International Patient and Family Centrered Care Conference #2

Collaborating with patient and family advisory council during major budget cuts and work redesign – Vanderbilt University Medical Center, Nashville TN

So I was drawn to this group not only to listen to Tennessee accents but also to hear how an organisation has partnered with consumers in one of the most difficult aspects of health care – budget cuts. The increasing pressure on the health dollar is a universal issue. Care costs more, and with the increase in non-communicable diseases across the western world we are seeing surges in demand for health care. We are not immune to this in Canberra. And as much of our health care is funded through taxation and co-payments the title of the presentation is apt: we are all in this together. So how can consumers contribute to these touch decisions?

Terrell Smith is from Alabama and her gorgeous accent didn’t disappoint! We do not want to talk about budget cuts in health care but it is a reality in the US. This is looking at academic medical centres as health reform which is having a tremendous impact on these services.

Fee for service model dominates the US health system, although this is better described as a a disease treatment system in the US and not a health care system. This payment model did not present incentive for keeping you well. Doctors were requesting more tests to confirm diagnosis in response to the increased rates of litigation. So defensive medicine is alive and well. But there is a disparity of health outcomes in the US, those people who have money and education have a longer life expectancy.

There is waste in the health system. 40c in the health dollar in the US is spent on chronic conditions and 15-20% is spent on potentially avoidable complications. So better management of people with these diseases and improving the design of services is one of the ways in which improvements can be made for the bottom line as well as health outcomes.

University medical centres have three areas of focus: Healthcare, research and education. Cleveland Clinic 44,000 employees and staff account for half of the costs.

Moody’s investors service shows declines in revenue in hospitals for the past ten years, so who would invest in health care at the moment?

How can value based care change this? Vanderbilt is looking to focus on consumers receiving everything they need and nothing they don’t.

Vanderbilt quietness initiative 40% wake you up lab tests might not be critical and they are looking to reduce these. Has two benefits, improves the patient experience and protects sleep but also removes the costs of pathology that is unnecessary and not contributing  to improving patient care.

The AAMC Framework Continuum of care Vanderbilt Heart’s Proposed Interventions along AAMCs framework was put on the screen and it showed that patient and family engagement was core to

Clear communication has to be on everyone’s radar and health literacy is critical to improve, shared decisions making, teach back

Council volunteers to teach the nurse to practice teach back.  A great investment of time – are your patients

Vanderbilt experienced $130m in reduction last year. This financial year they will reduce by a further $150m. Not sure what proportion this is of their total budget but it seems like a lot of money to me!

Reduced 1000 FTE, early retirement and had to lay 400-500 people off. No accrual vacation, did not accrue 3 days of vacation, ended sick leave cash out if you left the org, drug utilisation, discretional spending (cell phones), travel if you are speaking at a conference, put off minor construction.

Wanted to add another element to considering this work as there are things that the staff cannot see.

Maryann was Chair of the Advisory Council for four years. You can lower cost of health care by having patient and family advisors (who are volunteers) and listening to their views on your service.  Maryanne is a CPA and health care is a learned proposition for her and it is incredibly meaningful to her.

There are three Advisory Councils at Vanderbilt. One for Children’s Hospital. The one for the adult hospital started on 2006 and is vital to leadership of the hospital. Also have a Council for Behavioural Care (psychiatric hospital). The CEO and Chief Nursing Officer are there for each meeting. They respond as necessary but mostly are listening. They investigate all the issues the Council picks up. There is good communication and it is a trusted relationship.

All three Councils were brought together to consider the issues around the billing process. The billing process is an area for improvement in most hospitals across America.

One man accesses multiple clinics but is never checked in the same way. This began a focus on standardising the appointments processes.

They put up a SLIDE that provided an overview of the Clinic Operating Model Redesign: Access, check in, wait times, physician encounter and check out and follow up. Good questions on this slide to consider the patient experience

Call management for ambulatory care clinics (eg diabetes, heart) – there were 940,000 calls annually and there was a 25% abandonment rate. There was no performance measurement. But after the redesign there was 4% abandonment and active daily management and data tracking.

Our Promise to You: Vanderbilt Patient and Family Promise. Took all of the pillars that Vanderbilt is based on and applied this to patient experience. We make those we serve our highest priority. This is a really nice idea and I am definitely going to follow this up for heath services when I get back to Canberra.

They hold Council meeting open forums on a quarterly basis where they discuss recent hospital and clinic experiences with senior leadership. They also have the opportunity to share what they are hearing for the community. And in turn they can give correct information to their friends and networks. Also discuss issues of interest to the Council regarding perceived needs. Discussions are generally positive, looking at ways to improve rather than dwelling on those

They are widely represented on hospital committees including Patient Education Council, Patient Experience and Service Improvement Council, HCAHPS Improvement Working Group, Quality and Safety Council, Food Service Advisory Committee, My Health at Vanderbilt, Strategic Planning Design Shops, PCORI Research Grant Steering committees.

Introduction to patient promise is part of the staff induction and they also talk about the importance of patient and family centred care. Clear communication and teachback are promoted to all staff in induction.

Question: How do you support your patient advisors? They do this by helping How to tell your story in 3 minutes.

Question: How do you recruit to your Council? Put out a call to social workers, physicians, nurses and ask them to nominate someone who they have had contact with who they think would be good to participate in the Advisory Council.

Darlene Cox
@darlenecox