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Relationship Activation - Patient Experience, Empathy Innovation
Relationship Activation: Why it Matters Susan M. Paschke, MSN, RN-BC, NEA-BC Objectives 1. Describe relationship activation and its relevance to care delivery 2. Identify approaches to relationship activation 3. Describe strategies to enhance patient and team member relationships Patient Experience Summit, May 17, 2015 l 2 Hildegarde Peplau Theory of Interpersonal Relations - 1948 Peplau’s Theory of Interpersonal Relations (1948) First nursing theorist after FN Identified the “nurse-patient relationship” Described relationships as integral to the process of healing transformation Believed the relationship had a beginning and an end Ida Jean Orlando The Dynamic Nurse-Patient Relationship - 1961 Orlando – The Dynamic Nurse Patient Relationship (1961) Reciprocal relationship formed between the pt and the nurse What each says and does affect both Goal is to get to know the patient, identify needs and find ways to meet them. Jean Watson Theory of Human Caring - 1979 Jean Watson’s Theory of Human Caring Basic Themes: Transpersonal caring relationships • Developing and sustaining a helping-trusting, authentic caring relationship • Promotes direct, constructive, respectful communication: IOM – Crossing the Quality Chasm (2001) First discussed patient centered care Fosters interactions that: encourage two-way sharing of information help patients and families in making clinical decisions facilitate access to appropriate care enable pts to follow through with behavioral changes to maintain or improve their health Relationships Today All healthcare is provided through relationships No one profession is the owner of the therapeutic connection or relationship Striving to create connections in providing care unites us as healthcare professionals Why Relationships Matter? Improved care for and of patients Improved patient well-being Minimization of disparities Increased value Enhanced quality and safety Patient and provider and team member experience Evolution of Terminology PATIENT ENGAGEMENT ↓ PATIENT ACTIVATION ↓ RELATIONSHIP ACTIVATION Patient Experience Summit, May 17, 2015 l 12 What is Patient Engagement? Actions taken by individuals to obtain the greatest benefit from the health care services available to them (Rovner et al, 2010) Patient Experience Summit, May 17, 2015l 13 Engaged patients are more likely to… • • • • • Have lower overall healthcare costs Have normal biometrics Engage in healthy behaviors Have higher patient satisfaction Participate in shared decision making Patient Experience Summit, May 17, 2015 l 14 Engaged patients are less likely to… • • • • Use the Emergency Room for basic care Be hospitalized Be re-admitted after initial hospitalization Experience problems with care coordination Patient Experience Summit, May 17, 2015 l 15 Patient engagement is suboptimal…what we are doing isn’t working! • 60-80% of medical info received by pts is forgotten immediately • 35-50% if pts leave the provider visit without understanding their treatment plan • 50% of information retained is incorrect • 25% of pts don’t fill prescriptions Patient Experience Summit, May 17, 2015 l 16 More evidence………… • 25% don’t take the medication after they fill the prescription • 15% believe they can remain passive recipients of care • 29% lack basic facts or understanding of their recommended regimens • 36% have facts but lack confidence and skills to apply them • 23% have adopted new healthcare behaviors but lack confidence in their ability to maintain them under duress Bodenheimer,T. 2010 Hibbard,J. 2011 Patient Experience Summit, May 17, 2015 l 17 CMS Framework for Patient and Family Engagement • Aim is to strengthen patient and family engagement by promoting patient-centered care delivery – Focus on: – Improved experience – Patient self-management – Enhanced shared decision-making • Success will be defined as management or resolution of clinical conditions AND achievement of the patient’s desired health outcomes Patient Experience Summit, May 17, 2015 l 18 What is Patient Activation? Understanding one’s own role in the care process and having the knowledge, skills, and confidence to take on that role (Hibbard et al, 2013) Patient Experience Summit May 17, 2015 l 19 4 Stages of Patient Activation 1. Belief by the patient that he or she serves a role in his or her health 2. Development of patient confidence and knowledge related to his or her health 3. Initiation of healthy activities 4. Maintenance of healthy activities (Greene,J & Hibbard, J., 2011) Patient Expereince Summit, May 17, 2015 l 20 Evidence for Patient Activation Supports the Triple Aim: Improved health outcomes Better patient care Lower costs/ less resources According to