Patient Engagement in Patient Safety Guide - ENGAGING

Preparing to load PDF file. please wait...

0 of 0
100%
Patient Engagement in Patient Safety Guide - ENGAGING

Transcript Of Patient Engagement in Patient Safety Guide - ENGAGING

ENGAGING PATIENTS IN PATIENT SAFETY
Patient Engagement Action Team – February 2018

ENGAGING PATIENTS IN PATIENT SAFETY – A CANADIAN GUIDE

Patient Engagement Action Team - February 2018

The Engaging Patients in Patient Safety – a Canadian Guide (Guide) was developed by the Canadian Patient Safety Institute, the Atlantic Health Quality and Patient Safety Collaborative, Health Quality Ontario and Patients for Patient Safety Canada in collaboration with an expert Action Team representing 16 organizations who are recognized leaders in patient engagement and patient safety. Click here to read more.
The Guide together with the complementary resources available at www.patientsafetyinstitute.ca/engagingpatients will be regularly updated and refined as new evidence emerges and new content is developed. Visit and bookmark the page above to ensure you are accessing the most up-to-date version.

1400, 10025 102A Ave Edmonton, AB T5J 2Z2
© 2017 Canadian Patient Safety Institute
All rights reserved. Permission is hereby granted to redistribute this document, in whole or part, for educational, non-commercial purposes providing that the content is not altered and that the Canadian Patient Safety Institute is appropriately credited for the work, and that it be made clear that the Canadian Patient Safety Institute does not endorse the redistribution. Written permission from the Canadian Patient Safety Institute is required for all other uses, including commercial use of illustrations.
Citation: Patient Engagement Action Team. 2017. Engaging Patients in Patient Safety – a Canadian Guide. Canadian Patient Safety Institute. Last modified February 2018. Available at: www.patientsafetyinstitute.ca/engagingpatients
For additional information, to contribute, or to provide feedback please contact: [email protected]
The Canadian Patient Safety Institute would like to acknowledge funding support from Health Canada. The views expressed here do not necessarily represent the views of Health Canada.
ISBN 978-1-926541-81-5 Print ISBN 978-1-926541-80-8 Online

2

ENGAGING PATIENTS IN PATIENT SAFETY – A CANADIAN GUIDE

Patient Engagement Action Team - February 2018

ABLE CONTENTS
Introduction: Partnering for safer healthcare .......................................................................................... 4 What is included in the guide?.................................................................................................................. 5
1. Engaging patients as partners .......................................................................................................... 7 1.1 Why partner on patient safety and quality?................................................................................... 7 1.2 Current state of patient engagement across Canada ................................................................... 9 1.3 Evidence of patient engagement benefits and impact ................................................................ 12 1.4 Challenges and enablers to patient engagement ....................................................................... 14 1.5 Embedding and sustaining patient engagement ......................................................................... 19 1.6 Summary – What you can do...................................................................................................... 22 1.7 Practice example......................................................................................................................... 23
2. Partners at the point of care............................................................................................................ 24 2.1. Partnering in patient safety ......................................................................................................... 24 2.2. Partnering in incident management ............................................................................................ 26 2.3. Summary – What you can do...................................................................................................... 30 2.4. Practice examples ....................................................................................................................... 31
3. Partners at organizational and system levels ............................................................................... 32 3.1 Preparing for patient engagement .............................................................................................. 32 3.2 Partnering in patient safety ......................................................................................................... 42 3.3 Partnering in incident management ............................................................................................ 47 3.4 Summary – what you can do....................................................................................................... 52 3.5 Practice examples ....................................................................................................................... 54
4. Evaluating patient engagement ...................................................................................................... 55 4.1 Introduction to evaluation ............................................................................................................ 55 4.2 Evaluating patient engagement at the point of care ................................................................... 58 4.3 Evaluating patient engagement at the organizational level ........................................................ 61 4.4 Evaluating patient engagement integration into an organization ................................................ 64 4.5 Summary – what you can do....................................................................................................... 66 4.6 Practice examples ....................................................................................................................... 67
Supporting References............................................................................................................................. 69

