Picker institute 2011 2012 annual report

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ADVANCING EXCELLENCE IN PATIENT-CENTERED CARE

THROUGH EDUCATION, RESEARCH AND THE

DISSEMINATION OF BEST PRACTICES STRATEGIES

for more information, please visit us at

About us2 0 1 1 - 2 0 1 2 A n n u a l R e p o r t

ABOUT PICKER INSTITUTE

Picker Institute is an independent nonprofit organization dedicated to promoting the advancement of patient-centered care to improve the patient and family experience with the healthcare system, and to assuring that all aspects of the patient experience will be Always EventsSM that happen for every patient every time.

Picker Institute furthers this goal through support to education, matching grant programs, research in acute and long-term care, publications on patient-centered care, partnerships with other like-minded organizations and the annual Picker Awards. Coupled with a strong commitment and an open mind, these have resulted in a diverse and deep range of projects that have made major contributions to the challenge of making quality healthcare available to everyone at a reasonable cost.

About uS 2

ContEntS 2

A LEttEr froM thE ExECutIvE DIrECtor AnD 3

thE ChAIrMAn of thE boArD

thE PICkEr PrInCIPLES 4–5

thE PICkEr AwArDS for ExCELLEnCE® 6–7

ALwAyS EvEntS SM 8–9

PICkEr rESEArCh AgEnDA 10–12

EDuCAtIon 13

ConvErSAtIonS wIth LEADErS In thE fIELD of 14–17

PAtIEnt-CEntErED CArE

fInAnCIAL hIghLIghtS 18

boArD of DIrECtorS 19

CoNtENts

www.pickerinstitute.org2

to our friends—

the man who died of pneumonia after a long and misdiagnosed illness in a new york hospital at the age of 74 in May 2008 was not just anyone. the scion of a family that could trace its roots back to the founders of this country on both sides of the tree, he was a broadly accomplished man in his own right. Educated at the best schools in the united States and abroad, he made a very distinguished name for himself in journalism, publishing and public television. nor did he rest on these laurels. he went on to become the president of a well-known college and a very active supporter of innovations in modern telecommunications.

the man whose dying wife asked him “why does it have to be this way?” when the drug that could have eased her painful spasms of coughing was not forthcoming was not just anyone either. the dean of the school of public health at a celebrated university and a prominent researcher in the fields of AIDS and heart disease, he was on a first-name basis with many of the first names in healthcare and a second-name basis with most of the rest of the healthcare community.

nor was the 57-year-old woman who died of undetected kidney failure at a medium-sized hospital in Chicago just anyone. Laid off as a teacher of at-risk children in elementary school, and consequently without health insurance and a primary-care physician, she put off seeking medical attention for her escalating abdominal pain for as long as she could. when she finally went to the emergency room, it was too late. but she was a wife and a mother. She loved teaching. She read avidly, and gardening in the small plot behind her house in one of the city’s suburbs was her passion. there is no question that had she had insurance she would have addressed her health issues much more quickly and lived to return to all the things she loved instead of slipping through the cracks and dying.

how did these people become the accidental victims of a healthcare system that loudly claims to be the best in the world? what does this say for our current healthcare system? how is this challenge to be addressed?

At Picker Institute, we believe that everyone deserves an optimal healthcare system, regardless of means or status. for us, the healthcare debate that is playing out all over our media is irrelevant. healthcare does not belong to one or another political party; it is in and of itself an end, a necessity of life every bit as important as food and shelter. we don’t care if healthcare services are delivered by the state, the federal government or a private entity, as long as they at all times measure up to a standard of excellence that is well within reach in this country but too often overlooked in the polarized flurry of threats and accusations that, unfortunately, have come to stand for dialogue in this vital realm of human activity.

the guiding principle at Picker Institute is that the patient’s perspective must be central to the design and delivery of the optimal healthcare system. Quality healthcare without patient-centeredness is not quality healthcare.

J. MArk wAxMAn, ESQ. Chairman of the Board

LuCILE o. hAnSCoM Executive Director

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opEN LEttEr

www.pickerinstitute.org

J. Mark waxman, Esq.

Chairman of the board

Lucile o. hanscom

Executive Director

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THE PICkER PRINCIPLESwe believe that all patients deserve high-quality healthcare, and that patients’ views and experiences are integral to reaching that goal. Quality care without patient-centeredness is not quality care. The principles of patient-centered care are:

Respect for patients’ values, preferences and expressed needs

Patients want to be kept informed regarding their medical condition

and involved in decision-making. Patients indicate that they want

hospital staff to recognize and treat them in an atmosphere that is

focused on the patient as an individual with a presenting medical

condition.

• Illness and medical treatment may have an impact on quality of

life. Care should be provided in an atmosphere that is respectful

of the individual patient and focused on quality-of-life issues.

• Informed and shared decision-making is a central component of

patient-centered care.

• Provide the patient with dignity, respect and sensitivity to his/her

cultural values.

Coordination and integration of care

Patients, in focus groups, expressed feeling vulnerable and

powerless in the face of illness. Proper coordination of care can

ease those feelings. Patients identified three areas in which care

coordination can reduce feelings of vulnerability:

• Coordination and integration of clinical care

• Coordination and integration of ancillary and support services

• Coordination and integration of front-line patient care

Information, communication and education

Patients often express the fear that information is being withheld from them and

that they are not being completely informed about their condition or prognosis.

