CPXP Exam Module 1 - Partnerships & Advocacy Flashcards
Partnerships & Advocacy
What do patients (consumers of healthcare) expect from their care according to the Beryl Institute’s “To Care is Human” report?
High quality, safe care
Connection to those providing care
Partnership
Clear communication that builds trust
How does the Joint Commission define Communication in healthcare?
the successful joint establishment of meaning, wherein patients and healthcare providers exchange information, enabling patients to participate actively in their care from admission to discharge, ensuring that the responsibilities of both parties are understood.
How is communication a two-way process?
It is both Expressive and Receptive, requiring the negotiation of messages until the information is understood by both parties.
Successful communication between patient and provider happens when?
When providers understand and integrate information provided by patients/families and when patients understand things accurately, in a timely manner, and receive complete/unambiguous messages from providers, in a way that enables them to actively participate in care.
Name 5 types of Interpersonal Communication
Verbal
Nonverbal
Written
Visual
Listening
Name 5 different contextual cues to be mindful of while communicating with others
Psychological Context
Cultural Context
Environmental Context
Relational Context
Situational Context
What impact does Psychological Context have on Communication?
What the people involved in the conversation bring to interaction. This includes: Needs, Desires, Values and their Personality
What impact does Cultural Context have on communication?
This includes the beliefs, spiritual needs, and may also impact communication preferences, like eye contact, gestures and tone of voice.
What impact does Environmental Context have on communication?
This can change the atmosphere of the interaction, depending on the physical location of the conversation, time of day, temperature and comfort of furnishings.
What impact does Relational Context have on communication?
This includes the way we view one another, and the reactions we have to each other. Includes assessing warmth and competence of another person, as well as explicit and implicit bias.
What impact does Situational Context have on communication?
The location or situation of the interaction will alter how it is received. Where is the conversation taking place? How was it entered into? Ambulatory visits vs. inpatient or home visits will change this as well.
Elements of Effective Interpersonal Communication
Tone of voice (tone, tempo, pitch), Body language Clear, concise messaging Context Eye contact Appearance Use of space Touch (when appropriate) Non-word sounds
Active Listening Emotional Attunement
What is the average reading level of the general public?
A 7th - 8th grade level
Why is being mindful of health literacy/considering your audience important?
This will impact how easily patients are able to understand the information we intend to communicate. This also impacts how we will choose to communicate with patients (verbal communication over writing is preferred for patients with low reading levels.)
Name 4 strategies to confirm understanding from patients/families
Avoiding Medical Jargon
Using Plain Language
Teach-Back / Confirm Understanding
Being mindful of the clarity of published information
Benefits of Effective Verbal Communication
Builds Trust, Enhances Messaging, Helps to engage others successfully, Patients and family members feel heard, respected and valued, More likely to understand plans of care
Benefits of Effective Written Communication
Creates understanding, Delivers messages with purposeful intent, Can serve as a resource for patients, Can lead to greater adherence to plan of care, and improved health outcomes
Name 5 different Communication needs patients/families may have
Hearing needs
Visual Needs
Language Needs
Low Health Literacy
Unable to speak due to medical conditions
What are Limited English Proficient (LEP) patients at risk of?
Experiencing preventable, adverse healthcare events and outcomes.
What is Empathy?
An expression of feelings that demonstrates understanding and connection with another person, while remaining somewhat detached personally from their situation.
What does Empathy require of healthcare workers?
The ability to understand others Feelings, Experiences and Point of View
What is Empathetic Attunement?
The ability to identify the feelings and emotions others are experiencing or conveying in an interaction.
What are necessary components of demonstrating empathy?
1) Cognitive - understanding the other person.
2) Affective - Do I feel connected to this person?
3) Behavioral - Can I communicate my understanding & connection to this person?
Why is demonstrating empathy important?
It helps patients / family members feel heard, seen and understood, and drives connection.
Knowing that staff are empathetic improves what for patients/families?
Satisfaction, Experience, Trust, Adherence to plan of care, Outcomes, Loyalty
What are the 3 C’s of the Emotional Attunement Framework?
Care
Connect
Communication
What is compassion?
The feeling that arises when we are confronted by another person’s suffering and feel motivated to relieve it in some way. Attending to the mind, body and spirit of a patient or family member.
What is the difference between Compassion and Empathy?
Empathy are the feelings that arise when confronted by another’s feelings; Compassion is when our own feelings drive a desire to help.
Name the 4 characteristics of Compassionate Care
1) Utilizing Emotional Support - to relieve suffering
2) Demonstrating Respect - for patient/family wishes, being unhurried
3) Communicating effectively - throughout all stages of care
4) Relating to the patient as a whole - not their diagnosis/disease
What are Communication Frameworks and what are their purpose?
