Patient and Family Advisory Councils for Quality and Safety

Adding the Patient’s Voice into the Safety Conversation

Rosemary Gibson is an author, speaker, and national leader in U.S. health care. She is principal author with Janardan Prasad Singh of the critically acclaimed book, Wall of Silence, which tells the untold human story behind medical errors, and The Treatment Trap, which tells the public what health care insiders know about the extensive overuse of unnecessary surgeries, CT scans and other procedures and tests. At the Robert Wood Johnson Foundation in Princeton, New Jersey for sixteen years, she led national initiatives to improve the quality of America’s health care and reduce the harm from medical errors and hospital-acquired infections.

She designed a $200 million national strategy using philanthropic funds to establish palliative care in hundreds of hospitals around the country. She is the recipient of the Lifetime Achievement Award from the American Academy of Hospice and Palliative Medicine.

Rosemary worked with Bill Moyers and Public Affairs Television on the PBS documentary, "On Our Own Terms," which showed to more than 20 million viewers how the U.S. health care system can better care for seriously ill patients and their families.

She has been a guest blogger for Consumers Union, KevinMD, and the policy journal, Health Affairs. Her website is www.treatmenttrap.org.

After graduating from Georgetown University and the London School of Economics, she joined the American Enterprise Institute as a senior associate in health policy. She became Vice President of the Economic and Social Research Institute, a policy think tank, and then a consultant to the Medical College of Virginia and the Virginia state legislature's Commission on Health Care. She has been a volunteer and board member for a free medical clinic in Washington, D.C.

Helen Haskell is founder and president of the patient organization Mothers Against Medical Error. Since the medical error death of her young son Lewis in 2000, Helen has devoted herself to patient safety advocacy in a variety of fields including medical education reform, patient-activated rapid response, infection prevention, medical error disclosure, and patient empowerment, among others. She is a director of Consumers Advancing Patient Safety, the Nursing Alliance for Quality Care and the Institute for Healthcare Improvement and a member of the National Patient Safety Foundation board of governors and the AHRQ National Advisory Council. She is author of numerous articles and patient educational materials and regularly conducts educational sessions for patients on navigating the healthcare system and avoiding medical harm.

Marty Hatlie is CEO of Project Patient Care (PPC) (www.projectpatientcare.org), a non-profit organization that uses the voice of the patient to improve care. PPC’s mission is to mobilize the diverse healthcare stakeholders in metropolitan Chicago to provide the best possible care to every patient every time, by eliminating preventable harm and implementing systemic change to ensure consistent excellence. He also is President of the Partnership for Patient Safety (p4ps) (www.p4ps.net) an Illinois company, and a co-founder of Consumers Advancing Patient Safety (CAPS) (www.patientsafety.org), a non-profit organization dedicated to fostering the role of the consumer as partner in pursuing healthcare that is safe, compassionate and just.

Drawing on experience as a civil rights attorney, malpractice defense litigator, lobbyist and coalition-builder, Mr. Hatlie is active in both public and organizational policy development on patient safety, litigation reform and patient safety issues. Mr. Hatlie works extensively with consumers and organizations to foster the cultural paradigm shift necessary to support a patient-centered, systems-based approach to the delivery of healthcare services.

He was a lobbyist for the American Medical Association for many years. In 1996, he was instrumental in developing the first Annenberg Conference on Patient Safety. In 1997, he coordinated the establishment of the National Patient Safety Foundation and served as its founding Executive Director (1997-99). From 2000 through 2002, Hatlie served as the National Chair of VHA Inc.’s Accelerated Learning Initiative on Patient Safety, working with VHA member hospitals across the country.

Mr. Hatlie is the co-editor of the Patient Safety Handbook (Jones & Bartlett Publishers, 2003), one of the first textbooks in the field of patient safety. He has authored numerous articles addressing patient safety, patient engagement and medical liability issues. Among other activities, p4ps develops case-based training tools exploring systems problems that produce adverse patient events. Its interactive educational programs, the First Do No Harm® video series, developed in partnership with the Risk Management Foundation of the Harvard Medical Institutions, are used widely in more than 40 countries.

