Patient and Family Engagement in the Surgical Environment Module

Slide 1: Patient and Family Engagement in the Surgical Environment Module

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Slide 2: Learning Objectives

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Image: Learning objectives are presented in a series of steps:
Define patient and family engagement.
Explain the importance of engaging patients and family members.
Determine the level of patient and family engagement at your facility.
Distinguish between different methods of engaging patients and family members.
Apply engagement methods to the ASC setting.

Slide 3: Overview

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  • Defining patient and family engagement.
  • Recognizing the importance of patient and family engagement for the ambulatory surgery center (ASC).
  • Understanding engagement in your facility.
  • Identifying barriers, facilitators, and motivators.
  • Communicating with patients and family members.
  • Utilizing patient advisers.
  • Finding opportunities for patient and family engagement in your facility.

Image: clip art of patient in hospital bed, with provider standing next to the bed.

Slide 4: Patient- and Family-Centered Care

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Involves “…collaborating with patients and families of all ages, at all levels of care and in all health care settings…acknowledges that families, however they are defined, are essential to patients’ health and well-being…”1

Image: Four boxes, each listing a characteristic of patient- and family-centered care. They are:
Dignity and respect
Information sharing
Participation
Collaboration

Slide 5: What Is Patient and Family Engagement?

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  • Patient and family engagement—2
    • Is an important component of patient-and family-centered care.
    • Creates an environment where patients, families, clinicians, and hospital staff all work together as partners to improve the quality and safety of health care.
  • Involves patients and family as—
    • Members of the health care team.
    • Advisers who work with clinicians and leaders to improve policies and procedures.

Slide 6: Benefits for ASC Providers and Facilities

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  • Improve quality, patient safety, satisfaction, and optimal patient outcomes.
  • Reduce institutional and individual cost.3
  • Comply with patient-centered policies and legislation.
  • Increase adherence to treatment regimens, reducing complications.2
  • Report on engagement as a metric for success.
  • Increase rapport between patient and staff.
  • Build community relationships.

Slide 7: Benefits of Participation in Care

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Patient Participation4

  • Improves safety and awareness.
  • Brings important perspectives about care, including cultural and religious preferences.
  • Provides timely feedback.
  • Provides access to patient’s history.
  • Builds trusting relationship with provider.

Family Participation​

  • Improves safety and awareness.
  • Offers familiarity with patient medical history, normal behaviors of patient.
  • Gives opportunity to teach family members about postoperative care.
  • Provides timely feedback.
  • Builds trusting relationship with provider.

Slide 8: Patient and Family Roles in Engagement

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  • Patients and their family members—5
    • Generally assume that most care is safe and that there are system checks to prevent medical errors.
    • Blame provider, not system, for medical errors.
    • Underestimate medical errors.
  • Patient and family engagement in health care may decrease medical errors by allowing patients and family to—
    • Be informed, asking questions about and participating in their care.
    • Help prevent specific safety events and/or medical errors.
    • Report on safety events after the fact.

Slide 9: Patient and Family Expectations

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Patients and their family members expect the following to occur when it comes to their health care:1

  • To be listened to, taken seriously, and respected as a care partner.
  • To be told the truth.
  • To have information communicated to their entire care team.
  • To have coordination among all members of the health care team across settings.
  • To be supported emotionally as well as physically.
  • To receive high-quality, safe care.

Slide 10: Patient and Family Expectations Specific to Surgical Environments

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In the ASC setting, patients and their family members should expect to—

  • Be educated about preoperative, operative, and postoperative care in person and through take-home written materials.
  • Have family, caregivers, and advocates included at the patient’s desired or age- or condition-appropriate level.
  • Be respected as an individual and not be identified as a surgical name or number.
  • Be given the opportunity to have all of their questions answered.
  • Be able to stop the process if they believe there are questions or problems.

Slide 11: Barriers to Engagement for Patients and Family

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Factors preventing successful engagement for patients and family include—3,4

Image: Fear and uncertainty
Comprehension and literacy levels
Provider bedside manner
Family reaction
Resources post-surgery
Dismissive attitudes

Slide 12: The Patient's Ambulatory Surgery Center Experience

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  • Patients in an ASC facility may not—
    • Understand the system or culture.
    • Know who different staff are and what they do.
    • Want to bother busy ASC staff.
    • Have a chance to have their questions answered, because they are only in the facility for a short time
  • Additionally, they may be—
    • Afraid or uncomfortable about their surgery/procedure.
    • Cared for post-surgery by their family members and caregivers after they leave the ASC setting.

