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CE article: Patient advisory boards engage patients in their own care*


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After reading this article, you will be able to:

  • Define patient-centered care
  • Identify the role of a patient advisory board
  • Discuss best practices for establishing a patient advisory board


AHRQ toolkit addresses best practices for forming board

In today's culture, many hospitals are increasing their focus on patient-centered care-involving patients in their own care decisions to improve outcomes. Click here for a patient-centered care improvement guide from the Planetree organization for more information about this issue.

One route facilities often choose is creating a patient advisory board or committee. "There are studies that have demonstrated that engaged patients who become informed and participate in their own healthcare have better outcomes," says Kathryn Leonhardt, MD, MPH, patient safety officer and medical director of care management at Aurora Health Care in Milwaukee. "We realize we need to find better ways to engage our patients. If patients are not engaged, it's because we as the healthcare system have not been effective in engaging them. The role of a patient advisory committee is to help us understand from the patient perspective which processes and tools can facilitate that engagement."

Leonhardt was part of a team at Aurora Health Care that received a grant from the Agency for Healthcare Research and Quality (AHRQ) to create a patient advisory committee toolkit. The grant, which ran from 2005 through 2007, allowed Leonhardt to study best practices for forming and maintaining a functioning patient advisory council and measure outcomes.

The toolkit, Guide for Developing a Community-Based Patient Safety Advisory Council, came from one of 17 grants in AHRQ's Partners Implementing Patient Safety (PIPS) grant series. The series broadened the scope of the AHRQ's grants at the time, which were mostly focused on developing new health services research. In 2005, however, as information started to come in from earlier grants, the AHRQ decided to broaden the scope of its grants and focus on existing interventions to see whether those could be shared with other hospitals across the country.

"AHRQ always thinks about patient safety as being something very local, so we knew that maybe one size didn't fit all in terms of implementation, but we thought it would be a good start to fund some projects that implemented certain patient safety interventions," says Deborah Queenan, patient safety task officer at the AHRQ. Queenan has been in charge of coordinating the PIPS grants. From there, the AHRQ could determine whether the project would be adaptable for many types of facilities. The information from the grant concerning patient advisory councils was put into the toolkit, published in March 2008, and can be adapted for use by any healthcare system. Using the toolkit as a resource to build a patient advisory board will help move the industry toward the practice of soliciting patient feedback.

"On a whole, the healthcare system has not generally been developed around patient-centered care and engaging patients," Leonhardt says. "With evidence from studies on quality and safe outcomes, we've just now realized the importance of patient engagement. The traditional healthcare system has really been much more provider-centric."

The beginnings of a patient advisory board

Forming a patient advisory board that will be functional and provide valuable information starts with the healthcare team adequately scoping the project. This is for advisory boards that are being developed to solve a certain problem. However, even for more general patient safety advisory boards, it's necessary to identify areas of focus.

"We kept scoping and scoping and scoping to a more narrow, specific area," says Leonhardt. "That really helped us identify the participants on the committee and also helped us keep our project moving forward."

A patient advisory board can only be successful if the correct patients and community members are chosen to serve on it. It's critical to have the right people, says Leonhardt, so asking clinical staff members for recommendations should be a first stop.

"What we recommend is talking to healthcare providers, doctors, nurses, and pharmacists and asking them, 'Who do you think would be great to join this council?' And that's primarily because, as with any relationship, many of these providers have known patients for years," says Leonhardt. Explaining to providers the council's goals, objectives, and time commitment that will be asked of participants will help them give you their best suggestions.

Roberta Mikles, RN, director of Advocates4SafeCare, serves as a member of the patient advisory board at Sharp Memorial Hospital (SMH) in San Diego. Mikles, a retired nurse who has devoted most of her time to patient advocacy, was approached by SMH to serve on its patient advisory committee in April because of a past experience she had at the facility during which her father acquired MRSA.

Another good way to find valuable members to serve on an advisory board is to reach out to patients or family members of patients who have presented concerns to the facility related to patient care, says Mikles. It's often those people who want to help make sure an error they have suffered does not happen to another patient.

