First, we want to thank you for getting this far on the journey. Please pause to acknowledge your efforts. We hope it has been fun, manageable and rewarding. By now you’ve:

✔️Agreed to champion the inclusion of patients as partners

✔️Gained leadership approval to plan partnerships to influence the work

✔️Raised awareness of the mission to promote patient influence

✔️Supported your team as they reached out and engaged patients as partners

✔️Found at least two patient partners to join your team!

You have led the team to a significant milestone. It is time to welcome and orient everyone to working together on the quality improvement trail. Step Four will involve planning thoughtfully for everyone’s understanding of what is needed to ensure that your team has F.U.N. together to begin reaping the rewards of working together

There is one word which may serve as a rule of practice for all one's life - reciprocity.

Confucius

A note from the authors about reciprocal relationships:

A diverse team whose perspectives and backgrounds vary will benefit from spending quality time being oriented to the joy and benefits of reciprocal relationship development. We discovered that by identifying shared values and common goals and establishing personal human bonds our team fostered trust. By being welcomed to the team as equivalent partners we saw each partner’s presence as valued and contributing to a respectful collaborative approach. Being asked to share lived experiences relevant to the team’s work was transformative for everyone. When we saw that others fully understood and were learning from our contributions and systems could change, our expertise, wisdom and presence was validated. This supported our confidence. Seeing a meaningful and positive impact of our contributions on the work, motivated our commitment and strengthened our ability to participate fully. When we voiced our needs and were met with kindness and appreciation we were inspired to continue learning, listening, and contributing. Structured facilitation for relationship development, orientation to the team and the work was instrumental in our ability to have a trustworthy, productive, rewarding, and meaningful team experience.

Belonging on the team

Team members will be inspired to continue bringing their best when they sense they belong, and their contributions are valued. It will help ease any concerns about belonging if new team members are included in planning, iterative discussions, and encouraged to ask questions, make comments and suggestions. If the actions of the team are in response to the needs and desires of the team members, their presence will have increased meaning and value. The results will reflect what matters to all team members.

Consider ways your team can invite PPs to influence the work: ✓

⬜ Listen to, understand, and respond to the system challenges and limitations you face

⬜ Collaborate to innovate new resources for patients and providers

⬜ Reveal how patients, families and community members can help

⬜ Encourage person centered medicine

⬜ Share patient preferences, needs, hopes, questions

⬜ Educate you about what matters most to patients

⬜ Reveal personal wisdom and insight from lifelong navigation of health systems

⬜ Share stories about lived experiences that inform your learning

⬜ Reveal what is needed between healthcare visits

⬜ Support team collaboration

⬜ Encourage innovation

⬜ Help you improve communication and relationships with patients and the community

On Being Disruptive

Quality improvement means changing the status quo. Patient Partners are on the team and must often find it necessary to be "disruptive" in order to help change the status quo. And yet they must also fit in to influence the team. This is a conundrum for everyone who works towards transformation. It is the job of the team to desire change and accept the insight offered with grace and a spirit of co-learning that may help transform health outcomes for patients.

About Engagement

It’s Bi-Directional

Successful engagement is a bi-directional learning and reciprocal relationship building effort. If participation needs and barriers are addressed, successful engagement and full meaningful participation can occur. Conducting needs assessments and/or personal check-ins regularly will allow system adjustments that might meet everyone’s team experience expectations. Discuss the results of needs assessments together by using the facilitation resources included in this guide to support your team as you establish, maintain, and sustain reciprocal relationships among diverse stakeholders.

Anticipate Barriers to the 7Ss Before They Arise

Real or perceived barriers to participation are normal and can be prevented if participation needs assessments are conducted regularly. Before beginning the project, conduct an affinity diagram exercise with the team to consider all possible participation barriers and how to address them together. This type of inclusive and collaborative upfront planning, discussions and conversations demonstrate that your team will work together to discover solutions to team problems and barriers to a team member’s ability to participate. The knowledge that flexibility, kindness and resources are available to prevent or eliminate obstacles goes a long way towards establishing strong reciprocal relationships between partners.