3

ENGAGING PATIENTS IN PATIENT SAFETY – A CANADIAN GUIDE

Patient Engagement Action Team - February 2018

Introduction: Partnering for safer healthcare
Message from the authors
During the past decade, we have seen evidence that when healthcare providers work closely with patients and their families, we can achieve great things. The healthcare system will be safer, and patients will have better experiences and health outcomes when patients, families, and the public are fully engaged in program and service design and delivery. Patient involvement is also important in monitoring, evaluating, setting policy and priorities, and governance.
This work is not easy and may even be uncomfortable at first. Providers may need to let go of control, change behaviours to listen and understand patients more effectively, brainstorm ideas together, build trust, and incorporate many different perspectives. Patients may need to participate more actively in decisions about their care. Leaders must support all this work by revising practices to embed patient engagement in their procedures, policies, and structures. But finding different and innovative ways to work together, even when it’s challenging, benefits everyone.
When patients and healthcare providers partner effectively, the results are powerful. We invite you to join us in advancing this work. We welcome diverse perspectives and beliefs to challenge the status quo. Let’s explore ways to shape new behaviours, using everyone’s unique perspectives and courage to make healthcare a safe and positive experience.
A deep belief in the power of partnership inspired the Engaging Patients in Patient Safety – a Canadian Guide. Written by patients and providers for patients and providers, the information demonstrates our joint commitment to achieving safe and quality healthcare in Canada.
Who is this guide for?
The guide is for anyone involved with patient engagement, including: • Patients and families interested in how to partner in their own care to ensure safety • Patient partners interested in how to help improve patient safety • Providers interested in creating collaborative care relationships with patients and families • Managers and leaders responsible for patient engagement, patient safety, and/or quality improvement • Anyone else interested in partnering with patients to develop care programs and systems
While the guide focuses primarily on patient safety, many engagement practices apply to other areas, including quality, research, and education. The guide is designed to support patient engagement in any healthcare sector.
What is the purpose of the guide?
This extensive resource, based on evidence and leading practices, helps patients and families, patient partners, providers, and leaders work together more effectively to improve patient safety. Working collaboratively, we can more proactively identify risks, better support those involved in an incident, and help prevent similar incidents from occurring in the future. Together we can shape safe, high-quality care delivery, co-design safer care systems, and continuously improve to keep patients safe.
4

ENGAGING PATIENTS IN PATIENT SAFETY – A CANADIAN GUIDE

Patient Engagement Action Team - February 2018

What is included in the guide?
Evidence-based guidance • Practical patient engagement practices • Consolidated information, resources, and tools • Supporting evidence and examples from across Canada • Experiences from patients and families, providers, and leaders • Outstanding questions about how to strengthen current approaches • Strategies and policies to meet standards and organizational practice requirements
Chapter summaries
Chapter 1 – Engaging patients as partners • Why partner on patient safety and quality • Current state of patient engagement across Canada • Evidence of patient engagement benefits and impact • Challenges and enablers to patient engagement • Embedding and sustaining patient engagement
Chapter 2 – Partners at the point of care • Partnering in patient safety • Partnering in incident management
Chapter 3 – Partners at organizational and system levels • Preparing to partner • Partnering in patient safety • Partnering in incident management
Chapter 4 – Evaluating patient engagement • Introduction to evaluating patient engagement • Evaluating patient engagement at the point of care • Evaluating patient engagement at the organizational level • Evaluating patient engagement integration
How and why was the guide developed?
The National Patient Safety Consortium, a group of more than 50 organizations, established the Integrated Patient Safety Action Plan, a shared action plan for safer healthcare. One of the plan’s guiding principles is patient engagement, and one of the shared actions is a comprehensive guide for patient engagement based on evidence and best practices.
The Canadian Patient Safety Institute (CPSI), a national organization established by Health Canada to improve patient safety and quality in the Canadian healthcare system, led this work. The Canadian Patient Safety Institute, along with the Atlantic Health Quality and Patient Safety Collaborative, and Health Quality Ontario provided leadership and funding to develop the guide. Beginning in 2016, the Canadian Patient Safety Institute brought together patients, government, and organizations responsible
5

