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Speak Up program effective tool for educating patients
Institutions must have culture of openness, teamwork
The Speak Up program, sponsored by The Joint Commission (TJC), based in Oakbrook Terrace, IL, is designed to improve patient safety by teaching patients how to become involved in their health care, thus reducing medical errors.
It was launched in March 2002, in conjunction with the Centers for Medicare & Medicaid Services, with the "Speak Up" brochure "Help Prevent Errors in Your Care." New topics are addressed periodically, with the most recent title, "Tips for Your Doctor's Visit," released in December 2009.
According to Ken Powers, a spokesman at TJC, topics are selected following discussions with people in the health care field who identify challenging issues and areas where patients might become involved.
"Going into a given year, we usually have a number of topics we would like to get out in a timely way," says Powers.
All the topics are about risk points where a patient or family and the health care system meet, and if the interaction is not completed correctly, there is potential risk to the patient, explains Robert Wise, MD, vice president of TJC's standards and survey methods division.
He adds that there are certain junctures in health care encounters where patients are most likely to benefit by acting as their own advocate. The brochures target these areas.
They include: "Help Prevent Errors in Your Care," "Help Avoid Mistakes in Your Surgery," "Information for Living Organ Donors," "Five Things You Can do to Prevent Infection," "Help Avoid Mistakes With Your Medicines," "What You Should Know About Research Studies," "Planning Your Follow-up Care," "Help Prevent Medical Test Mistakes," "Know Your Rights," "Understanding Your Doctors and Other Caregivers," "What You Should Know About Pain Management," "Prevent Errors in Your Child's Care," and "Tips for Your Doctor's Visit."
The brochures are not copyrighted and can be downloaded for free from TJC's web site. According to TJC, the most popular topics are preventing medical errors, preventing infections, avoiding medication mistakes, and patient rights.
Wise says Speak Up was designed to help patients and family members become active participants in their own care. Therefore, the information needs to get to the patients. He says the brochures work best as part of an active campaign or just-in-time education.
He has observed hand-washing campaigns at hospitals that included signs telling patients to remind health care staff to wash their hands. Institutions actively tell patients they will get the best care, but because the health care process is complex, it's good for the patient to be his or her own advocate. However, patients and their family members need to be told the junctures where they are likely to be the most effective, such as hand-washing for infection control, says Wise.
Just-in-time education occurs when the patient is thinking about a health issue. Therefore, the physician might have signs in the waiting room about discussing issues of pain during an office visit and use the pain management brochure to explain how to speak up, says Wise.
"The most important piece of education is about speaking up. The reason the program is called 'Speak Up' is it is exactly the problem that patients have. Many of the points in the brochures patients know, but there is no one really giving them permission to get over what often feels like an intimidating encounter," adds Wise.
There are many reasons a person may not speak up, whether it is feeling rushed, a lack of understanding, or not wanting to seem stupid, he says. So, it's not just giving information but the actual permission that is explicit from the health care organization "we want you to speak up," explains Wise.
Creating site-specific materials
When preparing for Patient Safety Awareness Week in 2002, staff in the patient education office at The University of Texas M.D. Anderson Cancer Center in Houston came across the new Speak Up program on preventing health care errors. They took the material from the brochure and personalized it by making it institution-specific.
"Instead of using The Joint Commission brochure verbatim, we created one and adapted the information, so it would be more specific to M.D. Anderson," says Karen A. Stepan, MPH, RN, CHES, a senior health education specialist.
For example, one of the points is to "ask a trusted family member or friend to be your advocate (advisor or supporter)." M.D. Anderson's version includes information about its patient advocacy department. When a patient is admitted to the cancer center, he or she is assigned a patient advocate. If there is a question or concern the patient and family do not feel is being addressed appropriately, they can contact the patient advocate. This person serves as a liaison between the patient and family and the institution.
The original safety brochure addresses seven points. In addition to soliciting the help of an advocate, points include:
Speak up if you have questions or concerns. If you still don't understand, ask again.
Pay attention to the care you get. Always make sure you're getting the right treatments and medicines by the right health care professionals. Don't assume anything.
Educate yourself about your illness. Learn about the medical tests you get and your treatment plan.
Know what medicines you take and why you take them. Medication errors are the most common health care mistakes.
Use a hospital, clinic, surgery center, or other type of health care organization that has been carefully checked out.
Participate in all decisions about your treatment. You are the center of the health care team.
The education department at M.D. Anderson reviewed all the points, adding in site-specific information when appropriate, such as information about Texas law regarding advance directives, and details about how best to obtain information in certain departments, such as the intensive care unit.
"We made it a little more specific to M.D. Anderson without taking away from the integrity of what The Joint Commission wanted to get across," says Stepan.
Although initiated during Patient Safety Awareness Week, the brochure is still used, with new information added when TJC introduces new topics. Several different venues are used to get the message of speaking up for safety to patients, says Stepan.
It's distributed in literature racks throughout the institution, within the three learning centers as a handout, and used during a new patient-family orientation class.
The University of Michigan Health System in Ann Arbor displays the full Speak Up series at the Cardiovascular Center Mardigian Wellness Resource Center. A few are also distributed at the patient education resource center at the Comprehensive Cancer Center.
"We decided to use these materials because of our emphasis on patient safety and because The Joint Commission is the most authoritative source," says Ruti Volk, MSI, AHIP, the librarian for these patient education resource centers.
The medications listed in the brochure on avoiding medication errors are printed separately and placed in plastic holders within exam rooms, along with pencils. "The medicine lists and pencils are very popular," says Volk.
In order for the brochures to be effective, the culture within the organization must support the Speak Up philosophy, says Wise. It must be apparent that all employees all the way to top leadership are interested in the patient becoming an active member of his or her own treatment, he explains. The brochures don't create that kind of culture; they support it, he adds.
Volk says she thinks the brochures help establish the culture. At the University of Michigan Health System, there are many messages to patients about hand-washing and other safety issues.
In 2008-2009, M.D. Anderson conducted a hand hygiene pilot using its Speak Up brochure and other tools to educate patients and staff on the importance of having patients ask their health care provider if his or her hands were washed. A survey taken pre- and post-education showed the education did have positive results. Education increased a patient's comfort level when asking about hand hygiene.
"A hospital that uses the Speak Up materials in a very thoughtful, useful way is doing a whole lot more than just giving out materials. That culture of safety and concern permeates a lot of what is done," says Wise.
For more information about using the Speak Up program, contact:
Karen A. Stepan, MPH, RN, CHES, Sr. Health Education Specialist, Patient Education Office, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 21, Houston, TX 77030. Telephone: (713) 563-8187. E-mail: firstname.lastname@example.org.
Ruti Volk, MSI, AHIP, Librarian, Patient Education Resource Center, Comprehensive Cancer Center and Mardigian Wellness Resource Center, Cardiovascular Center University of Michigan Health System, Ann Arbor, MI. Telephone: (734) 936-9947 or (734) 232-4122. E-mail: email@example.com.
The Joint Commission, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5000. Web site: www.jointcommission.org.