Welcome to Picker Institute

The Picker Institute 2008 Research Agenda

Research is a vital component of the Picker Institute, Inc., mission. The institute sponsors
research in patient-centered care in support of and in cooperation with educational and
medical institutions. The institute’s goal is to foster a broader understanding of the
theoretical and practical implications of patient-centered care by approaching healthcare
with a focus on the concerns of patients and other healthcare consumers.
The 2008 Picker Institute Research Agenda includes the following projects:

“Profiles of High-Performing Hospitals”

Team
Principal Investigator Dale Shaller, Ph.D., is the principal of Shaller Consulting, a healthpolicy
analysis and management consulting practice based in Stillwater, Minn. Shaller
Consulting provides education and technical assistance to national, state and local
healthcare coalitions, purchasing groups and provider organizations in their effort to
measure and improve the quality of healthcare.

Co-Principal Investigator Charles Darby, the former CAHPS (Consumer Assessment of
Healthcare Provider and Systems) project manager at the U.S. Agency for Healthcare
Research and Quality, has extensive experience with patient surveys, the development and
implementation of the CAHPS Hospital Survey (H-CAHPS) and quantitative and qualitative
research methods.

Project Summary
The aim of this project is to develop and disseminate profiles of 10 hospitals that score top
marks in patient-centered measurements (primarily H-CAHPS scores), and to develop a
summary analysis of the key contributors to their success. The project will provide vivid,
real-life examples of how hospitals can achieve measurable results in improving patientcentered
care and will be of value to hospitals looking for improvement strategies and
examples once H-CAHPS results are made public in March 2008.

“The Relationships Between Patient-Centered Care, Technical Care Quality, Other Care Processes and Outcomes”

Team
Principal Investigator Paul D. Cleary, Ph.D., an expert on ways to improve the quality of
patient care, is dean of public health and chairman of the Department of Epidemiology and
Public Health at the Yale University School of Medicine.

Project Director Mark Meterko, Ph.D., heads the methodology and survey unit at the Center
for Organization, Leadership and Management Research (COLMR) at the Veterans
Administration Boston Healthcare System.

Project Summary
This report will examine the impact of patient-centered care on health outcomes. Research
will be based on a sample of 1,859 patients who were hospitalized for acute myocardial
infarction during 2004 in the Veterans Health Administration and who completed Picker
patient-centered-care surveys subsequent to their hospitalization.

Patient-centered Professionalism (PCP) is an international project, led by the Picker Institute and involving partner organizations in the UK, USA and Canada, which aims to ensure that medical practice, standards, education and regulation are truly patient-centered

Patient-Centered Professionalism Project Overview

An international project to identify public expectations of doctors
We all want good doctors. We want our doctor to be honest, properly skilled, fully up to date, to inform us, to take account of our preferences and to treat us with dignity and respect. Such a doctor we can trust. Equally we want to be confident that the medical profession is making sure that these standards of good practice are observed by all doctors, everywhere.

This is the heart of patient-centred professionalism

The ProjectPatient-Centred Professionalism is an international project which aims to bring together evidence about patients' experiences and expectations to help the medical profession shape its roles and responsibilities in delivering patient-centred care. Our objectives are to:

·Learn more about what patients and the public expect of doctors, their professional standards and how these are regulated

·Disseminate these research results to inform and influence principles and, most importantly, attitudes and practice

·Share experiences and ideas of good practice widely amongst an international network of partners

There are two arms to the project:

The Evidence Base

A programme of research that identifies more clearly and precisely patients' expectations, shows how they are or are not already being responded to in different contexts of medical practice, and identifies important factors that ease or impede a patient-centred approach. The research programme includes conceptual reviews, evidence reviews, document reviews and primary studies.

The Forum

A web-based information exchange to help our network of partners learn about our research findings and share knowledge, experiences and good practice ideas. Forum membership is free and open to everyone with an interest in medical practice, standards, education and regulation, especially members of professional and patient organisations.

Message from Sir Donald Irvine

Sir Donald Irvine, Chairman of the Trustees of Picker Institute Europe, is calling on all those interested in building a strong consensus about what constitutes good medical practice.

We are building a strong consensus between the public and the medical profession on what constitutes good medical practice. In today's society, if the profession is not strongly proactive in making sure that the practice of all doctors licensed to practise can be regarded as 'good', it will never enjoy full public trust.

As patients we all want good doctors. We want our doctor to be honest, properly skilled, fully up-to-date, to inform us, to take account of our preferences and to treat us with dignity and respect. Such a doctor we can trust. Equally we want to be confident that the medical profession is making sure that these standards of good practice are observed by all doctors, everywhere. This is the heart of patient-centred professionalism.

Sir Donald Irvine

Chairman of the Trustees of Picker Institute Europe

Planetree / Picker Project

   The scope of this project is threefold.

