This session will describe educational concepts to enhance the orthopaedic patient experience. The elective nature of orthopedic surgery creates an opportunity to intervene with patients and family early and often throughout the episode of care. Multimodal teaching strategies (individual, group learning, written materials and web based tools) delivered prior to surgery and reinforced multiple times across care transitions can reduce anxiety, increase satisfaction, improve ability to manage pain and help patients feel more prepared for surgery. Improving the patient experience is increasingly important as quality and satisfaction metrics are becoming linked to reimbursement. Transitional care interventions, such as discharge planning, follow up calls with emphasis on participation in self care have shown to improve continuity of care, reduce readmissions and prevent poor health outcomes. About the Speaker: Jack Davis MSN, RN, ONC is the Manager of Patient Education Programs at Hospital for Special Surgery in NYC. Jack has over 30 years experience in orthopaedic nursing. He has been an active member of the National Association of Orthopaedic Nurses (NAON) since 1991. Jack currently serves as Director of the Orthopaedic Nurses Certification Board (ONCB). He is passionate about preparing patients and family for surgery and seeks to improve nursing practice through research, promoting specialty certification and nursing continuing education.

1. The Patient Journey
The Guided CarePath, as part of a multi-modal strategy, helps create a
single streamlined patient experience through the entire journey of a total
joint replacement.

2. Guided CarePath
Smart
Checklists for
Patients
Delivered online
and available 24/7
from home

3. Patient & Family Education:
A Multi-Modal Approach to
Improve the Experience
Jack Davis, MSN, RN, ONC
Manager, Patient Education Programs
Hospital for Special Surgery

4. HSS background
• Musculoskeletal
Specialty hospital
est 1863
• No. 1 ranking
orthopaedics
• Magnet Recognition
• Academic center
• Research division
RS Laskin MD

5. Conflict of Interest
• No financial affiliation with products
discussed
• My current role as Manager Pt
Education Programs for HSS
influences my views on the subject on
which I am presenting
RS Laskin MD

6. Objectives
• Describe methods used to educate
orthopaedic patients and families
across the continuum
• Recognize factors that may improve
the “experience”
RS Laskin MD

7. Poll Question #1
• Do you routinely use a preop
education class to teach patients?
1. Yes
2. No
RS Laskin MD

8. Educational Methods &
Strategies
–
–
–
–
–
–
Preop class group learning
Written materials
Web-based
Individual learning
Use of technology
Dedicated educator(s)
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9. Poll Question #2
• Do you routinely use internet or web based technology to teach patients?
1. Yes
2. No
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10. Organization’s Culture
• Identify models or theoretical frameworks
– Transpersonal Caring
– Relationship Centered Care
– Patient and Family Centered Care
– Transitional Care
– Magnet Model for Nursing Excellence
RS Laskin MD

11. Poll Question #3
• Do you routinely include family in the
education of patients?
1. Yes
2. No
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12. What metrics are used to
evaluate the education
experience?
–
–
–
–
–
–
Volume stats
Cost to educate
Outcomes associated?
Knowledge
Satisfaction
HCAHPS?
RS Laskin MD

13. Hospital Consumer Assessment of
Healthcare Providers and Systems
(HCAHPS)
• Publicly reported survey of patients’
perceptions of hospital care
• Satisfaction with the Experience
• Failure to report=reduced
reimbursement
• HCAHPS performance linked to
Value-Based Purchasing incentive
payments
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14. Poll Question #4
• Are you modifying teaching
strategies to improve HCAHPS
scores?
1. Yes
2. No
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15. Is the education of
Patient/Family relevant?
Patient education is critical to
helping patients successfully cope
with and recover from orthopaedic
conditions and surgery
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16. Is education relevant to
the organization?
• Sets expectations for experience
– Nursing & MD Care
• Courtesy, listen, teach, respond
• Manage pain, new meds, toileting
– Environment
• Clean, quiet
• Discharge disposition and transitions
RS Laskin MD

17. So is preop class best
practice?
• Pre-op program shows mixed results
– Anxiety, LOS, Pain, Expectations
• Joint Commission Disease Specific Care
Certification
– Formalized program that provides theory &
skills to manage disease
• AHRQ National Guideline Clearinghouse
– Pre op education program = moderate LOE
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18. Patient Education Framework
• Provide health information
• Facilitate knowledge & understanding
• Engage patients to take an active
role in care management
• Effect physical and mental health
outcomes
RS Laskin MD

