Anne Pendo: Well, welcome to our Intermountain Healthcare broadcast. I am Dr. Anne Pendo. I am a practicing internist and medical director for experience of care and the office of patient experience.
I am lucky and you are lucky to have the opportunity to speak with two of our guests today. Our topic is around our patient and family advisory councils, what we've learned from our patients, why that's important and how we do things differently because we've involved our patients in the processes and our planning.
Today we are lucky enough to have one of our Patient Family Advisory Council members from our system, PFAC, which is our acronym for Patient Family Advisory Councils, Bud and Dr. Denitza Blagev, who is the medical director for quality in the Office of Patient Experience responsible for our hospital side, specialty-based care side, and also a critical care physician.
I'm hoping today that they can share with us what their experience has been like, what they've learned, and we can think about the future of how we can bring our patients into the conversations earlier and in more areas.
Bud, I'd like to start with you if you would share with our audience today a little bit about yourself and then how you got involved in the Patient Family Advisory Councils.
Bud: I spent 26 years in the United States Army. I was an infantryman, a paratrooper, a pilot, and an aeronautical engineer. Couldn't hold a job.
Anne Pendo: Wow.
I'm joking. I retired. I came to Salt Lake City for a second career. Quickly my wife has had a number of surgeries. I was her caregiver. By the way, she says I'm an excellent nurse but a so-so cook.
Then I had a tumor removed from my pituitary gland in this facility. It led to both some wonderful experiences and a bad experience. I chose to write a letter to the president of the hospital, the chief of the hospital, about the good ones.
I kept their names. Then instead of filling out the wow ticket I wrote a detailed letter for each of these people that I wanted to recognize. A total of three nurses and a couple of nurses' assistants.
The bad thing that happened to me that I didn't bring up was in the recovery room and my wife and daughter were sitting next to me and they had a sliding glass door. It was malfunctioning. This guy opens the door and, wham, everybody jumped. He just stood there and looked at us. Didn't smile. Didn't say, "I'm sorry. Excuse me" or anything.
I said to him, "I want to get to you before my wife does and if you don't smile and if you don't say while you're here why you're here, get out."
Anne Pendo: And?
He turned out to be the doctor in the ICU. I will say that he was flexible because within 36 hours I think we were very good friends.
Anne Pendo: I love that.
Bud: That's how I got involved. I sent that letter in, Katy Jo Stevens, who runs the PFAC at that time, called me and asked me if I'd like to get involved.
Given with my background ... I had a hip replaced. I had a couple operations. My wife has had every one that you can do. That's led to a lot of caregiving, which I think is my strong suit, not the patient experience.
Yeah. I will say that one of the things that I've observed in our Patient Family Advisory Council meeting is that that's your strongest voice. When we are discussing a topic it's really how does this affect the patient but really more importantly the person who is going to be providing the care at home. I have appreciated your input and comments.
I'm curious to know what your observations are when you give feedback or input do you know what's done with that?
Most often we do because the people we provide the input to come back once they've accomplished that particular thing that they wanted to share with us and the development of that item or procedure.
Then they generally come back and ask for our comments again with the finished product. We generally see the results of what we input.
Great. Great. I'm going to turn to you now, Denitza. Share with us a little bit of your background and then talk to us about the experience that led us to be together today talking about Patient Family Advisory Councils and really the role of our patients in the work that we do.
Denitza Blagev:I, as you mentioned, I'm a pulmonary critical care doc and I still practice. Then I'm now the medical director for quality specialty care. As part of that role, one of the things we look at is trying to improve care for patients around specific metrics like trying to reduce mortality, reduce readmission rates or complication rates, and improve care.
I think many people have recognized that we just don't do well enough at knowing what medications patients are on, at explaining to patients and patients knowing themselves what medications they're on, and often because of our modern fragmented care there's multiple different providers.
You might go to a specialist and get some medicines and then the primary care doc might change them and then you come to the hospital and they get changed again and then you go to urgent care a week later. At the end it's a big mess.
Our approach in trying to improve patient experience and the quality of care and safety was really to focus on getting that one key thing right, which was medication reconciliation.
We had a big group with a lot of stakeholders in it that were meeting that agreed that this was an important thing to work on. Both representatives from inpatient pharmacy, community pharmacy, from care transformation and our kind of electronic health record and IT support, hospitalists and inpatients, outpatient doctors, adult doctors, pediatricians, and kind of a long list of people.
We had been meeting for I would say at least a couple of months trying to understand what the process is, why are we not doing this well, how should we do this better, when we thought about, "Well, let's bring in the voice of the patient" and we reached out to Anne and Corby, who is our Patient Experience Director, to seek guidance about how to do that.
