PFCC brings joy to holidays in the hospital

Providing good care to patients and families occurs every day of the week throughout the year. There are some days, however, that make it a harder day to be in the hospital, and away from family…such as holidays. The University Hospitals Patient and Family Advisory Council provided input about what it is like to be in the hospital over the holidays, and noted that while it’s tempting to pretend a holiday isn’t happening, the patient and family know better, and would appreciate any effort to make them feel connected to something beyond their health. One PFCC patient advisor, Georgiann Ziegler, shared a story of when she was in the hospital over New Year’s eve. When her meal was delivered, she had sparkling grape juice included in a fluted glass – which gave her some cheer, and she exclaimed to her care team, “this is perfect, since I was already in my backless blue gown!”

The UH PFAC learned, through a partnership with UH PFAC member, Maureen Schuster, Unit Host to the Surgical Intensive Care Unit (SICU), that while some units in the University Hospital might do something extra for patients over the holidays, there was nothing done system-wide. So, after discussion and exploration, set out to ensure that over the December holiday season, the PFCC Program would set out to provide a cheerful, colorful blanket to each and every patient that would be with UMHS over the holiday weekend. Cathy Kendrick, Clinical Nurse Manager, shared that when she passed the blankets out to the patients in her unit, they were “overwhelmed with joy.”

The Mott hospital has recognized this need for years, and has set up a donation program to bring the holiday spirit to the children’s hospital. Extending this to the adult patient units this year wouldn’t have been possible without the help of Byron Myer. Byron Myer is the Community Relations Coordinator at C.S. Mott Children’s Hospital. In his role at Mott, Byron coordinates all of the material donations for Mott, in addition to planning special events for the patients together with our generous partners in the community. Byron helped secure 550 blankets to help cover our patients this year, and the wonderful UMHS FRIENDS Program provided funds to help purchase those that were not donated. Importantly, Maureen Schuster worked with the PFCC Program to coordinate with the Unit Hosts across the hospital to help ensure that once delivered, the blankets will be shared, and with Laundry Services to borrow carts to help deliver the blankets. Local teens helped apply ribbons and tags. And UMHS Nurses assisted in blanket distribution. Truly a team effort!

And, for those patients and families on the adult side that were known to have children visiting them over the holiday weekend, the PFCC Program partnered again with Byron and his team, as well as UMHS Social Work, and nursing, to shop for their children at the “Mott Toy Shop”. The Mott Toy Shop helps these parents provide their child a holiday experience even while spending their holiday in the hospital.

The PFCC Program considers this a first step towards extending holiday warmth and comfort to the adult services side of the hospital in a systematic way, and will be working on programmatic efforts to sustain these and other initiatives in the new year. If you are interesting in learning more, or have ideas or would like to contribute to these efforts, please contact mollycd@med.umich.edu

Happy Holidays to you and yours!

2016 awards ceremony celebrates PFCC

 

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Here at the health system, being the best means more than just excellent clinical care.  The Evan Newport HOPE Award (Helping Our Patients Everyday) was established to formally recognize the ongoing patient and family centered care practices and initiatives occurring across the health system. Those nominated are engaging patients and families in meaningful ways, improving care as well as experience. This special award – with its simple and spirited origin inspired by the Newport family honors the people and teams embracing the idea of HOPE in partnership and collaboration with patients and families.

This year there were over 100 HOPE nominees. The award winners were announced on December 14 at a packed assembly in Ford Auditorium. Two JOY Awards were also given out, honoring patient advisors who went above and beyond. The newly created Celeste Castillo Lee Peer Mentor Award celebrates the wonderful work of two dedicated peer mentors within UMHS.

The winner of the Team HOPE Award for Adult Services was University Hospital Unit 6B. On this unit, physicians and nurses work with patients and families, and also the rest of their team – security, facilities, unit hosts – to ensure that they are providing a community of care. They began by working with a patient partner and took on nursing shift change report, then focused on creating quiet time so that patients could rest. They are so detailed and advanced in their journey, that they are even working on a tooth brushing campaign.