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for more information, please visit us at www.pickerinstitute.org4

based on patient interviews, hospitals can focus on three

kinds of communication to reduce these fears:

• Information on clinical status, progress and prognosis

• Information on processes of care

• Information and education to facilitate autonomy, self-care

and health promotion

Physical comfort

the level of physical comfort patients report has a

tremendous impact on their experience. from the patient’s

perspective, physical care that comforts patients, especially

when they are acutely ill, is one of the most elemental services

that caregivers can provide. three areas were reported as

particularly important to patients:

• Pain management

• Assistance with activities and daily living needs

• hospital surroundings and environment kept in focus,

including ensuring that the patient’s needs for privacy are

accommodated and that patient areas are kept clean and

comfortable, with appropriate accessibility for visits by

family and friends.

Emotional support and alleviation of fear and anxiety

fear and anxiety associated with illness can be as debilitating

as the physical effects. Caregivers should pay particular

attention to:

• Anxiety over clinical status, treatment and prognosis

• Anxiety over the impact of the illness on themselves and

family

• Anxiety over the financial impact of illness

Involvement of family and friends

Patients continually addressed the role of family and friends

in the patient experience, often expressing concern about the

impact illness has on family and friends. these principles of

patient-centered care were identified as follows:

• Accommodation, by clinicians and caregivers, of family and

friends on whom the patient relies for social and emotional

support

• respect for and recognition of the patient “advocate’s” role

in decision-making

• Support for family members as caregivers

• recognition of the needs of family and friends

Continuity and transition

Patients often express considerable anxiety about their ability

to care for themselves after discharge. Meeting patient needs

in this area requires staff to:

• Provide understandable, detailed information regarding

medications, physical limitations, dietary needs, etc.

• Coordinate and plan ongoing treatment and services after

discharge and ensure that patients and family understand

this information

• Provide information regarding access to clinical, social,

physical and financial support on a continuing basis

Access to care

Patients must know they can access care when it is needed.

Attention must also be given to time spent waiting for

admission or time between admission and allocation to a bed

in a ward. Focusing mainly on ambulatory care, the following

areas were of importance to the patient:

• Access to the location of hospitals, clinics and physician

offices

• Availability of transportation

• Ease of scheduling appointments

• Availability of appointments when needed

• Accessibility to specialists or specialty services when a

referral is made

• Clear instructions provided on when and how to get

referrals

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“The very act of being nominated for an annual Picker Institute award demonstrates your commitment to improve the lives of patients by making interaction with the healthcare system less stressful and more comfortable. The honor of winning will inspire others to do the same.”

gail L. warden, MhA

President Emeritus

henry ford health System

Picker Institute board of Directors

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THE PICkER AwARDS FOR EXCELLENCE® IN THE ADVANCEMENT OF PATIENT-CENTERED CARE

the identification and promotion of “best practices” that lead to the advancement of patient-centered care is an important element in Picker Institute’s mission. one method of promoting best practices is the recognition of professionals in the field whose work best exemplifies the Institute’s goals and philosophy.

the Picker Awards for Excellence® and the Picker Awards and Education Program were established in 2003 as an educational component of improving patient-centered care. “our mission is to make the patient’s experience, whether in a hospital or a doctor’s office, a better one,” said harvey Picker, the founder of Picker Institute. “the Picker Awards are intended to honor people and organizations who have made significant contributions to achieving this goal, and to highlight them as role models for others in the healthcare field.”

for more information, please visit us at www.pickerinstitute.org

2010 PICKER AWARDS

Paul D. Cleary, PhD Dean, yale School of Public health

Atul Gawande, MD, MPH general surgeon and author

Arnold P. Gold, MD founder, Arnold P. gold foundation

Karen C. Schoeneman, MPA Deputy Director, nursing home Division, CMS

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2010 Picker Award winner Dr. Atul Gawande and Picker Institute board member Dr. Stephen Schoenbaum 2010 Picker Award winners Paul Cleary, Ph.D., Dr. Arnold P. Gold and Dr. Atul Gawande

PAST PICKER AWARD WINNERS

2009Margaret E. O’Kane, President, national Committee for Quality Assurance Institute for Patient- and Family-Centered Care Dr. Bill Thomas

2008James B. Conway, Senior vice President, Institute for healthcare Improvement Cincinnati Children’s Hospital Medical Center The MedCom Danish Health Data Network

2007Edward H. Wagner, MD, MPh, Director, MacColl Institute for healthcare

ImprovementPioneer Network Agency for Healthcare Research and Quality

2006Prof. Sir Liam Donaldson, Chief Medical officer, uk Department of health Planetree Karen Davis, President, the Commonwealth fund

2005Albert G. Mulley, Jr., DMSc, MD, and John E. Wennberg, MD, MPh Cofounders, foundation for Informed Medical Decision Making Integrated Healthcare Association Initiativkreis Ruhrgebeit

2004Sir Donald Irvine, MD, frCgP, frCP, fMedSci, Chairman, Picker Europe

2003Margaret Mahoney, Past President, the Commonwealth fund

for more information, please visit us at www.pickerinstitute.org 7

Dr. Arnold P. Gold and Picker Institute board chairman J. Mark Waxman

Executive Director Lucile O. Hansom and 2010 Picker Award winner Karen Schoeneman

2010 Picker Award winners Dr. Atul Gawande and Dr. Arnold Gold

2010 Picker Award Winner Paul Cleary, Ph.D., and board member Gail Warden

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OvERvIEW Picker Institute is dedicated to enhancing the delivery of patient- and family-centered care throughout the u.S. healthcare system. In furtherance of this mission, Picker Institute has adopted an organizing principle focused on the concept of Always EventsSM /Always ExperiencesSM. Always Events are defined as “those aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the healthcare delivery system.”

