Rethinking "Patient Engagement" Evaluation: A Mixed Methods Approach

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Rethinking “Patient Engagement” Evaluation: a Mixed Methods

Approach

BC Quality Forum

Jessie Checkley

March 3, 2017


Collaborative Aim To build capacity and enhance organizational culture to partner with patients and families in order to improve quality across the healthcare continuum.

Partnering with Patients and Families for Quality Improvement Collaborative 2014-2015

Measurement Focus

VARIABLES OF INTEREST INSTRUMENTS USED FREQUENCY

Ability to complete QI project

Collaborative Assessment Scale (adapted IHI tool)

4 months

Individuals knowledge and skills (PE,PFCC, QI)

Poll Learning Objective and CQI Data

Monthly

Social networks used by teams

New survey developed

T1 & T2

Team effectiveness & team experience

New survey developed ** T1 & T2

Patient advisor experience Interview and survey done 3 months-post Collaborative

3 months post

Team leader experience Interview and survey 4 months post

Patient, staff, organizational outcomes

Final Report from Teams

Post

** Combined measures from West 1996, Orchard 2011, Shortell 2004, IPFCC 2010


Measurement Tools

1) Collaborative Assessment Scale

2) Social Network Analysis

3) Team Effectiveness and Team Experience Survey

4) Final Report Document Review

5) Interviews/Surveys with Patient and Family Advisors

6) Interviews/Surveys with Teams

7) Polls – Learning objectives and CQI Data

Social Network Analysis

small tightly connected team working closely together

one team member at the centre

sharing information

outwards

small core team connecting

with outer networks

Social Networks and Health: Models, Methods, and Applications. Thomas W. Valente. Oxford: Oxford University. Press, 2010, pp. 277, ISBN: 978-0-19-530101-4.

Level of Engagement – IAP2 Scale Within my QI Project Team, this person…

Informs Consults Involves Collaborates Empowers

…provides me with balanced and objective information to assist me in understanding the problems, alternatives and/or solutions.

…obtains my feedback on analysis, alternatives and/or decisions.

…works directly with me throughout the process to ensure that my concerns and aspirations are consistently understood and considered.

…partners with me in each aspect of the decision, including the development of alternatives and the identification of the preferred solution.

…places final decision‐ making in my hands.

T1 Avg. Per

Resp.

T2 Avg. Per

Resp.

2.2 2.3

2.2 2.4

2.3 2.5

1.9 1.2

0.6 0.6 160

170

177

82

44

176

179

183

150

46

Inform

Consult

Involve

Collaborate

Empower

T1: n=80, T2: n=70


How Were Patients Engaged To Effect Improvement?

› Consultation and Involvement roles:

• Patient and Family Advisory Forums/Councils

› Partnership & Shared Leadership roles:

• Episodic: Kaizen events, quality improvement teams

• Shared decision-making over time

• At direct care level: providing peer support as part of interdisciplinary team

• At governance/ policy levels: members of ongoing quality committees, board, senior leadership committees


What Patient Advisors

Had to Say….

1. Involve me from the beginning

2. Inform and educate team on why we are there

3. Facilitation by team lead “sets the stage”

4. Invite more than 1 patient advisor

5. Let us do more than just tell our stories

6. Cover out of pocket expenses

7. Recognition and loop back


Results: Quality of Care Improvements

• Improved Patient Experience of Care (21 teams)

• Built Patient & Family Engagement Infrastructure (20 teams)

• Coordination of Care & Transitions (7 teams) • Transfer of accountability at change of shift • Transitions from acute to rehab care • Multiple admission & discharge process improvements • Transition to adulthood for youth with complex conditions or

cancer

• Chronic Disease Self-care Management (4 teams) • Improving healthcare provider skills to support self-care

management in diabetic and renal populations • Patient engagement resource guide for primary care • Recruiting and training patient advisors


Results: Quality of Care Improvements

Timely access to care (3 teams) • Improved response time and effectiveness of response to patient calls

in a busy MS Clinic

• Improved Information about wait times in pediatric rehab

• Cancer care wait times addressed thru re-design of work processes

Peer Mentoring (2 teams) • Bedside Orientation in pediatrics by experienced parent mentors

• Peer mentoring following upper limb amputation

Use of technology in direct care to improve (2 teams) • Transition to adulthood for youth with complex conditions

• Reducing sense of isolation amongst dialysis patients


Capacity to Lead Improvement

Staff Learning: • How to recruit & orient patient advisors

• Patient and family centered care 101

• Communication skills: teach back, shared decision-making, bedside rounds

• Supporting self-care management in persons with chronic illness

Patient/Family and Staff Joint Learning: • Quality improvement methods: PDSAs,

process mapping, patient journey mapping

• Experience-based co-design methods

• Change management and facilitation

• Measurement

• Storytelling & video production


Strategies for Sustainability & Spread

Process Changes – 19 organizations

• Standardizing recruitment & orientation processes

for patient advisors; new resources and tools.

Changes in Structure – 14 organizations

• Patient and Family Advisory Councils

• New quality forums with patients as decision-making partners

• Family Partnership Committees focused on patient engagement

• Addition of patient advisors to existing committees or work groups

Creation of New Roles or Change in Roles – 8 organizations o Patient Partnership/Coordinator roles created to facilitate patient

advisor recruitment, and increase patient partnerships in future initiatives

• Paid roles as Patient & Family Coordinators

Regional or Provincial Spread - 13 organizations


Conclusions

› The Collaborative evaluation generated rich learnings

about organizations' readiness to engage with patients

and families in care design and how care team members

and patients and families can be effectively engaged

and motivated to work collaboratively.

› Effective patient-centered care and patient engagement

require changes in values and relationships which

depend on creating supportive structures, roles, and

policies. More mature contexts for engagement lead to

increasing sophistication of how patients and staff are

engaged together, which can lead to broader changes in

health service re-design.


The Canadian Foundation for Healthcare Improvement is a not-for-profit organization funded by Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. La Fondation canadienne pour l’amélioration des services de santé est un organisme sans but lucratif financé par Santé Canada. Les opinions

exprimées dans cette publication ne reflètent pas nécessairement celles de Santé Canada.

YOU

Jessie Checkley [email protected]

Date post:	22-Mar-2017
Category:	Healthcare
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