INVOLVING PATIENTS AND FAMILIES IN THE PRACTICE
Featuring Yogman Pediatrics
This is one in a series of stories about strategies primary care practices are using to increase patient engagement. MHQP is in a unique position to learn about structural programs and innovative practices that help empower patients to be active in their own care, as we have recently completed a first-of-its-kind statewide study of patient engagement activities in primary care practices in Massachusetts with the support of CRICO.
One idea that many practices are implementing is involving patients and families as partners in the practice.
It has often been said that patients are the greatest untapped resource in healthcare. Patients are in the best position to give constructive feedback to a practice. By giving patients and families a platform, in the form of a patient advisory group or Patient and Family Advisory Council (PFAC), the practice can create productive partnerships with its “customers” and use their guidance to continually improve service and care.
Pediatric practices are especially ripe for parental involvement. One practice that has been particularly innovative in this area is Yogman Pediatrics in Cambridge, Massachusetts. We spoke to Dr. Michael Yogman, the founder and principal partner in the practice, and Aaron Pikcilingis, a member of the parent advisory group, to learn about how they build productive partnerships between parents and the practice:
Michael Yogman, MD:
“Our parent advisory group is our chance to get advice from some of the already-engaged parents in our practice. We have about 10-12 people in the group – mothers, fathers, people of diverse racial and ethnic groups. We meet quarterly. We follow an agenda to keep the meetings focused.
Mainly we’re looking to them for advice on challenging issues. For example, we have a lot of issues with adolescent confidentiality and how to make the transition from visits where we’re predominantly speaking with the parents to telling the parents that now your teenager runs the show. We got a lot of advice from the group about how to negotiate that and they helped us create laminated information sheets for parents about that transition. Another example is they helped us design our system for getting everyone flu vaccines. These are things that affect the patient and parent experience. We also got a lot of help from the group around the difficulties of coordinating with schools and educational assessments and IEPs. And parents were incredibly helpful when we were enhancing our website. One of them helps us put topical posts on the site and keeps the site up-to-date, which is an enormous help.
They really are partners in the true sense of the word. From the very beginning, it was clear that this is the way to go, that this would lead to important breakthroughs. They volunteer their time and talents because they care about the practice and they feel like they’re active participants in shaping something bigger than just the care of their own child.”
“What I like best about the parent advisory group meetings is they get me thinking about kids who are different than mine. Specifically, older kids. Mine are still young – 6 and 9 – but we talk a lot about how the practice could help with transition to adolescence. Things in the practice can get sticky with that age group in terms of operations. For example, the providers were struggling with the question of when do you ask the parent to step out for the first time, so the doctor can have time with just the kid. The parents with older kids had some really helpful advice for the practice, I think, and hearing about it gave me a better sense of what is going to happen to me in the future. It’s nice to have a deeper connection to these kinds of issues.
I’m a stay-at-home dad. There are lots of places where that’s a surprise to people, which I find surprising. But the practice has done a really good job of not making me feel like it’s unusual or uncommon that I come there as a dad. Elsewhere, people always ask me if I’m baby-sitting. No, I’m parenting. But the expectation there is I know what’s happening and I know what to do, which is nice. And inviting me to be a part of the Parent Advisory Group was a further demonstration that they believe dads have an important role.
It’s always interesting hearing the different perspectives in the group, especially hearing from others who have been through things that my kids are going to go through. For example, some of the conversations have been about talking with kids about sex. To see how the practice is thinking through that stuff and that they were asking parents about it was really great. The parents say a lot of things that the physicians and the staff hadn’t really thought about. It’s hard to put yourself in a parent’s perspective all the time. And as a parent, you think about your kids and their experience, but if you have typically-developing kids, there’s going to be a whole host of other experiences. That’s a general theme that keeps coming up: there are so many different experiences. There’s common and uncommon and it’s really hard to think of those uncommon things. For me, what I’ve gotten out of this the most is thinking about those edge cases.
I think the practice has benefitted mostly around issues of communications with patients. They recently switched their EMR to EPIC and there’s been a lot of transition in their system as a result. Changing EMRs is a big deal. And we’ve been giving them advice on issues around how to help parents access information and effective communications during the transition. There are many operational issues – and it seems to me that getting feedback from parents is a lot more efficient than waiting for something to not work and hearing parents complain on their own.
From my perspective, it works best when they come to the meetings with problems and look to us to help find solutions. There’s usually a set agenda around things they’re doing and they’re trying to address a problem. But they also give us more open-ended opportunities to identify the problems that parents are dealing with. Sometimes parents just bring things up. So, they get a good sense of what’s happening and what’s not working for people.”