is your health care system conversation...
TRANSCRIPT
12/8/2013
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Is Your Health Care System Conversation Ready? IHI Forum: Workshop C20
December 10, 2013 1:30-2:45 PM ET
Christina Gunther-Murphy and Kelly McCutcheon Adams, IHI Directors
Disclosures
Christina Gunther-Murphy and Kelly McCutcheon Adams
are employees of the Institute for Healthcare
Improvement.
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This workshop
Since The Conversation Project aims for
individuals’ end of life wishes to be expressed
and respected, there is a recognition that our
health care system must be prepared to receive
an activated public and to fully respect end-of-
life wishes. This session will outline what it
means to be Conversation Ready and include
practical strategies from individuals in the field
working to meet these ambitious aims.
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Agenda History of The Conversation Project and Conversation Ready – Christina Gunther-Murphy
Current Conversation Ready Principles – Kelly McCutcheon Adams
Pioneer Sponsor: Beth Israel Deaconess Medical Center – Jennie Greene and Lauge Sokol-Hessner
Pioneer Sponsor: North-Shore Long Island Jewish – Mark Jarrett
Pioneer Sponsor: Henry Ford Health System – Sue Craft
Q&A
Phase 2 of Conversation Ready – Kelly McCutcheon Adams
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The Conversation Project
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Social Change 6
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The Gap
90% of people think it is important to talk about their loved
ones’ and their own wishes for end-of-life care.
27% of people have discussed what they or their family wants
when it comes to end-of-life care.
Source: The Conversation Project National Survey (2013)
What Is The Conversation Project?
National media campaign to support having all people’s
wishes for end of life care expressed and respected
Uses social and traditional media
Website and tools to help people get started
Working with employers, hospitals, faith-based groups
Change culture around end-of-life conversations in
America (and beyond)
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Our Goal
The goal of The Conversation Project is to ensure
that everyone’s wishes for end-of-life care are
expressed and respected.
www.theconversationproject.org
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Conversation Ready
Perspective From the Field
"When you talk about dealing with people who are nearing the end of
their life and their family members, the work that we do stays with them
forever. It's the same way that people tell stories about the birth of their
children, they also tell stories about the death of a loved one. And I just
feel like you have one chance to do it right, and if we can work harder
and harder to get it right on each patient and family, then that's what we
have to do. People in the hospital recognize that, even people who may
not like working with patients at the end of their life, they understand
that when that's their task they have one chance and they need to get it
right that time. That's important."
Julie Knopp, NP, Palliative Care, Beth Israel Deaconess Medical
Center
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Conversation Ready
IHI is working with leading health care organizations in
the US and internationally to ensure the health care
delivery system is prepared to receive, record, and
respect patients’ wishes
The Pioneer Sponsor year spanned from October 1,
2012 to September 30, 2013
Pioneers collaborated with IHI to design and test the
Conversation Ready principles for use in their own
systems and for possible adoption across the US and
internationally
Now we are ready for Phase 2
Pioneer Sponsors
Beth Israel Deaconess Medical Center (Massachusetts)
Care New England Health System (Rhode Island)
Contra Costa Regional Medical Center (California)
Henry Ford Health System (Michigan)
Mercy Health (Ohio)
North Shore‒Long Island Jewish Health System (New York)
St Charles Health System (Oregon)
UPMC (Pennsylvania)
Virginia Mason Medical Center (Washington)
Contributing Sponsor: Gundersen Lutheran
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Current Conversation Ready Principles
1. Engage with our patients and families to understand what matters most to them at the end of life
2. Steward this information as reliably as we do allergy information
3. Partner with our patients to develop appropriate goals of care
4. Exemplify this work in our own lives so that we understand the benefits and challenges
5. Connect in a manner that is culturally and individually respectful of each patient
Engage Steward Partner
Exemplify
Connect
Examples from the Field
1. Engage with our patients and families to understand
what matters most to them at the end of life:
• St Charles – Heart Failure University
• Mercy and Contra Costa – Primary Care appointments
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2. Steward this information as reliably as we do allergy
information
• Virginia Mason – Advance Directive Note Type
• BIDMC – IT revision
• NSLIJ – MOLST work with skilled nursing facilities
Examples from the Field
Examples From the Field
3. Partner with our patients to develop appropriate goals of
care
• Care NE – Conversation Nurse
• UPMC – Partners Program
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Examples From the Field
4. Exemplify this work in our own lives so that we
understand the benefits and challenges
• UPMC – Day of Conversation
• Mercy – Employee Focus Groups
• BIDMC – Talk Turkey and Story database
Examples From the Field
5. Connect in a manner that is culturally and individually
respectful of each patient
• Henry Ford – faith community summit
• Contra Costa – medical interpreters
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Jennifer Greene, MS Project Manager
Communications Manager
Department of Medicine
Lauge Sokol-Hessner, MD Project Leader
Attending Hospitalist
Instructor in Medicine
Associate Director of Inpatient Quality
Conversation Ready
Key Changes
• Building the infrastructure for large-scale culture change
– Stories
– Metrics
– Champions, Change Agents, Conversation Coaches
– Information Technology
– Frameworks, Training and Documentation
– MOLST
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Key Lessons
• Learn from and leverage existing structures, programs and leaders
• Focus on and include patients from the start
• Shape a vision that sticks and keep sharing it (“Four Rs” – Reach, Record, Retrieve, Respect)
• Craft tools that help others change
– Data for learning, not judgment
– Information technology support
Institute for Clinical Excellence & Quality
Conversation Ready North Shore-LIJ Health System
Mark P. Jarrett, M.D., MBA
Chief Quality Officer
NSLIJHS
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Institute for Clinical Excellence & Quality
Key Lessons
We learned the following:
As a community we are not prepared to have the
Conversation – this includes patients, families, and
health care workers
The local healthcare environment is not conducive to
having the conversation – we talk about how much
care – not the right care
Can change this situation – but need to catalog all of
the barriers and figure out how to fix them ONE at a
TIME in each site of care
Institute for Clinical Excellence & Quality
Key Changes
First step is to find a few champions – especially a Nurse and
Physician who are senior and seen as respected clinicians.
Others, such as Social Workers, are obvious champions, but
may not sway the ”docs.”
Engaging families early on
Examine the whole workflow process looking for the easiest
places to succeed – need a few winners to develop
momentum.
Plan is to form focus groups, inform them of our goals and
ask them to come up with triggers, documentation, and
measures to test.
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Director, Care Coordination Initiatives
Sue Craft, MSA, BSN, RN
Key Changes Tested Engage frontline staff to identify challenges and barriers:
– Employee focus groups.
– Woodhaven Clinic Process Test: Passive to Active process for
engaging patients. No impact on workflow - positive influence on
employee perception of “no time” to do this work (barrier).
Leverage electronic health record to provide easy access
and standardized documentation
– Multidisciplinary team designed & tested documentation approaches
within Epic EHR environment. Now in monitoring, tweaking phase.
Engage community partners, i.e. post-acute care partners
and faith leaders
– Teams formed, learning cycles in progress
– Faith leader/health care provider conference scheduled
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Key Lessons Learned A necessary first step is to discover, understand and
resolve organizational barriers.
Engagement, preparation and readiness of our
employees will be critical to success.
Provide structure to make it easy to do the right thing
No “one size fits all” approach.
– Many variables influence values and beliefs including culture,
religious beliefs, developmental/psychosocial stage, economic
status, health status etc., and present challenges that need to be
considered.
Faith-based community outreach and partnerships is key
to help effect change and sustain progress.
Questions?
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What Is Next?
Conversation Ready Health Care Community:
Schedule
Nine month learning and innovation community with
approximately 35-40 organizations
Schedule:
– Pre-work: January 2014
– Virtual Learning Session 1: February 2014
– In-person Learning Session 2: Spring 2014 (Boston – dates TBD)
– Virtual Learning Session 3: October 2014
Ongoing support through faculty, listserv, extranet, change
package, measurement strategy
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What Participants Can Expect
Participation in a vigorous and innovative learning
community
Coaching to accelerate rapid-cycle testing of the change
package
Peer-to-peer learning with colleagues around the country
(and hopefully around the world)
Teaching from expert faculty
Expectations of Sites
Committed Senior leadership support
Dedicated project team able to test at the frontline
IT representation on team
Commitment to join one in-person (in Boston in the
spring of 2014) and two virtual Learning Sessions
Participation in monthly calls
Data sharing
Program Fee: $12,000 plus travel to in-person meeting
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How to Learn More
http://www.ihi.org/offerings/MembershipsNetworks/collab
oratives/ConversationReadyCommunity/Pages/default.a
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Call or email:
Kelly McCutcheon Adams, LICSW, Director, IHI
Ph: 802-879-2905