They are a tool to help healthcare staff connect with and engage patients. They will help to move from Transactional Interactions to Relational Interactions
Name the parts of the GREAT Communication Framework
Greet
Relate
Explain
Ask
Thank
Name the parts of the CONNECT Communication Framework
C - Contact
O - Opening greeting
N - Name
N - Needs explanation
C - Closing statement
T - Thank
Name the parts of the RELATE Communication Framework
R - Reassure
E - Explain
L - Listen
A - Answer
T - Take Action
E - Express Appreciation
Name the parts of the AIDET Communication Framework
Acknowledge
Introduce
Duration
Explanation
Thanks
How to build rapport while wearing a mask
Practice PAVE:
P- Pause
A- Accentuate
V- Volume
E- Emotion
What channels exist for patients/family members to share feedback?
Patient/Provider Relationship, Patient Advocacy, Patient Satisfaction Surveys, Comment Cards, Social Media / Community channels, Patient and Family Advisory Councils (PFAC)
Why is Partnership with patients and families an important part of healthcare?
Patients/families are looking for partnership from healthcare staff. Partnerships are key to increased trust/loyalty/outcomes and providing the best care possible
What is Patient and Family Centered Care(PFCC)?
An approach to the Planning, delivery and evaluation of healthcare that is grounded in mutually beneficial partnerships.
Who does PFCC benefit?
Everyone: Patients, families, and healthcare staff.
What are the core concepts of PFCC and what do they stand for?
RIPC:
R- Respect
I- Information Sharing
P- Participation
C- Collaboration
Who may be in the patient’s circle that healthcare staff should be aware of?
The patient’s family, Other healthcare delivery professionals, Healthcare support professionals, Peer supports and mentors or caregivers, Cultural Brokers (Clergy, community), Hired resources
When should we check with patients regarding who they would like us to keep involved in important conversations about their care?
Throughout the continuum of care as patient support circles may shift.
What are the benefits of effective Care Team Partnerships?
Increased understanding of patient needs, Alignment to common goals / what matters most, Everyone is on the same page / connected to purpose, Family feels supported / increased trust, safety and outcomes
Potential Risks without Partnerships
1) Lower adherence to plans of care,
2) Reduced Health outcomes,
3) Increased re-admissions,
4) Decreased patient satisfaction scores,
5) Increased complaints about care
Steps to active partnerships prior to a clinic visit or hospitalization
Identify & Empower family or support figures to be involved in care. Determine patient language needs, Document any partnership plans in pre-admission forms, Advanced Directives, Proxy forms, DNR or other necessary forms
Steps to activate partnerships during an active care encounter or hospital visit
1) Identify patient wishes while developing a communication plan,
2) Communicate care team members in EMR and patient portal,
3) Ask for patient/family understanding of plan of care,
4) Ensure all care partners are aware of plan of care
5) Remember to check in regularly to ensure alignment to goals
Steps to activate partnerships during Discharges or transitions in care
Consider who can be disengaged from the team, Ensure all aspects of the plan are in place before transitioning, Ensure patient/family supports understand plan, Communicate discharge expectations and timelines openly and honestly.
Name the FIRST 4 steps of agenda setting Conversations during Transitions of care
1) Elicit Questions - use open ended questions
2) Actively Listen - with curiosity
3) Stay on topic - avoid distractions
4) Reflect back understanding - to ensure you’re on the same page
Name the LAST 4 steps of agenda setting Conversations during Transitions of Care
1) Prioritize needs - negotiate collaboratively,
2) Support Hope - while being clear about probabilities of outcomes,
3) Finalize an Agreement & Summarize,
4) Use Empathy & Compassion
What are some PFCC tools available at the point of care?
Whiteboards, Teachback Method, Bedside, Shift Report, Shared Decision Making / “What matters to you” Post-discharge phone calls / Rounding, Spiritual Healthcare, Patient Advocacy
What are some other partnerships that exist in healthcare?
Experience Based Co-Design, Patient Advocacy, Safety Reporting & Analysis, Patient and Family Advisory Councils (PFAC)
What is Experience Based Co-Design (EBCD)?
A process of engaging everyone involved in or affected by care processes for their input on experiences. Focused on challenging assumptions about experiences, and identifying emotional pain points to identify what really matters to patients/families and staff.
What are some Co-Design solutions used in EBCD?
Observation of Workflows
Interviews of staff and patients
Focus Groups
Affinity Diagrams
Journey Mapping
What are the steps of the EBCD Framework?