The Buddy System will also enhance team success and individual participation. Pairing each member of the team with a supporting partner can help prevent and prepare the team for challenges that arise along the way. These dyads can be rotated based on the timeline for the project.

The 5Rs of a Team

The 5Rs of your practice: Roles, Requirements, Responsibilities, Resources and Respect

Create the 5Rs resource directory together for improved engagement. The 5 Rs worksheet can be a simple framework to support learning and collaborative development while you conduct the clinical tour for new team members.

Provide a Clinical Practice Tour

New team members will need to see operational details of your clinic from the “backstage view” before they can begin working effectively with you on the IBH-PC-Initiative. If possible, tour the clinic during a time when the clinic is in operation so PPs can observe practice members in action. Use this time to inform how the work you are planning may impact patients as well as the operational aspects of the clinic. Encourage your new partner to take notes.

Welcome New Members

People keep showing up when they feel welcome, and logistics for participating are clear and accessible. To set a tone of inclusiveness and equity, respond with appreciation to new team member’s requests, questions, comments, and logistical needs. Continue to encourage everyone on the team to maintain this culture of compassion and helpfulness to strengthen participation and confidence. Welcome grows into belonging, then into confidence when a new team member feels they are in the right place.

Establish Meeting Norms and Rules of Engagement

Not all new team members will have the same comfort level for the healthcare working environment. Facilitate discussions on the working environment with the entire team to demonstrate a strong interest in their perspective. Allow everyone to practice establishing trust through shared values and accepting different views. These reciprocal relationships are critical to the decision making your improvement team will make in the future.

Conduct facilitated activities to help establish rules of engagement and meeting norms.

The 3 Cs of Engagement:

Communication, Confidentiality and Contracting

Team Communication

A new role represents a rare opportunity to speak up and make a difference. PPs who join quality improvement work must be kept in the loop to stay informed and participate meaningfully. Information on all aspects of the initiative must be shared openly and transparently with all members of the team throughout all stages. Use a virtual communication platform to connect and learn with your partners through online conversations. Act on contributions by bringing concerns, ideas and suggestions to the group for further understanding and discussion. Be sure to conduct technology needs assessment to determine the training required for all team members.

Provide structured methods for all team members to provide an appreciative and personal response to initiative plans, goals and tasks. Establish trust by involving PPs genuinely in decision-making. Do this synchronously during meetings or asynchronously on a virtual communication platform such as Basecamp, Teams or Slack. Emails are not always appropriate to address productive conflict or for discourse between meetings.

Note: PPs may need time to observe before speaking up, especially if traditional power dynamics or social biases are inherent in the culture or the pace, language, or methods used for is new. Prompt new partners for their insight as much as possible but stay tuned to signs of disengagement. (Silence, harsh criticism, anger, withdrawal).

Open and transparent communication skills if modeled and practiced can build powerful reciprocal relationships. Practice the art of humble and appreciative inquiry with topics that matter to everyone one Facilitated exercises allow all voices to be included and can help everyone enjoy the process and build sustainable reciprocal relationships. Everyone can have F.U.N. if you prepare for the journey together!

Confidentiality Training

You may be required to hold a HIPAA training session with new team members in person or online. If possible, to save time, invite new team member to view any learning content at home in advance of the session and use in-person time to discuss learning objectives together about what matters most to team members regarding confidentiality. This can be a critical team building activity. Bringing up an important topic in a safe and structured way gives everyone a chance to learn from each other’s perspectives and hear lived experiences that highlight the importance of the topic. Facilitating the conversation to hear all views will help establish trust, share common team values, and develop common goals.

Contracting

Ensure that all team members are clear about the expectations, team norms and rules of engagement developed during facilitated group processes or via one-on-one conversations. Encourage accountability to upholding the ethics and values that are developed by the team by creating personal contracts that support reciprocal relationship behaviors. Keep any contractual language respectful and non-punitive to foster co-learning, trust and mutual agreement. Hold structured orientation sessions with the entire team that promote team building, communication skills, valuable team norms, rules of engagement, the human bond and relationship strengths.

