PERSON-CENTRED CARE: WORTH MY TIME OR JUST FLUFFY …€¦ · We work with hearing care...

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Dr. Ena Nielsen, Associate Director, Ida Institute

PERSON-CENTRED CARE: WORTH MY TIME OR JUST FLUFFY STUFF?

September 18 Slide 2

•  About the Ida Institute •  Some important trends •  Person-centered care: What is it and why do it? •  Video case: Being person-centered in the clinic •  Ida Institute Tools: Designed to enable person-centered practices •  Ida Telecare – a tool example •  Inspired by Ida •  My Ida Moment

AGENDA

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THE IDA INSTITUTE


FACTS •  Non-profit organization established in 2007 •  Funded by the Oticon Foundation •  13,000 + members in the Ida Community

ABOUT THE IDA INSTITUTE

We believe that every person and every hearing loss is unique. We work with hearing care professionals from around the world to develop and integrate person-centered care in hearing rehabilitation. Together we develop knowledge and tools to strengthen the counseling process, enabling people to express their individual needs and preferences and take ownership of their hearing care. Helping people hear is about knowing how to listen.

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Universities: Uni. of Sao Paolo Uni. of South Florida Uni. of Queensland Uni. of Aston Rush University Uni. of Cape Town Uni. of Southern Denmark

Patient organizations: Ear Foundation Action on Hearing Loss SHHH Australia Høreforeningen Hearing Loss Association of America (HLAA)

Prof. Organizations: British Society of Audiology ASHA South African Association of Audiologists Audiology Australia

PARTNERSHIPS


IDA ADVISORY BOARD 2018-2020

Uwe Hermann

Ph.D Communication Pathology Professor, Department of Speech-Language Pathology and Audiology University of Pretoria

DeWet Swanepoel

Senior Director and Head of Eriksholm Research Centre Dipl.Ing.Univ in Electrical Engineering from University of Erlangen-Nuernberg

Ph.D Professor, Speech Language Pathology and Audiology Department School of Dentistry of Bauru University of São Paulo

Louise Hickson

Deborah Ferarri Ph.D. Deputy Chief Patient Care Services Officer Rehabilitation and Prosthetic Services U.S. Department of Veterans Affairs

Lucille Beck

Darcy Benson Au.D., Audiologist & Practice Owner California Hearing Center and Audiology Services, Inc.

CEO of the Ear Foundation, UK, Audiologist

Melanie Gregory

Ph.D. Associate Professor of Audiology at the College of Medicine, Mayo Clinic Foundation Senior Consultant in Otorhinolaryngology and Chair of the Audiology Division at the Mayo Clinic Florida

David A. Zapala

Ph.D. Professor of Audiology Co-Director Communication Disability Centre The University of Queensland

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INNOVATION SEMINARS

Generating new knowledge, insights, models and tools on chosen topic

Explore Create Understand

Defining Hearing / Motivation / Communication Partners / Living Well / Managing Change / Person-Centred Care / Cochlear Implants/ Tinnitus/ Hearing Journey

400+ Participants

32 Countries

20+ Innovation seminars &

workshops


CO-CREATION IS THE HEART OF IDA’S WORK

User-Driven Innovation Involving Professionals and

PHL

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IDA RESOURCES FOR PERSON-CENTERED CARE

Clinical tools Ethnographic videos

Professional development tools

Telehealth tools for clients/ patients

Selected tools available in other languages (French, Spanish, German & Danish)


SOME IMPORTANT TRENDS

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The patient will see you now: •  Patients consumers •  Demand for individualised, flexible care •  Dr. Google +

Systems under pressure: •  Demographics are changing •  Working seniors •  Increased needs for care – fewer resources •  Cost-effective and high-quality care needed

SOME IMPORTANT TRENDS


New expectations New roles: •  Clients and their families •  Professionals

Client / professional relationship is changing

POSSIBLE IMPACT

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PERSON-CENTERED CARE: WHAT IS IT AND WHY DO IT?


Think of a time when you were a patient. What did the doctor / other health professional do that was helpful? What did they do that was less helpful? Tell your story to the person next to you. Then swap over

EXERCISE: WHAT IS IT LIKE TO BE A PATIENT?

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COMMUNICATION PATTERNS IN TYPICAL CONSULTATIONS: HISTORY TAKING (GRENNESS ET AL 2015)

6.4.2018 Slide 15

•  Audiologists tended to control the agenda •  Initiated consultations with close-ended questions 62% of the

time •  Interrupted patient talk after 21.3 sec on average •  Increased verbal dominance & control over content of questions •  Audiologists asked 97% of the questions during history taking,

using mostly close-ended questions •  Aud talked as much as the patient, and much more than

companion when present •  Aud questions balanced in topic: Biomedical & lifestyle •  Few emotionally focussed utterances (less than 5% of

utterences)

