Knowledge to action: changing the dynamic between patients and providers - engaging patients

Knowledge to Action: Changing the Dynamic
Between Patients & Providers
– Engaging Patients
Keynote Presentation to The Alberta Medical Association, Choosing Wisely Alberta Symposium
February 29, 2016
Paul W. Gallant, CHE, PhD(c), MHK, BRec. (TR)
Principal, GALLANT HEALTHWORKS & Associates
www.GallantHealthWorks.com
Permission for non-commercial use granted when
referencing Paul W. Gallant, GALLANT HEALTHWORKS (2016).
For commercial use kindly contact the presenter.
@HealthWorksBC

Choosing Wisely Alberta Symposium:
Excerpt from Alberta Medical Association, President
Steven Lewis gave the first keynote address: “Winning Conditions for Uptake, Spread and Scale.” He spoke
about change management and presented a list of strategies for success, including engaging doctors and
patients, using supportive data, and applying behavioral economics principles to avoid ineffective incentives.
He emphasized that discussion about appropriateness should focus on reduction of waste and harm, not
rationing. He also addressed the cultural changes that are required.
The final keynote speaker was Paul Gallant: “Knowledge to Action: Changing the Dynamic between Patients
and Providers: Engaging Patients.” It is clear that the roles of providers and patients are evolving. The medical
profession is no longer the sole source of health information. Patients are diverse, but passive patients will
gradually become a thing of the past. We need to recognize that every patient is unique, and that access to
their own health data and relationships with providers are key to their participation in their own health care.”
Carl W. Nohr, MDCM, PhD, FRCSC, FACS President, Alberta Medical Association (2016)
https://www.albertadoctors.org/media-publications/presidents-letter/pl-archive/march-4-2016-presidents-letter
2Paul W. Gallant www.GallantHealthWorks.com Twitter @HealthWorksBC

A Slide Deck Index to Help You Navigate
• Intended audience, Slide 4
• Why engage? Slide 6
• Meaningfully Engaging Patients & Having Some Power, Slide 12
• Patient Advisor as a Voice (example YouTube) Slide 16
• Practical Components of Success in Patient Engagement, Slide 18
• Mitigating Risk, Slide 22
• Simple Actions, Slide 24
• What Can Health Providers or Health Delivery Organizations Do? Slide 26
• What Can Healthcare Leaders & Policymakers Do? Slide 27
• What Can Clinicians Do? Slide 29
• Ground Rules for Dialogue, Slide 30
• Resources with links, Slide 31
• Contact or connect with the presenter, Slide 35
www.GallantHealthWorks.com @HealthWorksBC 3

Intended Audience
The following presentation excerpt is reduced and updated since the original keynote
presentation to the Choosing Wisely Alberta Symposium, held Feb. 29, 2016 in Calgary, Alberta.
Symposium delegates/invited attendees included:
GPs, specialists, physician leaders & Alberta Medical Association leaders/staff
Choosing Wisely Alberta staff/leaders
Health authority leaders
Other health care service providers
Health care patient advocates
Ministry of Health leaders
Academic partners: providers of CME, physician training
Others

Presenter Background/Roles Include:
Past
• Allied health clinician (most acute clinical areas)
• Operations Leader Provincial Mental Health
• Adjunct faculty/teaching: UBC, BCIT, Douglas College
• Governance of non-profits & professional associations
Present
• Specialty consulting/contracting in Canada, China, USA
-project leadership physicians, strategic planning/advising, needs assessments, service reviews
including First Nations’ Government, hospice, Academic Divisions (Medicine)
• Entrepreneur
• Patient experience advocate & conduit
• Chair, Mentor & 2014 Distinguished Service Award recipient
BC Lower Mainland Chapter
Member

Not engaging is not an option
• It’s our job
• Code of ethics many professions
• Missions of many organizations
• Canadians fundamental freedoms include:
freedom of thought, belief, opinion
& expression

World Health Organization (WHO), 2013
8

Let’s Continue to Evolve
• We must accept that the roles of health care provider and patients have evolved over the last few years.
• Whereas the traditional model of care adopted a more paternalistic approach on the part of the healthcare professional, the
role of the patient has changed to a more active one.
• Indeed, doctors today are continually greeted with patients who have downloaded Internet-based information or consulted
so-called experts the email social media on their health.
• Engaging patients tangibly intelligently in managing their condition and has been shown to improve clinical outcomes.
• Indeed the health care systems of the future will be partnered with patients as co-producers of health, with each party
actively involved in championing the patient journey towards achieving a healthy state.
• Moreover, as medicine continues to evolve, a greater repertoire of treatment and technologies will be offered for a complex
conditions and providing patients with tools to help ensure decision-making will be crucial to good outcomes.
Sir William Donaldson, WHO, Patient Safety Envoy, exploring patients in reducing healthcare related safety risks. 2013
9

PATIENT ENGAGEMENT IN AN URBAN
HOSPITAL: DIVERSITY TASK FORCE
11

Meaningfully Engaging Patients
& Having Some Power
We heard from Annette McKinnon:
• A Health Leader/Blogger/Colleague
• Empowered Patient
• Board Member, Numerous Organizations
Twitter: @anetto
Click on photos to the right for two clips.