Providing Opportunities to Speak up and Share Wisdom

Create a Regular Process

Asking for insight and wisdom allows meaningful reflection on new perspectives. PPs can help you gain insight on the impact of your actions and on what goes on outside of your view. How patients are managing their health conditions at home can help the team validate or innovate new clinical resources. Allowing time for the PP experience to be clarified, and fully understood can begin building relationships with your patient community. Reflecting what is being learned from each story can be transformative.

Acknowledge Value and Impact

The insight and wisdom that the lived experience contributes to everyone’s learning must be acknowledged. Listening deeply will help the team discover the true gems inherent in the stories shared. Deepen engagement by reflecting what you learn and acknowledging appreciation for the courage it takes to share the valuable patient, provider, or staff perspective.

There are endless topics that you may be interested in eliciting for the patient perspective:

• The burden and/or stigma of illness and injury

• Health care quality

• How treatment options impact patients and families

• Gaps that exist in care and services

• Ideal health care experiences

• What research may be important to patients

Guided storytelling can nurture relationships among team members by developing a deeper understanding and appreciation for each other’s views, perspectives, and priorities.

Guided Story Telling: The Shared Lived Experience Process

Facilitate the sharing of lived experiences on your team by using the Shared Lived Experience process.

Staying Steady as We Go

New Perspectives

Patient Partners will bring life experiences from working outside the clinic in other fields. This “breath of fresh air” may evoke new ideas, new visions, and new methods of collaborating effectively. Encourage all team members to build a more culturally aware and appreciative environment for welcoming diverse perspectives, backgrounds and voices.

Follow the Follower: Shifting leadership to team-based collaboration can help everyone slow down and pay closer attention to those who may not be as fast or as well informed. Allow time for clarifying confusion, acknowledging learning curves and maintaining a safe and steady pace for all team members. Pause and walk alongside new members of the team to find out what impact the journey is having on their ability to participate. When this congruence occurs “teamwork becomes the dreamwork”.

Appreciation and Celebration

Make this a regular moment during team meetings. Life is too short to skip the good stuff. Provide opportunities to express self-compassion and demonstrate examples of life/work balance to demonstrate value for critical health and wellness behaviors.

Food and Timing

Yes, food! Nourishing food is a huge draw for making meetings more engaging and for developing the human bond. If you must be virtual, allow time for self-disclosure, laughter and joy to be infused into the meeting.

Regular Check-ins

Remember, everyone needs a buddy on a new adventure or long journey. Assigning dyads or buddy teams comprised of diverse perspectives and scheduling regular check-ins for them will allow for confidential conversations, and co-learning about topics that can be very relevant to the initiative.

Collaborating for patient health brings a deeper understanding of what truly matters.

PPs who show up, stay informed, speak up, share wisdom and insight and stay steady as you go, will be able to play a positive role on the team. By acting quickly and revisiting the elements in the 5S checklist, you can make gentle adjustments and learn together about what is fundamentally understood to be needed. Have F.U.N together! Please remember, moments of uncertainty and surprises are to be expected but will be worth it if it helps redirect medicine towards more patient and person-centered team-based care which are filled with life enhancing practices that support all people’s ability to thrive and flourish.

Take frequents pauses to take in the view together as you go……

"One can never consent to creep when one feels an impulse to soar"

-Helen Keller

To access the tools for Step 4 please click on each link below. Once you arrive at the link, click file to either download or make a copy, rename and save to your google drive.

Here’s a list and live links for all Step Four tools:

4.1-Checklist and Timeline for Step 4

4.2-The Dyad System

4.3-Materials list and order of delivery

4.4-Invitation to Practice Members to Welcome PPs

4.5-Checklist for Conducting Orientation Sessions

4.6-Enrolling in the IBH-PC Initiative Canvas Courses

4.7-IBH-PC Learning Community Forum Sign Up

4.8-IBH-PC Patient Partner Handbook

4.9-IBH-PC Glossary of terms (with suggested definitions)

4.10-The 5Rs of Clinical Resources Directory worksheet

4.11-Team Engagement Exercise: Beyond our degrees and diseases

4.12-Sharing Information with Stakeholder for Critical Response

4.13-Personal Contractual Language

4.14-PPG Partnering PowerPoint-The challenges and rewards of partnering

Here’s a link to a google drive folder of all Step 4 tools.