual preferences dictate, and arts
and humanities programmes nourish the spirit. In the community,
from the earliest school days the citizenry works with health
professionals to adopt responsible health behaviours. Communities
join in selecting and educating health professionals and barter
systems improve access to care. Finally, lay individuals partner with
professionals on all local, regional and national governmental and
private health agencies.
144 Ó Blackwell Science Ltd 2001 Health Expectations, 4, pp.144±150
2. Healthcare in a land called PeoplePower, T Delbanco et al. 145
and creativity, the faculty charged the Fellows
Introduction
with incorporating this principle into a new
World-wide, health professionals scramble to health care system for a mythical republic called
improve the quality of health care, focusing on PeoplePower. There, the new prime minister
everything from changing roles for a wide range swept into oce promising to design an entirely
of health workers, to new technologies, physical new health system through a joint e€ort by her
plants, education for patients and professionals, lay and professional citizenry. She commissioned
and the allocation of resources. These days, the Seminar participants to develop a `personal
virtually every health organization is knee-deep health care system for PeoplePower' and, in
in `redesign'. Few, however, invite patients to order to stimulate creativity, she announced that
join in such e€orts. Consensus reached at a 1998 any discussion of `feasibility' would be left for
Salzburg Seminar entitled `Through the Patient's another occasion.
Eyes', suggests that e€orts to improve care might Working in small teams late into the night, the
take strikingly di€erent shape if patients worked Fellows elaborated initiatives involving indi-
as full partners with health professionals to vidual patients and clinicians, hospitals,
design and implement change. To illustrate this communities and the government, both federal
point, we summarize recommendations that and local. For each initiative, we describe the
emerged from intense debate and discussion principal recommendations that won consensus
among 64 individuals from 29 countries over the for the foundation of the new system. Re¯ecting
course of 5 days. our shared aspirations, we describe PeoplePower
Founded in 1947 in the spirit of post-war as if it exists. Indeed, what follows is consciously
reconciliation, the Salzburg Seminar o€ers a `Utopian', re¯ecting hopes and aspirations
neutral forum in Salzburg, Austria, where indi- unleavened by the multitude of con¯icts and
viduals from around the world express, challenge pressures that competitive, materialistic societies
and examine their beliefs and those of others on a engender.
wide range of topics.1 The seven faculty for our
Seminar, active in clinical care, medical
The clinician±patient relationship
education, health policy, community develop-
ment, quality improvement, consumer advocacy Where technologically and ®nancially feasible
and shared decision-making, facilitated the within the widely varying regions of People-
work of 57 Fellows nominated and sponsored Power, computer-based guidance and commu-
by national and local agencies, practices or nication systems are central to the new health
communities. The faculty and Fellows (whose care system. They serve not as a replacement for
median age was 40) represented nations as the clinician±patient relationship, but to enhance
diverse as Australia, Argentina, China, it at every turn, while dramatically reducing
Romania, Russia, Sweden, South Africa, Malta, human error. Electronic patient records provide
Israel, the United States and the United the backbone for decision support systems, as
Kingdom. They included physician assistants, well as a focal point for the clinician±patient
practitioners of alternative medicine, patient interaction. Patients and clinicians depend
advocates, health educators, doctors, healthcare heavily on secure electronic mail for communi-
administrators, social scientists, nurses, philan- cation2 and a growing number of technologies
thropists, medical reporters, a storyteller and a help patients monitor symptoms and signs in the
theatre artist. home. Patients and their families use these tech-
In the introductory group meeting the Fellows nologies also to monitor adherence to medical
developed a guiding principle for patient/citizen regimens,3 pro®ting from reminders such as
involvement: `Nothing about me without me', an electronic alerts and diaries.4 Higher level guid-
emphatic statement that posed dicult chal- ance, including patient-speci®c disease manage-
lenges for the week's work. To foster imagination ment, preliminary diagnosis and triage for
Ó Blackwell Science Ltd 2001 Health Expectations, 4, pp.144±150
3. 146 Healthcare in a land called PeoplePower, T Delbanco et al.
patients at home, and even higher-level diag- Community-based teams of lay persons and
nostic assistance for patients and doctors toge- health professionals monitor and recommend
ther, are increasingly employed and continuously interactive material from selected Internet sites,
improved. which complements and ampli®es the clinical
issue at hand.
