Profiles of Patient and Family Advisors and Leaders
Essentia Health Patient Partner: Wade Roseth
Two remarkable events took place in Wade Roseth's life in 2008: he became a member of the Essentia Children's (Duluth, MN) Family Advisory Council and had a pulmonary embolism.
Wade has Factor V Leiden, a hypercoagulability disorder. During the acute phase of Wade's pulmonary embolism, Wade, who was away from home, called and described his symptoms to his primary care physician (PCP). The PCP told Wade to drive over 80 miles to the PCP's office to be treated. Wade's PCP did not involve Wade in creating his treatment plan and did not remember that Wade's dad had died at age 61 from similar circumstances. Wade grew concerned that his primary care physician was not paying attention either to him or to his disease, which required a hospital readmission and lifelong treatment to prevent a reoccurrence, and, as a result, Wade felt forced to reconsider his medical care.
Wade consulted with another physician who asked Wade, upon their first meeting, "What do you want to accomplish in your life?" Wade realized that what he wanted was to be actively involved in his daughter's up-bringing; he wanted to be alive and healthy for as long as possible so that he would some day be involved with his grandchildren! That realization made him switch his PCP, and in 2008 Wade had a new physician and a membership on the Duluth Children's Family Advisory Council.
Since Factor V Leiden is hereditary, Wade and his wife, Lisa, who are both actively engaged in their daughter's health care, went to talk to their 8-year-old daughter Alexis' pediatrician, Dr. Gordy Harvieux. They discussed the disorder with Dr. Harvieux, who then referred the Roseths to a pediatric hematologist. It was determined that Alexis also has Factor V Leiden. Dr. Harvieux suggested that Wade apply to become a member of the Duluth Children's Family Advisory Council, which he did.
Wade's experience led him to believe that the patient must be at the center of the health care team's decision-making. He believes that patient literacy and engagement are key issues that need to be addressed for a care team to succeed.
Since 2008, Wade Roseth has participated as a patient partner with five groups at Essentia Health.
Duluth Children's Family Advisory Council
From 2008-2010, Wade sat on the 19 member Duluth Children's Family Advisory Council—a network of 4 health care providers and 15 family members committed to providing coordinated, consistent, family-centered primary care to children and their families throughout Essentia Health*, formerly St. Mary's Duluth Clinic (SMDC). The council's function was to enhance the quality and safety of ambulatory primary health care for children and their families.
As part of the council, Wade worked with a mentor, an Essentia Clinic Director, to learn how to tell his story in a concise and interesting manner. "Initially", he said, "I took too long and over-told my story with too much minutiae." The Council provided a safe environment for dialogue and story telling that facilitated his becoming "impactful." His mentor directed him to limit his story to 3–5 minutes and to end his account with, "If I could leave you with just one thing..." Wade reiterates, "If you tell your story and ask the listener to act on only one thing, you are more likely to get cooperation and understanding than if you talk for too long without a primary request for action."
During his two years on the Council, Wade and other council members provided advice that fostered the following changes in the pediatric clinic, as well as in the waiting room of the Emergency Department, and in patient hospital rooms:
- Parents are at the side of their child's bed in emergency, pre-op, post-op and hospital rooms 24 hours/day, 7 days/week.
- Families are actively engaged with their child's health care decisions.
- Physicians and nurses turn computer screens towards family members and children while reviewing information and speak to the family and not the monitor.
- Families are included in hospital rounds. The schedules of family members are taken in consideration to ensure that the family can participate in the discussions.
- The Starlight Cafe was created to serve children friendly meals for the pediatric patients.
- The safe-hold procedure was implemented, wherein two nurses administer medication together; one nurse administers the injection while the other sings, talks, or otherwise distracts the child.
- Scales are in every exam room, allowing family members to remain together in one room during the visit, rather than having to go to another location to be weighed.
Wade and Lisa witnessed all these changes first hand, when on New Year's Day, 2012, Alexis had an appendectomy. The Rosethes remained at Alexis' side throughout her hospitalization. Alexis, and her parents were actively involved in the discussion about the decision to operate, speaking directly with the surgeon and the anesthesiologist. Alexis' parents were with her during the preoperative and the post acute care phases of her hospitalization. Alexis and her parents participated in nurse change of shift at the bedside and physician rounds.
The Rosethes knew that if they stayed by Alexis' side during her hospitalization that she would get "better, quicker." They believe that health care is a partnership and joint effort of patient, family members, nurses, doctors, and other health care staff to help their daughter feel better and recover. Alexis and her parents participated in nurse change of shift at the bedside and physician rounds.
Essentia Primary Care Delivery Model Task Force
their pet dog, Bryn
As a patient leader, Wade provided the patient perspective in creating an Essentia model for Primary Care Delivery by advising the task force on how to incorporate patient-and family-centered care principles in decisions related to the Strategy Map, role definition, responsibilities, linkages, and health care transitions. The objectives of this task force are to improve the health of the patient population through enhancing patient care, quality, access, and reliability. An additional outcome of the model is to reduce or control per capita cost of care.
This model provided guidance for the Patient-Centered Primary Care (PC2) Steering Committee and the Department of Primary Care for Essentia.
Patient-Centered Primary Care (PC2) Steering Committee
In 2010, Essentia Health developed the Patient-Centered Primary Care Steering Committee and Wade has been an active participant since its creation. The committee provides strategic oversight of the Health Care Home (also known as the Patient-Centered Medical Home) in order to optimize clinical outcomes for all patients through the partnering of prepared, proactive teams and informed activated patients.