(1)    Analysis of Patient Perspectives and Leadership Roundtable   ~ (March, 2008)

  Planetree co-hosted a leadership roundtable with Picker Institute in March, 2007.  The leadership roundtable convened organizations with expertise in patient-centered care to discuss the barriers to implementation of patient-centered care and strategies to overcome those barriers.  Barriers explored included systems barriers that prevent caregivers from providing patient-centered care.  In order to keep the meeting focused on the patient perspective, Planetree analyzed patient focus group data, gathered by Planetree, to identify patient priorities. That analysis was provided to the roundtable participants to structure the discussion.  Planetree and the Picker Institute collaborated on development of the agenda for the meeting, which was structured around different dimensions of patient-centered care.  Aspects of patient-centered care explored included: fast access to reliable health advice; effective treatment delivered by staff you can trust; involvement in decisions and respect for patients' preferences; access to clear, comprehensible information and support for self-care; physical comfort and a clean, safe, healing environment; access to satisfying food, complementary therapies, and therapeutic diversions, such as music and the arts; empathy and emotional support; involvement of family and friends and support for caregivers; continuity of care and smooth transitions; and contributions to healthy communities.  The definition of patient-centered care, used for purposes of this RoundTable discussion, was:  "Patient-centered care” is “healthcare in which providers partner with patients and their family members to identify and satisfy the full range of patient needs and preferences.”

(2)  Development of Report and Resource Compendium ~ "Patient-Centered Care Improvement Guide"

Following the leadership roundtable meeting, Planetree prepared a patient-centered care improvement guide for broad distribution by Picker and Planetree.  The patient-centered care improvement guide includes the following information: (1) a summary of the leadership meeting identifying barriers to implementation of patient-centered care and strategies to overcome those barriers; (2) the evidence-base supporting a variety of patient-centered practices; (3) “best practices” in patient-centered care identified by Planetree affiliates; and (4) patient perspectives on aspects of patient-centered care drawn from the analysis of recent Planetree focus group data.

(3)  CEO Summit Meeting  ~ (October, 2008)

Since the publication of the Institute of Medicine report in 2001 identifying patient-centered care as one of the six aims of a quality health care system, the phrase “patient-centered” has been often repeated, frequently by individuals and organizations who have vastly different understandings of what constitutes patient-centered care. The adoption of the HCAHPS patient experience of care survey as a national standard and the launch of public reporting of HCAHPS data has raised hospitals’ awareness of the need to take action to improve the patient experience,
but many are uncertain of where or how to start to become more patient-centered.

This day-long summit for hospital CEOs will address these questions by focusing on strategies for comprehensively transforming the patient and staff experience and enhancing organizational performance. At the meeting, Planetree and the Picker Institute will release a new Patient-Centered Care Improvement Guide which will present best practices in initiating and sustaining a culture of patient-centered care, specifically addressing common barriers to implementation.

“Leadership Roundtable, Improvement Guide and CEO Meeting”

Team
Principal Investigator Susan Frampton, Ph.D., is the president of Planetree, a nonprofit
membership organization working with hospitals and health centers to develop and install
patient-centered-care healing environments.

Project Director Carrie Brady, J.D., is vice president for quality at Planetree, a nonprofit
membership organization working with hospitals and health centers to develop and install
patient-centered-care healing environments.

Project Director Sara Guastallo is a philanthropy specialist at Planetree, a nonprofit
membership organization working with hospitals and health centers to develop and install
patient-centered-care healing environments.

Project Summary
Planetree and Picker Institute will collaborate on the production and broad dissemination of
a patient-centered-care improvement guide to help healthcare organizations improve the
patient experience by implementing patient-centered care. The guide will feature best
practices in patient-centered care, strategies for overcoming common barriers and an
overview of the evidence base for a number of patient-centered practices.

Picker Institute Challenge Grants Program
The Challenge Grant Program was established in 2005 with the goal of integrating Picker
Institute’s patient-centered-care mission into the graduate medical education (GME) of
future practicing physicians. The program focuses on enabling teaching hospitals and
residency programs to assimilate the concept of patient-centered care into their curricula
and to maximize its impact on residents and their training programs.

2007 Challenge Grant project

“Emergency Medicine Resident Training in Interprofessional Skills: Evaluating a Needs-Based Curriculum”

Team
Principal Investigator Sondra Zabar, M.D., is an associate professor of medicine at the New
York University School of Medicine.

Co-Investigator Linda Regan, M.D., is an assistant professor of emergency medicine at the
New York University School of Medicine.

Project Summary
Since the 1960s, Emergency Medicine (EM) researchers have worked to demonstrate the
importance of patient-centered doctor-patient communication, only acknowledging decades
later that advancing such patient-centered care will require increased and effective provider
education. Having had experience with the development and implementation of a controlled
study on the impact of a comprehensive, integrated clinical communication skills curriculum
on students’ patient-centered skills, Section of Primary Care faculty at New York University
School of Medicine were prepared and eager to partner with Emergency Medicine faculty on
this very important topic. With the commitment of NYUSOM-Bellevue Emergency Medicine
Residency leadership, the Emergency Medicine Professionalism and Communication
Training (EMPACT) Project was created.