Picker Institute’s Always EventsSM Challenge grant Program provides matching grants of up to $50,000 each to support the development and implementation of innovative projects that demonstrate how the Always Events concept can be implemented in practice. the projects are intended to produce strategies, programs and processes for achieving selected Always Events that can be replicated across a variety of healthcare delivery settings and thus contribute to widespread and measurable improvements in patient- and family-centered care.

GUIDING THEMES based on input from patients, families and frontline caregivers, Picker has identified two key areas of focus for Always Events:

• Communication: the interactions and exchange of information between patients and providers, as well as among the team of providers responsible for a patient’s care, must involve the patient in an appropriate, patient-centered way; and

• Care transitions: Patients need an appropriate level of communication when moving from one provider or healthcare setting to another (for example, from primary care doctor to specialist, from hospital to home, long-term care or rehabilitation facility and from emergency department to inpatient unit).

COLLABORATIvE LEARNING NETWORK As the demonstration projects are developed, Picker will support a collaborative exchange of information among the project teams through periodic conference calls, bimonthly webinars and e-mail blogs. this learning network will be a source of tools and strategies for achieving the selected Always Events.

Picker will also support the development of key messages and media tools, including establishing a presence in online social media networks, to provide communications support for the demonstration projects.

BEST PRACTICES COMPENDIUM OF TOOLS & STRATEGIES At the conclusion of the one-year program, Picker will produce a com-pendium of lessons learned and tools and strategies derived directly from the research projects to promote and achieve the specific Always Events selected for focus in the demonstration projects and to generate replicable models for adoption and use by other on a national scale.

AMERICAN ACADEMy OF PEDIATRICSProject: “family feedback—Always! (ffA)”

ANNE ARUNDEL HEALTH SySTEMProject: “the SMArt Discharge Protocol”

CLEvELAND CLINICProject: “unmet Expectations regarding ICuPatient outcomes: Identification andManagement of At-risk families”

DARTMOUTH-HITCHCOCK MEDICAL CENTER Project: “Implementation of a Set ofAlways Events that will Increase Communication”

HEALTH CARE FOR ALLProject: “Patients and familiesImproving hospital Discharge”

INOvA HEALTH SySTEMProject: “Developing a Patient-CenteredApproach to handoffs”

IOWA HEALTH SySTEMProject: “Always use teach-back!”

LAHEy CLINIC MEDICAL CENTERProject: “transitions of Care Partnership Project”

MARCH OF DIMESProject: “Close to Me”

MASSACHUSETTS GENERAL HOSPITALProject: “Always know your Caregiver/ Always responsive”

NORTHEAST vALLEy HEALTH CORPORATIONProject: “team up for health”

PLANETREE/GRIFFIN HOSPITALProject: “Same Page transitional Care:Creating a template for optimal transitions”

QUALITy PARTNERS OF RHODE ISLANDProject: “Enhancing Medication Safetythrough Picturerx”

SAINT JOSEPH HOSPITAL FOUNDATIONProject: “Comfort and Pain relief Menu”

ST. JUDE CHILDREN’S RESEARCH HOSPITALProject: “Parent Mentor Program”

UNIvERSITy OF CALIFORNIA–SAN FRANCISCO MEDICAL CENTERProject: “Improving Patient- and family-CenteredCare for hospitalized Persons with Dementia”

UNIvERSITy OF MINNESOTA AMPLATz CHILDREN’S HOSPITALProject: “MyStory”

UNIvERSITy OF PITTSBURGH MEDICAL CENTERProject: “Care team twittering and guardian Angels”

vANDERBILT UNIvERSITy MEDICAL CENTERProject: “Effective Communication and Collaboration with Patients and families for falls Prevention”

yALE–NEW HAvEN CHILDREN’S HOSPITALProject: “Premature Life transitions: A Patient- and family-Centered End-of-Life Care Program for neonates”

for full descriptions and updates on the Always EventsSM projects,

visit http://alwaysevents.pickerinstitute.org/.

ALWAyS EvENTSSM RESEARCH AGENDA

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ALWAyS EvENTSSM RESEARCH AGENDA

PICKER INSTITUTE ALWAyS EvENTSSM NATIONAL STEERING COMMITTEE

Cochairs: Gail L. Warden, MHA,J. Mark Waxman, Esq.

Picker Institute board of Directors

Lucile O. HanscomPicker Institute

Karen Adams, PhDnational Quality forum

Barbara Balik, RN EdDInstitute for healthcareImprovement

Katherine Browne, MBA, MHACenter for health Care Quality

Joyce C. Clifford, PhD, RN, FAAN

the Institute for nursinghealthcare Leadership

Eric A. Coleman, MD, MPHPractice Change fellows Program

Nancy Foster, PhDAmerican hospital Association

Thomas James III, MDhumana Inc.

Beverley JohnsonInstitute for Patient- andfamily-Centered Care

Gregg S. Meyer, MDMassachusetts general hospital

Ken MizrachvA Medical Center East orange

Debra Nessnational Partnership forwomen & families

Peggy O’Kanenational Committee forQuality Assurance

Barbara Packer, MSthe Arnold P. gold foundation

John Santa, MDConsumers union

Gerald M. SheaAfL-CIo

Liaison:Carolyn Clancy, MD

Agency for healthcareQuality and research

www.pickerinstitute.org

Susan Frampton Planetree“we define Always Events as things that are important to patients and families and then we develop strategies to make sure they happen as often as possible.”

Jennie Chin Hansen American Geriatrics Society“to strip the dignity and humanity from patients is just wrong.”

John Santa, MD Always Events NSC“It’s surprising to me how many hospitals and patients are reluctant to share their successes.”

Peggy O’Kane Always Events NSC“A list that’s not too long will enable us to focus on the right things.”

