Deja Vu All Over Again William Schwab M

Deja Vu All Over Again? William Schwab, M. D. Department of Family Medicine and Community Health University of Wisconsin School of Medicine and Public Health www. ipfcc. org

“It’s not enough to be busy, so are the ants. The question is, what are we busy about? ”. - Henry David Thoreau

What Patients and Families Want to Know From Clinicians Ø What is the problem? Ø How can it be diagnosed and treated? ***************************

What Patients and Families Want to Know From Clinicians Ø What is the problem? Ø How can it be diagnosed and treated? *************************** Ø How can I contribute to the process to enhance the quality and safety of care? Ø When/where/how will we communicate? Ø Will you listen? Ø What does this mean for my family’s life? Ø What is the plan? Ø How will we best continue care at home?

Patient- and Family-Centered Care An approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families - Institute for Patient- and Family-Centered Care

Patient- and Family-Centered Principles Ø People are treated with respect and dignity. Ø Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Ø Individuals and families build on their strengths through participation in experiences that enhance control and independence. Ø Collaboration among patients, families, and providers occurs in policy and program development and professional education, as well as in the delivery of care. - Institute for Patient- and Family-Centered Care

The Triple Aim Better Health Better Care Lower Cost

The Triple Aim Patient- and Family-Centered Care Better Health Better Care Lower Cost "The most direct route to the Triple Aim is via patient- and family-centered care in its fullest form. ” Don Berwick former director of CMS June 5, 2012

Patient- and family-centered care provides the framework and strategies for improving quality, safety, and the experience of care.

Communication Patient- and family-centered care is not just "being nice. “ It is a direct and intentional effort to unequivocally communicate to patients and their families that they are viewed as distinct and valuable individuals with a family and place in the community. Relationships between patients, families, and providers are essential alliances and partnerships with each bringing expertise to decision-making to improve care.

High above the hushed crowd, Rex tried to remain focused. Still, he couldn’t shake one nagging thought: He was an old dog and this was a new trick.

Laying the Groundwork for Change. . . Institute of Medicine

Institute of Medicine — Crossing the Quality Chasm: A New Health System for the 21 st Century (2001)

Quality is more than technical quality. The patient’s and family’s experience can be a driver for quality improvement.

Why Patient- AND Family-Centered Care? Individuals who are most dependent on health care most dependent on families… The very young; The very old Those with chronic conditions. “Family plays a vital role in ensuring the health and well-being of people of all ages. ” - Providence Health Care, Vancouver BC

Patient- AND Family-Centered Care “Social relationships, or the relative lack thereof, constitute a major risk factor for health—rivaling the effect of well established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity and physical activity” —House, Landis, and Umberson; Science 1988 ▼ Across 148 studies (308, 849 participants), the random effects weighted average effect size was OR = 1. 50 (95% CI 1. 42 to 1. 59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Julianne Holt-Lunstad, Timothy B. Smith, J. Bradley Layton (2010). Social Relationships and Mortality Risk: A Meta-analytic Review PLo. S Med 7(7): e 1000316. doi: 10. 1371/journal. pmed. 1000316.

Why Patient- AND Family-Centered Care?

Why Patient- AND Family-Centered Care? Families can be allies for quality and safety They often are the constant support across settings and assist with transitions of care. • They can participate in the development of a care plan and support adherence to the plan. • Social isolation is a powerful risk factor. • The majority of patients have some connection to family or natural support.

What is a Family? (cont’d) From The Christ Hospital in Cincinnati, OH: “The word “family” refers to two or more persons who are related in any way - biologically, legally or emotionally. Patients and families define who is family to them. ” - www. thechristhospital. com/pfcc

What is a Family? (cont’d) ▼ A family is a group of people who make an irrational commitment to each other’s well being to the point of making each other crazy. -Uri Bronfenbrenner

Patient- and family-centered care is working with patients and families, rather than doing to or for them.

The NEW Mission Statement PATIENT- and FAMILY-CENTERED CARE

Family/Professional Collaboration At all Levels of Health Care Ø In the care for an individual patient. Ø In program planning and evaluation. Ø At the policy level.

Patient and family advisors at Ocean Park Health Center, San Francisco, CA

“You will never develop true patient - and family-centered care by using patients and families merely as focus groups”. - Lawrence Schulman, M. D. Physician-in-Chief Dana-Farber Cancer Center

“To write prescriptions is easy; but to come to an understanding with people is hard. ” - Franz Kafka “A Country Doctor” (1916)

“I didn't really say everything I said. ” - Yogi Berra

Sustaining and Spreading Change Moving Forward

“It was impossible to get a conversation going; everybody was talking too much. ” - Yogi Berra

“You can observe a lot just by watching. ” - Yogi Berra

“When you come to a fork in the road, take it. ” - Yogi Berra

“I didn’t want to make the wrong mistake. ” - Yogi Berra

Sustaining and Spreading Change Planning for Success

“You've got to be very careful if you don't know where you're going, because you might not get there. ” - Yogi Berra

“If you can't imitate him, don't copy him. ” - Yogi Berra

“You better cut the pizza in four pieces because I'm not hungry enough to eat six. ” - Yogi Berra

Yogi's wife Carmen once asked, “Yogi, you are from St. Louis, we live in New Jersey, and you played ball in New York. If you go before I do, where would you like me to have you buried? ”

Yogi's wife Carmen once asked, “Yogi, you are from St. Louis, we live in New Jersey, and you played ball in New York. If you go before I do, where would you like me to have you buried? ” Yogi replied, "Surprise me. "