6.4.2018 Slide 16

•  Mean length of time for DMP was 29 min (range 2.2 – 78.5 min) •  Opportunities to build relationships were missed •  Psychosocial concerns rarely addressed •  Patients/Companions rarely involved in MP •  Amount of talk was asymmetrical •  Majority of Education & counselling time focussed on HA’s while

only 56% of patients opted to obtain HA’s by end of session •  HA’s recommended 83% of the time •  Alternative options rarely provided (shared decision making rare) •  HL diagnosed & HA’s recommended without patient involvement •  When more time was dedicated to DMP, patients had greater

input & control by asking more questions & requesting further information

Opportunities to build relationships were missed

COMMUNICATION PATTERNS IN TYPICAL CONSULTATIONS: DIAGNOSIS & MANAGEMENT (GRENNESS ET AL 2015)

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A client goes to see the hearing care professional

Gets hearing aids

Copes well with the hearing aids and the hearing loss in daily life

THE IDEAL WORLD

However, up to 40% of hearing aids dispensed are not used regularly


2) Patient could not remember what the doctor had said

Doctors often assume two reasons for this: 1) Patient did not understand what the doctor said

WHY DO WE NOT ALWAYS FOLLOW RECOMMENDATIONS?

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This information can be quite different from the information made available to professionals!

Patients based decisions on: Personal considerations about pros and cons Personal context and constraints

HOW DID THE PATIENTS MAKE DECISIONS?


Hearing care professionals can form an active, co-operative relationship with clients by: •  Understanding clients’ desires, needs and constraints •  Acknowledging and respecting clients’ decision making abilities •  Creating a shared understanding with the client •  Setting common goals

HEARING CARE PROFESSIONALS AS PARTNERS AND ADVISORS

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PERSON-CENTERED CARE

Shared goal setting & decision making

Empathy & active listening

Understanding of individual preferences & needs

Involvement of family and friends

Dialogue based on open- ended, reflective questions


Biopsychosocial Model •  Horizontal communication

•  Interactive, facilitative •  PHL identifies problems

•  Clinician does something with PHL

•  Person focused •  PHL’s perceptions and needs determine

goals, strategies •  For chronic conditions requiring self-

management/adherence

•  Empowering

Medical Model •  Top-down communication

•  Authoritarian •  Clinician diagnoses

•  Clinician does something to PHL

•  Disease/impairment focused •  Clinician knows what’s best and sets

treatment goals •  Curative

•  May be necessary in acute, emergency situations

MEDICAL MODEL VS. BIOPSYCHOSOCIAL MODEL

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•  The client is viewed as a whole person

•  The client’s story, or narrative, is at the center

•  The practitioner fosters an empathic, trusting relationship by understanding and by being

understanding

•  Shared communication, decisions, and responsibilities

•  Clients are engaged in treatment plans and process

THE BIOPSYCHOSOCIAL MODEL


Clinical benefits Financial benefits Professional benefits

WHAT ARE THE BENEFITS OF PERSON-CENTERED CARE?

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•  Greater satisfaction with care

•  Better results of treatment

•  Easier to follow recommendations of the HCP

CLINICAL BENEFITS OF PERSON-CENTERED CARE


Fewer diagnostic tests Fewer hearing aid returns Fewer hearing aids in dresser drawers Fewer “chronic complainers” Improved adherence/compliance Client loyalty

FINANCIAL BENEFITS OF PERSON-CENTERED CARE

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Enhanced self-esteem Improved relationships with clients Improved relationships in team Decreased levels of stress and burn-out Clinician’s relationship with self enhanced

PROFESSIONAL BENEFITS OF PERSON-CENTERED CARE


MYTHS ABOUT PERSON-CENTERED CARE

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PERSON-CENTERED CARE: A CLINICIAN’S REFLECTIONS


What stood out to you in Bridgitte’s description of how she chooses to work with person-centered care? Why does she think it is important?

REFLECTIONS

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CASE: BEING PERSON-CENTERED IN THE CLINIC


EMILY & MORAG

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Discuss in pairs: •  What stood out to you about the communication between professional and patient? •  What was the patient’s agenda/goal? What was the professional’s agenda/goal? •  What does person-centered care look like in cases like this one?

EMILY & MORAG


EMILY & MORAG: CLINICIAN’S REFLECTIONS

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IDA INSTITUTE TOOLS SUPPORT PERSON-CENTERED PRACTICES


EXAMPLES OF IDA TOOLS

Motivation Tools Increase client motivation with the Line, the Box & the Circle

Communication Partners Involve the family and other communication partners

Living Well Help people manage hearing loss in daily life

Tinnitus Management Provide Hope for Tinnitus Patients

Pediatrics Support children with hearing loss and their families

Ida Telecare Improve and extend care beyond the appointment

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IDA TOOLS: PEDIATRICS

Transitions Management

My World

My Turn To Talk (Parent Version)

Ida Telecare for Tweens and Teens


TOOL EXAMPLE: IDA TELECARE

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IDA TELECARE – ONLINE RESOURCE FOR PATIENTS

An online, interactive framework for patients structured by the steps in the clinical journey Tools and resources to help patients: •  Prepare for appointments and

important decisions

•  Involve their families

•  Live good lives with hearing loss


1. Prepare for your First Appointment •  Living Well •  My Turn to Talk •  Why Improve My Hearing •  Tinnitus Thermometer

2. Prepare for Follow-Up Appointments •  Living Well •  My Turn to Talk •  Tinnitus Thermometer

3. Everyday Life with Hearing Loss •  Communication Strategies •  Dilemma Game

THREE STEPS TO IDA TELECARE

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PREPARE FOR APPOINTMENTS

www.idainstitute.com/telecare


LIVING WELL ONLINE

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IDA TELECARE FOR TEENS AND TWEENS


USING THE IDA TELECARE TOOLS WITH PATIENTS

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Extend your services beyond the clinic

Provide guidance before and after the appointment and save time

Empower clients to self-manage their hearing loss

IDA TELECARE: www.idainstitute.com/telecare

INSPIRED BY IDA

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INSPIRED BY IDA

Enables you to promote PCC and integrate it into your practice To join the program: Complete 2 courses in the Learning Hall Signal your commitment to high quality personalized care via the Inspired label. For both individual HCPs and clinics

WHY BECOME INSPIRED?

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ACCLAIM ONLINE BADGING SOLUTION


Allows for seamless sharing: -  FB, Twitter, LinkedIn -  Emails (with customized message) and email

signature -  Mobile sharing: WhatsApp, Messenger -  Embedded on website

MARKETING KIT FOR CLINICS

ZIP file containing: •  Client brochure

•  High resolution logo •  Catalogue with inspiration for how to

use the logo •  Sample press release

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LEARN MORE


VISIT www.idainstitute.com/tools

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LEARN, EXPLORE, CONNECT WITH THE IDA LEARNING HALL

Bite sized learning & courses accredited by AAA, BSHAA, Audiology Australia, HCPSA, and AG Bell

Community discussions & interactions

Online learning platform for person- centered care


MY IDA MOMENT

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MY IDA MOMENT

What can you do right away to make your work with patients / clients even more person-centered than it is today?


REFERENCES

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REFERENCES ●  Audiological Counseling: A Biopsychosocial Approach. Sue Ann Erdman. Adult Audiological Rehabilitation; Joseph J. Montano, Jaclyn B. Spitzer, pp. 171 –

215. ●  Patient-centered care: A review for rehabitative audiologists. (Caitlin Grenness, et al. International Journal of Audiology 2014) ●  A Study of Patient Clues and Physician Responses in Primary Care and Surgical Settings (Levinson et al. 2000) ●  Effect of patient-centered care on patient satisfaction and quality of care (Wolf et al. 2008); A retrospective evaluation of the impact of the Planetree patient-

centered model of care on inpatient quality outcomes (Stone 2008) ●  The effects of physician empathy on patient satisfaction and compliance (Kim, Kaplowitz, and Johnston, 2004) ●  Patient-centered communication and diagnostic testing. Annals of Family Medicine. Epstein RM, Franks P, Shields CG, Meldrum SC, Miller KN, Campbell TL,

et al. 2005;3(5):415-421. ●  Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Boulding W, Glickman S, Manary M, Schulman K, Staelin

R. American Journal of Managed Care 2011;17(1):41-48. ●  The impact of patient-centered care on outcomes. Journal of Family Practice. Stewart M, Brown J, Donner A, McWhinney I, Oates J, Weston W, et al.

2000;49(9):796-804. ●  Patient-centred care: Improving quality and safety through partnerships with patients and consumers. Australian Commission on Safety and Quality in Health

Care, 2011. ●  Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. Little P, Everitt H, Williamson I,

Warner G, Moore M, Gould C, et al. BMJ 2001;323(7318):908-911. ●  Patient and family-centered collaborative care: an orthopaedic model. DiGioia AI, Greenhouse PK, Levison TJ. Clinical Orthopaedics and Related Research

2007;463:13-19. ●  Do patients treated with dignity report higher satisfaction, adherence, and receipt of preventive care? Beach MC, Sugarman J, Johnson RL, Arbelaez JJ,

Duggan PS, Cooper LA. Annals of Family Medicine 2005;3(4):331-338. ●  Grenness, Hickson, Laplante-Levesque, Meyer & Davidson (2015a). The Nature of Communication throughout Diagnosis and Management Planning in Initial

Audiologic Rehabilitation Consultations. JAAA, 26:36-50 ●  Grenness, Hickson, Laplante-Levesque, Meyer & Davidson (2015b). Communication Patterns in Audiologic Rehabilitation History-Taking: Audiologists,

Patients, and Their Companions. Ear & Hearing, 36:191-204

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PERSON-CENTRED CARE: WORTH MY TIME OR JUST FLUFFY …€¦ · We work with hearing care...

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