Slide 13: Barriers to Engagement for Health Care Personnel

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  • Perceived level of time and effort.4
  • Communication challenges
    • Culture, language, power dynamics, navigating patient and family preferences.
  • Professional norms and experiences
    • Health care workers’ understanding and knowledge of engagement, workplace culture, patient and family engagement skills (lack of skills or negative experiences).
  • Patient situation upon discharge
    • Patient sedation, rapid discharge (less than 24 hours).
  • Fear of litigation
    • Transparency and adverse events, compliance with patient privacy laws.

Slide 14: Privacy Barriers – HIPAA

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  • The Health Insurance Portability and Accountability Act (HIPAA) aims to protect patient health information, but may present unique challenges for patient and family engagement. However, HIPAA and Patient and Family Engagement share the following objectives:5

HIPAA and Patient and Family Engagement

  • To restore and strengthen trust among patients, families, and health care professionals.
  • To enhance the patient’s experience.
  • To improve the efficiency and effectiveness of care.
  • To enhance patient rights.

Slide 15: Privacy Barriers – HIPAA Continued

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HIPAA Barriers to Patient and Family Engagement6

  • Depersonalizes patient experience by referring to patient by a number instead of name.
  • Creates concerns with confidentiality by questioning legality of family members.
  • Discourages family member presence before and after surgical procedures.

Recommendations for Patient and Family Engagement With HIPAA

  • Maintain confidentiality by creating cover sheet for patient information but allowing access to patient and family.
  • Provide information about patient privacy in preoperative materials.
  • Share discharge and summary reports with patient and family members at the patient’s discretion.
  • When possible, encourage family member inclusion before and after surgery.

Slide 16: Understanding Patient Engagement in Your Facility

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  • Measuring baseline culture assessment.
  • What is your patient and family engagement level?
  • What are your personal attitudes about patient and family involvement in their own health care?

Image: two people reviewing a document.

Slide 17: Facilitation of Engagement for Health Care Personnel

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Participating in patient and family engagement can be made easier by—

Image: Four boxes listing a way that participating in patient and family engagement can be made easier:

Alignment of patient safety culture and facility goals.
Leadership models for patient and family engagement.
Experience with patient and family engagement.
Increased teamwork.

Slide 18: Facilitators of Patient and Family Engagement

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For Patient

  • Invitation to participate.
  • Information.
  • Confidence in abilities to engage in personal health care.

For Family Member

  • Invitation to participate by patient.
  • Understanding of the importance of family involvement in preoperative and postoperative care.
  • Inclusion in care discussion by provider.

Slide 19: Methods of Engaging Patients and Family Members

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  • Ask patient first, in private, what matters most to them.7
  • Determine level of family engagement based on patient’s desires and wishes for their care.
  • No one size fits all
    • Patient and family engagement and engagement incentives will look different for practice specialty and patient demographics (i.e., age).
  • Find individual case studies and strategies for engaging health care users in Engaging Health Care Users: A Framework for Healthy Individuals and Communities.8

Slide 20: Communication Guide for Providers

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  • Communication techniques9
    • Make eye contact, smile, introduce yourself and others.
    • Ask how the patient would like to be addressed.
    • Include the patient and family as members of the health care team.
    • Ask about and listen to the patient and family’s needs and concerns.
    • Help the patient and family understand the health condition, procedure, and next steps in their care.
    • Work with patients to ensure that they fully understand health information and use that knowledge to make informed decisions themselves.
  • Tool: Communicating to Improve Quality (Tool 5 AHRQ)9

Slide 21: Communication Guides for Patients and Families

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  • Question prompt sheets, such as AHRQ’s “Questions Are the Answer”10
    • Includes questions for patient and family to ask their health care providers before, during, and after a procedure
  • Preoperative and postoperative materials for preparation, such as “Helpful Information for the Day of Your Surgery”
    • Explains how to prepare for surgery and what to expect the day of surgery
    • Describes health care provider roles
  • Informed consent materials
    • Details risks of procedures/benefits of procedures

Slide 22: Opportunities for Patient and Family Engagement in Your Facility – Introducing Health Care Personnel

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Image: Video icon
Click to play

Select to play video: https://youtu.be/X3KGKqFChi8

Slide 23: Opportunities for Patient and Family Engagement in Your Facility – Checklist

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Encourage patient and family engagement in the use of the safe surgical checklist:

  • Patient identifies surgery site
  • Patient verbally lists medication allergies
  • Patient is active in own surgery preparedness
  • Patient and family are active in discharge process

Image: Video icon
Click to play

Select to play preoperative video: https://youtu.be/8gmMfZ__ibw

Image: Video icon
Click to play

Select to play recovery video: https://youtu.be/GpsdM9-Hi6s

Slide 24: Opportunities for Patient and Family Engagement in Your Facility – Informed Consent

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  • Fully disclose risks using simple, slow, clear language
  • Check understanding of risk and procedure
  • Offer opportunity for questions

Image: clip art of patient in bed and family and provider on the side of the bed.

