In 2012, leaders at Health Central Hospital in Ocoee, FL, were concerned that the patient voice was not heard and thought overall patient care and satisfaction could be improved by listening to them more. They created a patient and family advisory council (PFAC) to ensure that patients and family members were included in all hospital operations.
Patient and family advisors (PFAs) now are a key part of hospital operations, participating on 12 hospital committees and conducting more than 11,000 patient experience visits a year. They donate 7,000 hours each year, which the hospital values at $158,900. More than 90% of the donated hours involve PFA patient rounding, in which the volunteers observe key interactions between clinical staff and patients and family members and round on patients in the hospital and ED. (For more information on creating a PFAC, see the story on page 104.)
Their immediate goal is to identify unmet needs, but they also gather information that will help guide policy and practices for future improvements in patient care, says Christina McGuirk, MSHA, BSN, RN, NEA-BC, CENP, chief nursing officer at Health Central Hospital.
The effort began in 2010, when hospital leaders heard anecdotal feedback from patients and family that was not encouraging. They invited patients, family members, and community members to come in and discuss their concerns about the hospital, says Bibi Alley, patient experience consultant at the hospital.
“Sometimes it’s hard to see the trees for the forest, so when you sit behind a desk you don’t really know what’s going on in the trenches,” Alley says. “After several focus groups and other meetings over a couple of years, we weren’t seeing improvement in the comments, so we did some research into the ways we decided to form a patient and family council that reports to our board. We train them as a new team member, onboard them like anyone else joining the organization, and welcome them as part of this hospital.”
Variety of People Selected
Participants are first invited by the hospital to join the council and then must undergo a background check. Health Central invites a range of people from different demographics and experiences with the hospital so they can bring a variety of opinions and ideas, Alley says. Potential PFAC members also may meet with McGuirk, the hospital president, and the chief operating officer.
“It’s almost like an interview, where we’re trying to get a sense of their background and we’re trying to think where they might have the most impact in our operation,” McGuirk says. “But they’re interviewing us, too, because we want them to start finding out who we are as a hospital, our goals, and see if this is a good fit for them to do volunteer work.”
Volunteers are trained in HIPAA and other compliance issues before they are allowed access to patient areas.
The PFAs can spend more time with patients and family than clinicians sometimes can, McGuirk explains, and they relate with fellow patients and family members in a different way. Patients and family members will sometimes be less intimidated when talking with a PFA and disclose important information or ask for help that they didn’t want to request from the doctor or nurse.
Alley points out that people recruited for a PFAC all will come with their own agendas, borne of their prior experience with the hospital. Those desires can be useful for identifying problem areas, but be aware of personal agendas and make clear the overall goals of the PFAC, she advises.
Rounding Has Big Impact
PFAs can be assigned to specific projects within the hospital, but Alley always asks new volunteers to simply visit the hospital and give their first impressions.
“They told us things like how they came to the hospital and had no idea where to park. The parking lots had no differentiation or indicators where you should park depending on why you were at the hospital,” she recalls. “That was not a good introduction to your hospital experience, so we decided to color coordinate the parking areas. That’s how we began our journey, looking from the outside at first impressions — the parking, signage, everything.”
But the biggest impact came from having the volunteers round on the floors, Alley says. Introduction of PFAs has been credited with a reduction in patient falls and improved patient experience scores regarding staff concern for privacy, McGuirk says.
“They bring a different eye and ask questions we wouldn’t think of, or they see things in a different way,” McGuirk says. “We involved them in a project to look at the whiteboards in patient rooms and how we use them, looking for ways to revise that. We got feedback from clinicians, but then we put them in front of our PFAC members and they helped us identify how information was not clear to them. That had a big influence on the way we currently use whiteboards.”
PFAs also have observed hand hygiene practices, visiting floors and watching whether people wash their hands when entering and exiting patient rooms. They can be especially useful with projects like that, which require a time commitment but not the skills of a clinician or manager, McGuirk says.
No One Dies Alone
Input from PFAs also resulted in a new ED policy to allow family members to remain with loved ones while clinicians remove life-sustaining equipment.
Doctors and nurses thought they were doing the right thing by having family members leave the room while completing the task, then ushering them back to the patient’s bedside. But moving in and out of the room was disruptive and sometimes resulted in the patient dying without loved ones.
The clinical staff asked PFAC how the process could be improved.
“They told us that no one should die alone, so we created that policy,” Alley says. “‘No one dies alone’ is now our policy. The team member and the chaplain and staff all work together so that we can streamline the procedure and have some loved one sitting at the bedside, versus everyone crowded around. We bring everyone back in afterward and everyone gets the same information together.”
The PFAC involvement has helped improve the nursing component questions on Press Ganey surveys, Alley says. PFAs talk with patients about questions similar to those on the survey, such as how long it takes for a nurse to respond when the patient uses the call button. Information gathered in that way can help identify issues that may need to be addressed throughout the hospital, or it can show that there is a problem in a particular area.
“There was one unit where that information led us to really focus on some patient satisfaction issues, and the results pre- and post-intervention were dramatic,” Alley says. “This is the kind of information that we can glean from the time our volunteers spend with patients, information we might never have found before.”
PFAs also have assisted with patient experience training for staff, posing as patients and role-modeling interactions, McGuirk notes. The PFA may role-play a particular type of patient interaction that could prove difficult or result in an unhappy patient, giving an instructor the opportunity to teach the best way to handle the situation. The volunteer also provides feedback and suggestions to the staff member.
“It offers a safe space for the team to continue to learn, from people who have either been patients or family members at our hospital,” she says.
Build Relationship With Staff
It is important to build a relationship between the PFAs and the hospital staff with whom they will interact, Alley says. The hospital introduces the volunteers to department leaders and frontline staff so they can understand their background and why they are donating their time.
Alley and other hospital leaders also meet with the staff separately to explain the goals of the volunteer program.
“If the PFAC members just show up on the unit, unfortunately the team kind of questions why they’re there, what information they are collecting, and how it will be used,” Alley says.
“We want them to view the volunteers as an extension of the team, rather than something separate or a secret shopper, which people don’t take to very well. As long as they know the background and the purpose, they embrace them and now they get disappointed if they’re not there to help.”