Mr. Hatlie currently serves on the Leapfrog Group Board of Directors, the Joint Commission Patient Safety Advisory Group, and the Board of Advisors of Parents of Infants and Children with Kernicterus. He also serves on the Steering Committee of Patients for Patient Safety, an action area of the World Health Organization’s (WHO) World Alliance on Patient Safety. Hatlie has organized and facilitated patient safety workshops for the WHO across the globe.

Previously, Mr. Hatlie was a member of the Harvard Kennedy School’s Executive Session on Medical Error and served on the boards of the Anesthesia Patient Safety Foundation, the Physician Insurers Association of America, and the American Tort Reform Association. He was the Founding Chair of both the Health Care Liability Alliance and the National Medical Liability Reform Coalition – both are Washington, D.C., based coalitions that advocate civil justice and patient safety reform. Mr. Hatlie is licensed to practice law in Massachusetts and Illinois.

Carole Hemmelgarn, MS, has worked in the healthcare field with Industry for 25 years. Her early years were spent in sales interacting with private practice providers, and academic institutions with interns, residents, fellows, and attendings. Her past nine years consist of working with Health Plans, Medical Groups, and Employers collaborating on quality improvement, disease management, and prevention programs for their patients and employees. Personal interest in the field of Patient Safety has led Carole to get a Master of Science Degree in the field of Patient Safety Leadership from the University of Illinois Chicago. Carole is currently working on a second master's degree in the field of Bio Ethics from Creighton University.

Parent and Family-Centered Care Advocate

On February 22, 2001, eighteen-month-old Josie King died from medical errors. Following the death of her eighteen-month-old -daughter, Josie, Sorrel King became a leading advocate for patient safety for patients and their families.

Together with her husband, Tony, Sorrel King founded the Josie King Foundation in 2001 to prevent others from dying or being harmed by medical errors. According to the Institute of Medicine, 98,000 people die every year from medical errors, making it one of the leading causes of death in the United States.

By uniting healthcare providers and consumers, and funding innovative safety programs, the Foundation hopes to create a culture of patient safety. The Josie King Foundation supports innovative patient safety programs that influence the way safety is incorporated into medical care. The Josie King Pediatric Patient Safety Program at the Johns Hopkins Hospital’s Children’s Center received initial funding from the Josie King Foundation and currently serves as a model for patient safety programs across the country.

Sorrel has worked to support the patient safety movement to ensure that what happened to Josie will never again happen to another patient. Her book Josie’s Story was published in September 2009 by Grove/Atlantic; Inc. Josie’s Story was named one of the best health books in 2009 by the Wall Street Journal and won the “First Book” award at the 2010 “Books for a Better Life” Awards. The account of one woman’s unlikely path from full-time mom to nationally renowned patient advocate, Josie’s Story is the inspirational chronicle of how a mother—and her unforgettable daughter—are transforming the face of American medicine. Sorrel was chosen as one of “50 Women Changing the World” by Woman’s Day magazine in February 2010.

As a public speaker, she brings Josie’s powerful story and the successes of Foundation-sponsored safety initiatives to wide audiences to ensure that what happened to Josie will never happen to another patient. The DVD copy of her speech is used by thousands of hospitals and health care systems around the world to inspire doctors, nurses, and administrators to create a culture of patient safety at their institutions. She has shared her personal story with hundreds of different groups around the country.

Parent and Family-Centered Care Advocate

Sherri Loeb has been a health care professional for 33 years. She received her a BS in Biology from Drake University in Des Moines, Iowa and a BS in Medical Technology concurrently from Northwestern University School of Medicine in 1980. She continued her studies at Northwestern and received a BSN and RN in 1983.

Sherri has extensive nursing experience having functioned for many years as a staff nurse at Northwestern Memorial Hospital and NorthShore University HealthSystem on adult cardiac and general surgical care floors, cardiac electrophysiologic intensive care units and general intensive care units. She also has experience working in a university affiliated physician office specializing in cardiology and endocrinology. She has spent time working in utilization review. Sherri also served as the sole nurse for a five physician, university affiliated ambulatory surgical practice specializing in cosmetic and reconstructive surgery.

