Area of Improvement
The domain I chose that I believe could use improvement is the Advisor domain, and the element chosen is “Patient and family advisory council”. I chose this domain and element because I believe patients and families should have a right to voice their concerns or ideas to any organization to improve their delivery of care. Surveys are handed out to patients and family members to fill out after discharged but it does not include them in any advisory councils in the hospital. By including them as a member, the hospital is not only improving their patient-centered care delivery, they are gaining knowledge, ideas, and insight that could better the organization and increase patient satisfaction.
Creating a PFAC will increase patient-centered care in my rehabilitation facility. Working with PFAC can offer insights about the hospital and areas that need a change. This is because the PFAC members are earlier patients who can offer insight on patient-based care rather than assumptions. The PFAC team can offer feedback on practices that patient and family members find meaningful. PFAC has the potential of increasing patient loyalty, patient satisfaction, reducing medical errors, and improve better health outcomes for patients. Better patient outcomes will increase the organizational financial performance. The initial step will be to write up a proposal. This proposal, with evidence-based information, will identify the lack of a PFAC and the benefits of incorporating PFAC into the organization. The proposal will outline my plans and overall goals for the PFAC. The proposal will be in a form of PowerPoint presentation. I will present the presentation to each unit, the CEO and upper management, unit managers, and staff members. I will take a survey/vote, through email, to find any interest from staff members in joining the PFAC committee. With the approval of higher-ups, the next step will be to create a stakeholder committee. This committee will involve members of different disciplines that have shown interest. Stakeholders will meet to discuss how to move forward in creating a successful PFAC. The discussion will focus on how to identify, choose, and reach out to patients to join the PFAC.
System or Change Theory
To incorporate family and patients into hospital councils, I followed Lewin’s Change Theory. Many organizations have used Kurt Lewin’s theory in creating change within their organization. The theory comprises of three different phases known as unfreezing, moving and refreezing (Bozak, 2003).
Unfreezing Stage: The first step of Lewin’s Change Theory involves identifying the focus; including patient and families in the advisory council within the St. Francis Rehabilitation hospital. While in this stage, the first step is to gather data from HCAHPS surveys and research how these surveys have affected the organization.
Once evidence is collected and there has been a substantial amount of proof, I would select potential stakeholders for this change and present the reason I believe it's important to include patients and families in the advisory council including the benefits of working with patient and families. For example, I would explain to the stakeholders that it's important to work with patients and families as advisors at an organizational level because it is part of the patient and family-centered approach in improving quality and safety. I would further explain that their input and experience can improve the safety and quality of care delivered. The unfreezing stage requires strong communication within the stakeholders as many people can be resistant to the change. During this stage, there will be a roundtable discussion to decide the positive and negative impact of carrying out this change. I will give every member of the team an opportunity to voice their concerns. Restraining and driving forces will help decide the barriers that may need to be defeated.
Moving stage: The moving stage is the period of the actual change including the planning and the implementation stages of the project (Bozak, 2003). To begin the process of integrating patent and families as advisors, five steps are taken which include:
1. Identify a staff Liaison: the project will begin by determining who will oversee this project. Emails and memos will be sent to staff members who shows interest in the role; staff members who are passionate about patient-centered care and can relate with the goal of the PFAC. This person must be able to build a rapport with the team members and with the patient and families involved. Selection will be based off of experience and dedication.
2. Recruiting patients and family advisors: brochures and postcards will be delivered to past and present patients and their families. The information will explain the role of PFAC. It will include, how they will help the hospital, the benefits of being an advisor, and PFAC eligibility. Forms will be included for patients and families to fill out if interested. The form will require whoever is interested to fill out their demographics and answer eligibility questions. There will be an advertisement on the company website. I will hold information sessions for those who are interested. The information session will comprise of explaining the goals of implementing patients and families as council advisors and what their responsibilities will be.
