Download Facility Self-Assessment

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Putting the Pieces Together
Patient and Family Centered Care and Patient Engagement
Facility Self-Assessment
How Are We Doing?
This self-assessment tool provides a platform for dialysis facilities to determine the degree to which patient- and family-centered principles,
concepts, and patient engagement approaches are embedded in their current organizational culture.
Ideally, the assessment is completed individually by leadership at the facility level - the medical director, facility administrator, nurse manager, the
social worker, and the dietitian. Then combine results and hold a meeting to discuss findings and plan accordingly.
Instructions:
1. Complete the table below by marking the box that most appropriately captures the current status of the described practice at your facility.
2. Use the following criteria:
Fully Implemented
Fully implemented throughout the facility for both patients and families, if patients and families are indicated on the
statement.
Partially Implemented In progress or in place in some areas, but not all.
There are specific statements that reflect the practice is in place for patients and family/family members.
— If the practice is implemented for patients but not family members, circle P for Patients.
— If the practice is implemented for family members but not patients, circle F for Family.
— If the practice is implemented for patients and family/family members, but is in progress and not fully implemented or
is in some areas but not all, circle O for Other
No Activity
There is no activity in place for this practice.
Not Applicable
The majority of the items on this tool are applicable to all dialysis facilities. An example for when to choose Not Applicable
is if a facility has only one patient population that speaks only one language, then Not Applicable is appropriate as an
answer for item # 40 “Trained interpreters are available”.
3. Provide Comments to back up responses, as necessary.
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Fully
Implemented
Partially
Implemented
No Activity
Not Applicable
Fully
Implemented
Partially
Implemented
No Activity
Not Applicable
LEADERSHIP, STRUCTURE
The facility’s vision, mission, philosophy, core values reflect the principles of patientand family- centered care.
The facility’s vision, mission, philosophy, core values which reflect the principles of
2 patient and family centered care are formally and consistently communicated with
patient, families, visitors, staff, leadership, and medical staff.
Patient-centered behavior expectations are included in all job descriptions,
3
performance evaluations, and contracts.
The facility’s leaders through their words and actions hold staff and clinicians
4
accountable for collaborating with patients and families.
5 Facility leaders are held accountable for “walking the talk” of patient centered care.
6 Physicians are held accountable for “walking the talk” of patient centered care.
Staff, at all levels, clinical and non-clinical, have the opportunity to voice their ideas
7
and suggestions for improvement.
Comments
1
PATIENTS AND FAMILIES AS ADVISORS
Patients and family members have been invited to share their experience by attending one or more of the following:
P
8
 a patient council
P
9
 support group
P
10
 vocational rehabilitation group
P
 new patient adjustment group
11
F
F
F
F
O
O
O
O
The organization conducts patient and family centered meetings which include one or more of the following:
12
13
14



a patient council
support group
vocational rehabilitation group
P F
P F
P F
O
O
O
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Fully
Implemented
 new patient adjustment group
Patient and family members have been invited to participate in the facility’s Quality
16
Assessment/Performance Improvement (QAPI) Committee meetings.
Patients and family members participate in the organization’s QAPI Committee by
17
attending the facility’s QAPI Committee meeting or portion thereof.
Patient and family members have been invited to participate in the facility’s
18
Governing Board meetings.
Patients and family members participate in the organization’s Governing Board
19 Committee by attending the facility’s Governing Board Committee meeting or portion
thereof.
The input provided by patients and families is used to inform and guide the facility’s
20
strategies, action plans, and improvement projects.
Comments
15
Partially
Implemented
P F O
P F O
P F
O
P F
O
P F
O
P F
O
Fully
Partially
Implemented
Implemented
PATIENT AND FAMILY PARTICIPATION IN CARE AND DECISION-MAKING; PERSONALIZATION OF CARE
Policies, programs, and staff practices are consistent with the view that patients and
P F O
21
families are allies for patient health, safety, and well being.
Patients and family members are made aware of how to raise a concern related to
P F O
22
patient safety and/or their care.
23 Patients and families are encouraged to ask questions.
P F O
Systems are in place to capture questions that arise when caregivers are not present
24
to answer them.
Systems are in place to assist patients and families in knowing who is providing their
P F O
25
care and what the role is of each person on the care team.
Resources are available to staff to educate them on different cultural
26
beliefs/traditions related to health and healing.
Patient and their family members, according to patient preference, are encouraged
P F O
27
and supported to participate in care planning meetings.
28 Opportunities exist for patients and family members to meet with multiple members
P F O
No Activity
Not Applicable
No Activity
Not Applicable
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Fully
Implemented
of the patient’s health care team (including the nurse and physician) at one time.
