2013 nhlc plenary session report final nhlc plenary session report final.pdf ·...

Plenary Session Report Nancy Abbey, NewProspex Healthcare Consulting

June 10 -11, 2013 | Niagara Falls, Ontario

From rhetoric to action:

Achieving person and family-centered

health systems

2013 National Health Leadership Conference

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2013 National Health Leadership Conference – Plenary Session Report Nancy Abbey, NewProspex Healthcare Consulting Introduction The Canadian College of Health Leaders and the Canadian Healthcare Association hosted their annual National Health Leadership Conference (NHLC) from June 10-‐11, 2013 in Niagara Falls, Ontario. The conference is the largest gathering of health system leaders in Canada and provides a forum for questions, debate and sharing strategies and solutions to the most pressing health system challenges. The theme for the 2013 conference was From rhetoric to action: Achieving person and family-centered health systems. Health leaders enjoyed an outstanding plenary program and concurrent sessions including oral abstracts, panel sessions and workshops. This report summarizes the plenary program, which consisted of four sessions. Margaret Trudeau opened the conference speaking about her experience as a patient and her journey to recovery. An interactive panel session with Dr. Brian Goldman, Shirlee Sharkey, Dr. Durhane Wong-‐Reiger, Barbara Farlow and Hèléne Campbell discussed steps required to achieve person and family-‐centered health systems. Dr. Bridget Duffy shared her knowledge about transforming the patient experience. Dr. Alex Jadad closed the conference with his address on how to drive action and implementation to achieve optimal levels of health for all. Family-centered health systems: A patient’s journey Margaret Trudeau - Celebrated Canadian and Mental Health Advocate At the age of 22, Margaret Trudeau married the Prime Minister of Canada and was parachuted into public life. With honesty and candor, Ms.

Trudeau shared her personal story of suffering from a mental illness and the profound affect it has had on her and her family. From Ms. Trudeau’s experience it is clear that the health system has to make tremendous strides to be considered patient and family-‐centered for those suffering from mental illness. It is also clear that the stigma of mental illness can lead individuals and family members to deny there is an issue, making it difficult to receive the right care at the right time in the right place. Despite evidence that mental illness was a problem at a young age, it took decades for Ms. Trudeau’s health issues to be diagnosed and effectively treated. Multiple health professionals tried various medications and treatments to address the erratic mood swings and periods of depression from which she suffered. It was only when Pierre Trudeau died, two years after the couple’s youngest son Michel was killed in an avalanche in British Columbia, that Ms. Trudeau and her family were forced to come to grips with the severity of her illness. Ms. Trudeau’s journey highlights that, unlike those suffering from acute illness, there is a greater challenge for the health system to be patient-‐centered for those suffering from a mental illness. Support and resources are likely required over many years and the system is not well designed to offer this type of care. Ms. Trudeau encouraged those suffering from mental illness to reach out for help as soon as possible and not let the stigma of the disease prevent them from seeking treatment. In her own life, Ms. Trudeau adopted a version of the twelve steps from Alcoholics Anonymous forgiving herself first for her behaviour, before asking others for forgiveness. For health leaders, Ms. Trudeau stressed the need to offer individuals suffering from mental illness the compassion, understanding and information necessary for them to physically

2013 National Health Leadership Conference – Plenary Session Report

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understand their illness in order to get on a path to recovery. Patient and family-centered health systems: The next steps Panelists: Dr. Brian Goldman – Host of the CBC show White Coat, Black Art Durhane Wong-Reiger – President and CEO, Institute for Optimizing Health Outcomes Shirlee Sharkey – President and CEO, Saint Elizabeth Health Care Hélène Campbell – Double-‐lung transplant recipient Barbara Farlow – Member, Patients for Patient Safety Canada (a patient-‐led program of the Canadian Patient Safety Institute) Moderator: Susan Kwolek, CHE – VP Patient Services and Chief Nursing Officer, Niagara Health System The purpose of this session was for the panelists to share their views on how systems can be changed so that patients and families are viewed as equal partners by healthcare providers with the right to participate in decisions affecting the planning, delivery, and evaluation of care. For patients to be considered equal partners, the panel spoke about the need for patients to be engaged, not just with managing their own care but also with decisions being made about health policy and system design. This means patients will need to have the information and options presented in a way they understand and then have the right to express an opinion about what choices are relevant based on their own experiences. Panel members stressed the importance of healthcare professionals accepting patients as an equal partner. Dr. Goldman acknowledged that for doctors, used to being considered the expert or believing they need to be the expert, it is a difficult shift to engage a patient in their care. Patient-‐centered care, ne noted, changes the culture of medicine and this will be easier for some physicians to accept than others.