Once the interested patients and family members have returned their form, stating their interest, the stakeholders within this project will interview and select twelve advisors PFAC. They will choose twelve advisors to cover the three units of the rehabilitation unit. Once chosen, letters and phone calls will be made to those who have been accepted and denied. The chosen advisors will attend another information session/orientation with detailed information on what their roles will include, statement of confidentiality to sign and introducing the members to the stakeholder team. Role of the advisors: the advisors will collaborate with the stakeholders in terms of patients and family members on policy and program decisions. They will identify ways to improve the patient and family experience, policy and practice changes, and improve patient and family engagement. Their role will include reviewing the patient and family surveys, rounding on patients and families during their hospital stay, reviewed policy and practices and generating ideas for improvement. They will serve as a sounding board for new hospital initiatives, evaluate programs that are in place for patients, and offer input as necessary.
3. Collaboration with Stakeholders and Advisors: Both stakeholders, hospital leadership team and advisors are given a chance to meet. Within this meeting, it will be important for every member of this project to build a positive rapport. A barrier they may face is, clinicians or management team may believe the advisors are not “qualified” to be a part of the team. Advisors may fear they’re not on the same level of their colleagues. They can complete team building exercise to build an effective partnership. The meeting will discuss the overall goal of this project, how it will be carried out, meeting times, and other important information. I will also provide logistic information for all team members. The logistic information will include, reimbursement or compensation availability, available trainings and the overall expectation.
4. Orientation: PFAC is oriented to the hospital. They will receive a tour of the different units and go through basic hospital orientation to familiarize themselves with the hospital and its practices
5. Implementing and Coordinating: The final step is, to begin with, a small project. The advisors may review patient and family surveys. They can analyze the results as a team. Because the project is new, weekly meetings will be held for support. The meetings will offer the advisors time to ask questions and voice their opinions. Once the time has passed and every member of the project feels comfortable with their progress, other tasks and projects for the advisors will be carried out and meetings will be conducted on a monthly basis.
Freezing (refreezing) Stage: In this final stage, “the process of freezing or refreezing the changed practice occurs and leads to a time of stability and evaluation” (Bozak, 2003). Ongoing support from the stakeholders to the advisors should continue. After three to six months of implementation, they should hold a meeting to discuss any issues, concerns, successes, and challenges that may arise. They should discuss ways to improve future projects. Patient and family advisors can offer insight about the hospital’s strengths & weaknesses and ways to improve.
When implementing the PFAC, financial implication must be factored. Funds are required to pay for materials such as brochures, forms, online materials and handouts that are given to patient and families. Background checks may need to be conducted when selecting advisors. The stakeholders should consider compensation and reimbursement. It’s important to consider a monetary compensation to cover the advisor’s parking, transportation, child care if needed, and a quarterly stipend. By providing some form of compensation, advisors will be more willing to continue their active role as advisors. As for the stakeholders, it’s important to consider a monetary compensation, whether bonuses or pay per meeting, for their time and support. Other budget costs items may include, refreshments for orientation, information session, meetings, and trainings.
The method that will evaluate the success of the advisory council will be to use a qualitative measure form. The advisory council will work on assessing patient and family surveys and actively working with patients and their families. After six months of implementation, the staff liaison can hand surveys out to both advisors and stakeholders for their feedback. If all goes well, the organization can review HCAHPS surveys from the time they initiated the advisory council to the present time. By reviewing these surveys, members of the organization can decide if changes made, by implementing PFAC, are noticeable in the surveys. Reviewing the surveys will decide if there's a positive or negative impact and it can capture areas that have shown improvement and areas that may need improvement. Another method of evaluation can include surveys and feedback from healthcare providers and management team of the organization.
As before mentioned, there will be stakeholders or staff committee involved in implementing the patient and family advisory council. These staff members will include, a doctor, a nurse, human resource staff, and a staff liaison. I will limit the stakeholders to just four staff members because it's important for patients and families to feel that the advisory council belongs to them.
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