Nancy Foster, PhD Always Events NSC“for me, the most important Always Event would be for the clinician to ask the patient, ‘what do you hope to achieve, and how can we help you get there?’”

Bev Johnson Always Events NSC“I like it that this concept is targeted to individuals and families as well as to healthcare professionals.”

Mary Ann Peugeot vanderbilt Medical Center“Always Events are what you know is always going to happen.”

Sir Donald Irvine, MD Always Events NSC“how did we come to Always Events? out of a concern that the scientific excellence of medicine wasn’t always matched by good care.”

Debra Ness Always Events NSC“the goal is to have it used continually by doctors to improve the care they give.”

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David Leach, MD, ChairmanPicker Institute board of Directors Lucile o. hanscomhannah honorMr. Max bassettMr. Jim Cichonvirginia Collier, MDMs. nettie EngelsSusan frampton, PhD

richard frankel, PhDMary Joyce Johnston, MJAdina kalet, MD, MPhCarl A Patow, MD, MPh, MbA, fACSv. Sreenath reddy, MD, MbArichard wardrop III, MDMitzi williams, MD

2010–2011

BETH ISRAEL DEACONESS MEDICAL CENTER/HEBREW SENIOR LIFE

Project: “how Do you have the Conversation?A Curriculum for residents”

BRIGHAM & WOMEN’S AND BOSTON CHILDREN’SHOSPITALS/HARvARD MEDICAL SCHOOL

Project: “transitioning from Pediatric- to Adult-Centered Medical Care (the Patients’ Perspective)”

CHILDREN’S HOSPITAL OF ORANGE COUNTyProject: “training Pediatric residents in the Deliveryof news and the Discussion of Issues related toDeath and Dying in a Pediatric Population”

DARTMOUTH-HITCHCOCK MEDICAL CENTER Project: Integrating Patient- and family-CenteredCare Principles into a Simulation-basedInstitutional Curriculum”

THE JOHNS HOPKINS UNIvERSITy SCHOOL OFMEDICINE/BAyvIEW MEDICAL CENTER

Project: “Developing and Implementing aPatient-Centered Discharge Curriculum”

MOUNT SINAI SCHOOL OF MEDICINEProject: “Project PArIS (Patients and residents in Session)”

RIvERSIDE METHODIST HOSPITAL/OHIO HEALTHProject: “teaching Disclosure: A Patient-CenteredSimulation training for the Crucial Conversation”

UNIvERSITy OF CALIFORNIA–IRvINEProject: “humanism in the Perioperative Environment”

UNIvERSITy OF MASSACHUSETTS SCHOOL OF MEDICINEProject: “home Medication Education and Support(hoMES): A resident Module on home Care for Children”

UNIvERSITy OF MARyLANDProject: “Empowering Patients to optimize theirMedication regimens: A Multidisciplinary Approach”

UNIvERSITy MEDICAL CENTER FOUNDATION ARIzONAProject: “the native American Cardiology CulturalCompetency Curriculum”

WAKE FOREST UNIvERSITy HEALTH SCIENCESProject: “Improving transitions of Care for older Adultsthrough Interdisciplinary Education for Medical residents”

GRADUATE MEDICAL EDUCATION ~ RESEARCH AGENDA

Picker/Gold FoundationGraduate Medical Education ~ Challenge Grant Program

the Picker/gold graduate Medical Education Challenge grant Program provides annual grants for the research and development of innovative projects designed to integrate successful patient-centered care initiatives and best practices into the education of our country’s future practicing physicians.

the Arnold P. gold foundation became a partner in the program in 2009. working together, Picker Institute and the gold foundation seek to improve the quality of medical education and healthcare delivery by incorporating the patient’s point of view.

2009–2010

ALPERT SCHOOL OF MEDICINE/BROWNUNIvERSITy/HASBRO HOSPITALS

Project: “Developing health Care transitions:A resident Learning Module on building bridges”

AURORA HEALTH CARE INC.Project: “Screening/Managing Interpersonal violenceDuring Pregnancy at an urban teaching hospital”

BETH ISRAEL DEACONESS MEDICAL CENTER“Improving Patient Communication SkillsAmong Surgical residents”

CHILDREN’S MERCy HOSPITALProject: “Introducing a family-Centered CareCurriculum to a Pediatric residency Program/MeasuringIts Effects on the Centeredness of Pediatric residents”

DUKE CHILDREN’S HOSPITAL & HEALTH CENTERProject: “teaching family-Centeredness in the PICu:A novel Approach using Medical Simulations”

UNIvERSITy OF CONNECTICUT HEALTH CENTERProject: “Communication in family Meetings: Developingand Assessing a Curriculum for residents”

UNIvERSITy OF WASHINGTON FAMILy MEDICINE RESIDENCy Project: “Creating a Patient-Centered Care Plan (PCCP)within an Electronic Medical record; and Evaluating theImpact of PCCP use on Patients and healthcare team Members”

PROJECT EvALUATION COMMITTEE

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Consistent with Picker Institute’s credo that quality of life is as important as quality of clinical care in all healthcare settings, the institute inaugurated its long-term care program in March 2008, taking the mission to promote patient-centered care to the nursing home and long-term care arena.

under one aspect of the program, Picker awards grants to support initiatives aimed at improving the quality of life in all LtC settings, with the goal of making patient-centered care a reality in many more nursing homes throughout the country.

PICKER LTC RESEARCH AGENDA

“ACHIEvING STAFF STABILITy AND IMPROvING PERFORMANCE: A NURSING HOME LEADER’S GUIDE”

the American College of health Care Adminis-trators received a long-term care grant to pro-duce a book on achieving staff stability and improving performance. the book, now titled Meeting the Leadership Challenge in Long-Term Care: What You Do Matters, written by

barbara frank, David farrell and Cathy brady, was published in early April2011. AChCA plans to work with the authors and other long-term care colleagues to distribute the book widely among practitioner and academic networks.

