\n
by Emily Wittenhagen<\/span><\/p>\n Organization: <\/strong>WSMA I was happy recently to sit down for a talk with Jessica Martinson, \u200ethe Director of Clinical Education and Professional Development at the Washington State Medical Association, known to many in our state as WSMA (pronounced wizma<\/em>).<\/span><\/p>\n ABOUT THE WASHINGTON STATE MEDICAL ASSOCIATION<\/span><\/strong> DESCRIBE THE PATIENT SAFETY CONCERN YOU OR YOUR ORGANIZATION WAS AIMING TO EFFECT<\/span><\/strong> DESCRIBE THE CHALLENGES YOUR TEAM OR ORGANIZATION FACE. HOW DID YOU OVERCAME THESE BARRIERS?<\/span><\/strong> Instead, the reality is that many people don\u2019t think to have these conversations until it\u2019s too late, if they have them at all. Sometimes the conversations happen after a serious diagnosis. But all too often we see the worst-case scenario: a person has a medical emergency and they cannot speak for themselves, leaving their families to guess what kind of care their loved one may want.<\/span><\/p>\n SOLUTION: BUILDING URGENCY<\/span> CHALLENGE #2: LACK OF INTEGRATION<\/span> SOLUTION: INTEGRATING BOTH TOP-DOWN & BOTTOM-UP LEADERSHIP<\/span> \u201cThe thing I like the most about this program is that it takes a systems-based and team-based approach to integrating advance care planning into routine care. It should be as routine as taking someone\u2019s blood pressure or making a referral.\u201d <\/em><\/strong><\/span><\/p>\n Implementing a strong ACP program means changing workflows, training staff and changing EMRs. Jessica has high praise for the over 200 front-line staff who are doing the nitty gritty work of putting this work into practice. \u201cThey deserve all the credit,\u201d she says. \u201cIt\u2019s hard, disruptive work. It takes persistence and patience. They\u2019re doing an incredible job.\u201d<\/em><\/strong><\/span><\/p>\n CHALLENGE #3: LACK OF TIME<\/span> \u201cIt\u2019s always too early until it\u2019s too late.\u201d<\/span><\/strong><\/em><\/p>\n WHAT WERE THE BIGGEST CONTRIBUTORS TO THE SUCCESS OF THIS PATIENT SAFETY PROJECT OR INITIATIVE?<\/span><\/strong><\/p>\n <\/br>WHAT IMPLEMENTATION LOOKS LIKE IN PRACTICE<\/span><\/strong> Advance care planning facilitators undergo a formal certification process in which they are taught to guide patients in thinking about their values, goals, and preferences for end-of-life care. One-on-one consultations typically take an hour, and the presence of the health care agent is encouraged as the \u201cgold standard.\u201d Facilitators follow a guide or roadmap to lead the patient through key questions: who should be your health care agent, what gives your life meaning and what type of medical treatment would you want if you had a sudden event that left you unable to communicate. The focus of the conversation is on exploring acceptable vs. unacceptable outcomes rather than answering \u2018yes\u2019 or \u2018no\u2019 to whether they would want specific medical interventions.<\/span><\/p>\n WHAT WERE THE PRIMARY OUTCOMES OF THIS WORK?<\/span><\/strong>
\nProject Name\/ Title: <\/strong>Honoring Choices\u00a0Pacific Northwest
\nPoint of Contact: <\/strong>Jessica Martinson, jessica@wsma.org<\/span><\/span><\/span><\/p>\n
\nWSMA represents over 10,000 physicians, resident physicians, medical students and physician-assistants throughout Washington State, the only professional organization in the state that represents the interests and priorities of all physicians, regardless of specialty or practice type. WSMA\u2019s mission is to provide strong physician leadership and advocacy to shape the future of medicine and advance quality care in Washington State.<\/span><\/p>\n
\nJessica has worked since 2014 on the Honoring Choices\u00ae\u00a0Pacific Northwest initiative. Co-sponsored by WSMA and the Washington State Hospital Association, this collaborative effort between physicians and hospitals will ensure that health care providers are prepared to discuss and honor patients\u2019 end-of-life wishes. Honoring Choices PNW is one of the biggest rollouts of an advanced care planning program in the country and works in partnership with Respecting Choices,\u00a0an internationally recognized evidence-based model of advance care planning (ACP). The first cohort on the project is made up of 32 teams from 23 healthcare organizations, representing every major healthcare system in the state, as well as rural and critical access hospitals and medical groups.<\/span><\/p>\n
\nCHALLENGE #1: LACK OF URGENCY<\/span>
\nTo begin with, the Honoring Choices\u00a0PNW team is focused on First Steps\u00ae conversations with healthy adults. While advance care planning is not the \u201cbiggest fire burning\u201d for adults when they are happily enjoying good health, this is precisely the right time to get the conversation going.<\/span><\/p>\n
\n\u201cTo address that,\u201d Jessica says, \u201cwe have to move the conversation upstream.\u201d As the saying goes, \u201cIt\u2019s always too early until it\u2019s too late.\u201d<\/em><\/strong> A key strategy is to have healthy adults think about a sudden illness or accident that leaves them unable to communicate. Even the most invincible person can relate to that type of scenario. The aim is to demonstrate the importance of having these conversations long before people think they need to have them.<\/span><\/p>\n
\nAdvance care planning is not yet fully integrated into routine care.<\/span><\/p>\n
\nJessica\u2019s team is engaged in an intensive initiative to get advance care planning integrated into routine care. The first step was to ensure leadership engagement. Although the need was clear, the team was surprised by the overwhelming demand to join the first cohort. Once the leaders signed on, front-line staff were eager to get to work designing and implementing their customized advance care planning programs to ensure the conversations were part of routine, patient-centered care. The strong mix of both top-down and bottom-up leadership is a key ingredient for success.<\/span><\/p>\n
\nPhysicians don\u2019t have time to have lengthy conversations with each one of their patients about their values, goals, and preferences related to end-of-life care.
