A Comprehensive PFCC Curriculum for Healthcare Professionals

Transcription

Communicating and Implementing
Patient - and Family - Centered Care
A guide for MHS Leaders and Managers
Patient- & Family-Centered Care Tool Kit
INVITATION TO FAMILY-CENTERED CARE
Paula Solomone, RN, Pediatric Ambulatory Services, Joe DiMaggio Children’s Hospital
Learn not as you have always learned
But learn from the family’s experience of care
Think not as you have always thought
But think with a deeper understanding,
An openness of mind and heart
Feel not as you have always felt
But feel with a deeper empathy and compassion
For “the face behind the five”
Do not as you have always done
But do as you would have done for your own family member
Say not as you have always said
But say it in an empowering and respectful way
Give information not as you always have,
But share it in a complete, unbiased, useful, timely, affirming way
Provide choices not as you have always provided choices
But as a way to enhance a patient and family’s sense of independence
And control over their situation
Support patient and family not as you always have,
But through establishing trust, collaboration, and flexibility,
Providing reassurance, identifying patient and family priorities and needs,
Honoring cultural differences, listening actively1`
and providing ‘comforts of care’
Care not as you have always cared for someone
But care about someone
We are embarking on a journey
with a richer appreciation of what it takes
to practice in a collaborative partnership
Patient, family and healthcare provider
We are transcending the practice of traditional caregiving
From caring for someone to caring about someone
COME JOIN US
Open your heart. Open your mind.
Listen to our stories!
Toolkit v1.0
Page 2
2/26/2007
PURPOSE OF THIS TOOL KIT
The information in this Toolkit will help you introduce and reinforce the
Patient- and Family-Centered Care philosophy to your staff. It includes
outlines for staff discussions, worksheets you can duplicate, and tips,
guidelines and strategies to use for unit-based initiatives. The topics
included were prioritized by a representative group of leaders. Your
feedback about other topics to include in a future edition of this Toolkit
would be helpful .
The toolkit is available on CD or as a .pdf file in Adobe Acrobat. Both formats
are printable by the user. For additional assistance or information, contact
the Patient-and Family Care Services department.
Note:
If you are accessing the Toolkit on a CD or as a .pdf file:
•
•
Click on the underlined words in color (e.g. Resources). It
will take you to the indicated section of the document.
To return to the previous section, Click on Return to Main
Menu
MAIN MENU
The Basics
Patients &
Families as
Allies
Discussion Tools
Implementation
Frequently asked questions, core concepts, talking points
for staff discussions, the connection to Studer principles
and Press Ganey.
How to encourage patient and family involvement in
developing policies, programs, and practices.
Outlines for staff meetings, worksheets, and thought
proving questions for staff discussion about PFCC.
Ideas and strategies for implementing PFCC concepts
in your unit or department.
Staff
Development
Coaching staff about PFCC standards of behavior; PFCC
required orientation; peer interviewing questions.
Resources
Websites, videos, books, articles.
Toolkit v1.0
Page 3
2/26/2007
PATIENT and FAMILYFAMILY-CENTERED CARE
A Journey, not a Destination
As leaders of change and
The journey toward PFCC is
improvement, each of us is accountable
similar to the culture change initiative
for how patients and their families are
we undertook in the Memorial
involved with our staff, systems, and
Healthcare System when we
procedures.
introduced and supported the Studer
approach to Service Excellence.
Moving the organizational culture
to one that is grounded in the values,
The same principles and
behaviors, and approaches of Patient-
methods of building a strong culture –
and Family-Centered Care (PFCC) is a
known as “hardwiring” – apply to
process, not a one-time event. It is
infusing Patient- and Family-Centered
very appropriately called “a journey.”
Care philosophy and values into our
There is no end-point, but rather a
organization. PFCC approaches
continual evolution toward our goal of
incorporate and build upon everything
creating partnerships among healthcare
we have learned, developed, and
practitioners, patients, and families that
“hardwired” in our ongoing quest to
will lead to the best outcomes and
be “Simply the Best” in service and
enhance the quality and safety of
satisfaction.
healthcare.
Toolkit v1.0
Page 4
2/26/2007
What you can do now as a leader
Define your own values and beliefs about patients,
families and the experience of care.
Read and stay current on the growing body of literature related
to Patient- and Family-Centered Care (PFCC). Relate information
to your areas of responsibility.