“CREATING HOME: ADvOCATING FOR CHANGE IN HOW AND WHERE WE AGE”

In collaboration with its partners, Pioneer network developed this consumer education pilot in response to the growing realization that consumer awareness of and advocacy for culture change are critical to its widespread dissemination. Partners included the American Association of homes &

Services for the Aging, American College of health Care Administrators, American health Care Association, American Medical Directors Association, the Coalition of geriatric nursing organizations and national Consumer voice for Quality Long-term Care.

“vIvE: DEvELOPMENT OF TOOLS TO IMPROvE NURSING HOME PROvIDERS’ ASSESSMENT SKILLS”

VIVE: the video on Interviewing vulnerable Elders, which was released in July 2010, is a tool to teach care managers how to interview nursing home residents using the MDS (Minimum Data Set) 3.0 implemented by CMS in october 2010. As of the end of March 2011, it had been viewed on the Picker Institute and other web sites more than 13,000 times.

“NURSING HOMES AS CLINICAL TRAINING SITES: RECOMMENDATIONS TO THE FIELD”

the goal of this project is to develop and disseminate a module to be used as a core training tool in presentations on how to maximize the use of nursing homes as clinical training sites. Recommendations will seek to improve the number, quality and preparedness of nursing and other academic healthcare programs using nursing homes as clinical training sites, and to improve readiness to serve as clinical training sites.

“LONG-TERM CARE IMPROvEMENT GUIDE”

following the model of the highly successful Patient-Centered Care Improvement Guide, published in october 2008, the Long-Term Care Improvement Guide serves as a practical resource for long-term care organizations that are working to become more patient-centered.

LONG-TERM CARE PROGRAM

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Lucile O. Hanscom, Picker Institute, and Bonnie Kantor-Burman, Ohio Health Dept.

Anne Basting, TimeSlips Dr. Bill Thomas, The Picker Report on Aging

Christa Holjo, PhD, vA

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A compendium of best-practices tools and strategies, it explores the experiences of residents, their families and their caregivers in long-term care settings across the country and highlights practices that have been developed to meet the needs of this population in an environment where expectations, preferences and priorities may be different from those in a hospital setting.

“TIMESLIPS”

the mission of timeSlips, by replacing memory with imagination, is to bring meaningful, creative engagement into the lives of people dealing with dementia resulting from conditions such as Alzheimer’s disease and stroke, and to help create person-centered care environments for people with dementia. timeSlips envisions a society where people with dementia and memory loss and their caregivers have the highest possible quality of life and a society free of the stigma so often associated with dementia and memory loss.

“THE PICKER PAPERS: A SyMPOSIUM ON CULTURE CHANGE AND DINING”

the Picker Papers are a dynamic learning experience featuring a comprehensive background paper and webinars of presentations by nine of the most sought-after minds in culture change and dining.

“‘ALMOST HOME’ OUTREACH: EDUCATING EMPLOyEES ABOUT ELDERCARE AND CULTURE CHANGE”

In february 2006, filmmakers brad Lichtenstein and Lisa gildehaus made a documentary film called Almost Home.

Shot on location in a retirement community in Milwaukee, wisc., it chronicled the daily life of residents and staff as they struggled with understanding and implementing revolutionary adjustments in the way the community operated—a process that has come to be known as “culture change.” Lichtenstein’s production company, 371 Productions, will work with rose Marie fagan of Lifespan of greater rochester, new york, to convey the film’s lessons about aging, caregiving, end of life and culture changes to more than 300 employees through programs conducted in eight rochester-area workplaces. A consumer engagement project, the program seeks to enlist consumers as catalysts for change.

“THE PICKER REPORT ON AGING WITH DR. BILL THOMAS”

the goal of this partnership, which began in May 2010, is to raise public awareness of and build support for making long-term care person-centered. to that end, the project has taken advantage of the tremendous scope and delivery of the social media network. bill thomas is known throughout the world for his passionate advocacy of elders and elderhood, which he believes do not receive the attention or respect they deserve. using videos, blogs, commentary and news updates on facebook, youtube, twitter and the other social media, Picker Institute and Dr. thomas are building a strong connection among people who share his and Picker Institute’s vision of how person-centeredness enhances variety of life and quality of care in long-term care settings.

In 2009, Dr. thomas was the first winner of the Picker Award for Excellence in the Advancement of Patient-Centered Care in a Long-term Care Setting.

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Jim Conway, IHI, and Sir Donald Irvine, Picker Institute

J. Mark Waxman, Picker Institute, and Bev Johnson, IPFCC

Lucile O. Hanscom, Executive Director, Picker Institute

THE PICKER PAPERS A Symposium on Culture Change

and Dining


EduCAtIoNPicker Institute sponsors educational workshops, summit meetings, the Picker Lectures and the Picker Awards to further its mission of advancing and implementing patient-centered care.

THE PICKER PLENARy LECTURES

the Picker Plenary Lecture is delivered annually by a Picker Award winner at one or more of the conferences at which Picker Institute is present.

2010Dr. Atul Gawande

2010 Picker Award for ExcellenceDr. Carolyn Clancy, Director, AhrQ

2007 organizational Picker Award for ExcellenceKaren Schoeneman, CMS

2010 Picker Award for Excellence in Long-term Care

2009Dr. Bill Thomas

2009 Picker Award for Excellence in Long-term Care

2008Jim Conway, IhI

2008 Picker Award for Excellence

2007Dr. Karen Davis, President, The Commonwealth Fund

2007 Picker Award for Excellence

THE PICKER PATIENT ExPERIENCE SERIES

Picker’s educational workshops are an essential component of the institute’s mission to educate the healthcare industry and the general public to the benefits of patient-centered care. Picker sponsors workshops at national and international conferences convened by healthcare organizations like Planetree, Pioneer network, the Institute for healthcare Improvement, ISQua and others.