ENGAGING PATIENTS IN PATIENT SAFETY – A CANADIAN GUIDE

Patient Engagement Action Team - February 2018

for improving patient safety and quality at the national or provincial level on an Action Team to help develop the guide.
The Action Team included: • Accreditation Canada – Health Standards Organization • Alberta Health Services • Atlantic Health Quality and Patient Safety Collaborative • B.C. Patient Safety and Quality Council • Canadian Foundation for Healthcare Improvement • Canadian Patient Safety Institute • Centre of Excellence on Partnership with Patients and the Public • HealthCareCAN • Health Quality Council of Alberta • Health Quality Ontario • IMAGINE Citizens Collaborating for Health • Manitoba Institute for Patient Safety • Manitoba Health, Seniors and Active Living • Ontario Ministry of Health and Long-Term Care • Ontario Hospital Association • Patients for Patient Safety Canada • Saskatchewan Health Quality Council • University Health Network • University of Montreal
A consultant team (One World Inc.) supported the Action Team’s work by conducting an environmental scan to identify current evidence, leading, and emerging practices, and by drafting the content of the guide. The environmental scan offered examples of patient engagement in patient safety and quality, a targeted review of academic literature, a web scan, and interviews with key informants in the field.
Fourty patients and providers from across the country participated in focus groups to help develop the guide’s scope and content, including feedback on drafts. Ten patients and providers also participated in a usability pilot to validate the format and provide ideas on how to make the guide easier to use.
The guide will be regularly updated and refined as new evidence emerges and new content is developed. To contribute to the guide (e.g., with resources, leading practices, potential topics), or to be the first to know about updates, email: [email protected]
Complementary resources, including the Canadian Patient Engagement Network and the Canadian Foundation for Healthcare Improvement Patient Engagement Hub, are available here.

6

ENGAGING PATIENTS IN PATIENT SAFETY – A CANADIAN GUIDE

Patient Engagement Action Team - February 2018

1. Engaging patients as partners
The vision is “not of staff striving to engage patients in ever more meaningful ways, but of patients and staff having collective ownership of efforts to improve their shared healthcare services; power residing not in any stakeholder group, but within the process of co-production/co-design.”1
Patients, providers, leaders, researchers, and policy makers now agree that engaging patients and families is essential to safe care. Partnering with patients shows respect, values their insights and experience, and empowers them to take an active role in their care. Many organizations, including hospitals, home and community care, long-term care, and primary care facilities are making great strides towards patient engagement, but they are still learning how to do this work collaboratively. This chapter summarizes the benefits and impact, current state, challenges, and enablers to setting up and embedding patient engagement in an organization.

1.1 Why partner on patient safety and quality?
Canada’s healthcare system is faced with growing healthcare costs, increasing rates of chronic disease, and an aging population. While it performs well on some measures, it ranks behind other Western countries on providing patient-centred care (eighth out of 11 countries), timeliness of care (11th out of 11), coordinated care (eighth out of 11), and safe care (10th out of 11). In 2014–2015, there was at least one harmful incident for every 18 Canadian hospital stays (138,000 out of 2.5 million hospital stays).2,3

Patients, providers, leaders, researchers, and policy makers now agree that patients and families are essential to ensuring safe and quality care. They are creating new knowledge and tools to

Patient: includes client, resident, person, individual, etc. and refers to those most impacted. See Glossary.

accelerate patient engagement.7,8,9,10,11,12,13,14

Patient engagement: an approach to

Fundamentally, patients expect to be safe while receiving care. Evidence and practice increasingly show that patient engagement is important to prevent patient safety incidents from occurring, respond to incidents, learn from and improve care safety. Because patient safety is an element of quality of care, engaging patients in patient safety is linked to other quality dimensions (e.g., accessible,

involve patients, families and/or patient partners in:4 • Their own healthcare • The design, delivery, evaluation of
health services • A way that fits their circumstances

appropriate, effective, efficient, equitable).