Obstacles to making the changes that are required include breaking down the “wall” that often exists in a patient/physician relationship and eliminating the fear factor of patients not wanting to challenge the physician. Ms. Farlow suggested that the patient experience should be part of doctor and nurse training, noting that compassion and empathy at times are often the best medicine. Dr. Goldman spoke about physicians needing to lose the shame associated with saying “I don’t know”. Ms. Sharkey commented that patients might be reluctant to participate in system design and planning decisions. Organizations will need to invite and encourage those that are interested to engage in those discussions. Making it easier for individuals to access their own medical records is an important enabler for patient-‐centered care. Equipped with the right information, individuals can be empowered to be his or her own advocate. Ms. Campbell introduced herself as CEO of her own health and said that access to her health records would give her the information necessary to do her job. This means a transformational change in how patients and families assume responsibility and the way they are perceived by healthcare professionals and organizations. Too often what is done in fast-‐paced hospitals is “for” or “to” the patient and not “with” the patient. Dr. Wong-‐Reiger cautioned that individuals would need to be prepared and ready for this change as they often expect too much from their healthcare providers. Leadership for person and family-centered health systems Bridget Duffy - Chief Medical Officer, Vocera Dr. Bridget Duffy, Chief Medical Officer for Vocera and previous Chief Experience Officer (CXO) of the Cleveland Clinic, has first hand experience with how healthcare organizations are transforming the human experience both for staff and patients.


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Dr. Duffy’s presentation examined why the time is now and the need is great for organizations to create an experience-‐based culture that restores the joy to medicine. Recent statements from health providers to Dr. Duffy have been “it is hard to remember why we are in healthcare in the first place” and “we are increasingly feeling like assembly workers. That is okay for my car – it doesn’t notice and has no experience”. Dr. Duffy has observed that the focus on reducing cost and stripping out waste in the system has caused staff and physician burnout and poor outcomes for patient safety and quality. Vocera’s creation of a National Patient Experience Collaborative is bringing Chief Experience Officers (CXO) from across the country together to help organizations transform the human experience both for patients and staff. The ideal experience, based on their work, is one that not only focuses on efficiency (quality, safety and flow) but also on empathy (emotion, communication, relationships). Dr. Duffy shared with Canadian health leaders ten suggestions for how they could start to transform the human experience within their own organizations.

1. Make experience your #1 strategic priority

2. Designate a Committee of the Board 3. Appoint a Chief Experience Officer (CXO) 4. Integrate with quality, safety and

performance improvement 5. Map gaps in the human experience of

care from point of first impression to last impression

6. Map gaps in the physician and employee experience

7. Proactively listen to the voice of patient consumer

8. Capture relevant and actionable data 9. Hold teams and individuals accountable 10. Differentiate with innovative “always

events” that optimize the experience

Acknowledging that many organizations are overloaded with strategic priorities and often don’t know where to begin their transformation

journey, she advised leaders to start with innovative Always Events™ that optimize the experience for physicians and staff. Dr. Duffy encouraged health leaders to start making the right investments so employees aren’t checking their souls at the door. Dr. Duffy shared with the audience a number of innovative Always Events™ currently being adopted in U.S. organizations that incorporate the following principles:

1. Address patients emotional and spiritual needs

2. Put nurses and doctors back at the bedside

3. Improve physician and nurse communication

4. Engage patients and families in plan of care

5. Create consistent seamless journeys

Dr. Duffy’s comments and ideas provided the audience with inspiration for how to transform the human experience with many ideas not requiring additional funding, just a new way of thinking. As Dr. Duffy stressed many times, ideas that can be started “next Monday morning”. Driving action and implementation to achieve optimal levels of health for all Dr. Alex Jadad - Canada Research Chair in eHealth Innovation Dr. Alex Jadad provided a thought-‐provoking presentation, challenging everyone’s views about the meaning of health and the role that the health system should play to enable us to live full lives in the 21st century. Dr. Jadad asked the audience to define “what is health” and provided a number of definitions including one from the World Health Organization (WHO) that defines health as a state of complete physical, mental and social well-‐being and not just the absence of disease or infirmity. The irony is the WHO defines health in terms that makes it almost impossible for most people to achieve.


