Milestone 4 Summary

Description: Practice can demonstrate that it encourages patients and families to collaborate in goal setting, decision making, and self-management.


 

What does success look like?

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Practice is training its staff in shared decision making approaches and developing ways to consistently document patient involvement in goal setting, decision making, and self-management. Practice is training its staff in shared decision making approaches and developing ways to consistently document patient involvement in goal setting, decision making, and self-management. Practice is training its staff in shared decision making approaches and developing ways to consistently document patient involvement in goal setting, decision making, and self-management. Practice is training its staff in shared decision making approaches and developing ways to consistently document patient involvement in goal setting, decision making, and self-management.

Note: numbers are PAT scores

 


Why is this important?

Patient experience has been increasingly recognized as one of the three pillars of quality healthcare, along with clinical effectiveness and patient safety.1 Patient experience has been positively linked to health outcomes such as adherence to medical treatment, better use of preventative services, and improved mandatory reported safety indicators.2 Patients and their families are essential partners in the effort to improve the quality and safety of health care. A number of approaches to improving the patient care experience have demonstrated notable impact, measured by patient satisfaction surveys, including perceived quality of communication between the clinical staff and patient, perceived and expected waiting times, and improved patient understanding of the care they receive.3 There are a number of strategies practices can employ to encourage patients to actively participate in their care in order to reap these and other benefits.


Potential Tactics

  • Train all staff in shared decision making, teach-back and health literacy universal precautions
  • All frontline staff complete IHI Open School modules on person- and family-centered care (PFC 101, PFC 102, PFC 201, PFC 202)
  • Create a standardized template for Shared Care Plans to be used across the practice4
  • Use EMR flags to guide follow-up with Shared Care Plan4
  • Ask every patient about their health goals for the visit and long-term disease management4

  


Tools and Resources

 


What might this look like in practice?

In a local Internal Medicine Clinic, the staff decided to engage patients in goal setting, decision making and self-management through encouraging each patient to proactively consider and document any issues they wished to address at their care visit. Often, patients are simply asked for their chief complaint, “why are you here?” which is unlikely to address all of their current needs and concerns. Many patients then struggle to insert additional needs into the conversation during the care visit or worry they may bother their doctor by bringing up another issue. This new process allows the provider to see a list of patient needs at the beginning of each visit to ensure all items are addressed.

Routine reminder calls were updated to inform patients of a new process being implemented to encourage patients to be more involved in their care and to ensure their needs are addressed at the visit by arriving with a prioritized list of care needs and concerns. Upon clinic arrival, the receptionist asked each patient if they brought their list, copied, and put in paper file or scanned into the EHR. If the patient didn’t bring a list, they were provided a piece of paper and a pen to create a list while waiting to be seen. The provider’s documentation and visit summary given back to the patient addresses each of the items on the patient’s list in some way and includes patient identified goals for aspects of self-care.

 


References

  1. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press, 2001.
  2. Doyle C LL, Bell D.  A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3:e001570.
  3. Margaret ND, Clark TA, Warden CR, Magnusson AR, Hedges JR. Patient Satisfaction in the emergency department- a survey of pediatric patients and their parents. Acad Emerg Med. 2002 Dec;9(12):1379-88.
  4. Shared Care Plans: A Reference Guide. Rev. 1/29/2015. Available at http://www.healthteamworks.org/wp-content/uploads/2016/05/Shared_Care_Plans_Reference_Guide.pdf