Slide 25: Opportunities for Patient and Family Engagement in Your Facility – Discharge

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IDEAL discharge planning11

  • Include the patient and family.
  • Discuss with the patient and family five key areas to prevent problems at home.
  • Educate the patient and family throughout their time in the ASC facility.
  • Assess how well health care providers explain the diagnosis, condition, and next steps in their care — use Teach Back.
  • Listen to and honor the patient and family’s goals, preferences, observations, and concerns.

Slide 26: Opportunities for Patient and Family Engagement in Your Facility

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  • Disclosure and apology for unexpected adverse outcomes.12
Immediate Steps
  • Provide care for the patient.
  • Report to appropriate parties.
  • Communicate with the patient and/or family.
  • Document event in the medical record.

Next Steps

  • Investigation.
  • Continued communication with the patient and/or family.
  • Apology and remediation.
  • System and process improvement.
  • Measurement and evaluation.

Slide 27: Improving Engagement at Organizational Level – Patient Advisers

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  • Advisers are collaborative partners in developing and revising facility policies, procedures, and practices.
  • How might that look in the ASC setting?
    • Patient and family advisory boards.
  • Are patients and family members currently playing an advisory role at your facility? If not, is there an opportunity for patient advisers?

Image: clip art of meeting around conference table.

Slide 28: Summary

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  • Effective engagement and communication among patients, family members, and other members of the health care team impacts health outcomes and patient, family, and staff satisfaction.
  • Although barriers to engagement exist for both patients and families and health care personnel, creating a patient-centered environment that encourages open communication from all parties can facilitate engagement.
  • Opportunities for engagement exist throughout the ambulatory surgery center experience.
  • Organizations should be prepared to respond and communicate proactively when adverse events occur.

Slide 29: Tools

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For patients and families:

For providers:

For more support tools and free downloads, please refer to the Patient- and Family-Centered Care Web site at http://www.ipfcc.org.

For ongoing implementation support, please refer to “A Leadership Resource for Patient and Family Engagement Strategies.”3

Slide 30: References

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  1. Conway J, Johnston B, Edgman-Levitan S, et al. Institutes for Patient-and Family-Centered Care. Partnering with Patients and Families To Design a Patient-and Family-Centered Health Care System. A Roadmap for the Future. A Work in Progress. June 2006.
  2. Patient and Family Engagement. June 2015. Agency for Healthcare Research and Quality, Rockville, MD.
  3. A Leadership Resource for Patient and Family Engagement Strategies. Chicago: Health Research & Educational Trust, July 2013.
  4. Advancing the Practice of Patient-and-Family-Centered Care in Primary Care and Other Ambulatory Settings. How to Get Started…Institute for Patient-and Family-Centered Care. 2011.
  5. Maurer M, Dardess P, Carman, KL, et al. Guide to Patient and Family Engagement: Environmental Scan Report. (Prepared by American Institutes for Research under contract HHSA 290-200-600019). AHRQ Publication No. 12-0042-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2012.
  6. Institute for Patient-and Family-Centered Care. HIPAA – Providing New Opportunities for Collaboration. October 2010. http://www.ipfcc.org/advance/hipaa.pdf.
  7. Scholle SH, Torda P, Peikes D, et al. Engaging Patients and Families in the Medical Home. (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO2.) AHRQ Publication No. 10-0083-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2010.

Slide 31: References

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  1. American Hospital Association. Engaging Health Care Users: A Framework for Healthy Individuals and Communities. Chicago: American Hospital Association, Committee on Research; 2012.
  2. Strategy 2: Communicating to Improve Quality (Tool 5). Implementation Handbook. Overview of Communication Competencies. Guide to Patient and Family Engagement. Agency for Healthcare Research and Quality. Accessed July 2013.
  3. Questions To Ask Your Doctor. September 2012. Agency for Healthcare Research and Quality, Rockville, MD. Accessed July 2013.
  4. Care Transitions from Hospital to Home: IDEAL Discharge Planning Training. Guide to Patient & Family Engagement. Strategy 4: IDEAL Discharge Planning (Tool 4) Agency for Healthcare Research and Quality. Accessed July 2013.
  5. Federico F, Frankel A, Huber S, et al. PS 105: Patient Safety and Communicating with Patients After an Adverse Event (updated August 15, 2016, to Responding to Adverse Events). Open School. Institute for Healthcare Improvement. August 2010.
  6. Advancing the Practice of Patient-and-Family-Centered Care in Primary Care and Other Ambulatory Settings. How to Get Started…Institute for Patient-and Family-Centered Care. 2016.
Page last reviewed May 2017
Page originally created April 2017
Internet Citation: Patient and Family Engagement in the Surgical Environment Module. Content last reviewed May 2017. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/training-tools/pf-engagement-slides.html
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