1) Capturing the experience - via observation
2) Understanding the experience - via interviews/focus groups
3) Designing improvements - collaboratively
4) Measuring the Improvements - how have experiences been impacted?
What is the goal of Capturing Experiences in the EBCD Framework?
Observing existing processes within a workspace to understand how the work is being done and by whom. Documenting observations at all touch points where emotions are increased. Interviewing patients, families and staff using open ended questions. Summarizing these observations for themes, overall impressions, touch points and emotions
What is the goal of Understanding Experiences in the EBCD Framework?
Using Focus groups to continue identifying themes and pain points and understand the lived experiences of those effected by a process.
What should Focus Groups in EBCD include?
Staff and patients/family members. Clear expectations for the focus group, Guided exercises and tools to help participants recall experiences, Opportunity for participants to discuss what they feel is the most pressing issue, and also an opportunity to learn how their feedback will be used.
What are some tools that can be used in Focus Groups in EBCD?
Rose Bud / Thorn Emotional Journey mapping
Affinity Diagrams
Prioritization
Debriefing
What is the goal of Designing Improvements in the EBCD framework?
To invite patients and families to brainstorm improvements to a process and identify which may be the most impactful or easy to execute, as well as be involved in developing a plan for implementing those improvements.
What is the goal of Measuring Improvements in the EBCD Framework?
It’s important to evaluate the success of your solution and understand the impact it has had.
How can Improvements be Measured?
Subjective outcomes - the way patients, families, and staff feel about their experiences.
Objective outcomes - tangible/visible impacts, (reduced wait times, better outcomes, reduced re-admissions, etc.).
Compare the improved service to the old - revisit the people you interviewed in the Capturing Experiences stage, ask how their experiences have changed.
What is Cultural Competence?
IHI defines Cultural Competency as the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients social, cultural and linguistic needs.
What is the body of knowledge, congruent behaviors, attitudes and policies that enable effective work in cross-cultural situations?
Cultural Competence
What is our own capacity to function within the context of others Cultural Beliefs, Behaviors and Needs?
Cultural Effectiveness
Cultural competence is the key to identifying communication and cultural barriers in what 3 relationships?
Patient <> Provider/Staff
Family <> Provider/Staff
Manager <> Direct Reports
How can you develop awareness of cultural context and associated expectations?
Ask about preferred communication methods
Ascertain English proficiency
Ask about cultural preferences
Be aware of non-verbal cues
How can you identify potentially culturally relevant, religious or spiritual considerations for patients?
Ask open-ended questions, Use empathy and show genuine interest in patients backgrounds, experiences and preferences and use normalizing statements
What can you do to be mindful of bias?
Reflect on your assumptions.
What is Bias?
A tendency or inclination in the way we view the world that results in judgement without question.
What is Explicit Bias?
A conscious act, such as preferring to work with someone of your own gender, race, age
What is Implicit Bias?
An unconscious processing of our brain that results in stereotyping and generalizations that may be harmful. This often is rooted in race, class and power dynamics based on structural divisions in society. Often conflicts with our intentions.
What is the ladder of Inference?
The ladder of inference is a model of decision making behavior originally developed by Chris Argyris and Donald Schoen. It describes the mental steps we take between what we see/observe, how our brains process that information, and guides the action we take.
What do assumptions create?
Blinders that lead to potential bias, conflict, and poor decision making
Describe the steps to address Unconscious/Implicit Bias and challenge assumptions
Take conscious action to become aware of cultural biases, Slow down your responses, Analyze what brought you to a conclusion before responding, Understand the other possible reactions, interpretations and judgements that may be possible before taking action
Describe using PAUSE to address unconscious bias
P - Pay Attention
A - Acknowledge Assumptions
U - Understand your Perspectives
S - Seek Different Perspectives
E - Examine your options and make a decision
What does DEIB stand for?
Diversity, Equity, Inclusion, & Belonging
What is Diversity?
The differences between people: Identity, beliefs, cultures, race, ethnicity, sexual orientation, language, nationality, disability status
What is Equity?
Ensuring everyone has the opportunity to obtain their full health potential. Ensuring that each person has the tools and resources they need to succeed, and that no one is disadvantaged due to their social position, or other socially determined situation.
What does Equity require?
Value for all people
Name 3 Benefits of Equity
Addresses avoidable inequalities and historical/contemporary injustices,
Mandates moving towards the elimination of healthcare disparities,
Frees organizations from Bias and Favoritism.
What is the difference between Equality and Equity?
