Virginia Mason continues striving to become an organization that routinely listens to and deeply understands customers’ experiences. This goal is embedded in our strategic plan, which puts the patient at the top and sets the direction of deliberately incorporating the voices of our patients and families to foster innovation and extraordinary experiences.
Our approach involves (1) use of experience-based design methods to understand the emotional experiences and touch points of patients and families; (2) a patient-family partner program systematically embedding volunteers in improvement work to co-design; and (3) integration of these strategies into our improvement methodology—the Virginia Mason Production System. The positive impact of this three-pronged strategy is observable on a typical week through the direct contributions of patient-family partners in improvement efforts, the patient-centric perspectives increasingly being embraced by teams, and the positive assessments from patients-families.
PROBLEM IDENTIFICATION & SOLUTION
A key tenet of our lean-inspired Virginia Mason Production System (VMPS) is that the customer defines value. With our long-term commitment to these foundational elements, we have come to understand more deeply how many assumptions we make every day about what matters to our patients and what is shaping their care experiences. For many years, we involved patients and family in organizational activities on a limited scale. We believed we were listening effectively when one patient participated in an improvement workshop or when we channeled patient and family input into our improvement projects to help us define scope and targets. Often, however, there was reluctance to expose our customers directly to our messy processes. In these cases, involvement was at arm’s length, by gathering some satisfaction data and/or customer reactions to ideas being implemented. We needed to rethink how we could truly engage deeply with our customers, before and during the process, as we seek to improve their experience of care.
We studied the work of the National Health Service in the United Kingdom around experience-based design and began adopting these methods in our organization. In addition to traditional methods of gathering input through satisfaction surveys, we are increasingly using the qualitative experience-based design (EBD) methods to study the experiences of patients and families (or other care companions identified by patients). This can involve use of one or more of the EBD methods—observations, interviews, questionnaires, focus groups or, new in 2015, video ethnography.
Core VMPS tools such as flow mapping and value stream maps also have been retooled so data are presented through the eyes and experiences of patients and their care companions. We also began to implement formal program strategies to increase the volume and breadth of patient-family involvement in helping design processes that make sense to them.
PATIENT & FAMILY INVOLVEMENT
We gather experience data through EBD studies. Most EBD studies are small-scale, although we’re able to leverage EBD-trained leaders for larger-scale and organizational initiatives. And the patient-family partner program now has approximately 134 on-boarded volunteers ready to contribute to improvement activities. They sign up for opportunities through an electronic “job board.” We also push out notifications. Activities include participating on workshops, serving as members on committees and guiding teams, reviewing educational materials, speaking and presenting, and helping design curriculum. Most surprising and equally exciting is what we’re experiencing with access to these skills-based patient-family volunteers. While they initially sign up due to particular care experiences, many then contribute their broader knowledge and skills. We have patient-family partners with backgrounds, for example, in engineering, finance, business, healthcare, technology start-ups, legal, instructional design, construction and academia. Patients and families also are coming up with new ways they want to be involved, such as designing and teaching a class about how to deliver bad news to patients and enrolling in our VMPS training.
Patient family partners have helped us learn how to approach the “difficult conversation” around a serious diagnosis, informed patient education materials, and guided on the pace of education for chronic disease. Patients also directly influenced creation of a “know me” tool being rolled out that communicates their needs and preferences to the care team. We communicate about this culture-shifting set of strategies through regular forums to increase interest, understanding and usage. This includes providing program updates during the Tuesday morning “stand-up” ritual attended by top leadership where recent organizational VMPS projects are reviewed, presenting educational content in a VMPS collaborative forum attended by leaders and staff trained in VMPS, publishing bios of patient-family partners on the staff intranet so teams can get to know them as complete persons, and maintaining intranet pages with tools and guidelines on both experience-based design and patient-family partner involvement.
INSPIRING STAFF TO FOCUS ON PATIENTS & FAMILIES
Gathering EBD data typically increases teams’ understanding of customers’ experiences and receptivity to make changes. Direct involvement in improvement work helps teams feel supported, as evidenced by these two comments:
• The patient “was an amazing asset to our workshop team. She had a unique way of sharing her patient experience and then switching roles to share her business experience to give the ‘outside’ eyes perspective. I have worked with multiple patient family partners and have always had a great experience. This was very unique as it was two perspectives in one person, which was truly a gift.”
• The patient “was instrumental as a team member on an event focusing on the information flow of admissions to the hospital. He brought a perspective both as a patient and background in the health care industry. He challenged the team to think differently on a process where many were stuck in current ways.”
TRANSFORMATION OF CARE DELIVERY
This work is expanding our understanding of the patient family experience. It uncovers issues we might not discover on our own, helps prioritize improvements, and busts our assumptions about what matters. Examples of these assumptions include:
• Assuming a patient’s immediate family members are the people who know them best or that they want involvement in their care.
• Assuming clinical outcomes are most important (the care journey and participating in specific life events might be equally important).
• Assuming family members have what they need to care for their loved ones.
• Assuming our patient-friendly terms make sense.
• Assuming patients have a greater emotional burden than their care companions.
Examples of solutions shaped by EBD data and/or patient/family involvement include:
• Creation of a patient peer partner program for total joint replacement patients.
• Care companions participating in improvements for end-of-life ALS care, building trust between patients and caregivers, personalizing care, and implementing ideas to increase feelings of safety (physical & psychological).
• Initiation of a partnership with Alcoholics Anonymous to offer outreach to hospitalized patients experiencing alcohol withdrawal.
• User testing and editorial support of eHealth and pharmacy communication products.
IMPACT ON PATIENT EXPERIENCE & OUTCOMES
2014-15 activity tracking shows growth in teams pulling in experience data and patient-family involvement. This indicates we are progressing from a push to a pull culture where including the voice of the customer is becoming the norm.
• EBD methods used to inform several improvement projects.
• Patient-family volunteers contributed 900 improvement project hours in 2014 and 2,371 hours in 2015.
• Patient-family partners serving as regular members on organizational committees and guiding teams increased from two volunteers on two committees in 2014 to 10 volunteers on eight committees in 2015.
• Two metrics are tracked monthly to help focus programmatic efforts:
o Percent of patient-family partners participating in at least one improvement opportunities (last measure: 67%).
o Percent of time leaders say yes when patient-family partners offer to be involved in an improvement activity (last measure: 66%).
Patient-family testimonials about the benefits of being involved are becoming routine. Examples include:
• “Providing a patient and caregiver’s perspective to these quality improvement programs has been very rewarding and insightful.”
• “I have been extremely impressed by the passion brought to these committees by their professional members. I am very much looking forward to additional opportunities in any situation where I might be of help.