EMPACT aims to expand on previous work by assessing and improving EM resident
competency in communication and professionalism through the development,
implementation and evaluation of new curriculum and assessment measures. The project
proposes to:

1. Design, implement and evaluate a patient-centered healthcare curriculum for all 60 EM
residents.

2. Evaluate the predictive validity of Objective Structured Clinical Examinations (OSCEs) by
assessing the correlation of OSCE performance with actual resident performance in
emergent care setting for cohort of PGY2 residents.

3. Disseminate this Patient-Centered Care educational program to EM programs nationally.

2006 Challenge Grant Projects

“Cultural Sensitivity Initiative for Medical Education”

Principal Investigator John M. Tarpley, M.D., is a professor of surgery at the Vanderbilt
Medical Center at Vanderbilt University.

Patient-centered care requires knowledge of and sensitivity to cultural and faith-related
issues. Dr. Tarpley’s research revealed the degree to which people in the medical
profession are confronted by these issues, and the subsequent need to educate medical
personnel to understand and respond to patients’ cultural and spiritual concerns.

His findings include a proposal for developing a graduate medical education curriculum
focusing on teaching healthcare professionals how to respond to patients in a culturally

“Improving Patient Compliance and Outcomes in Hypertension Management in the ‘Stroke Capital’ of the World”

Project Director William H. Hester, M.D., Richard R. Howell, M.D., and Cindy Lawrimore,
F.N.P., are principals in the McLeod Family Medicine Residency Program in Florence, S.C.

Hypertension is the most common primary diagnosis in the United States. Primary care physicians manage the majority of hypertensive patients. Effective communication between Patients with uncontrolled hypertension were enrolled in the McLeod study. Each patient received education regarding hypertension through the use of four specific tools and was also instructed in the DASH diet. Medications were adjusted to attain a systolic blood pressure of 140 mm Hg or less. Patients’ comprehension of each educational tool was measured with a brief questionnaire after each visit.

The results of the study showed that patient education can be an important factor in treating hypertension; that simple educational tools can improve physician-patient communication; and that effective communication between patient and physician improves blood pressure control.

“Simulation Used to Measure the ACGME Core Competencies and Patient- Centered Care”

Pamela J. Boyers, Ph.D.
Riverside Methodist Hospital

In 2002, the Accreditation Council for Graduate Medical Education (ACGME) introduced competency-based education into the institutional and program requirements for all U.S. allopathic residency programs. The six core competencies—medical knowledge, communication, professionalism, practice-based learning and improvement, systems-based care and patient care—comprise a set of standard principles by which residents can be
evaluated and a general framework for curriculum development.

At present, there are no uniform guidelines to measure the successful integration of these core competencies into residency education or resident progress toward proficiency. By “simulating” doctor-patient scenarios involving such common complaints as retinal detachment, colon cancer and low back pain. Prior to and after each simulation, residents were asked to assess their own level of expertise, as was a physician who had observed the simulation.

An examination of these scores indicated that “it is possible to objectively measure the principles of patient-centered care embodied in the ACGME Core Competencies,” Dr. Boyers concludes. The multifaceted evaluation process, which includes residents’ self perceptions, recorded observations by attending-level physicians, 360-degree evaluations
by standardized patients and an objective examination, has the specific advantage of measuring and recording the data generated by multiple separate observations of a given skill set. Dr. Boyers concludes that “we must continue to work to better define and measure
skill sets within each competency, and to demonstrate that mastery of each competency translates into excellence in patient-centered medical care.”

“Development and Implementation of an Interdisciplinary Palliative Care End-of- Life Education Program for Residents Who Rotate through the Surgical Intensive Care Unit

Anthony A. Meyer, M.D., Ph.D.
Renae E. Stafford, M.D., M.P.H.
Trauma and Critical Care Services
The University of North Carolina
at Chapel Hill

Drs. Meyer and Stafford prepared for their study by surveying 28 surgical residents on endof-
life issues and bioethics and by administering to them a standardized palliative-care
knowledge examination. Survey data and exam scores “clearly elucidated the need for
further education.”

The doctors then instituted an educational program that involved the surgical residents in
formal lectures, role playing, experiential learning with participation in family meetings, grand
rounds presentations and journal clubs. Residents were also exposed to discussions about
end-of-life and palliative care in morbidity and mortality conferences and in surgical
intensive-care-unit daily rounds.

While the study has not yet been formally concluded, it has led to several initiatives that
have enhanced patient-centered care at UNC, according to Drs. Meyer and Stafford. These
include inclusion of surgical ICU nurses and students in the educational program; an
enhanced relationship with the palliative-care service; and the institution of a “family center”
near the surgical ICU to provide a place for family meetings and a quiet, restful space where
families can gather, process information and grieve as loved ones face the end of their life.

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