19. Patient Education
“ …is more than just having the nurse
review discharge instructions prior to
leaving the hospital, it is a means for
the nurse to assist the patient in the
enhancement and expansion of his
ability to provide effective self-care”
(Bastable, 2006).
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20. Increased responsibility to
educate the patient’s family
members and caregivers d/t
shorter hospital stays and
earlier transitions to home
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21. Is there a best or most
effective method to teach
orthopaedic patients?
•
•
•
•
Combined teaching strategies
Repeated/reinforced three times
Patient/Family engagement
Grounded in multiple theory
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22. Transpersonal Caring
•
•
•
•
Watson’s 10 Carative Factors
Deep caring spiritual connection
Provides comfort & Pain control
Well being, Wholenss & Healing
(Gallagher-Lepak and Kubsch, 2007)
RS Laskin MD

23. Watson’s 7th Carative
Factor…
• Promotion of transpersonal teachinglearning
– Interpersonal approach nurse to patient
and not information
– Assess readiness to learn
– Respect pre-existing knowledge
– Understand feelings about content,
goals/desired outcome
(Gallagher-Lepak and Kubsch, 2007)
RS Laskin MD

24. Relationship Centered Care
Respectful of and responsive to
individual patient preferences, needs
and values and ensuring that patient &
family values guide all clinical decisions
(Epstein, Fiscella, Lesser &
Stange, 2010)
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25. Healing Relationships
• A two-way sharing of info patient &
provider
• Explore values & preferences
• Help patient & family make decisions
• Facilitate appropriate care
• Follow through with behavioral change
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26. Similar to self-management
• Model used in chronic disease
• Problem solving and decision making
• Patients engage in daily process to
manage own care
• Use family, health team & community
to manage consequences of health
conditions
(Richard & Shea, 2011)
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27. Poll Question #5
• Do you routinely use Clinical
guidelines or pathways?
1. Yes
2. No
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28. Patient & Family Centered
Care
• More popular approach
• Patient & Family Partnership
• Supports family presence and
participation
• Enhance access to information
• Encourage shared decision-making
• Promote safety & well being
RS Laskin MD

29. Outcomes?
• Better adherence to medications
• Improved disease management,
problem solving and decision making
• Improve self-efficacy and ability to
navigate health system
RS Laskin MD

30. Transitional Care
• Ensure health care continuity
• Avoid preventable poor outcomes
• Promote safe and timely transfer
– One level of care to another
– One type of setting to another
(Naylor et al. 2011)
RS Laskin MD

31. Helps identify the best
time to teach
• Before surgery
• Access to information after consults?
• During the hospital when taking
medications?
• Reminders sent after discharge?
• Across all transitions of care?
• Who is the target audience?
RS Laskin MD

32. Orthopaedic Transitions
•Out Patient office
consult
•Operating Room
•Post op follow up
•Primary care
•Internist
•Anesthesia
•Other Consultant
Surgical
Service
Post
Surgery
•PACU
•In-patient
•Home
•Rehab
Medical
Service
Pre
Surgery
•Patient Education
•Admission
•Nutrition
•Holding
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33. Transitional Care
Interventions
•
•
•
•
•
Discharge planning
Patient and family teaching
Home visits
Calls or surveys after discharge
Improve continuity of care & prevent
readmission?
(Coleman et al,2006)
RS Laskin MD

34. Magnet Model of Nursing
Excellence
•
•
•
•
•
•
Nurse as teacher concept
Patient education program
Interdisciplinary team input
Other members of team?
Address diverse patient/family needs
Communicates across the organization
RS Laskin MD

35. Interdisciplinary Patient/Family Centered Education Committee
Revise content
Condition & process
Office practice
Service lines
Written
Classroom
Patient
Education
Knowledge Outcomes
retention
Press Ganey
Multimedia
Web-based
& other
Interactive
formats
RS Laskin MD