Equity represents the advantages and disadvantages that impact the opportunity everyone has to be successful. Equality would be to provide each person the opportunity to complete a task, whereas Equity would ensure each person had what they needed to successfully complete it.
What is Inclusion, According to the Center for Global Inclusion?
A dynamic state of operating, in which diversity is leveraged to create a fair, healthy and high performing community
Name 4 behaviors that foster Inclusive Environments
Belongingness
Connectedness
Consideration of Differences
Value and Respect for All
What is an Inclusive Environment at work?
The degree to which employees perceive that they are esteemed members of a work group, through experiencing treatment that satisfies their need for belongingness and uniqueness.
What is Maslow’s Hierarchy of Needs?
An idea proposed by Abraham Maslow in 1943 that human needs were arranged in the form of a hierarchy, with physiological (survival) needs at the bottom and needing to be completed before more creative and self-actualized needs could be met at the top.
Where does the idea of Inclusion fall on Maslow’s Hierarchy of Needs?
In the Belongingness and Love Needs section in the middle of the pyramid. Patients and employees need to feel psychological safety and belonginess before they can pursue the ability to fulfill their potential.
What does a high value in uniqueness and high belongness create for an individual?
Inclusion/acceptance. Individuals are treated as insiders and valued for their uniqueness that they bring to the group.
What happens when behaviors are not inclusive, or do not value uniqueness?
People feel out of place, unsafe either physically or psychologically. People are unable to meet their full potential. They may become disengaged from the work, or the plan of care.
Where can patients go to report a complaint or grievance relating to quality of care?
Patient Advocacy/Patient Relations
Why is it important to be mindful of patient satisfaction and delivering excellent service?
Reimbursement incentives are tied to the public reporting of experience metrics.
When did the American Hospital Association first adopt a Patient Bill of Rights?
1973
What is the purpose of a Patient Bill of Rights?
As the setting for the provision of health services, hospitals must provide a foundation for understanding and respecting the rights and responsibilities of patients, their families, physicians, and other caregivers. Hospitals must ensure a health care ethic that respects the role of patients in decision making about treatment choices and other aspects of their care. Hospitals must be sensitive to cultural, racial, linguistic, religious, age, gender, and other differences as well as the needs of persons with disabilities.
What is a Complaint?
A verbal report from a patient/family member that can often be addressed on the spot, or within 1 business day with something as simple as an apology or resolution to a simple issue.
What is a Grievance?
A written or verbal report of complaint from a patient/family member that will require investigation, conversations with staff, review of medical records, and hospitals are bound by regulatory bodies in how quickly they must respond.
What are some sources of complaints in healthcare?
Long wait times, Lost Items, Lack of Compassion, Access to Care, Delays, Transitions in Care, Errors, Lack of information / Unclear information, Poor communication in general
How is patient feedback a gift?
Often represents a teachable moment or an opportunity to identify gaps in standards of care for process improvements. Can also identify themes for leadership to be aware of. It also gives us the opportunity to perform service recovery.
What is service recovery?
The act of hearing a patient’s concerns or complaints openly and offering a genuine apology for the emotions they experienced due to an issue, as well as taking an appropriate step to resolve the issue.
What are benefits of Service Recovery?
Restores Trust & Loyalty
Restores confidence in care
Protects Organizational reputation/brand
Prevents negative impact to the bottom line
Who is responsible for performing Service Recovery?
Everyone
What should an employee do when they hear a patient voice a concern?
Feel empowered to act. Don’t take things personally, Stay professional / Don’t place blame, Be Compassionate, Act with Empathy, Provide Relief
Describe how to de-escalate upset patients/family members
Listen actively, Demonstrate Empathy, Clarify messages, Respect personal space, Be aware of your body language, Ignore challenging questions, Permit verbal venting when possible, Set and enforce reasonable limits, Keep non-verbal and verbal cues non-threatening, Avoid overreacting, Keep it short and simple
Describe the steps in the Service Recovery Framework: LAST
1) L - Listen Attentively & Actively
2) A - Apologize with Empathy
3) S - Solve first by confirming the patient’s desired outcomes and Share what can be done now
4) T - Thank them for bringing their concern forward
Describe the steps in the Service Recovery Framework: HEART
Hear
Empathize
Apologize
Respond
Thank
Describe the steps in the Service Recovery Framework: CARE
Connect, Apologize, Resolve, Express Gratitude
Why is Scripting sometimes helpful in healthcare?
It helps to prepare employees for what to say in the eventuality of an event occurring, such as a breakdown in delivery of a service.
What should scripting provide?
Scripting should provide expectations for patients next steps.
