'Transparency community' involves patients
Patients placed on key hospital communities
At St. Joseph's PeaceHealth in Bellingham, WA, a former patient has been sitting on the facility's medical executive committee for more than a year. Another patient is part of the interview team that is selecting a new CEO. These are just the latest in an ongoing stream of initiatives that have placed patients on many key hospital committees.
It's all part of the "transparency community" established by PeaceHealth, a health system located in the northwestern United States. Its organizational chart would be the envy of a major corporation: At the top of the chart sits the PeaceHealth board and executive team, comprising the advisory group (board members, patients and staff); the project management team (which coordinates the work of all transparency teams); and regional champions. Reporting to them are:
- change management: the quality improvement leadership team;
- communications team: this team provides regional liaison between communications and QI;
- measures team: they evaluate and refine measures;
- technical team: responsible for the transparency web site;
- patient medical records access team: develops a strategy for giving patients access to their electronic medical records.
The initiative got its impetus about six years ago, "partly as result of our hospital and our community being recipients of one of the Robert Wood Johnson and [the Institute for Healthcare Improvement] grants for 'Pursuing Perfection,'" notes Marla Sanger, RN, MBA, vice president, quality and process improvement, noting that there were only seven recipients of the grant in the United States. "We had the opportunity to network with our colleagues; each approach was different, but we were all very focused on the patient's health and well-being, their experience throughout the continuum of care, and patient-centered care."
One of the key messages the system adopted at this time, she recalls, was the creed: Nothing about me without me. "The point is that information belongs to the patient, and we are here to partner with the patient to optimize their experience and outcomes," Sanger explains. "If you have knowledge, you can make informed decisions, but you can't have that without transparency."
Invitations issued
In 2002 says Sanger, who headed up the inpatient efforts at St. Joseph's related to the "Pursuing Perfection" grant, "we invited patients to be part of the [program's] design, planning, and decision making," she says.
"At that time we had some patients in the hospital working on medication reconciliation and improving care for diabetes, and we also had patients on PI teams," says Sanger. "One patient, who was on diabetes care, was later invited to be part of the pharmacy and therapeutics committee."
That invitation came in 2004, says Sanger, and it was the first time a patient was asked to become part of a medical staff committee.
"It's been a journey," Sanger concedes. "When the concept was first introduced, some worries came up." For example, she notes, the staff wondered if the patient would be able to keep information confidential, and some said they might feel uncomfortable speaking candidly. They also feared that the patient would ask for information that they just couldn't provide.
"We addressed these issues one at a time," says Sanger. "At the very beginning, we just said we didn't know how things would unfold, but as we started to gain experience, we were able to say that most concerns proved to be unfounded. There's now enough volume of experience to know that those things do not play out as real worries."
All patient participants go through a "modified" orientation process similar to that given to all the hospital volunteers — fire safety, a brief infection control course, and so on. "Then, depending on what team they're on, training gets customized," says Sanger. "For example, the lady on the MEC spent two days observing an orthopedic surgery and following the intensivists around so she could gain a better understanding of their work." And, as with anyone who joins the staff, they are asked to sign a confidentiality agreement.
On to the MEC
Putting a patient on the MEC was "a logical extension" of what had already been happening, says Sanger, noting that "we felt we were getting value from having patients sit in on other committees."
This latest move began a couple of years ago when the immediate past chief of staff, as she was rotating off, asked the MEC to add a patient. "She prefaced her remarks by saying that patients had been involved on different teams already, and she believed it was important to improving quality that they have a seat at the MEC table," recalls Sanger, who is a non-voting member of the MEC.
The group expressed many of the same concerns that others had previously voiced, "but she said that any group that had had a patient on their team felt it added value, and most said they would never go back to the way things were before," says Sanger.
Still, the group was not comfortable with having a patient there if they were talking about a specific clinician PI plan or disciplinary action, or credentialing or privileging. "She said that was fine, that the group could excuse the patient during those parts of the meeting," says Sanger. "They voted approval that day — assuming I could find the right patient to invite."
Making the selection
That took several months, because of the criteria that were used. "We wanted someone who had enough experience to be a member of a team, and who showed they could work collaboratively, solving difficult problems," Sanger says. "They could not have a personal agenda, and had to be able to safely hold all confidentiality." Potential candidates were screened by the members of the committee.
The top candidate turned out to be someone whose daughter worked in the medical staff office. "She had been on the board of a credit union and other groups as well," says Sanger. "They asked her how she could handle all the private information she would hear, and she responded that most people are even more private about their money than their medical care, and she had been successful dealing with that."
They also asked her if she could handle the sometimes rough tone of the meetings, and she replied that she has successfully worked with Texas oil men in contentious situations and felt she could handle whatever came her way.
For the first four to six months, says Sanger, the patient would be asked to get up and leave the room during sensitive parts of the meetings. "Then, all of a sudden, the chairman — who had always asked her to leave — forgot to do so, but she got up and stepped out anyway." After she had been attending meetings for close to a year, says Sanger, the committee voted to allow her to stay, and today "she is a full partner."
Positive changes made
Sanger says the hospital has clearly benefited from having patient input. For example, she says, one patient who works in surgical infection prevention is a retired nurse, and made some suggestions about making hand hygiene gel more easily accessible — and the hospital listened. "She came in one day, and saw gel dispensers everywhere she looked," Sanger says. "She felt she had really made a difference."
These experiences "make patients feel very connected; it gives them some sense of accountability for the hospital and a deeper understanding of the complexity of providing health care," says Sanger.
Sanger "highly recommends" this approach to other facilities. "I can't emphasize enough how important I think it is," she says, while cautioning that real success "requires ongoing nurturing."
As for the link between transparency and quality, Sanger is emphatic. "It's hard for me to even separate the two in my head," she says. "Transparency is an integral part of quality."
[For more information, contact:
Marla Sanger, RN, MBA, Vice President, Quality and Process Improvement, PeaceHealth. E-mail: [email protected].]
At St. Joseph's PeaceHealth in Bellingham, WA, a former patient has been sitting on the facility's medical executive committee for more than a year.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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