Partner with Patients

Phase I: Implementing Foundations for Improvement


Partner with patients for wellness and health

July – Oct 2016

  • Leaders and team understand the transformative power of partnering with patients and families to plan, design and build person-centered care
  • Learning Session patient journey to whole health

Oct 2016 – Feb 2017

  • Teams map patient journeys to understand the experience of care and identify areas for improvement
    • Include patient in mapping when possible
    • Map diverse patient journeys
    • Shadow patients’ care experience beginning with access and partner with patient(s) to ID improvements
  • Seek regular guidance from individuals with lived experience to design integrated whole person care
    • Patient/Consumer Advisory Councils and/or specially convened patient groups
  • Based on patient input and mapping of experience, identify, design and test practice changes care design strategies to increase patient/provider partnerships
    • Site-based ‘storytelling’ monthly of partner impact.

July 2017 – July 2018

  • Sites learn from each other and share stories of  “partnering in action” during web and in-person meetings
  • Implement concrete practice change strategies to increase patient/provider partnerships
    • Track results through patient experience measures where possible
Engage in shared decision-making honoring patient goals, strengths, and preferences as critical drivers of treatment, and health/self-care behaviors

Oct 2016 – Feb 2017

  • Clinic team/clinic staff are introduced to the effectiveness research and basic elements Shared Decision Making
    • Seek patient participation
    • Explore treatment options
    • Understand patient’s values and preferences
    • Reach a shared treatment decision
    • Follow-up re: results (AHRQ Share Approach)
  • Use Motivational Interviewing to support shared decision-making

July 2017 – Feb 2018

  • Track patient response to focus on shared decision making in treatment planning and self-management support.

See Patient Experience survey question.

Measure & improve patient experience at clinic through team reflection on monthly results, setting monthly goals; tracking quarterly impacts & trends

July – Oct 2016

  • Teams and organizations are introduced to evidence that improving patient experience is correlated with better health outcomes
  • Virtual site-level sharing of how team engagement is creating patient engagement
  • Summary of research demonstrating how team/staff is a driver of patient experience

Oct 2016 – Feb 2017

  • Teams and organizations understand intent of patient experience process with emphasis on meaningful dialogue and
    goal setting.
  • Patients are requested (a minimum of once a month) to participate in a confidential patient experience survey
  • Team reflects on monthly results, and sets monthly goals for improvement. Team plans and tests changes to achieve goals.
  • Team lead tracks estimated patient participation in survey and monthly goals for potential patient experience improvements and impacts
  • Team Lead tracks participation and goal setting
  • Team leader tracks and reviews patient experience quarterly impacts and trends

July 2017 – Feb 2018

  • Team lead tracks estimated patient participation in survey and monthly goals for potential patient experience improvements and impacts
  • Team continues to plan, test and implement practices/ activities to improve patient experience
    • Patients and peer providers are involved in designing and evaluating improvements
    • Improvement efforts are focused through staff involvement in goal-setting sessions with meaningful dialogue vs. scores on surveys.
  • Clinic and organization leaders track participation, quarterly impacts and trends and share results across the organization
  • Leaders include patient experience in organization’s quality improvement plan and develops plan to test and spread beyond integrated complex care management team and to other clinics
Print Friendly, PDF & Email


Comments are closed