⇒ Refer to Resources section.
Network inside and outside our healthcare system.
Check PFCC-related websites periodically for useful updates.
⇒ Refer to Related Websites section.
Encourage a climate of openness, communication, and
innovation in your areas.
Model collaboration with patients and families in clinical and
operational settings.
Offer staff opportunities and support for acquiring new knowledge
and skills concerning patient- family-centered care.
⇒ See the Resources section for CE opportunities.
Provide ways for staff to discuss and learn from you and each
other how to apply patient and family-centered principles and
strategies to routine and difficult/challenging situations (“reflective
practice”).
⇒ Refer to The Basics for frequently-asked questions and the
core information about PFCC
⇒ Refer to the Discussion Outlines section for suggestions for
staff discussions “beyond the basics.”
Ensure that interested staff at all levels have opportunities to
serve on patient-and family-centered care committees for the
hospital or the unit.
⇒ Refer to Advisory Councils
Toolkit v1.0
5
2/26/2007
What you can do now as a leader,continued
Include patient- and family-centered goals in your
department/unit plans.
Examine your unit/department policies, procedures, and
practices to find opportunities for patient- and familycentered approaches.
⇒ Refer to the Implementation section
Create a variety of ways that patients and families can
serve as advisors.
Use program planning, space/facility design, patient safety
and quality improvement initiatives as opportunities to
involve patients and families as advisors.
⇒ Refer to Patients and Families as Allies section
Coach, train, and mentor your staff.
Define the specific performance expectations you have for
your staff related to patient/family-centered care.
•
Get specific about behaviors (verbal/non-verbal) that
are/are not patient and family-centered
•
Discuss these at staff meetings, and with individuals.
⇒ Refer to the Staff Development section
Hold staff accountable for learning and changing behaviors.
•
Follow up during Rounds, and other opportunities.
•
Recognize them for doing it right.
•
Recruit, hire, and retain staff with patient- and familycentered skills and attitudes.
Toolkit v1.0
6
2/26/2007
What you can do now as a leader,
continued
Coach, train, and mentor your staff.
Develop a personal interviewing strategy to elicit PFCCrelated information.
•
Help your peer interviewing groups define questions
relating to PFCC knowledge and behaviors.
•
Ensure that your unit’s personnel practices support
professional caregivers and their families.
Recognize and reward excellence in patient- and
family-centered practice.
Identify and measure outcomes for patient- and familycentered care changes.
⇒ Refer to Press Ganey dimensions.
Create opportunities to celebrate individual and collective
accomplishments.
Implement unit-based initiatives.
Collaborate with patients and families. Use program
planning, space/facility design, patient safety and quality
improvement initiatives as opportunities to involve patients
and families as advisors.
⇒ Refer to the Patients and Families as Allies,
Implementation and Resources sections.
Toolkit v1.0
7
2/26/2007
Return to Main Menu
Toolkit v1.0
8
2/26/2007
Patient- and Family-Centered Care
Questions & Answers
If you want to review…
Go to
Q: What is Patient-and Family-Centered health care?
p. 10
Q: What is the goal of patient- & family-centered care?
Q: Where did this concept come from?
Q: Why is PFCC a necessary direction in healthcare?
p. 10
p. 10
p. 10
Q: What are the key principles of PFCC?
p. 12
Q: Is there a difference between “family-centered” care and
“family-focused” care?
p. 12
Q: What are the Core Concepts of PFCC?
p.13
Q: What is meant by the word “family”?
p. 14
Q: Who defines the word “family”?
p. 14
Q: What are some misconceptions about PFCC?
p. 15
Q: How does PFCC relate to our safety pillar?
p. 16
Q: How does PFCC relate to our quality pillar?
p.18
Q: How does PFCC relate to service excellence?
p. 19
Q: What are the Press Ganey dimensions relating to PFCC?
p. 20
Q: Is HIPAA a barrier to PFCC?
p. 21
Toolkit v1.0
9
2/26/2007
Q: What is Patient-and Family-Centered health care?
A: Patient- and Family-Centered Care (PFCC) is an approach to health
care that offers a new way of thinking about the relationships between
patients, their families and healthcare providers. It is founded on the
understanding that the family plays a vital role in ensuring the health
and well-being of patients of all ages.