The winner of the Individual HOPE Award for Adult Services was Mary Gagnon, nurse in the Surgical Intensive Care Unit. Mary is known for providing exceptional care as a highly skilled nurse, but she also tuned into what matters most to the patient and family. One of Mary’s patients had a terminal illness and was engaged to be married. The patient was too sick to leave the hospital, so the patient and their significant other got married right here in our SICU with Mary’s coordination. Mary chairs the PFCC Committee in the SICU, and ensures that the SICU models the highest levels of patient and family centered practices.

The winner of the Team HOPE Award for Children’s, Women’s, and Psychiatry services was the Family Behavior Response Plan team (or FBRP). The FBRP team is a multidisciplinary team of folks with representation from Social Work, Nursing, Psychiatry, patients and families, Security Services, and physicians. This team collaborated to develop, design, and implement a flow chart to help staff identify problematic family behaviors earlier, and provides resources to stem the possibility of escalation. This flowchart and process helps guide care staff and faculty to not only better identify problematic behaviors, but also to document and provide better team communication, as well as tools to work through the behaviors so that families can remain with their loved one and everyone is in a safer environment.

The winner of the Individual HOPE Award for Children’s, Women’s, and Psychiatry Services was Linda Gobeski, nurse supervisor in Von Voigtlander Women’s Hospital Women’s Birth Center. Linda is committed to providing compassionate and collaborative care to all of her patients and families. She understands the fear and anxiety that patients feel, as well as the devastation felt after a loss. Linda’s flexibility and compassion to meet the patient where they are, and support patients with all experiences and outcomes, speaks to her commitment to provide and help others provide great patient care.

Gabrielle Tazzia and Cathy Hanson won JOY Awards for their volunteer work as PFCC Advisors. Cathy Hanson joined PFCC as a family member advisor in 2012, and started volunteering on UMHS Falls Committee, working on a pilot to develop new fall risk signage. Since then, she has been involved with the Department of Psychiatry PFAC, an intensive research project on falls known as STRIDE, as a patient advisor for LHSNet, and as a co-chair for the UM Local Patient Stakeholder Council and a member of the National Patient Stakeholder Council – in addition to many more commitments. Cathy’s contributions and leadership in ensuring the patient and caregiver voice is included in UM’s patient-centered outcomes research cannot be overstated. She has pioneered how research projects utilize advisors, and has been instrumental in empowering other advisors to further the patient and family voice at UMHS and across the country.

Gabrielle Tazzia is a mom to 3 beautiful children. Her son Wesley brought her and her family into the heart Mott Children’s Hospital.   Gabrielle has been partnering with PFCC for over 8 years as a parent advisor. She has served as a parent advisor on numerous committees over the years, including Mott Quality and Safety Committee, Palliative Care strategic planning, behavioral integrated task forces, and much more. Gabrielle has also provided hope and healing to other parents as a keynote parent speaker for the Mott Memorial.  It is through the very full life Wesley lived that Gabrielle has helped shape healthcare team to appreciate the impact a medically complex child has on all family members.

UMHS Peer Mentors Mark Reese and Colleen Schomaker were recognized with the first Celeste Castillo Lee Peer Mentor Award for their commitment to mentoring at UMHS.

Mark Reese is a PFCC Advisor and member of the Bone Marrow Transplant Unit Based Committee, where he is relied upon for his honest and valuable feedback. He is also a successful and committed BMT Peer Mentor – visiting regularly with patients and families. He is able to provide support, comfort and advice to our patients- from someone who has not only been there – but survived! Mark and his wife Cindy, know what it is like to be in the different stages that these current patients and their caregivers feel, and show dignity and grace in sharing from their heart.

Colleen Schomaker, PFCC Parent Mentor, has provided a level of commitment and passion to the UM Congenital Heart Center for the past five years.  She has supported and engaged with hundreds of patients and families by providing weekly on-site mentoring opportunities. Colleen is an incredible role model to patients, families, faculty and staff.  She had developed and sustained relationships that empathize and emotionally support families through inpatient and outpatient experiences at the Congenital Heart Center.  Her wisdom and life experiences through her heart warrior “Tommy” have provided hope and joy to other families.