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Dr. Carolyn Clancy, AHRQ Dr. Elliott Fisher and Dr. Atul Gawande Gail Warden, Picker Institute

Panel members at the LTC Leadership Summit

LONG-TERM CARE LEADERSHIP SUMMIT

the 2010 Long-term Care Leadership Summit on oct. 5, 2010, brought together leaders in the field of long-term care to talk about implementing and advancing culture change. Speakers included Dr. bill thomas (“the Picker report on Aging in America with Dr. bill thomas”), David farrell and barbara frank (“Meeting the Leadership Challenge in Long-term Care: what you Do Matters”) and others. the highlight of the summit was the release of the Long-Term Care Improvement Guide, a compendium of best-practices innovations and approaches for initiating and sustaining a resident-centered culture change in long-term care and a partner to the very successful Patient-Centered Care Improvement Guide published by Picker and Planetree in 2008.

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CoNVErsAtIoNs wItH LEAdErs IN tHE FIELd oF pAtIENt-CENtErEd CArE

one of the ways Picker Institute supports patient-centered care is by recognizing people in healthcare who have made significant contributions to achieving patient-centered care worldwide.

Conversations with Leaders in the Field of Patient-Centered Care is a regular feature that highlights people who have promoted patient-centered care in

their work or through their organization.

A Conversation with Dr. Atul Gawande

Dr. Atul Gawande is a general surgeon in Boston, Mass., and the author of several internationally best-selling books on modern medicine, including, most recently, the Checklist Manifesto, which reached the New York Times’s nonfiction bestseller list in 2010. He has also been a staff writer at the new yorker magazine since 1998, and many of the pieces published there about his life as a surgical resident have played a larger role in clinical and political developments in the healthcare industry.

At the Institute for Healthcare Improvement’s 22nd Annual National Forum on Quality Improvement in Health Care, you participated in a discussion of the “triple aim”: lower costs and higher quality resulting in better healthcare. As a surgeon and a writer, how do you approach this issue?

I don’t understand abstractions, as a surgeon or as a writer. In both modes, I need to understand a situation through knowing what happens to a particular individual. Let me give you an example: not too long ago I attended a parent-teacher conference at my son’s school. I was interested in meeting the new school superintendent and asking him what he was working on. I thought he’d say educational reform, how to restructure the educational system. but what he spends his time on, he said, is healthcare. As a result of property tax reform in Massachusetts, his budget for teachers has been slashed. At the same time, the cost of medical benefits for teachers has risen by 9 percent. what is he to do?

A little later I was talking to my son’s math teacher. he couldn’t quite remember where my son was. with 35 students in the class and one teacher, my son was disappearing somewhere in the middle.

As I left the classroom, I ran across a teacher whom I’d operated on for lymphoma. She was tough—she’d survived. but 5 percent of teachers account for 60 percent of teachers’ total healthcare costs, and I suddenly realized that I was part of the reason my child was being neglected.

Seeing these issues in terms of the community where they were happening, I could understand the problem: Does great healthcare for this teacher have to bankrupt my son’s future?

Do you have an answer for that question?

I think hope lies in the bell curve for healthcare costs. there’s a very wide variation, with most people grouped in the mediocre middle. the same is true of quality outcomes: Most people are in the middle. where I see hope in those facts is that the best results often come at the least expense, and the least expensive care often achieves the best results.

you’re mentioned “community” several times. How important is community, as a concept and as a fact, in achieving the triple goal?

Community matters. there’s always a tension between maximizing revenues and meeting the needs of the community. In the end, all medicine—like all politics—is local. the communities that have healthcare systems rather than fragments of care are getting better results at lower costs.

Central to achieving the triple aim is improving results divided by lowering costs: reducing emergency room visits, eliminating

Dr. Atul Gawande

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unnecessary imaging and surgery. the teacher I treated—can we take care of her lymphoma by doing less, by making it easier for her to live her life and at the same time giving her the best chance of surviving?

What do you think of President Obama’s healthcare legislation?

I think it creates great opportunities for developing systems. however much it is attacked, it provides the tools we need, and the question for us is how do we want to use these tools? Do we want to use them to drive up revenues—and there are a lot of people saying that—or do we want to use them to create better healthcare systems in communities so healthcare for teachers doesn’t mean sacrificing our children’s future? how do we lower costs without compromising the quality of care?

we can set goals, but is it remotely possible that we can succeed? I’m a little skeptical that a community of 10,000 people can come together and develop a master plan, and we’re a nation of more than 300 million. but if we start at the local level, we may just succeed.

How?

At the turn of the last century, a major problem facing this country was the cost of food. forty percent of a family’s budget went for food, and 50 percent of the workforce was involved in producing it. It was a fragmented system in which the evidence of how to put better food on the table at a lower cost was largely ignored. farmers for the most part repudiated what they called “book farming.”

In 1903 a man named Seamon knapp, whom we would deride as a bureaucrat, defied this logic by making a very simple, very small change: he persuaded a community of farmers to choose one of their number to try scientific farming, with the proviso that if the experiment failed the farmer would be reimbursed for his losses. not only did the experiment not fail, but when the community was hit by the boll weevil, the experimental farm survived and thrived. guided by this demonstrable success, farmers followed suit, and by 1930 there were 750,000 demonstration farms. A hodge-podge had come together as a success.

there were four elements that made this possible:

1. Making it possible for farmers to own their own land.2. Adding to the store of available knowledge with

experimental/research farms.