\nSOLUTION: RECRUITING A TEAM<\/span>
\nThe ACP program relies on a team-based approach, supporting physicians by certifying ACP facilitators to have in-depth conversations in their stead. The role of the physician is to motivate their patients to have a conversation and then refer them to a facilitator. Following the conversation, a summary of the key decisions and a list of clinical questions go back to the physician for follow up if needed.<\/span><\/span><\/p>\n\n
\n<\/strong>Honoring Choices PNW has the care teams start small \u2013 an approach called the \u201csmall test of change\u201d \u2013 and begin by having one or two doctors in a clinic integrate advance care planning into their routine care. The team can more easily assess what works and what needs changing, establish best practices and work flows, and then spread it to other clinic staff. In addition, organizations choose new sites to disseminate the work in a step-wise approach until everyone in the organization has adopted the practice.<\/span><\/li>\n
\n<\/span><\/strong>The Honoring Choices PNW team engaged with the WSMA & WSHA Medical Officer Collaborative, made up of Chief Medical Officers (CMOs), Vice Presidents of Medical Affairs (VPMAs), Chiefs of Staff, and senior-most physicians. These leaders are enthusiastic to make the advance care planning initiative one of their calls to action, supporting it for regional adoption, and prioritizing it within their organizations.A bonus of the collaborative is its built-in accountability. The group meets three times a year to report on the progress of their work, how it\u2019s being implemented, and any barriers they are struggling against. Jessica credits these meetings with helping develop a sense of ownership for the work and says they are one of the biggest contributors to the initiative\u2019s success, emphasizing one of their main philosophies: \u201cThe front line cannot be successful if they do not have leadership support.\u201d<\/em><\/strong><\/span><\/li>\n<\/ul>\n
\nMost commonly, patients are invited during the annual wellness visit by the physician who uses some key phrases designed to spark the conversation. For instance, a patient might be asked if they\u2019ve identified a person (e.g. a durable power of attorney; typically a family member or loved one) to speak for them should they ever be in a position in which they can\u2019t speak for themselves. It only takes a couple of minutes for the physician to make the invitation. Following this, if the patient is motivated to participate in further discussion, they are referred to a facilitator.<\/span><\/p>\n
\nThe Honoring Choices PNW team set several goals for organizations to meet. Three main goals stand out: 25% of conversations have a healthcare agent present, 95% of conversations are documented by a facilitator in the Electronic Medical Record (EMR), and patients rate the conversation as 4 out of 5 or higher. Organizations are well on their way to reaching and exceeding all three of these goals.<\/span><\/p>\n
![\n\n<\/strong><\/a>This post was written by Emily Wittenhagen, Marketing & Communications Manager for WPSC, with collaboration from Jessica Martinson and Graham Short of WSMA.<\/em>\n<\/a><\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"by Emily Wittenhagen Organization: WSMA Project Name\/ Title: Honoring Choices\u00a0Pacific Northwest Point of Contact: Jessica Martinson, jessica@wsma.org I was happy recently to sit down for a talk with Jessica Martinson,…","protected":false},"author":3,"featured_media":6696,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[9,8],"tags":[],"class_list":["post-4933","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-recent-news","category-the-safety-blog"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/posts\/4933","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/comments?post=4933"}],"version-history":[{"count":4,"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/posts\/4933\/revisions"}],"predecessor-version":[{"id":6793,"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/posts\/4933\/revisions\/6793"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/media\/6696"}],"wp:attachment":[{"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/media?parent=4933"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/categories?post=4933"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.qualityhealth.org\/wpsc\/wp-json\/wp\/v2\/tags?post=4933"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}](\"https:\/\/www.qualityhealth.org\/wpsc\/wp-content\/uploads\/sites\/3\/2016\/08\/SC-Adverse-Events.jpg\"){kind=link}