“Patients & Providers Meaningfully Engaged”
Meaningful change in the health system - that will ensure an affordable system
with the best patient experiences and best health outcomes, can only happen
when we all work together.

Who Was in the Room
• Health Authority Leaders
• Front-line workers: allied
• Patients, clients, family
• Non-profit & community organizations including
recreation, mental health, seniors, youth
• Doctors: family doctors and specialists
• Association members
• School Board
• Board/Staff/contractors
• Government, elected councilors
• RCMP

PATIENT ADVISOR
Cue to start at 22 seconds
End at 60 seconds
https://www.youtube.com/watch?v=ublEOZC
MM84

#CdnHealth Daily Informing Patients/Providers
See it here http://paper.li/HealthWorksBC/1308721020# About 60 articles from 4000+
Sources
www.GallantHealthWorks.com @HealthWorksBC 17Paul W. Gallant www.GallantHealthWorks.com Twitter @HealthWorksBC

Practical Components of Success
in Patient Engagement
Build Better Relationships
Make Engagement Meaningful
Every Patient is Unique
Co-create
Spread
Enjoyment

SOCIAL MEDIA: OUR PROFESSIONAL DUTY
Our professional & governing bodies
require that we are current in our
practice & knowledge.
Social media provides tools & channels
enabling rapid knowledge transfer, to
many people, including patients.
As “caring” professionals with
accountabilities, we must be able to
effectively update our patients, with
information that affects their health and
wellness.
We must at least be able to inform
patients, not in a month or a year after
this information becomes available, but
immediately.
19
“As health professionals we must reliably & effectively use social media to help in our
‘caring’, otherwise, we put our patients, ourselves & our professions at significant risk.”
Paul W. Gallant, CHE

Mitigating
• Have a risk management plan
• Have clear & articulated roles for staff, patients, working groups & governance
• Create an emotionally safe setting for dialogue, discussion
>guiding principles, trained facilitators, resources, evaluation feedback
• Set realistic goals: to be reached in the next ___months/yrs
• Monitor & modify with stakeholders
• Clearly communicate expectations, limitations, unforeseen findings or
processes & debrief
• Remain transparent and true to the process

Mitigating Continued
• Identify what is included & excluded in the scope of the work
• Listen… a lot
• Provide opportunities for skill building and development
• Support patients with briefings and information to improve health literacy
• Respond to their contributions (ongoing)
• Build a team that can work together and understand each other
• Be willing to learn from other’s experience
• Be willing to change in response to what you have learned
• Budget accordingly
• Communicate often & use multiple methods

Simple Actions

Engage &
Support
Engage individual patients &
their providers to improve
relationships, trust & better
self-management
Engage patients and families
to help improve services
Support staff to deliver
patient and family centred
care

What Can Health Providers or Health Delivery
Organizations Do?
• Give patients real-time access to their medical records, including input into their records
• Establish family presence policies that welcome family members to be with patients at all
times.
• Invite patients and families to provide input and feedback about how you can improve the
care you deliver to patients.
• Organize a staff education session, grand rounds, or CME session on patient and family
engagement
• Make sure that patients and families know who to contact if they have questions or
concerns about the quality or safety of care they have received.

What Can Healthcare Leaders & Policymakers Do?
Lead by example and be a visible presence.
• Make a direct connection with patients and families and ask them for feedback
about their experiences.
• For example, talk to patients and families while they are waiting for healthcare
appointments.
-Conduct leader rounds with patients in the hospital/clinic/program.
• Policymakers, talk to patients and families in the community—even if it’s just at
the local grocery store—about their health care experiences.

(Cont’d) What Can Healthcare Leaders and
Policymakers Do?
• Include goals related to patient and family engagement as key components of your
short- and long-term strategic plans.
• Identify specific areas of opportunity with measurable objectives and strategies for
achieving your goals
• Add patients and families to boards and committees
• Invite & support patients and families to participate in conferences and meetings as
keynote speakers or participants on panel presentations.
• Make patient and family engagement an agenda item at your next meeting

What Can Clinicians Do?
• Welcome input and feedback from patients and families.
• Maximize the potential of your patient portal.
• Use teach-back and other proven communication techniques
• “Can you tell me when and how you are going to take this medication?”
or…“follow-through with the exercises recommended?”
• Ask open-ended questions that help you elicit information and
understand the patient’s values, goals, and beliefs, for example: “What is
your goal for your care?”
• Ask patients what is important to them so that you can understand whether your
recommendations are a good match with their values and goals
• Contact your professional societies and encourage them to include patient and
family representatives as part of the process when setting clinical
recommendations or guidelines.