Q: What is the ultimate goal of patient- and familycentered care?
Return to previous section
A: The ultimate goal of patient- and family-centered care is to create
partnerships among healthcare practitioners, patients, and families
that will lead to the best outcomes and enhance the quality and safety
of healthcare.
Q: Where did this concept come from?
A: “Family-Centered Care” was first defined in 1987 as part of
Surgeon General Koop’s initiative for family-centered, communitybased, coordinated care for children with special healthcare needs and
their families.
Q: Why is PFCC a necessary direction in healthcare?
A: You might not think our American health care system needs to be
reminded to center its efforts on patients and their families. But as the
system has grown more complex and fragmented, and as providers
feel more pressure to see more patients in less time, care has too
often become centered not on the needs of patients, but around
the needs of the system itself.
Although Family-Centered Care was first intended for children with
special needs, and has been practiced primarily in pediatric settings,
Toolkit v1.0
10
2/26/2007
there is a growing national recognition that it is relevant to patients of
all ages, and it may be practiced in any healthcare setting.
Individuals who are most dependent on hospital care are also those
who are most dependent upon families: the very young, the very old,
and those with chronic health conditions.
Therefore, in a continuing effort to improve care quality, patient
safety, and nurse satisfaction, leading hospitals are expanding familycentered care to all of their units.
The spread of PFCC to adult care settings comes from the nationwide
movement to improve clinician-patient relationships, driven in part by
consumer demand, and in part by the Institute of Medicine’s
groundbreaking 2001 report “Crossing the Quality Chasm: A New
Health System for the 21st Century.” This report advocates that
healthcare organizations of all types should adopt Patient- and FamilyCentered Care concepts and methods.
Patient- and Family-Centered care focuses on treating patients and
their family members as partners on the care team. This
frequently involves the following:
•
•
•
Flexible visiting hours
In-depth information-sharing to help families make decisions about
current and continuing healthcare
Emphasis on partnerships with patients and families for safety and
quality
As the understanding of “partnership” grows, organizations that
embrace PFCC values learn to involve patients and family members on
committees, task forces, policy development groups, and facility
planning.
“You in healthcare are
our lifelines. It’s not
adversarial. We need
you – and you need
us, too!”
A family member
on a faculty panel
said…..
Toolkit v1.0
11
2/26/2007
Q: What are the key principles of PFCC?
A: The four principles of PFCC are:
1. People are treated with respect and dignity.
2. Health care providers communicate and share complete and
unbiased information with patients and families in ways that
support them and are useful.
3. Patients and family members build on their strengths by
participating in experiences that enhance control and
independence.
4. Collaboration among patients, family members, and providers
occurs in policy and program development and professional
education, as well as in the delivery of care.
Q: Is there a difference between “family-centered”
care and “family-focused” care?
A: Both approaches consider that involvement of the family is a
fundamental element of the continuum of care.
Patient or Family-Focused Care
Patient and Family-Centered Care
Professionals may provide care
from the position of an “expert”;
they tell the patient/family what to
do. They do things to and for the
patient and family, and consider the
family the “unit of intervention.”
This is a collaborative approach to
care giving and decision-making.
Each party respects the knowledge,
skills, and experience the other brings
to the health care encounter. They
work together as partners to get the
best outcome possible.
Toolkit v1.0
12
2/26/2007
PATIENT- and FAMILY-CENTERED CARE
THE CORE CONCEPTS1
RESPECT for each patient and his/her family.
Identifying STRENGTHS in every
patient and family, even in crisis
situations.
CHOICE for patients and families about approaches to
care and support.
FLEXIBILITY in policies, procedures, and staff
practices to tailor care to the needs, beliefs, and
cultural values of individual patients and their families.
INFORMATION to equip patients and
their families to make choices and assume
responsibility for their own care.
SUPPORT, both formal and informal, during procedures,
transitions, and difficult situations.
EMPOWERING patients and their families to discover their own
strengths and to make choices and decisions about their health care
and their experiences with health care.
COLLABORATION among patients, families, and
health care providers in the care of an individual patient;
in developing programs and policies in hospitals and
clinics; and in designing systems of care that better meet
the needs and preferences of patients and their families.
1
Institute for Family-Centered Care, “Hospitals and Health Systems Moving Forward With Patient &
Family-Centered Care” 2005 Seminar.