The cultural and spiritual practices of patient and family members are respected and
29
incorporated into care planning and decision-making.
Education regarding food options and dietary needs are available to meet the
30
preferences of different ethnic groups.
Providers encourage and support patients and their families, according to patient
31 preference, to set goals and create action plans for self-management of end-stage
renal disease.
Comments
Fully
Implemented
ACCESS TO INFORMATION, EDUCATION, AND SUPPORT
A process is in place by which patients and family members may request additional
32
information on their diagnosis , treatment options, etc.
Patients, according to their preference, have easy and continuing access to their
33 medical record while being treated, and are assisted in understanding the information
contained within.
Patients are made aware of the opportunities to review their medical record with the
34
support of a health care professional.
35 Patients are able to contribute their own progress notes in their medical record.
Patients and family members are offered a way to collect and organize personal
36 health information (e.g., patient portals to the electronic medical record, electronic
personal health record).
A range of informational and educational programs and materials are consistently
37
available to patients and families.
Written, audiovisual, and web-based information and educational resources are
38 provided in primary languages and at appropriate literacy levels for patients and
families served by the facility.
Written, audiovisual, and web-based information and educational resources include
39 examples and images that reflect the diversity of patients and families served by the
facility.
40 Trained interpreters are available.
Partially
Implemented
P F
O
P F
O
Partially
Implemented
P F
O
P F
O
P F
O
P F
O
P F
O
No Activity
Not Applicable
No Activity
Not Applicable
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Fully
Implemented
41
A peer-led educational program is available and accessible to patients and families.
Web-based opportunities for information-sharing and networking are offered to
42
patients and families.
A process is in place to disclose unanticipated outcomes to patients and family
43
members, as appropriate.
Comments
Partially
Implemented
P F O
P F O
P F
Fully
Implemented
CONTINUITY OF CARE
44 Plans of care are written in language that patients and families can understand.
Tools are provided to patients to help them manage their medications, medical
45
appointments, and other health care needs.
Comments
Fully
Implemented
Partially
Implemented
46
47
P F
No Activity
Not Applicable
No Activity
Not Applicable
O
FAMILY INVOLVEMENT
“Family” is defined by the patient.
Visitation is flexible and patient-directed.
Formalized training/education is available for a patient’s loved one who may be
48
providing routine care for the patient at home.
49 Support is provided to patients and families involved in an adverse event.
50 Support is provided to patients’ informal caregivers.
Comments
Not Applicable
O
Partially
Implemented
P F
No Activity
O
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Fully
Implemented
Partially
Implemented
No Activity
Not Applicable
Fully
Implemented
Partially
Implemented
No Activity
Not Applicable
ENVIRONMENT OF CARE
The following spaces create a first impression of “welcome”, “comfort” and “healing”
51
 Main Lobby
52
 Parking Lots/Garage
53
 Front Desk
54
 Treatment Bays
55 Patients are afforded privacy during check-in.
56 Accommodations are available for patients to have a private conversation.
57 Patients are able to adjust the lighting and temperature at their treatment station.
58 Patients have views to the outdoors.
59 A range of diversionary activities, beyond the television, are available to patients.
60 Overhead paging has been eliminated (with the exception of emergent needs).
61 Pleasant smelling, non-toxic cleaning products are used.
Signage reflects primary languages of populations served, and uses icons to aid in
62
comprehension.
63 Patients can easily find their way from the parking areas to their destination.
Comments
SPIRITUALITY
Resources are available to staff to educate them on different religious beliefs,
64
traditions related to health and healing.
Spiritual assessments look beyond a patient’s faith traditions to also capture what
65
comforts and centers them.
Comments
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Fully
Implemented
Partially
Implemented
No Activity
Not Applicable
INTEGRATIVE MEDICINE
Complementary and integrative therapies are available based on patient interest and
66
community utilization patterns.
Comments
The ESRD Network of Texas acknowledges the following resources which were utilized, and in some cases modified, in developing this assessment
1. Advancing the Practice of Patient- and Family- Centered Care in Primary Care and Other Ambulatory Settings, How to Get Started by the Institute for Patient-and Family-Centered Care, www.ipfcc.org,
http://www.ipfcc.org/advance/topics/primary-care.html : items 1,4,21,27,29,31,33,36-42
2. Self Assessment Tool from the Patient-Centered Care Improvement Guide by Planetree (www.planetree.org) and Picker Institute (www.pickerinstitue.org): items 2-7,22-26,28,30,32-35,43-66