It wasn't really clear whether this is the kind of thing where we would present a question to the PFAC. I think that's how it's been done traditionally and we did that and we got some feedback.
One of the things we wanted to try and we didn't really know what to expect was to actually invite a patient from the PFAC, and that was Bud, to one of our working meetings and just have him participate in the meetings.
If I can set the scene for you we had a room of about, I don't know, 10 or 20 people, a bunch of other people on the phone. We are all professionals working on this issue with deep expertise in it. Bud came in and I'm not sure how old you are but ...
86. We started asking him about medication reconciliation. In his very unassuming voice he said, "You know, there are these apps on the phones and you can bypass the emergency and find out what medications someone is on based on their phone but the problem is if you have an iPhone or an Android it's a different platform so there's no consistency."
I don't think I'm exaggerating when I say that jaws dropped in the room as our IT people are frantically and I'm frantically Googling what are these apps. We had not heard of them.
One, it sort of broke down our preconceived notions about what kind of feedback we might expect. I think it brought a point to us about expertise that patients have that we don't and I think very often we all think we're patients, right? We all might be physicians and nurses and so on and we occasionally go to the doctor, we have family members that go to the doctor.
I think there's a little bit of hubris on our part thinking, "We don't need the patient. We already are patients" when in fact it's a vastly different experience.
After that initial meeting where we're really going to try it out and bring Bud in for a conversation we decided that this was such a valuable input that Bud is now a regular contributor to our meetings and what we've noticed is we will throw out an idea like telehealth in pharmacy and other thoughts and just like the docs might chime in or the IT folks might chime in or the pharmacists might chime in, it's super helpful to us to have that patient voice early just even in the brainstorming session as what other things can we consider as we decide whether to go down these pathways.
Well, the good news is that Bud you're not shy in participating in the meetings, which is really appreciated. I'm wondering what you thought after that first meeting, both of you? Denitza, what did you think that you would do differently based on Bud's input?
Then I'll ask you a similar question is for you what was it like watching and hearing from, I've got air quotes here, "experts" when you spoke? Let's start with you, Denitza. What did you do differently after that first meeting?
I mean, I will say that even just after that first meeting very specifically it affected our overall strategy in terms of how the long-term view of, yes, this should be integrated with what we enter in the record and in the app and is that on the roadmap ahead and what is the timeline for that?
Even within that feedback about ... We had been meeting about, "Well, we should have a pharmacy visit before the primary care visit" and Bud's feedback again just really ... Immediately it was sort of like, "Well, most people don't want to go twice for something that can be done in one visit." We've sort of restructured that or are thinking about how to think about that.
I will say one of the things I've really appreciated about Bud's input is that he will give his own experience and his experience and assessment but also we'll reach out to other networks of patients and friends and social structures where we feel like he really tries to think through a breadth of patient and caregiver experience and he's not stuck in ...
Which is I think what many of us have a tendency to do is, "I'm stuck in my own personal experience of how this looks to me." He really has tried to do this broadly.
Then as a bigger picture, given all the help that we've had with just the med reconciliation and quality, we work on more than one thing so there are other meetings where we don't have ... The norm is that we don't have patients sitting in on those meetings.
I've started thinking about just making that a standard part of the groups and meetings that I'm working on is to bring in a patient to each of those work groups and work through it.
Anne Pendo: Immediate change, affecting your long-term planning change, and then really thinking more broadly about how you're going to do your work day to day. That's great. Thanks.
Bud, what was that like for you? I guess I should ask is this the first time you had been in a small group as a member of a working committee?
Anne Pendo: You had done that before?
Bud: My last job in the Army was the targeting and night vision system on the Apache, the guts of the Apache.
Anne Pendo: Wow.
In that job I used to joke ... They'd ask me, "What do you do?" I said, "I manage egos" because most of the people I worked with were PHDs and very, very brilliant.
My reaction when I went to the first meeting here with Denise was, "These people are brilliant in their own field and I really admire, one, that they acquire data and not just go on opinions." Opinions aren't worth anything when you're trying to get something done in the long run. They're nice to listen to but data provides you the opportunity to do something constructive.
I saw that and I was fascinated by it. By the way, I was a math major in college before I went and got a masters in aero engineering. I've had a statistics part of my education.
I just felt very comfortable. In fact, I told my wife when I got home I said, "This is just like [inaudible 00:15:41]" She said, "You're kidding." I said, "No, it's a bunch of super smart people working very hard and I don't ..."
By the way, my wife is a Phi Beta Kappa magna cum laude chemistry chemist. I've been around smart people. I'll add one more thing. My mother held the all-time record in the high school I went to. I didn't get on that list. Okay. I was very comfortable in the meeting.