Toolkit v1.0
13
2/26/2007
Q: What is meant by the word “family”?
A: Traditionally, the word “family” refers to two or more persons who
are related in any way -- biologically, emotionally, or legally. However,
in a PFCC environment, the definition of family, as well as the degree
of family involvement in health care, is controlled by the patient,
provided he or she is developmentally mature and competent to do so.
The term “family-centered” is in no way intended to remove control
from adults who are competent to make decisions concerning their
own health care. In pediatrics, families define for themselves who their
family members are, and the “family-centered” term became standard.
In adult healthcare settings, the terminology “patient- and familycentered” is used to make it clear that adult patients are the primary
decision-makers, and may include their families and loved ones to the
extent that they choose.
Q: Who defines the word “family”?
A: The patient and other family members define the family.
Staff can assist in this process by asking some key questions as early
as possible during the hospitalization:
•
Who is your emergency contact?
•
Who will be with you most frequently during your
hospitalization?
•
Who is your surrogate, advocate, or spokesperson to other
members of the family and friends?
•
Who will care for you after discharge?
•
Who do you want us to share information with?
Toolkit v1.0
14
2/26/2007
Q: WHAT ARE SOME MISCONCEPTIONS ABOUT PFCC?
Misconception
Reality
Patient- and
Family-Centered
care is just
“being nice.”
PFCC is an intentional
effort to meet the
individual needs and
preferences of our
patients and their loved
ones.
Patient- and
Family-Centered
care means the
staff must
relinquish all
decision making
to the family
Example
PFCC is about
partnerships in which
each partner brings
special expertise to the
table. Working
together, all parties
contribute to develop an
appropriate plan for the
patient.
•
•
•
•
•
•
Acknowledge and honor each
patient’s individuality.
Respect and encourage the
important role that patients and
families play in bringing their
expertise to the healthcare team.
Physicians bring medical expertise.
Nurses bring nursing expertise.
Allied health personnel each have
their areas of specialty.
The patient/family partner brings
continuity: knowledge of the
individual patient, the family
situation, their cultural beliefs in
terms of medical care, and their
strengths and needs.
Patient- and
Family-Centered
care means
there are
“No Rules.”
In healthcare there are
many policies that are
required for safety,
quality, and infection
control. However,
within those limits,
PFCC means offering
choices and flexibility to
meet the individual
patients’ needs.
•
Patient- and
Family-Centered
care means the
patient's
families may be
rude or abusive
to staff.
The great majority of
patients and families
want trusting
relationships with their
healthcare team, and
want to be active
participants in the care
of the patient.
•
Anxiety, fear, and lack of or
inconsistency of information may
cause family members to behave in
ways that can be perceived as rude
and abusive. Often, those behaviors
can be changed by providing
information and involving families
more effectively.
Patient- and
Family-Centered
care is difficult.
PFCC requires a
thoughtful & caring
appreciation of the
needs of patients and
their families.
•
Taking time to assess the patient
and families needs initially, then
partnering with them, saves time in
the long run.
•
Examine policies to determine if
restrictions are based in evidence, or
are simply because “we’ve never
done it that way here.”
Instead of “rules,” think
“guidelines.” Most patients and
family members welcome knowing
what the guidelines are, but want
our understanding and flexibility
when they have special
circumstances and concerns.
Toolkit v1.0
15
2/26/2007
Q: How does PFCC relate to our safety pillar?
A: Patient- and Family-Centered Care is safer care.
Most of the national accrediting and policy agencies
have adopted “patient-centeredness” as a key to
improving Safety in hospitals.
JCAHO is sponsoring a
number of initiatives,
including the “Speak Up”
campaign, among many
other initiatives. The 2007
Patient Safety Goals include
“patient involvement” as a
requirement.
The National Patient
Safety Council
recommends patient and
family involvement in safety
improvement processes.
The Agency for
Healthcare Research
and Quality (AHRQ).
AHRQ believes that
patient-centered and
family-centered care will
show improvements in
morbidity and mortality,
costs, and a reduction in
risk factors that lead to
malpractice suits.
Family members often play key roles in patient safety. They
frequently are:
•
Knowledgeable - the keepers of the patient’s history. They know
the story, if not always from a purely medical viewpoint.
