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Flashcards in IPE Test 3 Deck (13):

Define patient engagement

“A set of beliefs and behaviors by patients, family members, and health professionals and a set of organizational policies, procedures and interventions that ensure both the inclusion of patients and families as central members of the health care team and active partnerships with providers and provider organizations.”


Describe 3 levels of patient and family engagement

 Direct care of the individual
 Organizational design and governance of the institution, or system
 Policy making for society


Define scope of patient safety problem

Making dramatic improvements in patient safety will require the following commitments from both individuals working in health care and the organizations in which they work:
o Acknowledge the scope of the problem of medical errors and make a clear commitment to redesign systems to achieve unprecedented levels of safety.
o Recognize that most patient harm is caused by bad systems and not bad people, and therefore we must end our historic response to medical error, which has been saddled with finger-pointing and shame.
o Acknowledge that individuals alone cannot improve safety; it requires everyone on the care team to work in partnership with one another and with patients and families.iii


Describe relationship between patient engagement and safety

the patient engagement movement is just coming into its own in the 2010’s. Wide spread acceptance of this is growing as is the related research supporting patient engagement. As an example, in their 2014 publication “Safety is Personal: Partnering with Patients and Families for the Safest Care,” The National Patient Safety Foundation’s Lucian Leape Institute provides a report of a roundtable on consumer engagement in patient safety.


Include the patient and family as members of the health care team: techniques

Welcome the patient and family as partners of the health care team. Acknowledge their expertise.

React positively when people ask questions, volunteer information, share concerns, or want to take part in treatment decisions.


Ask about and listen to the patient’s and family’s needs and concerns: techniques

Invitation behaviors:
Use open-ended questions to encourage the patient and family to share health information.
Try to see the experience through the patient’s and family’s eyes.

Supportive behaviors:
Listen to, respect, and act on the observations and values of the patient and family.


Help the patient and family understand the diagnosis, condition, and next step: techniques

Invitation behaviors:
Give timely and complete information about the patient’s condition.
Check that you explained things well by using “teach back.”
Share as much information as they want.

Supportive behaviors:
Speak slowly.
Use plain language.
Invite the patient or family to take notes.
Let patients and families know you will find someone with an answer when you can’t answer a question.


Individual Strategies (3)

Communicate, Use shared decision making, Empower


Individual Strategies: Communicate

with patients/families in ways that improve care and safety.


Individual Strategies: shared decision making

Use shared decision making approaches (identifying patient needs, values, preferences and goals) to assure patients are both informed and drivers of their care decisions. Multiple tools exist for this including
a. Guides reviewing the 6 steps for shared decision makingvi:
1. Invite the patient to participate
2. Present options
3. Provide information on benefits and risks
4. Assist patients in evaluating options based on their goals and concerns
5. Facilitate deliberation and decision making, and
6. Assist patients to follow through on their decision
b. Decision aids such as ‘Option Grids’vii to assist with explaining options and giving patients the opportunity to be the decision maker for their treatment plan


Individual Strategies: Empower

Empower patients/families to speak up when they notice something concerning or confusing. This includes encouraging use of formal structures in place at institutions (like ‘Patient Advocates’ who speak on behalf of patientsviii, or ‘Rapid Response Teams’ where a team of providers respond to calls for help)
as well as informal methods. An example of a tool to support an informal method (that should look familiar) is a Patient SBAR guide from the Empowered Patient Coalitionix.


System Strategies

‘A Leadership Resource for Patient and Family Engagement Strategies’ developed in 2013 by the Health Research & Educational Trust of the American Hospital Association includes multiple institutional (i.e. system) strategy recommendations including:
1. Review policies impacting patient & family engagement
2. Develop mechanisms to report/correct failures to engage
3. Include patients & families on committees and advisory councils
4. Remove restrictions on visiting policies
5. Monitor outcomes for improvement linked to engagement initiatives.


Societal Strategies

Engagement strategies at the societal level include involving patients and families in decisions that are made about laws, policies and regulations by local or national governments. Additionally, they include organizational efforts (be they professional, special interest or otherwise) that are broader than those of a single institution or system. Finally, they include grassroots efforts by consumers who aim to influence communities or society at large. Examples of organizations and societal strategies include the following:
1) Patient safety advocacy organizations such as
a. Consumers Advancing Patient Safety (CAPS)
b. Empowered Patient Coalition
2) State, national and international organizations such as a. Think about it Colorado
b. Lucian Leap Institute of the National Patient Safety Foundation c. Centers for Medicare & Medicaid’s Partnership for Patientsxv
d. World Health Organization (WHO)’s Patients for Patient Safety
3) Law reform such as
a. South Carolina’s Lewis Blackman Act, whereby healthcare professionals are required to wear a
badge identifying their role, patients have the right to request a supervising physician
b. Colorado’s Michael Skolnik Medical Transparency Act, whereby malpractice judgments are part
of the public record.