HOPE Individual Finalists, Adult Services:

Daniel Cronin, MD – Internal Medicine

Norma Merritt, RN – UMHS Operating Rooms

Donna Murphy, LMSW, CLS – UM Comprehensive Cancer Center Patient & Family Support Services

Matthew Murray – UMHS Security Services

HOPE Individual Finalists, Children’s, Women’s, and Psychiatry Services:

Angelique Boerst, MA, CCC-A – Pediatric Audiology

Michele Brown, LMSW – Department of Psychiatry

Michelle Caird, MD – Pediatric Orthopedic Surgery

Sarah Shell, LMSW – Pediatric Social Work, Children’s Intestinal Rehabilitation Program

HOPE Team Finalists, Adult Services:

Frankel Cardiovascular Center Intensive Care Unit

UMHS Interpreter Services

University Hospital Unit 6C Nursing

HOPE Team Finalists, Children’s, Women’s, and Psychiatry Services:

Blenderized Tube Feeding Group

Cystic Fibrosis Center

STEPS Autism Program

JOY Award Finalists:

Robyn Bishop

Ben & Emily Bodkin

Emily Campbell

Cedric Clark

Claudette Garcia

Mike Hartwell

Julia Herzog

Lise Levie

Beth Litke

Kristin Meekhof

Michele Mitchell

Alison Paine

Katie Swift

Julie Tuttle

Carolina Typaldos

Billy Vickers

Amy Zampi

PFCC Advisors work to improve health care transitions

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By Norm Bash, PFCC Advisor

On April 8th, I participated in the I-MPACT (Integrated Michigan Patient-Centered Alliance in Care Transitions) kick-off meeting. I-MPACT is a state-wide Continuous Quality Improvement Initiative. Several UM PFCC advisors serve on area committees and twenty-one have been placed on I-MPACT’s e-advisory group.

The primary purpose of I-MPACT is to explore health care transitions. Master’s degree students and faculty in UM’s Penny W. Stamps School of Art and Design – Integrative Design Program are working with the I-MPACT Coordinating Center to bring an integrative design approach to dealing with the challenges related to Health Care Transitions. Doctors, nurses and health care professionals from hospitals and physician offices around the state are working with I-MPACT to improve patient transitions from the hospital to other facilities or home. Organizations participating in I-MPACT are required to integrate two patients or one patient and one caregiver into their teams in order to ensure the voice of the patient is heard and considered when developing strategies to improve transitions of care.

At the kick-off meeting, we received an overview of the I-MPACT project. PFCC Advisors Molly Brennan, Tom Hoatlin, and Joan Martin shared their health care journeys on a patient speaking panel. I was part of the University of Michigan Health Care unit and my table-mates included two doctors, two nurses, a skilled care administrator, two nurses, a social worker and two patients.

After sharing experiences, we developed a flow chart of all the transitions that the patient faces.  We also played a game where the responsibilities of each role were defined. This helped us to understand where problems of the person nearest to that problem has no authority to solve those issues that arise. Each team (table) prepared written problem statements and developed interventions. Our final two assignments for UMHS were to evaluate how care management can be embedded in the work of skilled health care facilities and improvements in post-discharge appointment scheduling.

I-MPACT works in partnership with Blue Cross Blue Shield of Michigan. Please click on the photo above to watch the I-MPACT video.

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Guiding Patients and Families through the Health System

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By Diane Drago, PFCC Advisor

Have you ever been lost or overwhelmed when visiting a large city that is new to you?  Or tried to navigate a road in thick fog?  If so, just imagine what our patients and families are feeling when they first enter the health system—or even for a return visit. They aren’t just entering a new, large place, they’re often doing so while frightened, confused and concerned about their health or that of a loved one.

Having easy access to basic health system information is imperative for our patients and families to navigate UMHS and is integral to us being able to provide the best patient- and family-centered care possible. While there is a fair amount of information online, not every patient and family member is able to access it and often times, doesn’t even think to do it prior to their first visit.  Therefore, UMHS’ Department of Patient and Family Centered Care (PFCC) embarked on project to design a new and improved guidebook for our patients and families.

The goal?  To provide a new, simplified and easy-to-use guidebook which can be used throughout the hospital on the adult side. (C.S. Mott is revising its own materials as well.)  Past versions were too long and confusing, essentially defeating its purpose.