The following are examples of the work of the committee:
- Discussed the implementation of quality efforts such as home blood pressure monitoring policy and process, standardized laboratory workflows, chart scrubbing, follow up appointments and diabetes summaries.
- Reviewed monthly quality reports for diabetes, cardiovascular care, depression, childhood immunization, body mass index, colorectal and breast cancer screening, and anticoagulation.
- Reviewed reports of risk stratification to ensure continuity of service.
- Created CCP registries for high-risk patients who receive care coordination. Discussed the title for Care Coordination position and advise Essentia on patient communication related to CCP.
- Discussed and approved the implementation of the Asthma Process Excellence project along with other Process Excellence projects related to primary care.
- Reviewed and approved recommended standard workflows.
- Established the Primary Care Patient Advisory Council and Patients as Partners programs.
- Discussed and promoted MyHealth, Electronic Medical Record projects.
- Discussed and reviewed the State Health Care Home Certification site visit by Minnesota Department of Health.
- Discussed how team interacts and roles of team members.
Department of Primary Care, Essentia Health Medical Group
Wade is one of two patient members who provide the patient perspective at the Department of Primary Care monthly meetings. This Essentia Health Medical Group is responsible for the governance of all clinical operations within the Department of Primary Care, which includes Family Practice, Internal Medicine and Pediatrics. The following items are the focus of this group's discussion and activities:
- Distribution of Evaluation Plan for Primary Care Model.
- Establishment of RN care coordination structure.
- Discussion of Quality Measures: status of report production, distribution and data reliability.
- Moving to standard appointment length.
- Implementation of Essentia Primary Care Delivery Model.
- Development of new strategic initiatives for the organizations fiscal year work plan.
Primary Care Patient and Family Advisory Council
As a patient leader and partner, Wade is a co-chair of this council with Amy Vanderscheuren, Essentia's Coordinator of Patient- and Family-Centered Care. He, with co-council members who represent patients from clinics in northern Wisconsin and Minnesota, assisted in developing the charter and criteria for membership on the councilThe council meets monthly to work on shared agenda items that, when acted upon, supports the culture of Patient- and Family-Centered Care across all the Essentia Health facilities. For example:
- Public display of quality measures—transparency initiatives began with public displays of quality information in the lobbies of clinics in downtown Duluth, Brainerd, and Fargo and in the lobbies of three hospitals: Essentia Health—St. Mary's Medical Center in Duluth, Essentia Health-Fargo and Essentia Health—St. Joseph's Medical Center in Brainerd.
- Initiation of Chronic Disease Group visits-diabetes visits in Ashland
- Launch of Process Excellence program—Process Excellence is a structured approach to improving quality, operational effectiveness, and the patient experience. Projects included are Rooming Optimization and One Touch Resolution, a system that allows patients to get their service request or question answered in one call.
- MyHealth organization strategic initiative makes it easy and convenient for patients, 24 hours/day, 7 days/week, via a secure on-line portal to:
- Review their medical history, including medications, test results, and immunizations;
- Send an e-mail to their doctor's office;
- See lab results in just a few hours; and
- Request an appointment online.
- "No Change Zone"—physicians make a pledge to scheduling appointments without changing anyone's appointment.
- Team-Based Care—team definition, team member roles and team-based communication.
- Patient Accounts—billing statements discussion led to a process excellence project.
- VIBE—"Values I Bring Every Day" discussion-conducted to help define Essentia health culture.
Patient Partners—including Wade—provide valuable insight on most aspects of operations. Wade has had the pleasure of working with many of the 180 plus patient partners at Essentia. Their feedback has resulted in changes to everything from appointment scheduling to the physical design of hospitals and clinics. Patient Partners are also becoming advisors on day-to-day operations through participation in clinic and hospital department meetings. One testament to the effectiveness of this voluntary program is that physicians and managers have begun requesting Patient Partners for their departments.
Over time, Wade anticipates that Essentia HealthCare partnerships will grow from 15 councils to more than two dozen. He foresees a day when patients will be involved in every part of the system, from food service and billing, to research and marketing. The success of these partnerships depends on the willingness of Essentia, patient and family members to work together to make health care more patient and family centered.
Wade received a BA in chemistry, BS in biology and Master in Environmental Health and Safety from the University of Minnesota-Duluth, along with an MA in Management from the College of St. Scholastica. He has served as an Occupational Health professional for three organizations including Texas Instruments, Boise Cascade, and Minnesota Power. He has also served on Planning and Technical Committees for the Minnesota Department of Health, American Industrial Hygiene Association, and the Minnesota Safety Council.
Wade teaches at the graduate level for the University of Minnesota-Duluth and undergraduate level for Duluth Business University (DBU). He also has taught at the graduate level for The College of St. Scholastica. He prepares students for professions in management, occupational health, and medical and veterinarian technical fields.
Wade lives in northern Minnesota with his wife Lisa of 16 years and daughter Alexis. They travel in the United States, Canada, and Europe to experience different cultures. He enjoys boating, fishing, and upland game hunting with his Labrador retriever, Bryn.
* Essentia Health is an integrated health system, serving patients in Minnesota, North Dakota, Wisconsin, and Idaho. In the summer of 2010, Essentia Health brought together the operations of St. Mary's Duluth Clinic Health System, Brainerd Lakes Health, Innovis Health, Essentia Community Hospitals and Clinics, and the Essentia Institute of Rural Health.