In 2010, Sherri was recruited to develop a new Clinical Research Center at NorthShore University HealthSystem. In this role, Sherri had responsibility for a two-bed outpatient unit used by physician investigators for studies related to stroke care, multiple sclerosis, rheumatoid arthritis, gout, lupus, vertebral compression fractures and pulmonary fibrosis. In this role, Sherri was responsible for regulatory affairs compliance, IRB compliance, and direct patient care with a focus on patient safety.

Her husband was diagnosed with stage IV prostate cancer in 2011, and when his condition worsened in early 2013, she resigned from the Clinical Research Center and became his caregiver, personal navigator and ombudsman. Even after almost 30 years as a registered nurse, our fractured health care system was an eye-opening experience. Her goal was to make sure that the care her husband received was safe, compassionate and evidence based as long as possible, and serves as a model for all patients entering the health care system. Together with her husband they were participants in a yearlong webinar on compassionate care and improving HCAHPS scores for Americas Essential Hospitals. Sherri has served as the keynote presenter at a recent conference for Hennepin County Medical Center in Minneapolis Minnesota and recently gave the closing talk at the 2013 Joint Commission Ambulatory Care Conference. She is scheduled to give Grand Rounds at CMS in Baltimore in January.

Sherri resides in Buffalo Grove, Illinois where she has been active for more than 15 years as a volunteer with the Buffalo Grove Fire Department. She and her husband have two daughters, one about to begin a residency in internal medicine, and the other a second-year law student about to begin a career in law enforcement. She is also the proud mom of two beautiful Havanese puppies.

Michael L. Millenson, president of Health Quality Advisors LLC, Highland Park, IL, is a nationally recognized expert on quality-of-care improvement, patient-centered care and web-based health. He is the author of the critically acclaimed book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, and holds an adjunct appointment as the Mervin Shalowitz, M.D. Visiting Scholar at Northwestern University’s Kellogg School of Management. National Public Radio called him “in the vanguard of the movement” to measure and improve American medicine.

In addition to work in health policy and strategy, Millenson has designed and implemented an Accountability Audit^SM for hospitals, websites to help in consumer quality-of-care decisions and a joint doctor-patient program to improve communication during office visits. His clients have included health plans, hospitals, pharmaceutical companies, entrepreneurs and non-profits. As a senior adviser to the Markle Foundation, he helped launch the Connecting for Health interoperability initiative. Prior to starting his own firm, Millenson was a principal in the health-care practice of a major human resources consulting firm. Before that, he was a health-care reporter for the Chicago Tribune, where he was nominated three times for a Pulitzer Prize.

Millenson has testified before Congress and the Federal Trade Commission, lectured at the National Institutes of Health and served as a faculty member for the Institute for Healthcare Improvement. He co-authored a case study for the Harvard Business School and policy papers on behalf of the Urban Institute, and he has written for publications ranging from the British Medical Journal and Health Affairs to The Washington Post, Kaiser Health News and Forbes.com. He is president-elect of the Society for Participatory Medicine and serves on the boards of the American Medical Group Foundation, the AHIMA Foundation and the American Journal of Medical Quality.

Co-Founder and President of Safe Care Campaign

In 2006, Armando Nahum and his wife Victoria established Safe Care Campaign after three members of his family became infected in three different hospitals, in three different states in 10 months’ time, culminating with the death of his son, Josh. He was 27.

The website: www.safecarecampaign.org, along with their organization were created to bring a sharper focus on infection prevention within the American health care environment. The Nahums have not only turned their family’s tragedy into a positive tribute to their young son, but Armando’s educational presentations “Hospital Associated Infections: What YOU Should Know” and “Change One Thing, Change Everything” inspire hospital administrations and frontline caregivers to remind, provoke and motivate all who work in the continuum of care of their most noble challenge and moral duty to prevent these infections that annually infect more than 1.7 million and kill more than 99,000 patients in the U.S.