The process?  PFCC’s intern, Anna Solomon, took responsibility for the enormous and painstaking research required to create a user-friendly version of the guidebook.  A group of PFCC advisers was also convened to review materials and offer feedback on what is most important to patients and families.  Anna spent most of her internship interviewing all known UMHS departments, to determine the critical information needed from their area.  This included departments such as social work, interpreter services, food service, complementary therapy and Gifts of Art, among others.

The result?  Anna completed her internship by providing a thorough outline of and the materials for the new guidebook.  It will include system-wide information such as maps, food service options, local hotels, hospital amenities, parking, financial services and tips for medical stays.  Important phone numbers for major clinics will be included, along with the ability for individual clinics to add their own, specialized information.  The guidebook is now being finalized by the PFCC office and is expected to be completed next year. It will also be hosted online.

Communication.  Information.  Education. As always, these are the themes which comprise quality patient- and family-centered care, and is the foundation of the new UMHS guidebook.

 

UMHS reimagines how pathologists interact with patients, families

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By Dale Parry, PFCC Advisor

Reinventing the relationship between pathologists and patients is one of the concepts being explored by the Department of Pathology’s new Patient Family Advisory Council (PFAC). The group, which has 36 regular members and seven patient/family advisers, began its work in July with Jeffrey Myers, M.D., (Vice Chair for Clinical Affairs and Quality) as facilitator.

“Patients and families may be unaware of the substantial role that pathology plays in their healthcare journeys,” Dr. Myers says. “Those who work in pathology, in turn, struggle to stand in our patients’ shoes to more deeply understand opportunities to improve the value of the services that we provide.  I believe that learning to partner with, rather than simply doing things to and for, patients and their families will transform our discipline and significantly improve the quality, safety and value of our contributions to an increasingly complex health care ecosystem.”

Dr. Myers believes that when pathologists are not so removed from patients and their families, they can drive safer, higher quality, and more effective pathology care for less cost.

The group’s initial areas of concentration:

  • Reimagining how pathologists share information with patients and families.
  • Making pathology more transparent and accessible.
  • Understanding how pathology can create new value in patients’ experience.

In November, 24 members of the Pathology PFAC – including three patient/family advisers – participated in the Institute for Patient- and Family-Centered Care’s intensive training seminar in San Antonio.

In 2017, the Pathology PFAC will be digging deeper with patients and families to determine how and where they as a department can turn from what is more system centered services to those that can embrace a patient and family centered care model. Working with the Institute’s faculty, they created an action plan to structure the PFAC’s next steps.

PFCC Partners to help cultivate a culture of advance care planning

By Diane Drago, PFCC Advisor

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PFCC and partners “talk turkey” about ACP during Thanksgiving week, staffing a table in the cafe.

Advance care planning (ACP) and end-of-life decisions—topics that few people can escape, yet we rarely want to discuss it until we’re forced to in a crisis. Research and anecdotal evidence demonstrate the tremendous benefits of quality ACP.  For patients and families, ACP can provide a higher quality of end-of-life care, higher health care satisfaction, lower anxiety levels, and less depression among caregivers.  For healthcare professionals and health systems, it enables better quality of care and decision making, fewer end-of-life hospitalizations and readmissions, and much higher patient satisfaction.

Having the difficult conversations about quality ACP is a keystone of Patient and Family Centered Care. Despite the enormous benefits and importance of ACP, what is the reality at UMHS?

  • Completion of all UMHS faculty and staff’s own ACPs still remains a work in progress.
  • In the most recent survey (October 2016) of patients aged 65+ being served at UMHS clinics, only three clinics had more than 40% of their patients’ ACP on file—Dexter Family Medicine (the highest at 43%), East Ann Arbor Geriatrics at 41% and West Ann Arbor General Medicine at 40.3%. The other clinics had results ranging from 15.4% to 38.2% completion rate.  While these figures show an increase since the beginning of 2016, they still fall short of UMHS’ goals.