Hibbard (2013), lower activated patients incur 8%-21% higher costs than those with higher activation levels Is it just patients who need to be activated? What about the rest of the team – providers, family and caregivers, community resources? Patient Experience Summit, May 17, 2015 l 22 What is Relationship Activation? Relationship The way in which two or more people or things are connected -the way they talk to, behave with or interact with each other Merriam-Webster Dictionary, 2014 Patient Experience Summit, May 17, 2015 l 24 Activation The act of causing to have energy or be active Sparking, triggering, turning on Stimulation of activity in an organism making it active and effective Merriam-Webster Dictionary, 2014 Patient Experience Summit, May 17, 2015 l 25 Relationship Activation Caregivers partnering with each other and patients /families/caregivers and the community through each phase of care to: organize activities support understanding of roles provide knowledge, skills and resources to empower patients to manage their health Patient Experience Summit, May 17, 2015 l 26 What We Know About Patients and Relationships Many are poorly engaged and not activated Different populations will require different tactics Changing behavior is very hard Relationships require time and effort Communication is crucial - multidirectional Patient Experience Summit, May 17, 2015 l 27 The healthcare relationship Requires Does not require • Personal connection • Friendship • Agreeing on everything • Unlimited time • Acceptance of boundary • Mutual respect • Genuine interest in the patient • Shared understanding of the patient’s “illness” vs. “disease” • Shared commitment to patient health & wellbeing crossings • Practicing outside your scope of practice Patient Experience Summit, May 17, 2015 l 28 Goals of Relationship Activation • Move patients from being passive recipients to ACTIVE PARTNERS • Participation replacing paternalism – shared authority vs control • Expand Patient/Physician or Patient/Nurse Relationship to Consumer/ Healthcare Team Relationship Patient Experience Summit, May 17, 2015 l 29 Outcomes of Relationship Activation Patient Empowerment and Confidence Increased Patient and Family Satisfaction Improved Staff and Physician Satisfaction Enhanced Clinical Quality Enhanced Patient Safety Improved staff recruitment and retention Patient Experience Summit, May 17, 2015 l 30 Strategies to Promote Relationship Activation 1. Care Coordination/Transition Management 2. Patient Centered Medical Home/Medical Neighborhoods 3. REDE Model of Healthcare Communication© 4. Relationship Centered Care Patient Experience Summit, May 17, 2015 l 31 Care Coordination/Transition Management CC: The deliberate organization of patient care activities between 2 or more participants (including the patient) to facilitate the appropriate delivery of health care services. TM: Ongoing support of patients and families over time as they navigate care and relationships among more than one provider and/or more than one health care setting and/or more than one health care service CCTM A patient centered interprofessional collaborative practice care delivery model that integrates the RN role as Care Coordinator and transition manager Supports the PPACA (2010) Need for individualized plans of care that move with patients longitudinally over time Supports Triple Aim improve the individual experience of care improve the health of populations reduce the cost of care Patient Centered Medical Home (PCMH) Care delivery model that facilitates partnerships between individual patients, their health care team, and the patient family or significant others Reflects comprehensive, coordinated, and accessible care accountable for meeting the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Partnering with patients and their families requires understanding and respecting each patient’s unique needs, culture, values, and preferences. The medical home practice actively supports patients in learning to manage and organize their own care at the level the patient chooses. Patient Experience Summit, May 17, 2015 l 34 The REDE Model of Healthcare Communication R elationship: E stablishment D evelopment E ngagement Patient Experience Summit, May 17, 2015 l 35 REDE Model Conceptual framework for teaching relationship-centered healthcare communication Applies communication skills to optimize personal connections Stresses interest in the PERSON first then in the PATIENT Patient Experience Summit, May 17, 2015 l 36 Its not what you say, its how you say it………….. “ When I look at you, time stands still.” OR “ You have a face that would stop a clock.” Patient Experience Summit, May 17, 2015 l 37 See Me as a Person…… not an adjective! Patient Experience Summit, May 17, 2015 l 38 Relationship