Patients, families become partners when institutions practice family-centered care
Patients, families become partners when institutions practice family-centered care
Model focuses on participation, collaboration, and information sharing
When staff at MCG Health worked on new protocols for patient codes, such as the code to indicate a patient was in cardiac arrest and required cardiopulmonary resuscitation, two patient and family advisors were on the code team. One was the husband of a cardiac patient with frequent hospital admissions who had coded seven times and survived.
Now, the protocol for CPR includes a place at the bedside for a family member with a place next to him or her for a support person from the code team. Of course family members aren't required to be at the bedside when CPR is administered, but they aren't kept from the room, either.
This change in policy is part of ongoing revisions that take place within a facility that practices patient- and family-centered care. Patient and family advisors are routinely included on committees so their perspective helps shape policy, says Patricia Sodomka, FACHE, senior vice president of patient- and family-centered care at MCG Health in Augusta, GA, and director of patient- and family-centered care at the Medical College of Georgia.
"You know the phrase 'nothing about me without me?' We take that seriously; so in our policy formation, in our practice development, in our operational divisions of care, someone from the patient's perspective is there so there is 'nothing about me without me,'" explains Sodomka.
The Institute for Family-Centered Care in Bethesda, MD, defines the concept of patient- and family-centered care as: "An innovative approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care patients, families, and providers. Patient- and family-centered care applies to patients of all ages, and it may be practiced in any health care setting."
It has four core concepts that include dignity and respect, information sharing, participation, and collaboration.
The concept of participation is clearly demonstrated in the policy at MCG Health to include a family member at the bedside when a team is trying to save the life of a patient. The Institute for Family-Centered Care defines the concept of participation as: "Patients and families are encouraged and supported in participating in care and decision making at the level they choose."
When the four concepts are implemented, dramatic changes from the traditional health care model can take place.
One way The Children's Hospital of Philadelphia addresses the concept of dignity and respect is to make sure family members as well as staff members have access to interpreter services at all times. Signs and materials in 10 different languages inform patients and their family members if they want to have a conversation with a clinician in the language they prefer they can take a card provided to request the service to any staff member for help.
"That tells patients from the beginning we are here to support what is best for you. That is a very basic dignity and respect factor," says Michele Lloyd, senior vice president of patient operations at The Children's Hospital of Philadelphia.
Dignity and respect is defined by the institute as: "Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs, and cultural backgrounds are incorporated into the planning and delivery of care."
"For the past several years, we have had an initiative as part of family-centered care called cultural effectiveness, and it is aimed at ensuring that families of diverse backgrounds, belief systems, and makeup all receive the same excellence in care, service, and communication," Lloyd says.
Full involvement pinpoints needs
Initiatives such as the cultural effectiveness program are driven by patient and family involvement. Lloyd says the family advisory council at The Children's Hospital of Philadelphia is asked on a daily basis to identify family members who can join a project, attend a staff meeting, participate in a task force or become part of a committee.
Beverley H. Johnson, president/CEO for the Institute for Family-Centered Care, says collaboration is at the heart of the family-centered care approach. The institute defines it as the inclusion of patients and families on an institution-wide basis. "Health care leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in health care facility design; and in professional education, as well as in the delivery of care."
To provide opportunities for collaboration, the University of Washington Medical Center in Seattle has a patient and family steering committee that determines what programs are deployed hospitalwide. In addition, four patient and family advisory councils oversee a composite of certain service lines, such as those involving childbirth, like the prenatal clinic, and labor and delivery.
At least two patient and family advisors are assigned to operating committees as well. Currently, 15 committees have advisors as members. This includes the patient and family education committee, safety committee, ethics committee, and grievance committee.
A special committee, called an esthetic committee, helps create a healing environment at the medical center by addressing such things as noise, clutter, and signage. The committee is working with the safety committee on the installation of hand-washing kiosks at main entrances. The members are helping create welcoming, non-alarming signs that encourage visitors to wash their hands before visiting friends and family in the hospital and to reconsider the timing of their visit if they have a cold or a cough.