•
The “bedside guardians,” often keeping watch – they can be the
“first responders” when a status change occurs, additional eyes and
ears for the medical/nursing staff. (Key: They must be taught
what to look for, and how best to be the “first responder.” Most will
rise to the occasion.)
•
Caregivers after discharge.
•
Intuitive. Patients and their family members often know when
something is “not right” based on their intimate knowledge of the
patient.
Toolkit v1.0
16
2/26/2007
Applying the CORE concepts to Safety
A growing body of evidence indicates that applying the core
concepts of Patient- and Family-Centered care results in a
climate of trust that improves safety.
From
VitalSmarts (March 2005)
Survey reveals most patients uncomfortable
confronting medical personnel
•
•
•
Less than half of the patients spoke up when unclear about diagnosis,
treatment options or next steps.
1 in 5 suffered substantial health problems as a result of not speaking up.
1/3 of patients DID NOT speak up if they thought the healthcare worker was
making a medication error.
RESPECT
Words and behaviors that show respect
strengthens trust. The patient and family are more
confident that their concerns will be heard. This
decreases the intimidation factor and the fear of
calling attention to a perceived potential error.
STRENGTHS
Encouraging patient involvement to details while
hospitalized, and in understanding potential errors
that they could make when they go home, increases
their safety overall.
CHOICE
Providing choices helps the patients maintain their
routines (i.e. stable diabetics can manage their own
food and insulin schedules in the hospital). This
increases the potential for safety.
FLEXIBILITY
One size does not fit all. Hospital schedules for
administering medications may conflict with schedules
patients themselves have established for managing
their multiple medicines. We need to tailor care when
possible.
INFORMATION
SHARING
Toolkit v1.0
The more the patient knows, the better the patient is
able to self-protect and be a partner in helping to
maintain a safe environment.
17
2/26/2007
Q: How does PFCC relate to our quality pillar?
A:
QUALITY
IMPROVEMENT
measures may be
Patient/Family BASED:
QUALITY IMPROVEMENT
measures may be
Patient/Family RELATED:
•
Patient and family
Satisfaction Indicators
•
Some measures are standardized
already, but families can help
design ways to improve outcomes
•
Patient and family
preparedness (activation,
engagement) indicators at
discharge (“Are you ready to
go home and take care of
your health?”)
•
Quality measures may be patientfocused rather than truly Patientand Family-Centered, but still may
be influenced by patients and their
families. For example, many
clinical QI markers (nosocomial
infections, pain assessment) may
be influenced positively or
negatively by family-focused
policies., or family behaviors.
•
Patients and families can be used
to design improvement systems.
•
Patient and family input can
be used to develop measures
to track improvements
(especially unit-based ones).
•
Patient and family input can
help design ways to obtain
data, and increase response
rates: If the goal is to “Reduce
nosocomial infection rate by
increasing handwashing
behaviors,”gather data from
patients and families and
ask them for input into how
best to educate them.
A family
member on a
faculty panel
said:
“I would prefer to SEE
you wash your hands in
my room and then I
don’t have to ask you to.
do it.”
Toolkit v1.0
18
2/26/2007
Q: How does PFCC relate to service excellence?
A: The concepts of service excellence work together with
the concepts of Patient- and Family Centered Care. They
are not separate, just different sides of the same coin.
A commitment to service excellence is necessary for an
organization to move forward with Patient- and FamilyCentered Care approaches to healthcare. But an
organization can provide “very good” customer service
and still be doing things TO and FOR the patient and
family, not WITH them.
A truly Patient- and Family-Centered healthcare organization is
committed to, believes in, and tries to practice PARTNERSHIP with
patients and their families in all aspects of the healthcare experience.
It is this level of service excellence that will surprise, delight, and
satisfy the majority of patients and their families with their healthcare
experience.
THE STUDER APPROACH TO IMPLEMENTING SERVICE
EXCELLENCE is an effective approach for “hardwiring” any
organizational culture change, including the journey toward Patientand Family-Centered Care.
•
The behavioral components of service excellence (key words,
AIDET, manage up, standards of behavior) are essential to a culture
that embraces and uses Patient- and Family-Centered approaches.
•
The fundamental leadership, operational management, and human
resources management techniques embodied in the “Healthcare
Flywheel” and the “Nine Principles” are those that are essential to
building a strong culture in any organization.
“Excellence is when employees feel valued,
physicians feel their patients are getting
great care, and patients feel the service
and quality they receive are
extraordinary.”
