Convening a Learning Community To Advance Patient- and Family-Centered Care in Hospitals
Convening a Learning Community To Advance Patient- and Family-Centered Care in Hospitals
In October 2014, the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange established three learning communities (LCs) to improve the quality of health care delivery by addressing challenges in high-priority areas that AHRQ identified. The Innovations Exchange defined an LC as a select group of potential adopters and stakeholders who engage in a shared learning process to facilitate adoption and implementation of innovations featured in the Innovations Exchange.
One LC, focused on advancing the practice of patient- and family-centered care in hospitals (the PFCC LC), included representatives of 11 Florida-based hospitals. These hospital teams worked together to adopt and implement select strategies published in the Innovations Exchange, with the primary goal of developing a new patient and family advisor program (or enhancing an existing advisor program). By the end of the first year of the LC’s work, all member hospitals had established patient and family advisory councils (PFACs). In the second year, members focused on ongoing implementation of PFACs and adopted several other patient- and family-centered care strategies captured in the Innovations Exchange.
To learn about the collaborative work of the PFCC LC, the Innovations Exchange interviewed its champions and expert faculty: Beverley H. Johnson, President and Chief Executive Officer of the Institute for Patient- and Family-Centered Care, based in Bethesda, MD; and Mr. Bernard Roberson, formerly Administrative Director of the Division of Patient- and Family-Centered Care at the Augusta University Medical Center in Augusta, GA, and now Corporate Director of Service Excellence at Phoebe Health System in Albany, GA. The PFCC LC members modeled their implementation efforts on the program that Bernard Roberson developed at the Augusta University Medical Center.
Innovations Exchange: What factors are driving increased interest among hospitals in advancing the practice of patient- and family-centered care?
Beverley H. Johnson: Interest in PFCC increased dramatically after the Institute of Medicine’s 2001 Crossing the Quality Chasm report made it clear that there are connections among PFCC, quality of care, and patient safety. In recent years, the Partnership for Patients initiative (a public–private partnership working to improve the quality, safety, and affordability of health care) has underscored the important role of PFCC in hospital quality improvement efforts. By partnering with patients and families, hospitals can achieve better outcomes and avoid penalties for unnecessary readmissions and hospital-acquired conditions.
Bernard Roberson, MSM, BA, HSC: Effective health care reform is all about partnering and working together to achieve better results. Unless patients, families, and providers come together to improve care, we’ll be pumping money into ineffective systems. Many hospitals are seeing the value of PFCC for promoting patient engagement, improving health care delivery, and achieving better results on quality reporting, including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. The Joint Commission’s efforts to promote health equity also emphasize the role of PFCC. Hospitals see that they need to get on board with this approach or they will lose dollars and market share.
What are the benefits of using an LC as a strategy to support the adoption and implementation of the patient advisor program innovation?
Roberson: I really liked the LC approach because it was an opportunity for a lot of hospitals to learn from each other and collaborate to make sure everyone succeeded. The PFCC LC allowed the hospitals to share the challenges they were facing and to offer suggestions for how to overcome those challenges. It was amazing to watch how the LC members were so eager to help one another. For me, it was a great opportunity to talk with people from multiple hospitals at one time and to work directly with the frontline staff involved in making the programs succeed.
Johnson: Until recently, not many hospitals in Florida were focused in a significant way on partnering with patients and families. The 11 hospitals in the PFCC LC now have 2 years of experience working together and sharing best practices. They will raise the level of partnerships with patients and families, set a new standard for all hospitals in Florida, and serve as a resource to the Florida Hospital Association as it advocates for these partnerships in Florida hospitals as a core strategy to enhance quality, safety, and cost-efficiency. An LC is a strategic way to drive change that we could replicate across the country. It has tremendous potential for bringing together the hospitals in a region so they can learn from each other about how to advance the practice of PFCC. In working with the LC, we didn’t feel that competitive pressures posed a barrier. That’s because working with patients and families moves the conversation to a different level. Everyone sees that developing PFCC is the right thing to do, and we should all learn from each other to improve the health care system.