Citizens from areas in PeoplePower lacking
Medical records and patient education
resources for such technologies subscribe
In PeoplePower, the Internet-based patient enthusiastically to the same underlying princi-
record exists as a single version that resides ples7 but rely on paper and pencil and, when
nowhere but is available everywhere. Oversight possible, the telephone to communicate. In these
by many users has greatly improved its reliab- parts of the nation, family members, volunteers
ility. Not only do patients have nearly complete or small audio or video recorders document
access to their medical record (although they interactions in the clinician's oce. For educa-
don't have to review their record if they don't tional material, patients and clinicians draw
want to), but they also write in it ± elaborating, regularly on libraries of books, articles and tapes
tracking and explicating problems, correcting focused on health promotion and the manage-
mistakes, prioritizing needs, and at times sug- ment of illness.8 Peer counselling for those who
gesting both diagnoses and treatment plans. are not literate plays an important role in elab-
Controlled layering of access provides far orating informed, shared decision-making,
greater con®dentiality than was previously which represents PeoplePower's national stan-
possible. Some parts of the record are for dard for clinical interaction.9
patients' eyes only. Others, such as clinicians'
reminders to themselves, are o€ limits to anyone
Clinicians and patients measuring
else, while employers, payers, etc., are privy only
and improving quality
to information authorized for their speci®c
purposes. Whichever technology they use, after patients
In clinicians' oces throughout PeoplePower, and their families re¯ect on and, when possible,
computerized voice recognition systems record review transcripts of the visit, health providers
encounters in real time, allowing patients to go expect to receive anecdotal feedback, sent
home with a hard copy of the visit to review at through secure e-mail systems when feasible. In
leisure thereafter. Others leave the clinician's addition, whether through face-to-face interview,
oce with a transcript recorded on a `smart paper and pencil, telephone, or with computer-
card', a machine-readable computerized storage assisted technologies, virtually all patients
system that holds also their medical histories, complete structured surveys that assess quality
prior visit transcripts, medication lists and `through the patient's eyes', providing data that
results of health maintenance and diagnostic guide clinicians in `real time' towards improved
testing.5 Bene®ting from PeoplePower's national care.10,11
obsession with secure and private communica- In PeoplePower, each citizen also owns an
tion lines6 still other patients access and shape individual `quality contract', agreed to and
their medical records via the World Wide Web, monitored by both the patient and clinician. As
o€ering their clinicians access to information an example, consider a middle-aged obese,
that the patients, and sometimes their families, hypertensive and diabetic man. He and his
elaborate and update regularly. doctor jointly design a programme to manage his
In PeoplePower, most patient education does care and together establish explicit, measurable
not take place during the actual patient±clinician goals for the year. The patient decides to lose
encounter. Rather, much occurs before and after 10 kg of weight, decrease his elevated glycoso-
visits to clinicians, with patient-speci®c materials lated haemoglobin level by 2%, and bring down
¯owing by e-mail from the clinician to patient. his mean diastolic pressure by 15 mm. To do this
Ó Blackwell Science Ltd 2001 Health Expectations, 4, pp.144±150
4. Healthcare in a land called PeoplePower, T Delbanco et al. 147
he works to change his eating habits, increase his unique to each individual's personal circum-
exercise, and adjust and adhere to his medical stance forces PeoplePower to consider actively
regimen. For her part, his doctor agrees to the issues of privacy, con®dentiality and consent
choose and send the patient relevant teaching for clinical research. PeoplePower is urging its
materials available on the Internet, to review and citizens to `donate' their own Individual Health
respond at least quarterly to the patient's elec- Data Account voluntarily and anonymously to
tronic diary, and to meet with him three times the PeoplePower Data Banks. The Data Banks
annually to monitor progress and address new store data that generate and track the various
issues. scores outlined above. They also a€ord the
Both the patient and clinician measure and country unique opportunities to aggregate data,
score performance and outcome, with the establishing a `virtual' national laboratory that
relative value of their speci®c goals enumerated houses standardized, core measures of the
in advance. Incomplete achievements ± only processes and outcomes of care. Investigators
2 kg of weight loss, or tardy responses by the draw on this invaluable source of data to conduct
clinician to a patient's e-mail and telephone evidence-based, epidemiological research that
queries ± yield lower scores. The goals the informs and improves care throughout the nation
patient and clinician establish include quanti- and beyond.
®able measures that document change in Patients in PeoplePower may choose clinicians
functional status and quality of life. In addi- well-matched to their individual preferences by
tion, errors and potentially preventable adverse reviewing taped statements o€ered by individual
outcomes a€ect the scores, as does the clinicians and some of their patients. The videos
patient's evaluation of speci®c elements of the describe attributes such as the clinician's back-
clinician's behaviour, with particular emphasis ground, training, experience, practice style and
on the recognition of individual dignity, pref- personal preferences. For each clinician, the
erences and needs. If all goes perfectly during videos also display anecdotal and aggregate
the year, the patient and clinician each earn feedback from patients, along with scores
100 points. outlining and analysing clinical performance.
When viewed in the aggregate, the People- Finally, PeoplePower rewards all citizens for
Power Quality Measurement and Improvement their contributions to the public's health by
System addresses both the process and outcome providing rapid access not only to their medical
of care and re¯ects both patients' and clinicians' records, but also to summaries of their data
performance. For example, in one 10 000-patient accounts, presented in ways that consider an
practice in PeoplePower, patients achieved last individual's literacy, education and cultural
year a mean Patient Quality Score of 63 out of a needs.
`perfect' 100. The practice and its patients have
jointly established a target score of 70 for the
Hospitals in PeoplePower
current year and together are elaborating strat-
egies to achieve their goal. Similarly, for the 15 PeoplePower is experimenting with a system of
clinicians in the practice, last year's mean Clini- accountability for patient advocates that mirrors
cian Quality Score was 68. This year, helped by a one in place in several newspapers in the United
team of patients, the clinicians are working hard States. As an example, the Boston Globe
to improve care and have targeted a score of 80 ombudsman who critiques articles appearing in
as their collective goal. that newspaper reports to the owner, not the
editor. Similarly, ombudspeople in PeoplePower
report to the ultimate hospital authority, beyond
Research, data management, and con®dentiality
the chief executive or his or her delegates. From
Placing the medical record front and centre and that prominent and protected vantage point, the
developing metrics to judge quality that are ombudspeople spearhead e€orts to improve care
Ó Blackwell Science Ltd 2001 Health Expectations, 4, pp.144±150
5. 148 Healthcare in a land called PeoplePower, T Delbanco et al.
by scrutinizing untoward patient experiences (NGOs) representing the categorical interests of
and advocating timely remedies. both healthy and ill individuals. Further promo-
Collaborating with social scientists, the ting a mix of professional and lay skills, the
ombudspeople also join teams of hospital hospitals house associations focusing on
workers who generate from patients and their diabetes, cancer, care at the end of life, parent
families a constant stream of feedback, both counselling or addiction. Hospital-based learning
through surveys designed to provide aggregate centres and libraries, similar to those pioneered
data and by inviting individual anecdotes. by Planetree in the United States,12 take a
Guided by the principle that an ecient, ener- central role in convening and networking patients
gized and satis®ed workforce provides the best and their families and friends. The centres work
care, the ombudspeople and social scientists closely with storytellers who both perform for
gather similar information from the hospital patients and elicit patients' stories, artists and
workforce, including professionals and those performers from a wide range of disciplines,
in supporting roles, using surveys that measure spiritual leaders from the community, and healers
workers' experiences in carrying out their from a broad spectrum of disciplines that
responsibilities and also evaluate job satisfaction. complement allopathic medicine.
On PeoplePower hospital ¯oors, families help
not only their loved ones, but also volunteer to
Community-based initiatives
aid many patients in the hospital. Similarly,
patients join in a wide variety of hospital e€orts, In communities throughout PeoplePower,
ranging from ad hoc work teams developing new primary care clinicians serve as `gateopeners', in
initiatives, to the array of committees overseeing striking contrast to their former role as `gate-
di€erent hospital functions. Such patient parti- keepers'. Community leaders work closely with
cipation provides further substance to People- health professionals and their students to
Power's `nothing about me without me' guiding encourage `community-oriented primary care'13
principle. that actively engages primary and secondary
With respect to hospitals and their physical schools, religious institutions, local businesses,
design, PeoplePower recognizes that individual the police force and prisons. In the elementary
preferences concerning privacy vs. group living schools in PeoplePower, health professionals
vary widely. Much like the stage in a theatre, the join teachers in preparing students from their
nation is building hospitals that house rooms of very ®rst days to take steps to maximize their
changeable shapes and sizes, thereby helping own health and to learn to deal with illness in a
sta€ and patients adapt to shifting usage and way that promotes informed, shared decisions
preferences. Where resources permit, each room between themselves and those who care for
holds an information centre, including the them.
patient's electronic medical record, a computer Lay citizens and clinicians join in educational
providing Internet access, CD ROMs o€ering initiatives designed to improve clinical, spiritual
education about disease and the processes of and managerial skills among health professionals
care, and recording and playback devices that and lay individuals involved in health care.