3. Collecting data: weather information, crop reporting, grading systems.

4. Sharing information through broadcasts, mailers, meetings.

this was not a case of the government taking control but of local farming communities trying to bend the bell curve of food costs. And it worked. by 1930 food was down to 24 percent of the family budget, and the workforce in food production was down to 20 percent. by the 1950s, both proportions were less than 10 percent.

these results were beyond imagining. the abundance in our supermarkets became the best argument for the American way of life and was critical to our becoming a superpower, with the attendant responsibilities. there were some painful dislocations, but no vast foreclosures and social unrest. the system was created by trial and error, and by focusing on results rather than ideologies.

I believe this is a road we can replicate. Like the food industry, healthcare is comprised of hundreds of thousand s of local entities. All of them want to provide great care, but they’re measuring success by revenues.

we’re at a time when hope and belief are sapped out of society. there is a lack of belief in the collective possibility of where we can go. with the wrong incentives, the results have been disastrous. Can it be fixed? no one knows.

In order to transform the food system everywhere, we needed to transform it somewhere. that is what we can do with healthcare, learning from it in the same way, through

1. Experiments in financing2. Collecting data. the scarcity of reliable healthcare data is

a total embarrassment—we know more about cows than we do about how many people died after surgery in the last four years.

3. Innovation4. Sharing what we learn

I don’t know if the government will step up to the plate. but we became the envy of the world with what we can do with food, and we can do the same in healthcare. It does not seem like it now, but all those small efforts we are making add up to being the accountable local community, the caring local community, the organized local community.

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Dr. Gold, you have a stunning resume and a long, long list of publications, honors and awards. But what was it that piqued your interest in your foundation’s mission of preserving the tradition of the caring physician and advancing humanism in medicine? And how long was it from the concept to the concrete?

So how did an academic and a clinician become an activist? In the 1980s I became concerned about certain trends in medicine. this was an exciting time for science and technology, and it was apparent that our fledgling physicians were becoming enamored with that aspect of medicine. Additional pressures, including limited time for examining patients, plus the other stresses of medical economics, distanced doctors from their patients. because my patients had taught me so much about the power of relationships and the importance of building trust and respect between doctor and patient, I could not accept a culture in which patients were referred to as “the tumor in room 202.”

Do you feel that these two pillars of the medical profession—what one might even call the basic principles—have lost some of their stature as medicine has advanced over the past 60 years? To what do you attribute this decline in civility?

when I began my medical career, for many serious, life-threatening illnesses there simply were no cures. All we had in our black bags was the ability to care. today, with our burgeoning science and technology, we have made great progress, but “cure” has overtaken “care” as the primary objective in healthcare. I applaud the miraculous scientific advances of the past half-century.

but I agree that we have lost something important—vital, even—in our modern medicine with its medical cures and medical perils. And it is

more than civility. I maintain that with science alone, we cannot provide the best healthcare possible, nor achieve the best healthcare outcomes, or fulfill the social contract that medicine has with society. we can cite all of the reasons—medicine as profit-driven rather than service-driven; the marketing behavior of the pharmaceutical industry; the demands of managed care with its limited time for communication and relationship-building; the threats of litigation pitting the doctor and patient on opposite sides, etc.—all forces of our contemporary healthcare system that have weakened the pillar of humanism.

your work focuses on children and neurology. In fact, the Dr. Arnold P. Gold Child Neurology Center at the Morgan Stanley Children’s Hospital of New york-Presbyterian Hospital, Columbia University Medical Center, was dedicated and opened in 2003. What drew you to these fields?

though my parents were both lawyers, I set my heart and mind on becoming a doctor as a young boy. My family played an early role in developing my professional persona. My mother taught me the importance of perseverance and intellectual excellence. My father was known for his humanism and sensitivity.

beginning with my parents, at each juncture of my journey, I found the essential mentor or friend who nourished and guided me.

of my teachers, I especially remember Dr. Margaret Smith at Charity hospital in new orleans. My internship at tulane under her guidance was pivotal in shaping my career. when I entered medicine, the formal curriculum was rigorous, but not nearly as voluminous as it is now. At that time, caring for the sick and dying was often a primary objective, since cures for many diseases were unattainable.

A Conversation with Dr. Arnold P. GoldDr. Arnold P. Gold, the winner of a 2010 Picker Award for Lifetime Achievement and Chairman Emeritus of the board and co-founder in 1988 with his wife, Sandra O. Gold, of the Arnold P. Gold Foundation, was honored for his lifelong dedication to the advancement of patient-centered care by preserving the tradition of the caring physician and emphasizing the crucial need for humanism in medicine.

The mission of the Gold Foundation is to preserve the tradition of the caring doctor and advance humanism in medicine through physician education. Students at more than 94 percent of the schools of medicine and osteopathy in the United States participate in one or more of the foundation’s nearly two dozen programs.

Dr. Gold is professor of clinical neurology and clinical pediatrics at Columbia University’s College of Physicians and Surgeons, with which he has been associated for more than 50 years. He received the college’s Distinguished Service Award in 1998. The author of more than 80 published articles and several books in the field of pediatric neurology, Dr. Gold has received numerous special awards, lectureships and professorships and has been a visiting professor at many schools and colleges throughout the world, including Africa and Europe.

The Dr. Arnold P. Gold Child Neurology Center at the Morgan Stanley Children’s Hospital of New York-Presbyterian Hospital, Columbia University Medical Center, was dedicated and opened in 2003.

