Did you know that people in British Columbia who receive health services are regarded as “partners” rather than “patients”? Or that one in 4 Americans is affected by a doctor “missing the boat” with a diagnosis? Or that engaging the public is a long-term commitment, rather than a short-term condition?
Those were themes in our IAP2 Learning Webinar on November 8, 2016, which featured the Core Values Award winners for Organization of the Year in Canada and the USA, and Research Project of the Year from the United States.
The British Columbia Ministry of Health was recognized for its “Patients as Partners Program”, which has been around less than 10-years (and counting) to give patients and their families a greater voice, choice and representation to improve healthcare at the individual, community and system level.
Shannon Holms, the program director, explained how the “old” approach to health care, structured around the needs of hospitals and healthcare providers, with medical staff regarded as experts and patients as recipients of information and instruction was no longer unsustainable. Costs were rising, taxpayers’ dollars were limited, the population was getting older and patients were demanding more input into their care.
In 2007, the British Columbia provincial government endorsed a new approach, which involved a common language, common tools and a common approach to involving patients and health care providers to foster their collaboration to improve healthcare in British Columbia. Holms explained that the IAP2 Core Values provided a “north star” for the Ministry and Delaney and Associates provided training for some 800 health care workers resulting in 40,000 engagements with patients.
Some of the results tailored for individual regions in BC include:
- The Vancouver Island Health Authority developed a program to prepare patients before surgery.
- The Interior Health Region engaged patient and family partners in the Interior Health Eating Disorder Regional Planning Day to foster engagement and collaboration and to gather information to be considered in the development of the Interior Health Eating Disorder Strategy.
- Northern Health engaged patient volunteers to streamline the process for transferring patients from hospitals to community care – condensing 24 forms down to one.
- Providence Health in Vancouver included patient partners on the committee to hire a new respiratory therapist.
- In Ridge Meadows, just east of Vancouver, patient volunteers were invited to work with general practitioners and radiologists to help improve communications and imaging results.
Among the lessons-learned, Holms says, is to maintain good relations with patient-partners and to keep leaders informed, involved and engaged.
Engaging patients in the health care process was also a key in “Clearing the Error”, which won Research Project of the Year from both IAP2 USA and the entire IAP2 Federation. The Jefferson Center and the Maxwell School for Public Affairs at Syracuse University teamed up with the Society to Improve Diagnosis in Medicine and the Agency for Health Care Research and Quality to look closely at the issue of diagnostic error.
It’s estimated that one in four Americans will, at some time in their lives, be affected by a problem with a medical diagnosis. It could be through mis-diagnosis (getting it wrong or incomplete the first time) or a missed diagnosis (not spotting the problem at all) or a mis-communication; any of which creates an avoidable delay in providing the right treatment. In fact, diagnostic error crops up in 10% of medical cases. What to do about it?
The research team used a variety of surveys and engagement tools and techniques, including Citizens’ Juries (check out the IAP2 webinar from 2015), to engage patients and healthcare consumers. Participants in the project identified roles patients might play to improve diagnostic quality and limit errors.
The research team found that deliberation had significant impacts on patient activation, health literacy, and other important measures. They also found that a majority of everyday citizens understood the recommendations and believed the recommendations were easy to use and would have a positive impact on diagnosis. The research team is currently working to assess the perceived quality of the recommendations created through deliberation as compared to recommendations made by non-deliberating bodies, including those made by a professional medical group. In the future, the team hopes to test the efficacy of the recommendations for improving the diagnostic process and diagnostic quality in clinical settings.
The City of Hillsboro, Oregon, is no stranger to the Core Values Awards. The fast-growing community 30 km west of Portland won Project of the Year in 2002 for its long-term visioning exercise to develop “Hillsboro 2020”. In fact, its updated version, “Hillsboro 2035” was initially entered in the Project of the Year category, but the IAP2 USA judges moved it to Organization of the Year because of the way P2 has become ingrained in the city’s fabric.
Hillsboro has seen a 40% increase in its population since 2000 – up to 97,000 as of 2015 and on-track to reach 116,600 by 2035. The demographic is changing, with an increasing Latino population, along with immigrants settling there from India and Korea. The daytime population also shifts since 70% of the residents go elsewhere to work during the day, while 70% of the workforce at businesses and industries (the tech sector is a major employer there) comes from other towns.
The City began developing “Hillsboro 2020” in 1997, recognizing the need to engage as much of the community as possible, and as more and more of the targets were achieved well ahead of plan, “Hillsboro 2035” was begun, working with Jason Robertson of J. Robertson and Co.
By then, the culture of P2 had become the way of life in Hillsboro. More than two dozen community organizations led the projects and a citizens’ Implementation Committee was overseeing the Action Plan. The Plan became a “living document”, being updated every five years, to prevent what city project manager Chris Hartye calls the “plan on a shelf” syndrome.
The engagement was accomplished through a combination of online and “traditional” tools. “There’s no substitute for face-to-face engagement,” says Hartye, as regular community events and presentations keep the connections and input flowing. He also points out that staff and supervisors get regular refreshers in P2, the city leaders have provided ongoing support and reasonable metrics help keep expectations in line.