Posted on December 02, 2016
Featuring the University of Michigan Health System - Welcome 24/7 Presence of Family and/or Patient Representative as Part of the Patient's Healthcare Team
Patient and family engagement, as broadly defined by Susan Dentzer, is an active partnership among individuals, families, healthcare clinicians, staff and leaders to improve the health of individuals and communities and to improve the delivery of healthcare. The foundation for engagement is patient- and family-centered care. In this 12-part series, we’ll hear directly from Michigan hospitals that have embraced patient and family engagement practices and ingrained them into their culture to work toward the goal of a patient- and family-centered healthcare system.
Family members and care partners play a vital supportive role in patients’ lives. Engaging families as partners in care can only be achieved if they are present, yet many hospitals continue to have restrictive visitation policies based on long-held beliefs that the presence and participation of families and visitors increases the spread of infection, interferes with patient care, and exhausts the patient. These misconceptions and myths are not supported by evidence. Conversely, a growing amount of evidence shows that the unrestricted presence and participation of family and friends – as partners in care- improves the safety of care, improves cost savings, enhances the patient and family experience of care, improves management of chronic and acute illnesses, enhances continuity of care, and prevents hospital readmissions. Organizations must shift the idea of families as visitors to families as a respected part of the care team in every area of the hospital, including the emergency department (ED) and the intensive care unit (ICU). Not only is it essential that restrictive visitation policies and practices be changed, but also that hospitals develop policies that support the patient’s right to identify who they view as family and/or care partners. Hospital policies that define family in the traditional sense of the form may exclude key care partners who provide support to the patient both in the hospital as well as after discharge.
"Only one parent had the chance to be by his side to say goodbye."
According to Kelly Parent, PFCC specialist for quality and safety, University of Michigan Health System (UMHS), the journey towards eliminating their restrictive visitation policy began in 2007 with the newly created Patient and Family Centered Care Program. Realizing the importance that families play, frontline staff would often make exceptions on a case-by-case basis and ‘bend’ the rules to allow families to be by their loved ones past the “Visitation Policy” allowable hours. Such “rule-bending” created inconsistencies in care experiences, leading to dissatisfaction amongst families, patients, and also staff. One incident in particular was the final thrust leading to the change when a child with a life-limiting illness was being transferred from the ED to the ICU at the hospital. The policies at that time allowed only one parent to accompany the child to ICU. Sadly, the child coded en route and never regained consciousness; therefore, only one parent had the chance to be by his side to say goodbye. This patient story forever changed the mindset of those involved, and with the already consistent need to make exceptions, it became clear it was time to change the restrictive “Visitation Policy."
“As the new PFCC program manager, one of the first projects that I was given was to change the visitation policy,” said Kelly. Co-led by the Manager of Uniform Services (Security) and “a dedicated mother of a “Mott child,” Mott and Women's Hospitals opened their doors to patient’s families 24 hours a day, 7 days a week in July 2008. A policy was then adopted system-wide by January of 2013. “The Family Presence policy is comprehensive,” said Kelly, “and addresses family presence overnight, in trauma bays, during codes and procedures, and during shift-change and medical rounds. It also addresses the support and presence of children as well as “large crowds,” and starts with the patients defining their family, which is defined as two or more persons who are related in any way—biologically, legally, or emotionally.”
“As with any significant change”, Kelly added, “organizations looking to change their visitation policies must understand that the process may take time, but you must stay the course.” It’s no surprise that changes in these policies and practices have immediate and significant day-to-day impact on clinical staff and other frontline staff. Leadership support is critical and organizations must provide the necessary support to their staff, be flexible in making policy revisions, and address special circumstances that are in the best interest of the patients and their families. To create buy-in, UMHS shared literature that supported the welcoming presence of families, leading to improved outcomes without compromising the safety of patient care. In special circumstances when safety is of great concern, staff must be equipped with the tools to communicate successfully with families. “Often times, it was the lack of communication skills and fear of not ever getting a break from the stressful work of caring for critically ill patients and their families that created resistance among staff,” said Kelly. “To ensure we addressed the concerns of all staff, we provided education, shared personal stories, discussed best practices, and engaged them in policy implementation.” Effective communication is key, but it’s also critical to provide appropriate education and ongoing support for staff. “There were some units that struggled more than others with the change,” said Kelly, “but we supported and guided them through the change by engaging the employee assistance program and holding town halls on all shifts, providing staff the opportunity to share their concerns and talk through different scenarios.”
After implementing such robust policies and practices, hospitals should circle back each year to ensure that policies are being implemented consistently and successfully across all units, to understand challenges, and to create task forces addressing concerns. An example of policy revision in response to staff concerns surrounds the creation of C.S. Mott’s “Compassionate Accommodation” guidelines. Generally, under the “Visitation and Family Presence” policy, children under the age of 18 are not permitted to spend the night. However, Compassionate Accommodations recognize and “accommodate” unique circumstances whereby it is in the best interest of the patient/family to allow a sibling less than 18 years of age to spend the night. With the assistance of an algorithm outlining decision-making guidelines, staff are able to support the patient/family andabide by the policy. “Imagine a single mother of two, who brings both children to the ED only to learn that her sick child is being admitted. It is late, and she has no family support. Rather than making her leave her sick child alone in the hospital during a most vulnerable time, Compassionate Accommodations empower staff to critically evaluate what is in the best interest of the patient and family and create a space where families may stay together,” echoed Kelly.
Is your organization ready to make the change towards a truly patient-and family-centered care culture? There are numerous resources available to guide you through your journey. Let us be a partner of that journey, guiding you to resources and tools that will help you achieve the goal of partnerships with patients, families, and their caregivers. Contact Ewa Panetta at the MHA Keystone Center to learn more.
Be sure to check back next week to read Part 10 of this 12 part series, featuring the Beaumont Health System. To view previous posts, click the links below.
- Susan Dentzer, Rx For The 'Blockbuster Drug' Of Patient Engagement, Health Affairs 32, no.2 (2013):202, doi: 10.1377/hlthaff.2013.0037
- Boudreaux, Francis, & Loyacono, 2002; Brumbaugh & Sodomka, 2009; Chow, 1999; Davidson, et al., 2007; Edgman-Levitan, 2003; Fumagalli, et al., 2006; Garrouste-Orgeas, 2008; Halm, 2005; Lewandowski, 1994; Sodomka, 2006; Titler, 1997
- Leape, L., Berwick, D., Clancy, C., Conway, J., Gluck, P., Guest, J., et al. (2009). Transforming healthcare: A safety imperative. Quality and Safety in Health Care, 18, 424-428.
Posted in: Patient Safety & Quality