allow patients and families to review important Acknowledging PeoplePower's national interest
discussions with caregivers. Volunteers help `low in developing health professionals with cultural
tech' patients work with these technologies. and ethnic backgrounds similar to those they will
Wherever feasible, hospitals in PeoplePower serve, community representatives help identify
bring natural light to the patients and workforce, candidates suitable for careers in health care and
gardens are abundant, pet animals are welcomed, join in the selection process for new health
and there is a sense of campus, rather than prison. professionals. Holding formal teaching appoint-
Hospitals support patients further by alloca- ments in health profession schools, both
ting space to non-governmental organizations healthy and ill lay persons teach young health
Ó Blackwell Science Ltd 2001 Health Expectations, 4, pp.144±150
6. Healthcare in a land called PeoplePower, T Delbanco et al. 149
professionals how to understand and draw upon service that delights and surprises both the
the patient's perspective.14 Apprenticeship pro- `caregiver' and `caregetter' with unanticipated
grammes deploy healthcare leaders as mentors to levels of excellence.16
those demonstrating particular promise as future Led by the national government, PeoplePower
leaders. is establishing a `patient bill of rights', developed
Peer counsellor programmes match patients in collaboratively by professionals and patients. It
need with individuals with similar clinical moves beyond current e€orts, as the nation
conditions and health needs. Individuals in local works to build consensus on complex issues such
healthcare volunteer corps serve as `navigators', as priorities for organ transplantation, mental
assisting patients with the services of NGOs, health care, entitlements for the poor, genetic
hospitals and practices providing ambulatory engineering and therapies, and care at the
care. Those helped by such e€orts are expected, beginning and end of life.
when possible, to reciprocate by volunteering In an e€ort to hold the media accountable, a
their services for other community needs. Thus, national programme to inform and educate the
for those capable of participating, a service media has established guidelines for fairness and
credit `barter system', similar to the `time-dollar' accuracy. National and local agencies assist and
initiatives emerging in some communities in the support the media in recruiting and retaining
United States, encourages people from all walks experts skilled in interpreting research studies
of life to contribute to the PeoplePower health who teach reporters to evaluate new ®ndings
system.15 critically. PeoplePower has also established
While much of the foregoing draws on incentives, including national and local `health-
voluntarism and reciprocity, such a system care media award programmes', that encourage
requires a robust infrastructure. Helped by the the media to join in e€orts to improve the health
federal government and private philanthropies, of the nation.
communities throughout PeoplePower take the Finally, accountability for health and illness
lead in providing ®nancial support that builds in the nation sits at multiple levels, such that
voluntary e€orts into the fabric of the nation. every citizen is growing con®dent that `nothing
about me without me' is embedded in all levels
of the delivery system. Accountability is
National and local governmental agencies
becoming transparent, functioning upward,
In PeoplePower, those who legislate, regulate downward and horizontally, with quality meas-
and pay for health care work closely with patient ured at every juncture. Indeed, as `infomedicine'
advocacy councils and include lay representa- becomes an equal partner with `biomedicine', all
tives on their principal committees, working citizens of PeoplePower share accountability for
groups, review boards and consensus panels. the quality of the new health system.
Similarly, the ministries of health and corres-
ponding local agencies have established high
Summary
level positions for individuals charged with
articulating and monitoring the patient's We paint the components of PeoplePower's
perspective. mythical health system with a broad, utopian
National and local quality task forces contain brush, and the landscape that emerges di€ers
a mix of health professionals and lay individuals. strikingly from the strategies, shape and philo-
They establish and monitor quality standards sophy of care deployed today in health systems
that amplify and aggregate the individual quality around the world. It is a scenario divorced
contracts and improvement initiatives outlined entirely from ®nancial, human, societal and
above. They work aggressively to identify historical constraints, and as such is suspect, can
`benchmarks' and `best practices' that stimulate never be realized in its entirety, and indeed runs
e€orts to improve care. The goal is a level of the risk of appearing cloying, simplistic and
Ó Blackwell Science Ltd 2001 Health Expectations, 4, pp.144±150
7. 150 Healthcare in a land called PeoplePower, T Delbanco et al.
beyond any possibility of approaching realiza- 3 Slack WV. Cybermedicine. How Computing Empowers
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San Francisco: Jossey-Bass, 1997.
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the night. At a time of frightening instability and Internet and the World Wide Web. Annals of Internal
change in health systems world-wide, our hope is Medicine, 1997; 127: 138±141.
that the readers of Health Expectations will be 7 Mandl KD, Katz SB, Kohane IS. Social equity and
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applications. Proceedings of the AMIA Annual Fall
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Acknowledgements 9 Rockefeller R. Informed shared decision-making: is
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10 Cleary PD, Edgman-Levitan S. Health care quality.
engendered the body of this paper. Thanks also Incorporating consumer perspectives. Journal of the
to Patty Russell BA for her assistance throughout American Medical Association, 1997; 278:
the Seminar and thereafter in the preparation of 1608±1612.
this manuscript, and to Erin Hartman MS for 11 Gerteis M, Edgman-Levitan E, Daley J, Delbanco
TL. Through the Patient's Eyes: Understanding and
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Promoting Patient-Centered Care, 1st edn. San
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