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Going back to the 20th century, Dr. Jadad noted that antibiotics turned physicians into god. Infections, which caused the majority of deaths at the time, could be cured. He then noted that the medical community focused on solving other diseases which has resulted in our system today being very good at treating acute illness and in particular the top three leading causes of death -‐ cancer, heart disease and stroke. What the system isn’t as good at treating, he said, are the reasons for these diseases. We don’t have a health system but rather a medical system that is based on a model to diagnose and cure. According to Dr. Jadad, we are now paying the price for our medical success and individuals are living long enough to accumulate disease, with an increasing percentage of the population having one or more chronic conditions. Data from the United States, and likely Canada is similar, indicates that 25% of Americans have more than one chronic condition. i Dr. Jadad asked if it is possible to have diseases and be healthy? According to the 2008 Canadian Survey of Experiences with Primary Health Care, 51% of seniors with three or more chronic conditions rated their health as excellent, very good or good and perception of health rises to 77% for seniors with two reported chronic conditions. For patients to achieve optimal health we need to acknowledge that a gap exists between saying we have a patient-‐centered health system and what is actually being provided. To illustrate this point, Dr. Jadad spoke of patients with chronic conditions often suffering from fatigue and pain and pain education in Canada being a national disgrace. A recent study showed that in veterinary medicine an average of 87 hours is spent learning about pain management compared to 16 hours in medicine and 31 hours for nursingii. Dr. Jadad noted that more time is spent teaching veterinarians how to deal with pain for our pets than teaching doctors and nurses to manage pain for their patients. With the rise in chronic disease, Dr. Jadad became part of a global effort to redefine health.

Given all aspects to be considered this became an ambitious and complex goal. Discussion among health experts led to replacing the definition of health with a concept or conceptual framework. Dr. Jadad and colleagues proposed that this new concept of health should be one’s ability to adapt and to self manage in the face of social, physical, and emotional challengesiii. Dr. Jadad challenged the audience to think about how they personally would fit within this new framework. He suggested leaders challenge themselves on what is preventing patients from being able to die healthy and happy. Leaders, he said, need to think about the demands being placed on staff and physicians that are leading to burnout and suicide rates much higher than the rest of the population. His belief is that 70-‐80% of what is currently being done in the hospital doesn’t need to be. In closing, Dr. Jadad stressed the importance of health professionals to be healthy and make hospitals healthier environments. “By working together, and making hospitals healthier places, it should be within each of us to have the opportunity to feel healthy, hopefully until our last breath”. Summary Patient and family-‐centred care redefines the relationships in healthcare from what traditionally has been the model. It is an approach to planning, delivery, and evaluation that is grounded in mutually beneficial partnerships among healthcare providers and institutions, and patients and families. To achieve this new model, a change in mindset is going to be required by all stakeholders. Dr. Duffy and Dr. Jadad inspired health leaders attending the conference with ideas for what they could be doing differently “on Monday morning” to change the culture within their organizations.


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Patients and families will need to be better equipped with the information and tools to become their own health advocate. This will require physicians and other healthcare providers to converse with patients in a manner that engages them to make informed decisions. During the panel session, Ms. Farlow appropriately quoted Sir William Osler to illustrate the value from redefining relationships between patients, families and health providers.

“Listen to your patient,

he is telling you the diagnosis”

References

i John Hopkins University, Partnership for Solutions. Medical Expenditure Panel Survey. 2001. Accessed from http://mpkb.org/home/pathogenesis/epidemiology, August 26, 2013. ii Watt-‐Watson J, McGillion M, Hunter J, et al. A survey of prelicensure pain curricula in health science faculties in Canadian universities. Pain Research and Management. 2009;14(6):439–444 iii Huber M, Knottnerus J A, Green L, van der Horst H, Jadad A et al. How should we define health. BMJ 2011; 343:d4163

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