>>KOPELOW: So, let’s talk about patients in the continuing professional education process. The World Health Organization, when they define interprofessional collaborative practice and interprofessional education, they said the interprofessional education is two or more professions learning together. And interprofessional collaborative practice involves two or more professions and the patients - and the patients. And as we develop interprofessional education there is resistance to the involvement of the patient in the planning of the education, in the execution of the educational activity. And we at the ACCME have introduced the idea of including this in one of our new criteria for Accreditation with Commendation. I’m interested in your experience both with this Ebola event and your other experiences in professional education about the inclusion of the patient as planner and teacher. So, why don’t we start, you know, with this Ebola thing at Rush University Medical Center; any patient involvement?
>>ROMORO: I could speak to both, actually, so, with the Ebola situation we did have a patient come in to the emergency department via O’Hare Airport, who was from Monrovia, Liberia. Fifty-something years old with Ebola symptoms, fever, vomiting, diarrhea; that’s Ebola, that’s the criteria for Ebola, and she was coming to Rush. We followed all our protocols, I was actually the physician in the emergency department who took care of her and I had two nurses with me. And it was fascinating
>>KOPELOW: All adequately trained?
>>ROMORO: All trained.
>>ROMORO: All who had been through the training.
>>ROMORO: And it was fascinating to see. Obviously nerves were high, anxiety was high, but to see, because they were well trained they went through their steps. If you didn’t have the training that anxiety would have take them over.
>>KOPELOW: Makes you pay attention.
>>ROMORO: And so they, they donned their PPE appropriately as did I, we waited for the patient, and when the patient came in, there was, the nurses became nurses again, not people in PPE. And it was so heartwarming to watch that experience unfold. They developed a bond with the patient. The patient herself was scared, the nurses apologized for how we looked, This is not normally how we dress, but we’re concerned for you and for our staff. The patient understood said: I’m not here to harm anybody, I just want the best care. And the nurses said to me after, I said, it seemed like you were scared at first and then your fear, it went away, what happened? And they said: well, we suddenly realized that Ebola is a deadly disease, but there is a patient behind that virus and we’re here to take care of the patient. So we learned, because they gave us, we learned some things not just about how to PPE during that event but we learned about a higher understanding of why we’re doing this. And we learned about some of the other equipment that we were using at the time that maybe needed to be modified.
On a different level, in answer to your question, in emergency medicine at Rush we have incorporated patients into some of our training. In terms of improving the patient experience, we started a year ago, we had, we invited patients back who actually did not have a good experience in our emergency department. So, we accepted the fact that we’re not perfect, that we sometimes can’t provide the best care and we asked those patients, some patients to come back. And we had small roundtable discussions with the healthcare providers that provided the care and the patient. The only rules we gave our staff beforehand was to keep your defensive guard down, don’t threaten the patient, don’t say that’s wrong, just listen. Listen and try and understand. And our staff thought it was one of the best events that we had ever put on. And the patients themselves were appropriately critical. But, also gave us credit for the things we did well. So, it was a learning experience that the staff has actually asked for more lessons like that.
>>KOPELOW: That’s an interesting set of advice to talk to the staff before they interact, that this isn’t, these people aren’t here to accuse you or to attack you these are, this is part of a team. These are people here to inform you. Their goal is to help us be better and they’re not our judges. I betcha that helped everybody a lot to calm down and just embrace the education.
Did, did that Ebola patient ever get more involved in formally or informally in how to train at Rush better? How to teach better? In the same sort of way?
>>ROMORO: That’s an interesting question. Actually, the nurses engaged the patient after her stay at Rush if she would come back and they at least wanted to talk with her and understand her experience and get to know her better. With this particular patient she was admitted to the hospital, when she was determined not to have Ebola had to get back on the road and travel again. So, we never had the chance to follow back up with her.
>>KOPELOW: You said you had a couple of examples, is there something from your past medical life that you used patients?
>>ROMORO: In my job previous to when I worked at Rush I was responsible for education of emergency medicine residents and I found that while through traditional education means I could teach them about congestive heart failure and pulmonary embolism, there were certain things I had a hard time teaching them. Things like empathy and understanding, grief and how to deal with patients who are grief stricken. And in that subset of patients it was children who died. And I reached out to mothers who had babies who had died of SIDs death, and asked, invited them to come and give a, an essentially a lecture to our students. I didn’t ask them to prepare PowerPoint slides or anything. It was really a panel discussion. And I said just talk about your experience and let the residents absorb what you’re saying and allow them to ask questions. The mothers were, they obviously do this for a reason, so they were prepared for the questions. They were well versed in the condition and obviously their own personal experiences. And it was a way to get something across to residents that I don’t think that we, as clinical educators, could get that message across. The residents found it extremely useful. You could see people shedding tears; it was very moving. And hopefully, I hope that, what happened is that was a experience that they have not forgotten.
>>FRIESE: And actually it’s interesting, and again, because Dino and I both teach as well as practice, we’ve incorporated his ideas into our doctoral nursing programs for public health and populations’ health. In exit interviews, a lot of the doctorally prepared nurses had no experience with people with disabilities. And Rush is known, also, for working with people with disabilities. So, one of our satellite nurse clinics, at the Chicago Light House for people who are blind or visually impaired, has a school for children with special needs. So, we started taking these doctoral students in the second quarter of their first year to interact with a lot of these students who were also patients at our hospital. And the change in them was very profound. I’ve even had them email and call and visit from other states and say: When I’m in Chicago or when I’m doing my doctoral presentation can I please go back to the Light House, because I saw these people as true human beings. Like Dino said, the nurse sees the patient and hopefully the patient doesn’t see the protective gear. So, that was a really profound tool that Dino shared with us and we’re able to incorporate in other school programs.
>>GRANTNER: And everybody gets a gold star when they apply for CME and they have actual patient outcomes to measure for their learning need. Kudos to you. I mean that’s a great tool to build in, right? That’s what we’re supposed to be doing is ultimately measuring patient outcomes. So, to use them for your gap analysis is perfect and everyone can do that who has a CME office and patients that they’re touching.
>>KOPELOW: You know I think that that’s a, I think that’s a fabulously insightful comment, Mary. I think that patient outcomes is usually thought of as an endpoint. That we’ve done our job and we’re going to get their input, and did we do good? But, you’re really describing it as the beginning of the next phase.
>>GRANTNER: Absolutely. It’s identifying your learning need.
>>KOPELOW: How have we done so far and what should we do next? I think that speaks for the philosophy that comes out of Rush University Medical Center. And I think it’s wonderful. Thank you very much
>>FRIESE: Thank you.
>>GRANTNER: Our pleasure.
This is a transcript of Involving Patients in Healthcare Improvement: Strategies and Observations from an Academic Medical Center - http://www.accme.org/education-and-support/video/interview/involving-patients-healthcare-improvement-strategies-and
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