Patients’ experiential knowledge is

recognized; and power is shared5 in

Here are a few reasons to engage patients and families:

ongoing, meaningful, constructive

relationships at all system levels:

It’s the right thing to do

• Direct care • Healthcare organization (service

Partnering with patients and families shows respect, values their

design, governance)

insights and experience, and empowers them to take an active role in their care. Those working in the healthcare system are morally

• Health system (setting priorities and policies)6

obligated to engage patients, whether as members of their care team and/or as partners in improving

healthcare safety and quality within the healthcare organization or the whole system. “Nothing about me

without me,” expresses this value.

7

ENGAGING PATIENTS IN PATIENT SAFETY – A CANADIAN GUIDE

Patient Engagement Action Team - February 2018

It’s the safe thing to do

As respected partners, patients and families can improve their own care quality and safety. The 2014 Report of the Roundtable on Consumer Engagement in Patient Safety15 described patients as being the extra sets of eyes and ears that should be integrated into the safety processes of all healthcare organizations because:
• They know their symptoms and their responses to treatments better than anyone else. • They are highly invested in their own well-being and outcomes. • They are always present in their own care, unless impaired by factors beyond their control. They
are the first to know or feel when a symptom changes or they experience treatment impacts, and they can communicate these to their care team. • Their courage and resilience can inspire and energize their care team. • They often have insights into the processes of care that providers lack because the providers are focusing on getting the job done.

It enables innovative solutions
Patient engagement has been called the “blockbuster drug of the century.”16 Patients bring new, innovative approaches:17
• Patients offer a unique perspective to decisions about their own health and treatment, to caredesign processes in their local health organization, or to the bigger policy decisions that shape the healthcare system. They are experts in their own care and are experienced health system users.18
• Engaged patients better understand and know more about their care, leading to better health service and resource use.19
• Partnering with patients in planning and designing healthcare services is an important way to improve care quality and accountability in the system.20 Patient partners on incident review teams or committees: o Offer a unique perspective: ▪ Another “discipline” around the table – specialized in the patient experience ▪ An integrated view of systems, where providers only know about their own part of the care journey ▪ New insights into incident analysis o Involve those who are most impacted by decisions. o Allow providers to speak exclusively to their own role rather than trying to imagine the patient and family perspective. o Diversify team problem-solving and identification of solutions.

It’s an expectation and a standard

Across Canada, governments and healthcare organizations are advancing patient and family-centred care, with patients and families taking on more active, informed, and influential roles.21,22

Find examples of Accreditation Canada’s requirements for patient

Healthcare organizations work with recognized accreditation bodies to review and strengthen their delivery of safe, high-quality care. New

engagement throughout the guide (identified with the Accreditation Canada logo).

Accreditation Canada standards require patient engagement in

governance, leadership, and service delivery. Evidence-based

accreditation standards are evolving to require that organizations implement policies and practices to

8

ENGAGING PATIENTS IN PATIENT SAFETY – A CANADIAN GUIDE

Patient Engagement Action Team - February 2018

support patient engagement and shift to more patient-centred care.23 Since 2016, healthcare and social services organizations participating in Accreditation Canada’s Qmentum program are evaluated against new client and family-centred care requirements to:
• Partner with patients and families in planning, assessing, and delivering their care • Include patient partners on advisory boards and planning groups • Monitor and evaluate services and quality with input from patients and families
Moreover, the Health Standards Organization is now purposefully engaging patients, families, health service providers, clinicians and policy makers in the co-design and revision of health standards, ensuring that all points of view relating to a new standard or a proposed standard revision are represented.24
Some provinces have introduced legislation that requires organizations to engage patients in health system planning. For example, Ontario’s Patients First Act requires that patient and family advisory councils be put in place for every local health integration network.
1.2 Current state of patient engagement across Canada
In Canada, patient engagement examples reveal courage, collaboration, innovation, and momentum for change in the face of significant obstacles. There is still a long journey ahead until patient engagement is standard practice in every interaction, every setting, and every sector. Since some of the major initiatives in Canada began around 2004, more evidence and changes that result in safer care at all system levels have been published.25
Patients and patient groups become trusted partners
For many years, patient groups, often organized around a common disease or health condition, have actively advocated to partner in their own care, in decisions about setting health service and research priorities, and in care-design and delivery.26 Since 2004, formal and informal patient groups have emerged and continue to emerge across Canada, indicating a strong desire to contribute to safe and quality care.
For more than a decade at the national level, patient groups like Patients for Patient Safety Canada and Canadian Family Advisor Network have worked collaboratively with many leaders, providers, and policy makers to include the patient’s perspective in service design and policy making. Their intent is to build a safer, more sustainable healthcare system that is responsive to patient needs. Patients shape tools, resources, guidelines, standards, and learning programs to help other patients, patient partners, providers, and leaders.
At provincial and local levels, patient groups like Patient Voices Network in B.C., and Health Quality Ontario Patient, Family and Public Advisors Council shape provincial and local policies, frameworks, performance measures, and point-of-care interactions.
Informal patient groups and networks are also increasing in number. Patients are connecting, supporting each other, advocating for change, and collaborating with providers, administrators, and policymakers to make positive changes in the healthcare system.
Emerging efforts focus on building connections among different patient groups in a “network of networks,” primarily by the Canadian Patient Safety Institute. Through meetings and building relationships, the
9

ENGAGING PATIENTS IN PATIENT SAFETY – A CANADIAN GUIDE

Patient Engagement Action Team - February 2018

Canadian Patient Safety Institute helps reduce duplication, transfer knowledge, and align efforts to achieve a common goal: safer care through patient engagement.
Grassroots efforts became embedded at all system levels
Early efforts in patient engagement for patient safety and quality grew out of the grassroots work of patients, clinicians, and leading healthcare organizations in patient and family-centred care.27,28,29,30,31
• The Canadian Foundation for Healthcare Improvement (CFHI) supports organizations to pilot and test projects related to patient engagement. This helped seed a nationwide patient and provider learning community to build evidence for the positive impact of engaging patients.32
• The Canadian Patient Safety Institute’s National Patient Safety Consortium identified patient engagement as a key focus area in the collective effort of key patient safety and quality organizations. The Canadian Patient Safety Institute has been modelling patient engagement in patient safety for more than a decade by ensuring that 100 per cent of programs are developed and delivered in partnership with patients. The Canadian Patient Safety Institute also develops specific resources for patients and the public, and supports Patients for Patient Safety Canada.
• HealthCareCAN helps train healthcare professionals and organizations through a comprehensive and practical online learning program focused on patient-centred experience and design.
• Accreditation Canada introduced client and family-centred care standards to support organizations increase patient engagement and to advance quality and safety in healthcare organizations across the country.
• The Canadian Institute of Health Research is advancing its own organizational strategy for citizen engagement. Patient engagement is a pillar of its Strategy for Patient-Oriented Research, with provincial and national capacity-building initiatives underway.
At the provincial and territorial levels, jurisdictions have launched structures and strategies to progress safe and quality care through patient engagement and patient and family-centred care:
• Saskatchewan’s 2009 Patient First review included patient and caregiver opinions in setting priorities for provincial health system reform.33 These priorities continue to shape progressive change that embeds “Patient First” as a core value and focuses on improving the patient experience. The Saskatchewan Health Quality Council’s number one priority is to integrate patients and families as partners in all aspects of healthcare.34
• British Columbia’s Patient Voices Network recruits, trains, and supports patients to partner in change processes that improve care and service design. Health authorities and other stakeholders collaborate to identify opportunities for engagement.
• Health Quality Ontario’s Patient Engagement Framework guides a provincial strategy to build capacity for patient engagement across the provincial health system and in its own organization.
Many more health authorities and healthcare organizations are taking steps to integrate patient engagement into their work:
• Kingston General Hospital in Ontario introduced the first organization-wide patient engagement policy. Patient partners are now on all major committees and are involved with hiring decisions, staff orientation, and healthcare provider education.35
• Capital Health Authority in Nova Scotia (now the Nova Scotia Health Authority) introduced a policy36 that embraces patient and citizen engagement as a core value and business process, offering tools and consultation support to build engagement capacity.
• The Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-duQuébec, has developed an integrated strategy based on three principles: (1) shared leadership
10
PatientsPatient EngagementPatient SafetyCareGuide