Partner with patients and families for education

How one educator involves families in care

As associate director of patient and family centered care and education services at the University of Washington Medical Center in Seattle, Cezanne Garcia, MPH, CHES, directs and facilitates a broad range of patient- and family-centered care, quality improvements, and patient education programs.

"My work focuses on how we can actively engage patients, families, and staff in collaborative partnerships to improve the care experience," says Garcia.

The goal is to bring the best patient education resources and processes to the fingertips of clinicians who are primary educators and to put in place processes that elicit patient and family involvement on quality improvement initiatives and operating committees so there is a complete interdisciplinary team present to make the best decisions.

Currently there are 18 committees on which patient and family members sit. These include the ethics committee, grievance committee, patient safety committee, and patient and family education committee.

The medical center is part of the University of Washington campus. Each year 18,000 to 20,000 patients are hospitalized and about 350,000 people are seen as outpatients.

Patient education is part of patient care services that includes nursing, therapies, social work, and interpreter services. Garcia reports to the nurse executive officer and the director of professional practice and quality improvement.

Her team includes three health educators who work part-time, a part-time production coordinator, an hourly graphic artist, a program support supervisor, and a part-time program coordinator.

Two of the health educators act as project managers for material production, from videos to written items. They also train staff on health literacy and communication. A third health educator was recently hired to oversee a health resource center that is opening in the main lobby. It is linked to six small libraries located throughout the clinical care areas.

The production coordinator helps manage the database of written materials distributed via the Intranet and does simple design and layout of posters and other signs. The graphic artist illustrates patient education materials.

The program support supervisor helps with office management, budget reconciliation, and departmental marketing and communications initiatives (e.g., newsletter, patient and family education toolkit, etc.).

The program coordinator helps manage projects, oversees councils, and recruits people for the patient and family advisor program.

Garcia states that it is the capabilities of her strong team, interdisciplinary committees, and patient and family advisors that keep activities in pulse with "point-of-care needs" and able to adapt to the constantly changing health care and patient and family care system needs and demands.

Garcia has been in her current position for 11 years. With a master's in public health and health education and a minor in health policy, she has held a variety of jobs including work as a senior health planner for the Navaho Nation. The patient/family-centered care work that is now part of her position is a new branch the medical center added in the past four years.

In an interview, Garcia, who also sits on the editorial board for Patient Education Management, discussed her job, her philosophy on patient education, the challenges she has met, and the skills she has developed that help her do her job well.

Family-centered care best success

Q: What is your best success story?

A: We now have 12 patient and family advisors who review our patient education materials and family-completed forms. They make sure the forms are easy to understand and have adequate space for people to write in their comments and the education materials are clear and understandable and that we address the key issues important to patients and families.

Additionally, we are engaging patients and families in the authorship of our larger publications, which are booklets or manuals of 15 pages or more. We work to have advisors on the writing/planning teams and when that is not possible we use surveys and send draft versions and core objectives to patients and their families to ask for feedback. Also, we send the tool out to patients after clinicians have done the final review. There are some tools in which the patients and families have been the main authors.

We have engaged our patients and families as faculty to help clinicians understand what is most important in the care experience.

Q: What is your area of strength?

A: To design, implement, and then continually refine organizational processes that address clearly defined objectives and goals, but are refined so they are as efficient as possible and bring forward the best quality product.

The skill that augments that is the ability to see the organization from point of care to the big system pieces. I am able to migrate up and down from those differing perspectives and try hard to bring forward the best work.

Q: What lesson did you learn the hard way?

A: Patient and family involvement in designing educational programs and materials requires a thoughtful and steadfast focus on culture change. Many of our clinicians are so oriented to what is needed for a technically competent care experience, but this also needs to be abridged with information that highlights the functional and emotional support needs of our patients and families.

The integrity of our efforts must include securing clinician and administrator commitment to not only listen, but hear and guide their actions to reflect patient and family-defined needs — not our translation of what "we" think they need or serves our system-centered or clinician-centered lens alone.

Q: What is your weakest link or greatest challenge?

A: Our greatest challenge is limited resources to support the growing programs and patient and family education needs of our clinical teams. The bottom line is having resources invested in the frontline clinical piece, where we give the time staff need to provide patient education and all the support functions such as documentation. We continue to groom systems so that with a click of a button on the computer they have material to reinforce verbal education or streamline the documentation as much as possible.

Q: What is your vision for patient education for the future?

A: To change it to patient and family education rather than just patient education; I think family involvement is often assumed but not directly engaged. In some areas with decreased length of stay we are increasingly sending patients home with family members or trusted friends who are providing clinical care.

Part of my vision is for us to robustly address and engage our patient and family members in our education and directives. We also need to more actively demonstrate our positive contribution to our organization's outcomes, whether clinical care, patient satisfaction, financial goals, patient safety (reduction of medical errors), or marketing strategies. There is a lot of opportunity to show how we demonstrate our integration with the financial goals and safety mission of our organization.

Q: What have you done differently since your last JCAHO visit?

A: Our last visit with the Joint Commission on Accreditation of Healthcare Organizations was about 18 months ago. We did very well in the patient education area and have not made any profound changes. We are continuing to direct our organization toward demonstrating the education provided by the use of documentation practices. We also are continuing to grow ways our patient and families are active partners in the care experience.

Q: When trying to create and implement a new form, patient education materials, or program where do you go to get information/ideas from which to work?

A: We talk directly with our patients and families and with the staff and try to engage as many of the interdisciplinary team members as we can. Also we go to the literature and do searches to see what is the best evidence-based practice. My strategy is to tear copies of articles and features from publications and file them according to specific diseases, processes, or skills, so that when I am working on diabetes, for example, I pull my folder out and see what I already have or what was culled from an earlier literature search. I have one general articles drawer and another that is more skills-based.


For more information on patient-centered care and other topics discussed, contact:

  • Cezanne Garcia, MPH, CHES, Associate Director, Patient & Family Centered Care and Education Services, University of Washington Medical Center, 1959 N.E. Pacific St., Box 358126, Seattle, WA 98195-6052. Phone: (206) 598-8424. E-mail: