Leadership Plan

 
To successfully engage patients and families in safety at the point of care and in safety improvement work, a healthcare organization must commit to and invest in a culture of safety and transparency.  This begins with and is dependent upon governance and executive leadership that also is committed to and engaged in achieving zero harm.  A robust PFE program can help organizational leaders both build and sustain the culture of safety.  For these reasons, the Leadership Plan for PFE incorporates and builds on the Culture of Safety Leadership Plan set forth in APSS #1. 
Leadership Plan for Culture of Safety (incorporated from APSS #1):
·      Hospital governance and senior administrative leadership must commit to becoming aware of this major performance gap in their own organizations. Senior leaders cannot merely be “on board” with patient safety—they must own it.
·      Hospital boards must focus on safety and quality, not just finances and strategy. Research demonstrates that patient outcomes suffer when boards do not make safety a top priority. 

·      Hospital governance, senior administrative leadership, and clinical/safety leadership must close their own performance gap by implementing a proactive, comprehensive approach to addressing the culture of safety.
·      Healthcare leadership (clinical/safety) must reinforce their commitment by taking an active role in championing process improvement; giving their time, attention and focus; removing barriers, and providing necessary resources.
·      Healthcare Leadership must demonstrate their commitment and support by shaping a vision of the future, providing clearly defined goals, supporting staff as they work through improvement initiatives, measuring results, and communicating progress towards goals.
·      There are many types of leaders within a healthcare organization, and in order for process improvement to truly be successful, leadership commitment and action are required at all levels. The Board, senior leadership, physicians, pharmacy and nurse directors, managers, unit leaders and patient advocates all have important roles and need to be engaged in specific behaviors that support staff to provide safer care.
·      Safety culture and performance must be valued and reflected in compensation plans so that leaders have direct personal accountability for results. 

Additional Leadership Plan Components for PFE:
·      Ensure your organization has a clear definition of PFE.
·      Discuss PFE with your senior leadership team so that they understand that it matters to you and the organization.
·      Elicit input from your board, your staff and representative patients and families about what your organization will look like if it is successfully engaging patients and families.
·      Make improving PFE an organizational goal.
·      Allocate time in meetings with senior leadership, staff and the board to hear and tell stories about engagement success and shortcomings.
·      Assess strengths and gaps in your organization’s PFE efforts by using this checklist:  Have you…
o   Elicited feedback from your senior leadership team, staff, patients and families about PFE efforts?
o   Inventoried policies, processes, position descriptions and training programs to determine whether PFE is included?
o   Discussed finding and conclusions with leadership, staff and patients to create awareness and lay the groundwork for improvement efforts?

·      Implement a system to monitor progress on improving person and family engagement using this checklist.  Did you…
o   Select measures that will allow you to see whether processes and patient safety outcomes are changing?
o   Ensure systems are in place so that needed data can be collected and shared?
o   Compile results in a format that is easy to understand and monitor?
o   Share results with staff, senior leadership, board, community and public?
[Adapted from Healthcare Research & Educational Trust, A Leadership Resource for Patient and Family Engagement Strategies.][i]

Practice Plan

Healthcare organizations should consider using the Carman framework or an alternative framework (see list below) to implement a PFE program that engages patients or their family members at two levels:
I. Avoiding preventable harm in their own care [Level: Direct Care], and
II. Serving as organizational advisors on operational improvement work or as contributors to Board of Governors oversight on patient safety [Level: Organizational Design and Governance].
Healthcare organizations should consider establishing a PFE infrastructure that aligns with and advances the innovation currently being driven by CMS.  In hospitals and multi-site systems, this includes deploying a five part PFE practice plan:
1. Use of a checklist during the patient discharge process for all elective hospital stays to ensure reliable transmission of discharge instructions [Level: Direct Care];
2. Performance of safety huddles and nurse shift changes at the patient bedside including active patient participation in the process [Level: Direct Care];
3. Assignment of PFE responsibility as the function of a hospital organizational unit or the job description of at least one hospital employee [Level: Organization Design & Governance];
4. Establishment of a Patient and Family Advisory Council or equivalent structure to include patient input into hospital safety and quality improvement work [Level: Organization Design & Governance];
Appointment a person who identifies primarily as a patient or family member to the hospital Board of Governors or a Board-level committee with oversight of safety and quality [Level: Organization Design & Governance].
[i] Healthcare Research & Educational Trust, A Leadership Resource for Patient and Family Engagement Strategies, accessed at www.hpoe.org/Patient-family-engagement.
Healthcare organizations should consider establishing a PFE infrastructure that aligns with and advances the innovation currently being driven by CMS.  In hospitals and multi-site systems, this includes deploying a five part PFE practice plan:
1.     Use of a checklist during the patient discharge process for all elective hospital stays to ensure reliable transmission of discharge instructions [Level: Direct Care];
2.     Performance of safety huddles and nurse shift changes at the patient bedside including active patient participation in the process [Level: Direct Care];
3.     Assignment of PFE responsibility as the function of a hospital organizational unit or the job description of at least one hospital employee [Level: Organization Design & Governance];
4.     Establishment of a Patient and Family Advisory Council or equivalent structure to include patient input into hospital safety and quality improvement work [Level: Organization Design & Governance];
5.     Appointment a person who identifies primarily as a patient or family member to the hospital Board of Governors or a Board-level committee with oversight of safety and quality [Level: Organization Design & Governance].
In non-acute care clinics or other ambulatory care delivery sites, a six part PFE practice plan should be considered.
1.     Use of a tool to assess patient readiness to be “activated” as a partner in the patient’s own care [Level: Direct Care];
2.     Use of a tool to assess a patient’s degree of health literacy [Level: Direct Care];
3.     Use of a tool to support shared decision-making between patients and their providers;
4.     Establishment of a process to support medication use [Level: Direct Care];
5.     Use of a technological platform to communicate with or provide information to patients [Level: Direct Care]; and
6.     Establishing a Patient and Family Advisory Council or equivalent infrastructure to include patient input into safety improvement work [Level: Organization Design & Governance] [Level: Organization Design & Governance].
At the Organizational Design & Governance level, healthcare organizations should consider engaging users of care in improvement efforts and measure progress in one or more of the following areas:
·      Adverse Drug Events
•       Catheter-Associated Urinary Tract Infections
•       Central Line Associated Blood Stream Infections
•       Injuries from Falls and Immobility
•       Obstetrical Adverse Events
•       Pressure Ulcers
•       Surgical Site Infections
•       Venous Thromboembolism
•       Reducing Hospital Readmissions
•       Clostridium Difficile (c-diff)
•       Airway Safety
•       Severe Sepsis and Septic Shock
•       Hospital Acquired Acute Renal Failure
•       Ventilator-Associated Pneumonia
•       Effective Management of Critical Test Results
•       Iatrogenic Delirium
•       Procedural Harm
•       Undue Exposure to Radiation
•       Failure to Rescue
•       Hospital Culture of Safety
•       MRSA
•       Pain management