Areas of Expertise

Presentation Objectives

At the end of the presentation, participants will:

December 2006 - Present: Safe Care Campaign, Atlanta, GA
Co-Founder and Executive Director

In 2006, Victoria Nahum became the face the American health care system has come to associate with the problem of health care acquired infections after 3 members of her family became infected in three different hospitals in three different states in 10 months’ time, culminating with the death of her stepson, Josh. He was 27.

Just weeks after Josh’s death, she and her husband Armando created Safe Care Campaign, www.safecarecampaign.org to bring a sharper focus on infection prevention within the American health care environment.

Safe Care Campaign partners with health care systems, hospital administrations and frontline caregivers to remind, provoke, motivate and inspire all who work within the continuum of care of their most noble challenge and moral duty to prevent these infections that annually infect more than 1.7 million and kill more than 99,000 patients in the U.S.

Areas of expertise

Prior to 2006: U.S. Broadcasting, Southeastern Region U.S. Radio Division
Director of Sales and Marketing

Victoria currently sits on the Joint Commission’s Patient and Family Safety Advisory, the Board of Directors at Consumers Advancing Patient Safety and the Georgia Hospital Association Advisory Board to Prevent Infection and is an Associate of The World Health Organization’s.

Mother-Founder- Executive Director, Citizens for Patient Safety

CPS is a non-profit organization that believes that patients must be a participant in their own healthcare and partner with their healthcare professionals. Ms. Skolnik is an international speaker and teaches Patient Advocacy “Taking a Safe Healthcare Journey” a course sponsored by medical facilities interested in educating their community. She also teaches the course “Switching Chairs” for health care professionals among other presentations. CPS has also published a personal health journal “Taking a Safe Healthcare Journey.”

Ms. Skolnik will tell you she did not choose Patient Safety as her profession but rather it chose her after the untimely death of her only child to medical error.

CPS has had three laws passed on transparency, the first time a law has been named after a person in the state of Colorado: The Michael Skolnik Medical Transparency Acts 2007, 2008, and 2010.There will be legislation going forward in 2013 to capture the balance of the regulated medical professionals.

Patty has been named one of CNN’s “Intriguing People” and was invited to the White House to discuss health care. She is the winner of the National MITTS HOPE Award, the Colorado Patient Safety Coalition: Patient Safety Leadership Award and The Colorado Trial Lawyers Consumer Protection Award in honor of her son. She is also featured in the new book “Take Back your Government” by State Senator Morgan Carroll and Unaccountable by Dr. Marty Makary from Johns Hopkins.

Ms. Skolnik has had a powerful press presence as well as being featured on The Today Show and many other national news channels.

Contact information for Patty and Citizens for Patient Safety is:

www.citizensforpatientsafety.org

patty@citizensforpatientsafety.org

303-226-5526

Washington, DHA, MHA, FACHE is a multi-dimensional professional with more than fifteen years cumulative experience serving both the payer and provider sectors of the health care industry. She has a demonstrated skill leading consultative performance improvement projects, facilitating change-management and innovation, developing strategic plans as well as designing and managing public health campaigns including advocacy and policy developments. Knitasha’s career path is guided by her vision to be at the helm of change that advances improved health outcomes and ensures a more equitable and values-driven healthcare system.

Dr. Washington has served a considerable amount of time in her consultative practice partnering with leading organizations across the country and promoting a systems approach toward quality improvement, patient safety, health equity and diversity. Knitasha has gained extensive knowledge of hospitals and health system’s operations to include safety net, public, community, private and academic medical centers. She is a high functioning relationship manager with a working knowledge of effectively building collaborative strategies designed using multiple disciplines and stakeholders to include patients, public officials, governmental agencies, allied associations, hospital administrators, physicians, clinicians, and front-line workers.