36. A Challenge
Research shows that patients
remember and understand less than
half of what clinicians explain to them.
(Ley, 1988)
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37. Barriers to learning
•
•
•
•
•
Patient health status
Medications
Anxiety
Teaching environment
Learning styles
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38. Individualistic learning &
retention
•
•
•
•
•
•
10% of what is read
26% of what is heard
30% of what is seen
50% of what is seen & heard
70% of what they say
90% of what say as do something
(Felder & Silverman, 2002)
RS Laskin MD

39. Engagement and
Evaluation of Learning
•
•
•
•
•
•
Is content provided?
Is it effective?
Knowledge gained?
Ability to manage self care?
How long is information retained?
Target patient & family
RS Laskin MD

40. Teach-Back: Closing the Loop
Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman A. Closing the Loop
Physician Communication With Diabetic Patients Who Have Low Health Literacy. Arch Intern Med/Vol 163, Jan 13, 2003
RS Laskin MD

41. Teach-back – Using it Well:
Elements of Competence
●
●
●
●
Responsibility is on the provider.
Use a caring tone of voice & attitude.
Use Plain Language.
Ask patient to explain using their own words
(not yes/no).
● Use for all important patient education, specific
to the condition.
● Document use of & response to teach-back.
RS Laskin MD

42. Even if teaching is good,
will it influence behavior?
Education occurs if learning takes place
with a resultant change in behavior,
skill or attitude.
(Falvo, 1994)
RS Laskin MD

43. Providers should understand
learning principles
• Active involvement
• Readiness to learn
• Conducive
environment
• Perceived
relevance
• Repetition
• Generalize info
• Pleasant
experience
• Begin with known
topics to unknown
• Present at
appropriate rate
(DeYoung, 2009)
RS Laskin MD

44. Ortho Patient Education
Best Practice Summary
• Multi-modal approach
• Reinforced across practice settings
• Pre-op to discharge instructions &
post-op calls
• Nurses to use teaching principles and
evidence-based strategies
• Engage patients & family in the
process
RS Laskin MD

45. Identify & link to models
•
•
•
•
•
•
Transpersonal Caring
Relationship Centered Care
Patient & Family Centered Care
Transitional Care
Magnet Model for Nursing Excellence
Others?
RS Laskin MD

46. More than the preop class
• It is about the nurse-patient
relationship
• It is about how we include the family
and convey messages
• It is about assessing individual
learning needs and styles
• It is about reinforcing across
transitions
RS Laskin MD

47. Improving the experience
•
•
•
•
•
•
Monitor HCAHPS & other metrics?
Feed form focus groups?
Engage the participants in process
Make it convenient
Expand access to info?
Use technology?
RS Laskin MD

48. Educational Methods &
Strategies case study
–
–
–
–
–
–
Written materials
Web-based
Classroom group learning
Individual learning
Use of technology
www.hss.edu
RS Laskin MD

49. Thank you!
Questions?
Jack Davis, MSN, RN, ONC
Manager, Patient Education Programs
Hospital for Special Surgery
davisj@hss.edu
RS Laskin MD

50. References
•
•
•
•
•
ANCC Commission on Magnet Recognition. (2008). Application
manual magnet recognition program (2008th ed.)
Bandura, A. (1977). Self-efficacy toward unifying theory of
behavioral change. Psychological Review, 191-215.
Kearney, M., Jennrich, M. K., Lyons, S., Robinson, R., & Berger, B.
(2011). Effects of preoperative education on patient outcomes
after joint replacement surgery. Orthopaedic Nursing / National
Association of Orthopaedic Nurses, 30(6), 391-396
Epstein, R. M., Franks, P., Fiscella, K., Shields, C. G., Meldrum, S. C.,
Kravitz, R. L., et al. (2005). Measuring patient-centered
communication in patient-physician consultations: Theoretical and
practical issues. Social Science & Medicine (1982), 61(7), 15161528.
Naylor, M. D. (2009). Transitional care model. Retrieved December
12, 2009, from www.transitionalcare.info
RS Laskin MD

51. The Patient Journey
The Guided CarePath, as part of a multi-modal strategy, helps create a
single streamlined patient experience through the entire journey of a total
joint replacement.

52. Guided CarePath
Smart
Checklists for
Patients
Delivered online
and available 24/7
from home