Research studies across the spectrum demonstrate that these completion rates are the norm across the U.S.  The “gold standard” in ACP remains Gunderson Health System’s “Respecting Choices” program.  Since its inception, this program in LaCrosse County, Wisconsin, data consistently shows that they have achieved nearly a 100% completion rate across all adult residents in the county, along with 99% of the ACPs available in the patient’s medical records and treatment consistent with the patients’ wishes.

The UMHS Initiative

Efforts are being undertaken at UMHS to improve ACP completion rates and enhance communication around this issue.  In late 2015, an ACP Steering Committee was established. Members include 13 physicians and nurse managers, administrators from Ambulatory Care Services, Medical Benefits, and Social Work, and PFCC Advisors.

The committee is charged with cultivating “a culture of advance care planning” at UMHS.  It serves as the internal panel of experts in ACP and patient-centered end-of-life care. Responsibilities include: (1) developing and implementing a strategic plan to embed ACP into clinical practice, (2) ensuring patients and clinicians have earnest conversations on ACP, and (3) working to see that ACP documentation flows seamlessly throughout the institution and community.

Committee Objectives

The objectives of the ACP Steering Committee are:

  • Improve the quality of ACP conversations across care settings.
  • Increase the rates of advance directives completion and documentation for patients aged 65+ with a UM primary care physician.
  • Increase rates of code status documentation for UMHS patients.
  • Increase the percentage of times healthcare providers use documented end-of-life wishes to make care decisions.
  • Improve transparency and coordination of ACP documentation with local health care partners.

The Work to Date

The Steering Committee identified two priority areas: Patient/Caregiver Education and Engagement and Patient-Provider Communication and Documentation.  To achieve the committee’s objectives, it is critical to ensure that patients and caregivers fully understand the status of their health/illness and to enable them to engage in robust ACP conversations and shared decision making.  Therefore, the majority of the work done in 2016 has focused on the burning issue of revising UMHS’ ACP booklet available to patients and families.

The information currently used at UMHS was developed in 2011, based largely on the State of Michigan’s information.  The committee discovered that patients, caregivers and front line workers found the 2011 materials confusing and not user-friendly (patients thought that three forms had to be completed), did not meet plain language standards, is costly to print, and had been developed without any patient or caregiver input.  Further, the committee learned that the materials were disconnected and found in at least three different “homes” within UMHS.

The committee embarked on an exhaustive study of best practices in ACP materials, including the previously mentioned Gunderson method, as well as other Michigan-based initiatives and materials, such as the work done by the Washtenaw Health Initiative, St. Joseph Mercy Hospital-Ann Arbor, and the Henry Ford Health System.  Within several months, a new, patient-centered, user-friendly booklet was created, incorporating plain language principles and patient and caregiver input.  It includes clear and straightforward information on advance directives and DPAs for health care; the forms themselves with instructions; and referral to the Patient Education Clearinghouse for FAQs and the DNR form.

Work is also continuing on the development and improvement of the culture and processes to support patient-provider communications. The November “Talk Turkey” initiative was one of those endeavors.

Next Steps

Watch for these next steps in the months ahead:

  • UMHS is currently reviewing the new materials.
  • The new materials will be piloted with UMHS primary care patients.
  • Creation of a new ACP page on the Patient Education Clearinghouse.
  • Development of more patient-centered educational materials. 

For more information on the ACP Steering Committee

Contact Kathryn Shindeldecker (kajab@med.umich.edu)

UMHS Windows Covered in Memorials, Well Wishes

Health care professionals, like patients and families, can be overtaken by the pain and suffering they witness day in and day out. Tremendous grief can impede one’s ability to care for themselves or others. Unrecognized effects of cumulative grief can lead to burn-out and stress.

Social Worker Lisbeth Harcourt, Program Manager Office of Decedent Affairs, is committed to recognizing a need for grief support and education among our health care workers who are often in an environment of loss and suffering. One way to offer support is through this December’s Grief Wall. The windows in the hospitals have transformed this week into a resource for faculty, staff, patients and families to express their grief and well wishes to patients. Using paint markers on the windows, our community will have an opportunity to share thoughts, messages, poems and coping strategies related to their personal loss and grief stories. This is an interactive way to display personal expression of grief and coping, and connect us all to this universal human experience.

For more information about past Grief Awareness Week activities and resources about grief and loss, click here.