The involvement of patient and family members helps improve the care experience, says Cezanne Garcia, MPH, CHES, associate director for patient- & family-centered care and education services at the University of Washington Medical Center and a faculty member of the institute for family-centered care.
For example, at the prompting of patient and family members on the inpatient cancer council, room service was implemented so patients could order meals from menus specific to their dietary needs. In this way, they never had to worry about coming back to their room from a procedure to a cold meal or being served while battling nausea.
"Sometimes patients and family members bring forward improvements they have identified and would like to see happen. There are also initiatives such as the proposed expansion where we invited advisors," says Garcia.
Ensuring patients have the facts
A fourth component in patient- and family-centered care is information sharing. The institute's definition for this concept is: "Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decision making."
While patient education encompasses all the components, information sharing is particularly focused on patient education. To improve access to information, one of the first things The Children's Hospital of Philadelphia did was develop a family resource center with paid librarians and staff.
The University of Washington Medical Center initiated a kidney early education program called KEEP, because patients with renal disease who were approaching the stage when they would have to go on dialysis wanted more information about this complex lifestyle change.
Patients partnered with an interdisciplinary team to design a six-week class facilitated by patient advisors, with clinicians as guest speakers. During this series of classes, patients on dialysis talk about their experience and answer questions from the audience members who are nearing that stage of their treatment, says Garcia.
Yet information is not limited to teaching materials and classes. It is also shared when health care professionals discuss a case. It is important for patient and family members to have the opportunity to participate in areas where information is shared, such as the process of rounds, says Johnson. However, such practices can be met with staff resistance.
"Who helps patients come home from the hospital and manage their chronic illness but in fact family members, and we discourage their presence; we don't work in including them as part of the conversation so they can really help keep their loved one out of the hospital," says Johnson.
According to Sodomka, allowing patients and families to be part of the health care team can be difficult for staff members who worry about such matters as malpractice litigation. Yet openness usually provides a greater understanding of the medical situation and reduces the likelihood of being sued.
She says the neuroscience unit at MCG Health was designed and built with full participation from patient and family advisors and care is provided in partnership with families.
They have observed from data collected that medication errors have dropped 60% and the length of stay for neurosurgery patients has been cut 50% since this new model of care was implemented.
"It is logical that when families are welcome to be in the room and you invite their observations, they are more likely to bring a medication error to your attention and you are more likely to hear it," says Sodomka.
Patient- and family-centered care is important because when health care is practiced in a collaborative way that truly engages patients and families, the result is better health outcomes, says Johnson. In addition, institutions make better use of scarce resources because patients can manage their care more effectively and don't overuse emergency departments. Also it improves patient satisfaction.
Clinicians find their work more satisfying as they gain confidence in partnering with patients. "It is really a win-win situation for everyone," says Johnson.
(Editor's Note: To learn more about patient and family-centered care visit the following web sites: Institute of Family-Centered Care: www.familycenteredcare.org; American College of Physicians: www.acponline.org/hpp/adv_med.pdf.)
Sources
For more information about patient- and family-centered care and its implementation, contact:
- Cezanne Garcia, MPH, CHES, associate director, patient- and 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: [email protected].
- Beverley H. Johnson, president/CEO, Institute for Family-Centered Care, 7900 Wisconsin Ave., Suite 405, Bethesda, MD 20814. Phone: (301) 652-0281. E-mail: [email protected].
- Michele Lloyd, senior vice president of patient operations, The Children's Hospital of Philadelphia, Philadelphia, PA. Phone: (267) 426-6974. E-mail: [email protected].
- Patricia Sodomka, FACHE, senior vice president, patient- and family-centered care, MCG Health Inc., director, patient- and family-centered care Medical College of Georgia, Augusta, GA. Phone: (706) 721-3924. E-mail: [email protected].
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