RESOURCES
• AHS http://www.albertahealthservices.ca/info/patientengagement.aspx
Toolkit http://www.albertahealthservices.ca/assets/info/pf/pe/if-pf-pe-engage-toolkit.pdf
• AMA https://www.albertapatients.ca/Portal/default.aspx
• BC Government, Patients as Partners http://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/patients
• Canadian Foundation for Health Care Improvement http://www.cfhi-
fcass.ca/WhatWeDo/PatientEngagement/PatientEngagementResourceHub/Results.aspx
• Carman KL, Dardess P, Maurer ME, Workman T, Ganachari D, Pathak-Sen E. A Roadmap for Patient and Family Engagement in
Healthcare Practice and Research. (Prepared by the American Institutes for Research under a grant from the Gordon and Betty Moore
Foundation, Dominick Frosch, Project Officer and Fellow; Susan Baade, Program Officer.) Gordon and Betty Moore Foundation: Palo
Alto, CA; September 2014. www.patientfamilyengagement.org. - See more at:
http://patientfamilyengagement.org/#sthash.GM8h0iZT.dpuf
• Change Foundation http://www.changefoundation.ca/topics/patientengagement/
• Joanna Siegel (2012). Innovative Methods in Stakeholder Engagement: An Environmental Scan. Agency for Healthcare Research and
Quality. http://www.effectivehealthcare.ahrq.gov/tasks/sites/ehc/assets/File/CF_Innovation-in-Stakeholder-
Engagement_LiteratureReview.pdf
• IAP2 Canada. International Association for Public Participation (Canada). http://iap2canada.ca
• Wallerstein (2006). What is the evidence on effectiveness of empowerment to improve health? Copenhagen, WHO, Health Evidence
Network report; http://www.euro.who.int/Document/E88086.pdf
• Weinstein, Plumb, & Brawer (2006). Community engagement of men. Primary Care Clinics in Office Practice. 33: 247-259. Abstract
http://www.primarycare.theclinics.com/article/S0095-4543%2805%2900107-7/abstract

RESOURCES (Cont’d)EeEEThis link is to caseEeEx
• Patient engagement examples, including over 30 cases
worldwide.http://participedia.net/en/search?search_api_views_fulltext=patients
• The National Coalition for Dialogue & Deliberation. NCDD serves as a gathering place, a resource clearinghouse, a news source, and a
facilitative leader for this extraordinary community. Over 180 tools and methods used for dialogue and deliberation are listed on this
website here: http://ncdd.org/rc/item/category/participatory-practices
• CPRN – Handbook on Citizen Engagement: Beyond Consultation http://www.cprn.org/documents/49583_EN.pdf
• Centre for Public Involvement (Edmonton Alberta) http://centreforpublicinvolvement.com/
• Examples through Paul Gallant’s SlideShare including mental health patient engagement, community engagement approaches,
engaging stigmatized stakeholders – males with eating disorders, social media http://www.slideshare.net/paulwgallant/
• WHO, 2013. Exploring patient participation in reducing health-care-related safety
riskswww.euro.who.int/__data/assets/pdf_file/0010/185779/e96814.pdf
• On Social Media:
• Linkedin follow specific groups and people with “patient engagement” as part of their skills/description.
• Set your privacy/group settings accordingly to avoid spam/unwanted emails, etc.
• On Twitter follow relevant hashtags and accounts including
• @albertadoctors
• #ChoosingWisely @ChooseWiselyCA
• #hcsmca @hcsmca
• #patientengagement @s4pm
• @HealthWorksBC (Paul Gallant);
• #cdnhealth
• #ptexp (patient experience)

YOUR VOICE MATTERS

THE CHANGE
FOUNDATION
An independent health policy
think tank, The Change
Foundation is changing the
debate, practice and
experience in Ontario health
care, prompting system-wide
improvements for patients
and family caregivers.

You are welcome to download this
SlideShare directly from this site.
Contact or connect with the presenter….including
workshop or presentation inquiries.
https://www.linkedin.com/in/paulwgallant
https://twitter.com/HealthWorksBC
info@GallantHealthWorks.com Direct: 604.999.9164
www.GALLANTHEALTHWORKS.com
https://www.facebook.com/GallantHealthWorks
33
www.GallantHealthWorks.com

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