Anne Pendo: You felt comfortable?
Very comfortable. Denise is a wonderful manager. She keeps things moving. She doesn't let things degenerate into endless discussion. It's just boom, boom, boom. Super. I'd have been glad to have her on the [inaudible 00:16:44]
I'll bet. It sounds like from what you're saying is you felt comfortable sharing your opinion. You felt safe doing so. I just want to check that I'm hearing you correctly is that you felt that you had something to offer the group that nobody else at the table had?
Anne Pendo: Yeah. Yeah.
Denitza Blagev: I think the entire group felt that way, that Bud had something to offer that no one else in the group was offering.
Yeah. My experience was at our we huddle, around our huddle board once a week, and we'd go through safety and quality and experience and review how we're doing.
Denitza shared this story of the med reconciliation meeting that you attended. Denitza was really excited and energized, I will say, and so was the group. A different group than at your med reconciliation meeting.
A lot of discussion about, "Okay, how can we expand this? How can we do this more broadly? How can we be really deliberate and mindful of as we're in meetings creating things for our patients to make sure that it's something that they actually want and is meaningful to them?"
We're thinking about expanding some of our traditional Patient Family Advisory Councils with the monthly meetings like you've experienced. Also, figuring out how can we have a network of patients that either if we've got a question, sending an email out that says, "We're trying to solve this. Can we get a group together for an hour to discuss?"
I'm imagining that that's something that we can do that would allow us to move things forward really very quickly rather than waiting each month for a meeting, which of course there's limited time so there's only so many topics you can cover in a day.
Wouldn't it be amazing to have this very large network of patients from really diverse backgrounds? Young people, parents with children who might not be able to attend a meeting in person but could be available for a call.
I think about really the work that we've done in this past year recognizing that we sometimes forget ... Just like what you said, Denitza, we think we know but we forget to ask. When we ask we get information that changes what we do and really makes a difference and is meaningful.
As I think about the med reconciliation committee and the work we're doing there what a great story to be able to tell if at the end we've got the data that says, "Because we're doing things differently, because we've got a broad set of voices at the table, our patients aren't coming back to the hospital. They're taking the medications as prescribed. The caregiver at home is more confident to provide that care." I think that would be a really great place to end up.
As we wrap up today, I'm wondering if, Bud, you could share what you think going forward your role might be with Intermountain Healthcare and our committees?
Well, I think that for the committee I am possibly the different input than the members and the different input is based on a different perspective as a patient and as a caregiver.
I'd like to add something here. It might be a little bit controversial. That based on my experience with the PFAC when you start selecting people so you have this network I suggest you observe them in the environment first because there's always a certain number of people that are enamored of their own voice and they talk a lot and say nothing of any consequence.
I think you have to be careful. The network is a great idea but I don't know how you select without observing someone in that particular environment.
Yeah. That's actually ... Yet again we've gotten good advice from Bud as we think about expanding our network. I think that that's really true. One of the things that is most valuable is that you, as Denitza mentioned, we have your voice as a patient, we have your voice as a caregiver, and then we've got your community network that voice that you bring in as well and you're able to represent them well. I will take that as adding to my to-do list for how do we figure out whose really going to be a useful partner with us? Go ahead, Denitza.
Denitza Blagev: Could I ask a question of Bud? I think one of the trepidations people had in terms of bringing a patient into a working meeting is that often we'll start meetings with a safety story where something went wrong and related to med rec.
I think a lot of caregivers have a lot of trepidation about sharing, "Well, this happened" and, "That went wrong" and someone was harmed and how a patient listening to that might react. I was wondering what your reaction was to that and how you feel hearing those stories of how sometimes things go wrong.
I have observed in a couple years on the PFAC that there are some people that really are alarmed when they hear that. I think one of the reasons I've been able to contribute in that environment is my father raised me with the following guidance. There's what's right, what's wrong, and what's possible. Don't waste a lot of time on the first two.
Now some people really get upset when you say you're putting right below possible. I said, " Well, it depends on how much you want to get done."
Some people on the PFAC, as a matter of fact, cannot sort out the difference between what might be absolutely right and what might be possible. I think that that again is one of the reasons you should observe before you pick.
Yeah. I love that. Right, wrong, and possible. I think that's a really excellent way to wrap up our conversation today is thinking about what is possible. Thank you again, Bud, for joining us today and Denitza, who was on call last night, for joining us. Thank you to our audience for joining us today. We'll look forward to chatting again in the future. Maybe we'll have you come back and share the final results of med reconciliation and we can hear what you're doing next.
Bud: Okay. Thank you very much for inviting me.
Anne Pendo: Thank you.
Denitza Blagev: Thanks.