How did the PFCC LC help hospitals overcome challenges in implementing the innovation?
Johnson: Nationally, the biggest challenge is that senior leaders often don’t understand the importance of partnering with patients and families. Leaders who lack experience with PFCC may think of it as “nice to have,” but not essential. In hospitals where patient and family advisors are meaningfully and effectively involved, leaders see the difference and become committed. The PFCC LC addressed the need for leadership support at the outset by requiring each hospital’s CEO to approve the hospital’s participation in the LC. That’s the beginning of leadership commitment to sustained support for patient and family partnerships as part of transformational change in organizational culture. It takes time to build trusting relationships with patient and family advisors, but hospital leaders come to recognize the many advantages to learning from their insights and perspectives.
Roberson: Many hospital leaders have competing priorities and don’t do enough to develop PFCC. It’s not enough for leaders to express support for the idea. Strong leadership means making a strong commitment to PFCC and saying, “We’re there with you to make this happen, provide the resources, have accountability, and make this a successful partnership.” In addition to getting commitment from the CEO, it helps to do what some of our LC hospitals did and have members of the senior leadership take part in patient advisory council meetings.
Another issue is that many hospitals think PFCC will cost them too much money. But at Augusta University Medical Center, we found that it didn’t cost a whole lot to bring people to the table and share ideas. For the most part, patient advisory councils actually save money by suggesting low-cost changes that improve safety and lead to better outcomes. Also, hospitals may fear that greater patient involvement will make problems more visible and lead to bad publicity or even lawsuits. Our experience at Augusta and with the PFCC LC shows that’s not what happens when patients and families work alongside providers, because everyone wants the same thing—better care.
How did group interactions and relationships contribute to the success of the PFCC LC?
Johnson: The LC’s monthly networking and education call was an opportunity for sharing ideas and asking questions. Also, project staff had individual coaching calls each month with each hospital that were really important for promoting accountability and dealing with concerns and questions. The LC’s online collaboration site allowed the hospitals to share useful tools and resources. Finally, I can’t overemphasize the importance of our two inperson meetings. The second one was particularly valuable because it included more patient and family advisors. Creating opportunities for leaders and patient and family advisors to learn together is a very effective way to build relationships and mutual trust. These opportunities for personal interaction energized everyone and accelerated the learning process.
Roberson: From the start, the LC members have to be willing to be transparent with each other and to truly share what their struggles are. After all, your struggle may have been a strength for me, and I’ll have an idea about how to overcome it. The sharing needs to be both verbal and written, including sharing all of the written materials that support a patient advisor program. Also, the LC members need to keep in mind that developing a successful program takes time. It’s a journey, not a destination. With the hospital’s leadership and physicians working together with patients and families, if all the stars align, you can pull together a really good program in 2 to 3 years.
Did participating hospitals need to adapt the original innovation to their unique organizational contexts?
Johnson: All participating hospitals developed a patient and family advisory council (PFAC), which represents the “core” of the original innovation profile. However, there was a huge range in the types of activities that patient and family advisors engaged in at the various hospitals. For example, the patient and family advisors at Health First's Cape Canaveral Hospital in Cocoa Beach, FL, are helping train community volunteers to serve on “patient welcome teams,” showing them how to be involved as partners in their care. Some of the hospitals with more mature patient advisor programs went beyond having patients and families serve on advisory councils. For example, at Health Central Hospital in Ocoee, FL, which has had a council since 2012, patients and family members now serve on seven different improvement committees. That is where all the hospitals are headed, but it takes a year or two to develop the mutual trust among patient and family advisors, leaders, staff, and clinicians to create the opportunity for patient and family advisors to serve on committees that deal with complex and sensitive issues.
Mr. Roberson, you left Augusta University Medical Center recently for your new position at Phoebe Health System, where you will develop a new patient advisor program. Do you see this as a form of innovation spread?