In her current role with MedAssets Healthcare Advisory Solutions (Denver, CO) Knitasha works with clients to employ “best practice” non-labor expense management strategic plans. Since 2008, Dr. Washington has also built an independent consultancy practice (Washington, Howard and Associates) where she partners with media, public relations and political expert Sean T. Howard to employ a thought-leadership skill set toward projects focused on policy and strategy design, health care innovations, research, quality, patient safety and patient engagement. Moreover, her experience and knowledge base expands internationally as she has completed health studies in Geneva, Switzerland at the World Health Organization; in the countries of Belize and Ethiopia and attended the 2012 World Congress on Public Health in Addis Ababa, Ethiopia.

Knitasha is also a Fellow of the American College of Healthcare Executives and the current President of the National Association of Health Services Executives Chicago Midwest Chapter. She serves on the NAHSE National Executive Committee and the Policy and Advocacy Committee. Her work has been paramount in NAHSE Chicago’s involvement in local policy issues and nationally with the NAHSE’s partnership role with the Commission to End Health Care Disparities. Her work and servitude spirit extends to various other boards including the Northwestern Office of Minority Health Ad Hoc Steering Committee, St. James Health System Missions HR Committee, Cross Roads Coalition of Cook County Southland, and Fertile Ground Foundation. In 2009, Ms. Washington in the memory of her late father expanded her intellectual capacity when she began representing and advocating the importance of diversity in the patient safety discussion and was nominated to serve on the Coalition for Quality and Safety of Chicagoland Council. In 2011 her work in patient safety extended to her appointment to the University of Illinois at Chicago (UIC) Seven Pillars Project Consumer Advisory Board and now in her advisory capacity with the DHHS National Partnership for Patients Initiative in collaboration with Project Patient Care. To her credit have been extended many nominations and awards including, 2013 ACHE Regents Health Care Leadership Award, 2009 NAHSE National Young Healthcare Executive Award and the featured cover story Spring 2010 of Girlfriends HealthGuide Magazine; added by so many other notable achievements.

Dr. Washington received her Doctorate of Health Administration Degree from Central Michigan University, Masters of Heath Administration from Governors State University (IL) and Bachelor of Arts (Chicago State University). Knitasha’s vision is to continue serving through her outward extension of ministry byway of her work creating social justice for the causes of health care and economic development. Her life is committed to being a transformational leader with a servitude spirit. Knitasha is the mother of two children, Knadya and Antwon and as a teenage mother uses her personal life’s testimony as a means of guiding youth mentees.

What are the Patient and Family Advisory Councils for Quality and Safety (PFACQS)?

PFACQS are advisory boards being established at all MedStar Health hospitals. The councils will be made up of patients, family members of patients, and people who work at MedStar hospitals, all working to help MedStar continuously improve the safety and quality of care and always with a commitment to putting patients first.

The objectives of the PFACQS are to:

Patients, family members of patients, and people who work at MedStar Health are invited to apply. This is an opportunity for those who want to be actively engaged as a volunteer in helping the hospital put patients first and continuously improve the safety and quality of care.

The term “family member” will be broadly defined to include persons related by blood, persons related by marriage, domestic partners as well as close friends or neighbors who have a relationship with a patient that includes helping care for their health.

For patients or family members: MedStar Health is interested in forming a partnership with people who have experienced high quality care, satisfactory care that could have been improved, or unsatisfactory care. All are eligible to apply. Persons who have health insurance and those who do not have health insurance are equally eligible to apply.

For MedStar Health associates: Associates are equally eligible to apply regardless of job title or rank.

The following eligibility requirements apply for each class of PFACQS members:

PFACQS members are expected to participate in meetings consisting of a minimum of 2-3 hours and on various committees or projects that will require a varied number of hours.

The PFACQS will meet for 2-3 hours on designated weekday evenings. Check with your local PFACQS for specific details.

To model partnership, the council will be co-led by two members, one of whom has been a patient or family member of a patient and one of whom is a person who works at MedStar Health.

The PFACQS will report to the site’s Health Quality, Safety, and Professional Affairs Committee (QSPAC), which is a committee of the Board of Directors.

The local PFACQS also will report and coordinate with a PFACQS established at the MedStar Health system level, the role of which is to maximize patient and family partnership across all care settings within the MedStar Health system.