Dr. Gold received the Lifetime Achievement Award from the Child Neurology Center in 2005 and an Honorary Doctorate of Humane Letters degree from the Mount Sinai School of Medicine in 2008.

Dr. Arnold P. Gold

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In the hot new orleans summer of 1954, I was working literally around the clock at Charity hospital. It was at the height of the polio epidemic, and we had 35 children in iron lungs requiring constant attention. wards were not air-conditioned, and electricity was not dependable. Like my mentor, Dr. Margaret Smith, I slept, ate and stayed at the side of my patients. her behavior was my curricula; her values informed my own. there were no mixed messages or competing values, as there are today. Doctors did what their attendings modeled. Meeting the needs of patients—whatever the personal cost—was the norm. Dr. Margaret Smith, with dedication, inspiration and scientific excellence, led me into the world of clinical pediatrics.

Serendipity plays such an important role in life. when I came to babies hospital at Columbia in 1957, I had planned to go to Johns hopkins to be a pediatric endocrinologist. At Columbia, I met my friend and a founding trustee of the gold foundation, robert Mellins, who was then a pediatric resident. bob convinced me to experience a new field called child neurology and led me to one of its founders, Dr. Sidney Carter. one evening I attended rounds with Dr. Carter, and the rest is history.

Sid was the ultimate and consummate role model–mentor. A brilliant clinician, Sid coupled scientific and diagnostic acumen with humanistic care at the bedside. under his influence, I decided to become a child neurologist in spite of my uncle’s warning that “this new field will never give you a single patient.” throughout my more than 50 years as a physician, I have tried to emulate this extraordinary man and to follow his example.

As I reflect on the experiences that have taught me the most about doctoring, I realized that my patient-centered practice was born from those early and essential role-model mentors, the explicit and implicit expectations that patients come first and foremost.

What would you say to today’s medical students to remind them of what medicine really is: caring for other people and trying to cure their ills? Can patient-centeredness be taught?

My entrance into medical school held the promise of new discovery. but from experience I learned that each discovery is replaced by the next, that papers and books “age out” and that the single most important aspect of my life has been the relationships I have enjoyed.

here’s what I tell medical students: while the textbook knowledge you have acquired over the years is certain to change, your raison d’être, if you will, will not. what will not change—what must not change—is your conviction that good medical practice is, and should always be, relationship-centered and humanistic. the realities of illness, death and dying require those skills so perfected by your predecessors—those who had less to offer scientifically, but who knew how to communicate compassionately and effectively with patients.

Seek to emulate those doctors who display technical competence, compassion, empathy and trust. Mostly, you can choose the doctor you want to be.

you and your wife, who founded the Arnold P. Gold Foundation with you, must have hope for the future of medicine, else you would not be working so hard to disseminate your own beliefs. Do you see progress? regress? no change in the status quo?

when we started the gold foundation, we felt a bit like the proverbial wanderers in the desert in search of an oasis. “humanism in medicine” was an amorphous concept, one that few people could wrap their arms around. no one was talking about humanism, and we felt very much out there, on the fringe. but we were encouraged by a buddhist notion: “not all who wander are lost.”

now here we are, more than two decades later, and the landscape has changed. humanism and professionalism are no longer an inspiring indulgence. Certification requirements instituted by the u.S. medical licensure agencies stipulate that in order to graduate, medical students and residents will have to demonstrate humanistic and professional behaviors as part of their core medical competencies. And we are beginning to see this same requirement for recertification of doctors in practice.

So we are optimistic...and hopeful. there’s no denying that we’ve left the desert. but we must also remain vigilant to insure that relationships and human beings remain at the center of any healthcare interaction.

read the entire Conversation with Dr. gold at www.pickerinstitute.org,

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Paul Cleary, PhD, Dr. Arnold Gold, Dr. Atul Gawande and Mrs. Sandra Gold Lucile O. Hanscom and Dr. Arnold P. Go.d

2010 STATEMENT OF FINANCIAL ACTIVITIES

EXPENSE PROGRAM EXPENSE ALLOCATION

totAL rEVENuE $1,770,403

totAL EXpENsEs $1,740,734

Programs 1,051,740

European offices 134,860

Meeting & Conferences 80,899

general & Administrative 367,215

Professional fees 106,021

NEt INCoME $29,669

Awards 12%

Education 14%

grants & Contracts 74%

Professional fees 6% Programs

60%

European offices 8%

Meetings & Conferences

5%

general & Administrative

21%

2 0 1 1 - 2 0 1 2 A n n u a l R e p o r tFINANCIAL

for more information, please visit us at www.pickerinstitute.org18

Lucile o. hanscom,

left, executive director

of Picker Institute, with

board members, from

left, gail warden, Sam

fleming, David Leach,

J. Mark waxman,

Stephen Schoenbaum

and Sir Donald Irvine.

PICkER INSTITUTE BOARD OF DIRECTORSJ. Mark waxman, Esq., ChairmanSamuel fleming, treasurer & SecretaryStephen C. Schoenbaum, M.D., vice ChairmanSir Donald Irvine, M.D., f.r.C.g.P., f.r.C.P., f.Med.Sci.David C. Leach, M.D.gail warden, M.h.A.

Lucile o. hanscom, Executive Director

11 Main St., 4th floorP.o. box 777 Camden ME 04843-0777tel 1.207.236.0157 1.888.680.7500fax 1.207.236.3570email [email protected] www.pickerinstitute.org


boArd

HARVEY PICkERfounder, Picker Institute

December 8, 1915–March 22, 2008“understanding and respecting

patients’ values, preferences and expressed needs is the foundation

of patient-centered care.”

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Picker institute 2011 2012 annual report

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