In my new position at Phoebe Health System, I have an opportunity to create a whole new program and spread PFCC into a different part of the State. I’ve worked with learning collaboratives with the Georgia Hospital Association, but it’s different to be able to start a new program. At Phoebe, the leadership is strongly committed to making this happen and developing a successful partnership among providers, patients, and families. We are all excited about getting started with this new approach.
About Beverley H. Johnson: Ms. Johnson is President and Chief Executive Officer of the Institute for Patient- and Family-Centered Care in Bethesda, MD. She has provided technical assistance and consultation for advancing the practice of patient- and family-centered care to over 300 hospitals; health systems; federal, state, and provincial agencies; military treatment facilities; and community organizations.
About Bernard Roberson, MSM, BA, HSC: Mr. Roberson is Corporate Director of Service Excellence at Phoebe Health System in Albany, GA. Previously, he was Administrative Director of the Division of Patient- and Family-Centered Care at Augusta University Medical Center (formerly Georgia Regents Medical Center) in Augusta, GA, where he worked with patient advisory councils that provided input into key operational and strategic decisions.
Ms. Johnson reported that the Institute for Patient- and Family-Centered Care received payment from the AHRQ Health Care Innovations Exchange for providing consultation services to the learning community, and that the Innovations Exchange reimbursed her travel expenses for attending learning community meetings.
Mr. Roberson reported that Augusta University Medical Center received payment from the AHRQ Health Care Innovations Exchange for providing consultation services to the learning community, and that the Innovations Exchange reimbursed his travel expenses for attending learning community meetings.
AHRQ Health Care Innovations Exchange. Innovation profile. Patient advisors participate in hospital councils, committees, staff training, and other activities, contributing to improved patient satisfaction and better organizational performance. Available at: https://innovations.ahrq.gov/profiles/patient-advisors-participate-hospital-councils-committees-staff-training-and-other.
AHRQ Health Care Innovations Exchange. Innovation profile. Organization-wide adoption of patient- and family-centered care leads to consistently high levels of patient satisfaction. Available at: https://innovations.ahrq.gov/profiles/organization-wide-adoption-patient-and-family-centered-care-leads-consistently-high-levels.
AHRQ Health Care Innovations Exchange. Quality tool. Recommendations and promising practices for designing a patient and family-centered health care system. Available at: https://innovations.ahrq.gov/qualitytools/recommendations-and-promising-practices-designing-patient-and-family-centered-health.
AHRQ Health Care Innovations Exchange. Quality tool. Guide to patient and family engagement in hospital quality and safety. Available at: https://innovations.ahrq.gov/qualitytools/guide-patient-and-family-engagement-hospital-quality-and-safety.
- AHRQ Health Care Innovations Exchange. Innovations Exchange learning communities. Available at: https://innovations.ahrq.gov/learning-communities.
- AHRQ Health Care Innovations Exchange. Advancing the practice of patient- and family-centered care in hospitals: an Innovations Exchange learning community. Available at: https://innovations.ahrq.gov/learning-communities/patient-and-family-centered-care.
- AHRQ Health Care Innovations Exchange. Innovation profile. Patient advisors participate in hospital councils, committees, staff training, and other activities, contributing to improved patient satisfaction and better organizational performance. Available at: https://innovations.ahrq.gov/profiles/patient-advisors-participate-hospital-councils-committees-staff-training-and-other.
- Institute of Medicine. Crossing the quality chasm. Washington, DC: National Academy Press; 2001. Available at: http://www.nap.edu/catalog/10027/crossing-the-quality-chasm-a-new-health-system-for-the.
- Centers for Medicare & Medicaid Services. Welcome to the partnership for patients [Web site]. Available at: https://partnershipforpatients.cms.gov.
- AHRQ. CAHPS Hospital Survey. Available at: http://www.ahrq.gov/cahps/surveys-guidance/hospital/index.html.
- The Joint Commission. Advancing effective communication, cultural competence, and patient-and family-centered care: a roadmap for hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010. Available at: https://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf.