Editor’s Note: MedStar Health’s Simulation Training and Education Lab was recognized as a finalist for the 2018 Sherman Award for Excellence in Patient Engagement for its digital patient education program. The Sherman Award is co-sponsored by Taylor Healthcare and the IHI/NPSF Lucian Leape Institute. In addition to selecting Sherman Award winners each year, the judges name finalists when the caliber of their projects warrant special recognition. Winners and finalists were announced at the IHI/NPSF Patient Safety Congress held in Boston, Massachusetts, in May.
Patient education is a critical aspect of patient safety and can impact the quality of care. MedStar Health’s Simulation Training and Education Lab (SiTEL) undertook reimagining how microlearning and a digital platform could be used to educate our patients. Historically, our organization – part of MedStar Health – has focused on the creation of education for our associates (e.g., nurses, physicians, environmental service workers). Our experience creating education in the digital domain provided a unique opportunity to create education tailored to patients in a method that was accessible to them and their families.
Digital Platform for Microlearning Aids Patients Throughout Their Care
We embarked on this endeavor because studies have shown that patients often forget information given to them during medical encounters; therefore, we wanted to give them access to pertinent education through an online platform they can access anytime, anywhere. Through conversations with patients, we found they often miss information about the entire experience that might help put them at ease. Education about what to expect, what things will look like, what things will sound like, the types of people they might meet, and how they might feel, are all topics that could help reduce anxiety around an already stressful experience. Additionally, much of the education available to patients is at a higher literacy level than is recommended and conveys information narrowly focused on a procedure or treatment.
Our platform, MedStar Health InFocus, blended the flexibility of a website with a microlearning approach to education. With a focus on the principles of engagement and health literacy, we created an online education platform that provides patients with information about what to expect before, during and after their care. This information was packaged in multiple bite-sized (60-180 second) videos focused on answering specific questions that patients might have about the whole spectrum of their care (e.g., preparing for their procedure at home, what to expect at the hospital, information about their procedure, how to care for themselves when they return home).
Incorporating Patient Feedback and Voices
A focus on education that patients wantis a key component of these videos. The voices of patients and families were critical to developing education tailored to their needs. We took opportunities to integrate their input – in some cases literally their voices – into our program. When determining which topics should be included in our bundles of education,we consulted both scientific literature and patients directly through our interactions with MedStar Health’s network of Patient and Family Advisory Councils for Quality and Safety (PFACQS). These councils reviewed and provided feedback on the educational content and format, as well as the online delivery platform. For some of our educational topics, we asked patients to share stories about their own healthcare experience to helpfuture patients and families facing a similar experience.
Ensuring that the content was relevant to patients was just the first step of our solution. The next step was to find a way to get it to patients so they could use it and share it. The accessibility of the online platform allowed patients to share the education about their treatment with their families and caregivers very easily. Patients were offered this education throughout the care continuum (i.e., before they arrived at the hospital, at the hospital before their procedure/treatment, during recovery and during discharge). Attention was paid to the health literacy of the patient population in the construction of the education. Conversational “living room” language, rather than medical jargon, was used to make the information more approachable and relatable. Varying educational formats were developed (live video, motion graphics, and animations)to best communicate the underlying intent of the videos. While we knew there was a need for this education, we also wanted to test that our solution was heading down the right path.
Program Implemented in Stages, with Pilot Studies
Between 2016 and 2017, we piloted several aspects of our new educational approach with patients receiving cardiac catheterizations. During February and March 2017, we anonymously surveyed 67 patients to gather feedback on the system in preparation for the completion of the pilot. The feedback was overwhelmingly positive. Patients rated nine items, covering usability of the videos and effectiveness of the content, on a scale from 1 = “strongly disagree” to 6 = “strongly agree”. The average rating on all items was above 5. Ratings on the following items were of particular interest:
“This education helped me better understand what I need to do to take care of myself when I get home.” Mean = 5.3, standard error (SE) = 0.2
“I will use this education when I go home to help remind me of what I learned from these videos.” Mean = 5.2; SE = 0.2
“I asked my nurse better questions because of what I learned from these videos.” Mean = 5.1, SE = 0.2
“I will share these videos with my family or caregiver.” Mean = 5.1, SE = 0.2
Version two of the online education platform, which was launched in May 2017, contained three content areas: cardiac catheterization, cardiac surgery and diabetes. By the end of 2017, there were 11 content areas containing 162 videos and 16 educational documents: (the original three plus) cardiac stress test, cardiac rehab, heart failure, ICU, chemotherapy, sepsis, stroke and total joint replacement). Overall, between May and December 2017, 2,313 patients accessed the online platform, viewing 10,618 videos and 404 educational documents.
With the success of the original initiative, in late 2017, we started another education pilot to begin addressing patient education needs related to shared decision-making conversations. That effort is still in development, but it stems from feedbackwe received from patients and families during our previous interactions. Our team’s driving motivation continues to be the creation of education that patients want, in a way they can use.