Quint Studer
Hardwiring Excellence.
Toolkit v1.0
Page 19
2/26/2007
Q: What Press Ganey dimensions relate to PFCC?
A: The core concepts of PFCC are embedded in several of the
questions on the Press Ganey survey. Those survey items
that are most commonly found in the Priority Index are most
highly correlated with patient and family satisfaction.
Press Ganey Item
Definition
Staff sensitivity to
the inconvenience
that health problems
and hospitalization
can cause/ Staff
concern for your
privacy
Degree to which
hospital staff
addressed your
emotional needs
How well staff understand
that the patient is not defined
by the illness, that the patient
is a person with hopes
dreams, and normal day-today roles.
Staff effort to include
you in decisions
about your
treatment
Information given to
your family about
your condition and
treatment
How well the staff
worked together to
care for you
Staff attitude toward
your visitors/
Accommodations and
comfort for visitors
Response to
concerns and
complaints
To treat the whole person,
hospital staff must attend to
the physical and the
emotional needs of the
patient.
The extent to which patients
feel awareness,
understanding, and
participation in decisions
regarding their care and
treatment.
How well staff communicate
with the important people in
the patient’s life.
Coordination of care among
the healthcare team caring
for the patient; consistency of
information received from
each; smooth transitions and
processes
How well the hospital made it
easy and comfortable for their
loved ones to be near.
How well staff respond to
something that troubles or
worries patient/family
PFCC CONCEPT
Dignity & Respect
Dignity & Respect
The Need To Be Near
Information
Support
Choice
Participation
Information
Empowerment
Collaboration
Participation
Information
Empowerment
Collaboration
Information
Participation
Collaboration
Need To Be Near
Dignity & Respect
Choice
Flexibility
Information
Dignity & Respect
Empowerment
Toolkit v1.0
Page 20
2/26/2007
Q: Is HIPAA a barrier to PFCC?
A: HIPAA is not a barrier to doing the right
thing for patients and their families – it was
designed to help us be more thoughtful and
respectful of patient rights to confidentiality
and privacy.
•
Confidentiality is not new.
HIPAA has made it clearer in terms of
protecting privacy, especially in how we
transfer information electronically.
•
HIPAA is a consumer empowerment strategy.
Patients now have more control over how healthcare providers of all
sorts use and distribute their personal health information.
•
HIPAA and Patient Rights must balance.
The patient’s right of access to information and the patient’s right
to privacy need to balance. The patient or family defines the family
and how they will be involved.
•
HIPAA can enhance trust.
Consumers now have a reason to trust that we DO protect their
privacy.
•
HIPAA allows for and encourages professional judgment and
flexibility.
HIPAA does not limit flexibility to do the right thing, using
professional judgment, doing what is reasonable in the best
interests of the patients, as they define those interests.
Toolkit v1.0
Page 21
2/26/2007
Return to Main Menu
Toolkit v1.0
Page 22
2/26/2007
patients and families as advisors:
broadening our vision2
Advisor
Any role that enables consumers to have direct input
and influence on the policies, programs, and practices
that affect the care and services that
individuals and families receive.
There are countless ways that patients and families can
serve as advisors to policy makers, program planners, and
care providers.
Patient and family input at the policy
and program level can be as formal, i.e.
the development of a paid staff position
for a parent consultant.
An informal coffee hour on a hospital
inpatient unit where patients and
families share their perspectives on the
hospital experience.
It can be an ongoing process, such as a monthly advisory
committee meeting, or a one-time activity such as a focus
group on a particular topic.
All of these approaches are valid and each can yield valuable
information from patients and families. What is important
is that patients and family input is sought and valued,
and that policy, program, and practice decisions are shaped
by the opinions and perspective of those they intend to
serve.
2
(Essential Allies: Families As Advisors, Elizabeth S. Jeppson and Josie Thomas. Institute for FamilyCentered Care, Bethesda, MD, 1995, p.14.)
Toolkit v1.0
Page 23
2/26/2007
patients and families as advisors:
broadening our vision3
ROLES FOR PATIENT/FAMILY ADVISORS include:
Advisor
ROLES
Task force members
Advocates
Advisory board members
Participants in focus groups
Program evaluators
Fundraisers
Co-trainers for in-service sessions
Members of committees hiring
new staff
Paid program staff or policy
consultants
Members of boards of trustees
Mentors for other families
Participants at conferences and
working meetings
Grant reviewers
Reviewers of audiovisual and
written materials
Participants in quality
improvement initiatives
3
(Essential Allies: Families As Advisors, Elizabeth S. Jeppson and Josie Thomas. Institute for FamilyCentered Care, Bethesda, MD, 1995, p.14.)
Toolkit v1.0
Page 24
2/26/2007
how to encourage family involvement4
1. Hold a monthly patient/family/staff coffee hour, and rotate the hosting
responsibilities among teams of staff members.
2. Solicit patient/family input for specific issues during Rounding.
3. Invite patients/families to serve on committees such as the quality
improvement task force, bereavement program work group, and facility
design planning teams.
4. Hold a brainstorming session with patients/families to develop
educational materials for your unit.
5. Have patients/families review drafts of all written materials that will be
given to patients and families.
6. Include patient/family members as part of orientation for new staff.
7. Ask veteran patients/families to lead family-to-family support programs.
8. Develop a “breakfast (or lunch) with the manager” program for
patients/families.
9. Keep a suggestion book in the waiting room or at the unit desk so
families can record their ideas.
10.
Convene focus groups of patients/families as specific issues arise.
11.
Invite patients/families to present at in-service programs for staff.
12. Create a Patient/Family Advisory Council and (in pediatrics) a youth
advisory group.
4
Adapted from: Jeppson, E. & Thomas, J., Essential Allies: Families as Advisor (1994) Institute for
Family-Centered Care, Bethesda, MD.
Toolkit v1.0
Page 25
2/26/2007
recruiting patients and families to serve in
advisory roles on your unit5
•
Identify likely participants during your daily
rounding. Ask them if they would be interested in
providing input.
•
Ask other patients and families who are already
involved if they have a friend who might be
interested in participating.
•
Ask physicians to identify patients and families.
•
Contact patient or family networks, support groups,
or advocacy organizations.
•
Post notices in appropriate languages on bulletin
boards in reception areas.
•
Place posters in community locations.
Selecting advisors
Look for people who are:
interested in serving as advisors;
comfortable in speaking in a group with
candor;
able to use their personal experience
constructively;
able to see beyond their own experience;
concerned about more than one issue or
agenda;
able to listen and hear differing opinions;
representative of patients and families
served by the hospital or program.
5
Toolkit v1.0
Page 26
2/26/2007
preparing advisors for task force or
committee assignments6
Having just one patient or family member on a committee is
not usually successful.
•
Strive for patients and family members to be one third of the task
force membership.
Serving as a patient or family advisor is a new role for many
people. Some patients and family members will need more
support than others.
•
•
Recognize that individuals can grow and develop in this role.
Provide clear information about the purpose of the
committee or task force and the roles of individual
members.
Ask for the opinions of patients and families
during discussions, encouraging their participation
and validating their role as committee members.
Avoid becoming stuck in the power of a
negative situation:
• Acknowledge the negative experience.
• Ask if there was anything supportive, helpful, or
Explain technical
terms when used.
positive for the group to learn from the situation.
• Ask for ideas and suggestions to prevent or improve the situation.
If a personal story becomes very prolonged:
•
•
Acknowledge the power and importance of the story.
Suggest that some policy implications can be learned from the story
and that there may be other more appropriate forums where this
story should be shared.
When there are extreme differences in opinions or perceptions,
Consider either:
• Appointing a task force for further study of the issue;
• Asking the opinion of other groups (e.g., another hospital
committee or patient/family advisory group); or
• Delaying a decision and considering at a future meeting.
6
Toolkit v1.0
Page 27
2/26/2007
CURRENT ADVISORY COUNCILS
Memorial Regional Hospital Patient and Family Advisory Council (PFAC)
Evening meetings: first Monday (Jan/Mar/May/July/Sept/Nov) MRH Auditorium , 6:30-8:00
pm. Day meetings: Third Thursday, Feb/April/June/Aug/Oct/Dec., MRH 6 North Conference
Room, 10:30-noon Contact: Susan Montgomery
Memorial Regional Hospital PFCC Steering Committee 10:30 – noon, MRH 6
North Conference Room (Jan/ Mar/May/July Sept/Nov). Contact: Susan Montgomery
Joe DiMaggio Children’s Hospital Family Advisory Council (FAC), First
Monday of each month at 6:30-8 pm in the MRH Auditorium. Contact: Nick Masi
Joe DiMaggio Children’s Hospital FCC Steering Committee: Monthly, second
Friday, 8-9 am, 8 South Conference Room at Memorial Regional Hospital. Contact: Nick Masi
Joe DiMaggio Children’s Hospital Youth Advisory Council: Meetings are TBA.