Centered Care “When the relational aspects of care are attended to, people tend to feel less as though things are being done TO them and more like they are an equal participant in the decision making process” Koloroutis, M & Trout, M, See Me As a Person, 2012 Relationship Centered Care Is the catalyst for Relationship Activation Relationship-Centered Care Relationships are a vital therapeutic agent Focus is to help the person – Cope with current circumstances – Understand the meaning of the illness or injury in their life – Take ownership for own follow through and management – Set goals and identify desired outcomes Koloroutis,M & Trout, M, 2014 Patient Experience Summit, May 17, 2015 l 41 Relationship Centered Care Build caring relationships that bridge demographic, social and economic differences Know and respect patient values, beliefs, hopes, expectations and ways of dealing with adversity – leads to personalized care Helps to address disparities and needs of minority populations, those with limited English proficiency and low literacy Relationship Centered Care • Is accomplished by: – Listening – Explaining – Informing – Generating options – Supporting – Advocating – Validating – Anticipating and preparing for future needs. Patient Experience Summit, May 17, 2015 l 43 Relationship Centered Care Moving From: Independence To: Interdependence Hierarchy Collegiality Parallel Functioning Team functioning Medical Plan Patient’s plan Resisting change Leading change Competing Partnering Indirect communication Direct communication Patient Experience Summit, May 17, 2015 l 44 Medical Neighborhoods Include Community health partners such as: Pharmacies Grocery stores Medical fitness centers Behavioral health centers Substance abuse programs Free Medical clinics Community Health Centers Visiting Nurse Associations Home Health Agencies Transportation Agencies Dental Clinics Hospice Organizations Patient Experience Summit, May 17, 2015 l 45 Cleveland Clinic Integrated Care Model A Value-Based Model of Care Retail Venues Community- Based Organizations Care System Post-Acute (other) Independent Physician Offices Skilled Nursing Facilities Home CareCare Chronic Care Clinics Emergency MyChart Ambulatory Clinicsics Hospitals Rehab Patient Experience Summit, May 17, 2015 Outcomes of Relationship Activation • Improved comprehension & recall • Symptom improvement or resolution • Enhanced trust & loyalty • Functional improvement • Improved sense of self- • Improved health status efficacy & support • Increased satisfaction with & quality of life • Enhanced safety care • Better treatment adherence • Improved self management of chronic disease Patient Experience Summit, May 17, 2015 l 47 More Relationship Activation Outcomes: Increase in healthy behaviors (physical activity, nutrition, etc) Appropriate use of the healthcare system Improved consumer behaviors (researching providers or health systems, checking quality scores, preparing questions) Better chronic self-care management (preventive measures, Improved control of chronic illness (fewer hospitalizations) OVERALL BETTER HEALTH OUTCOMES Patient Experience Summit, May 17, 2015 l 48 Lessons Learned 1. Relationships take time to develop 2. As team members change, the relationship changes 3. Single point person or point of contact works best 4. Patients will reach goals/outcomes at their pace not ours 5. Support and encouragement ≠ “fixing” or “doing for” 6. The patient is the driver! Patient Experience Summit, May 17, 2015 l 49 The healthcare system is SCARY……………… Relationship Activation makes for a smoother ride! References Greene,J & Hibbard, JH. (2011). “Why does patient activation matter?”. Journal of General Internal Medicine..27, (5). 520-526. Haas, S, Swan, BA, & Haynes, T. (2014). Care coordination and transition management core curriculum. Pitman, NJ: American Academy of Ambulatory Care Nursing. Hibbard, J & Greene,J. (2013) “What the evidence shows about patient activation: better health, better outcomes and care experiences”. Health Affairs.32 (2). 207-214. James, J.(2013). “Patient engagement”. Retrieved from http://www.healthaffairs.org/healthpolicy briefs. 5/11/2014. Koloroutis, M. Editor (2004). Relationship-based care: a model for transforming practice. Minneapolis, MN: Creative Healthcare Management, Inc. Koloroutis,M & Trout, M. (2012). See me as a person: creating therapeutic relationships with patients and their families. Minneapolis,MN: Creative Healthcare Management, Inc. Pelletier,LR & Stichler, JF. (2014) “Patient-centered care and engagement”. JONA. 44(9).473-480. Windover, AK, Boissy.A, Rice, TW, Gilligan, T, Velez, V, & Merlino,J. (2014). “The REDE model of healthcare communication: optimizing relationship as a therapeutic agent”. Journal of Patient Experience. 1 (1). 8-13.