Next, Leonhardt recommends conducting one-on-one interviews with potential advisory board members. It's important that potential members have specific attributes, such as strong communication skills, the ability to collaborate with others, knowledge of the topic/issue at hand, and being from within the demographic of the project's scope.

The interviews give the administrator a sense of whether potential advisory board members would be a good fit and provides the chance to explain to the patient the purpose of the council, says Leonhardt. Some potential members might realize during the interview that the advisory board is not right for them.

An equally important part of the advisory board is the presence of healthcare providers. Querying staff members will likely result in some who are eager to join and some who are turned off by the idea. It's important to approach both types of staff members, says Leonhardt. Those who believe that patient input into care is valuable already understand the point of the board.

"It's important to ask for members who are not really open to this concept and maybe don't believe that it's going to be effective ... because it really is incredibly eye-opening," says Leonhardt.

Conducting the first meetings

The person who is designated to lead the advisory board must be a strong facilitator, someone who can make decisions, keep the group on track, and communicate what the members' responsibilities will be, says Leonhardt.

"At the beginning of our first meeting, the chair, who is director of customer relations, discussed commitment and involvement," says Mikles. "It was up front so that those who were invited knew ahead of time. If [the] patient and/or family members are truly wanting to see changes so that which happened to them does not happen to another patient or family member, they will be willing to put forth the energy required."

This person should also be someone with whom members will feel comfortable and who can bridge the gap between healthcare providers and patients. While Leonhardt was conducting research for the AHRQ grant, the leader of her patient advisory council was a nurse who had worked in the community and was familiar with many patients and their families. She helped fill this role.

"For patients, it can be incredibly intimidating to come to a meeting with a bunch of doctors and nurses where they're going to be telling them, 'We don't like how you provide care,' " says Leonhardt. "To have a friend on the team who is really in a lead position made it a much more comfortable environment."

Leonhardt recommends hosting a one-day orientation to kick off the advisory board. The patient advisory committee during her grant consisted of about 11 healthcare providers and 11 patients or community members who met once per month for three hours. However, this one-day orientation really set the tone for all future meetings. Additionally, dropping all titles and calling people by their first name helped break down barriers, especially between patient members and healthcare provider members of the board. (Click here for more information on hosting successful meetings.)

Mikles, who says it has been gratifying to work with a hospital that has been so open to listening to her and other patients' feedback, has seen some of the ideas generated from her advisory board taken seriously. These include doctor-patient communication issues and infection control fixes.

"To date, my experience has been a truly rewarding one," says Mikles. "Several of my suggestions have been taken seriously and implemented."

Read more about how to develop a patient advisory council here.

Best practices for creating an effective patient advisory committee

Consider the following tips for creating an effective patient advisory committee:

  • Scope the project. Make sure you have a detailed idea of what the patient advisory committee is there to address, whether that is one specific topic or a process that involves general patient safety practices.
  • Recruit the right patients. Conduct one-on-one interviews to determine whether a patient is the right choice to serve on the advisory board.
  • Clearly outline board members' responsibilities. If patients serving on an advisory board are unaware of the time commitment, energy required, and expectation that they will share their opinions on how to improve patient care in front of hospital staff members, they may feel uncomfortable providing feedback and may not be valuable board members.
  • Set up an orientation. Many people serving on an advisory board-whether they are from the community or work at the hospital-will be doing so for the first time. Allowing everyone to get to know each other before discussing patient care will make future conversations more comfortable.



References

1. Frampton S, Guastello S, Brady C, Hale M, Horowitz S, Bennett Smith S, Stone S. (2008). Patient-Centered Care Improvement Guide. Derby, CT: Planetree. Available from www.planetree.org/Patient-Centered%20Care%20Improvement%20Guide%2010.10.08.pdf.

2. Heathfield, S.M. (2009). "Effective meetings produce results: Tips for meeting management—Ensure results by planning before the meeting." Available from http://humanresources.about.com/od/meetingmanagement/a/meetings_work.htm.

3. Agency for Healthcare Research and Quality. (2008). "Developing a community-based patient safety advisory council: Toolkit and resource descriptions." Available from www.ahrq.gov/qual/advisorycouncil/.


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