Contact: Nick Masi
Memorial Cancer Institute Patient and Family Advisory Council: First
Monday of every month on a rotating schedule, Jan/Mar/May/July/Sept/Nov at Memorial
Hospital Pembroke Main Conference Room. 6:30-8:30 pm; Feb/Apr/June/Aug/Oct/Dec 12:00-2
pm . Contact: Katharine Campbell, LCSW
Memorial Primary Care Services Advisors: Last Tuesday of the month at 6:30 pm.
Contact: Rebecca Adler
Memorial Healthcare System Special Needs Advisory Group: Quarterly;
meeting location rotates between Memorial Regional Hospital and Memorial Hospital West.
Contact: Tonya Fox Shaw or Karmel McCarthy
Memorial Hospital West Family Advisory Council: Meetings TBA. Contact
Karmel McCarthy or Beth Olafson
Memorial Hospital West PFCC Champions: Meet first Wednesday of every month at
1:00-2:00 p.m. in CET 1. Contact Karmel McCarthy or Beth Olafson
Memorial Hospital Miramar: TBA . Contact: Betty DelValle
Memorial Hospital Pembroke: TBA . Contact: Audrey Suiter.
Toolkit v1.0
Page 28
2/26/2007
Return to Main Menu
Toolkit v1.0
Page 29
2/26/2007
staff discussions about PFCC
Tips for staff discussions:
Ground Rules
Preface the discussions with some
ground rules for productive
discussion behavior.
Involve Advisors
Ask patient/family advisors to be
part of the discussions to lend their
perspectives.
Keep it open-ended
Encourage out-of-the box thinking. Instead of saying “we need to
improve….” Say “How can we improve…..”
• It is sometimes useful to use the “magic wand” framework:
“If we had a magic wand, how would we improve [the topic under
discussion] to be more centered around patient/family needs and
concerns?”
Record the ideas visually
Capture the ideas on flip charts or some visual memory medium. It
helps keep the discussion focused, acts as a record of the meeting,
and serves as a starting place for action planning.
Try it out one small step at a time
If good ideas arise during these discussions, be willing to try small
improvement projects on a pilot basis. If they work, tweak them and
expand them. If they don’t, abandon them and discuss the “lessons
learned.”
Toolkit v1.0
Page 30
2/26/2007
staff discussions based on the Pillars
Safety
•
How can we involve patients and families in our
Safety initiatives?
Quality &
Service
•
How could we get more patient/family involvement
in their care?
How could patients and families be more involved in
our unit’s PI efforts?
How could we better assess who “the family” is on
admission to the unit?
•
•
Satisfaction
•
What are the items on the Press Ganey survey that
are most closely correlated with Patient- and
Family-Centered Care?
People
•
How do we demonstrate “respect and dignity” to
patients and families on our unit?
Growth
•
How can we develop a unit-based plan for moving
toward PFCC Patient- and Family-Centered Care?
Finance
•
How could Patient- and Family-Centered Care?
principles help us control unit expenses?
Community
•
What community resources do our patients and
their families need the most when they leave our
care?
Toolkit v1.0
Page 31
2/26/2007
discussion outline
partners in caring
Use the following discussion items all at once, or one at a time
in a series of meetings.
Patients want to be consistently and respectfully involved in
decisions about their health care. They want their families
involved in ways they choose. As staff, we can….
Families want to be consistently and respectfully involved in
decisions about the care of their family member. As staff,
we can….
Patients and families want health care providers to listen to
their observations and incorporate their preferences about
treatment into the hospital plan of care. As staff, we
can….
Patients and families want and need useful and
understandable information from health care providers. As
staff, we can….
Patients and families want a personal connection, a
relationship with health care providers. They need to be
able to trust the people providing care. As staff, we can….
Patients’ comfort and the control of their pain is important to
their perceptions of the hospital experience, and to their
families’ perceptions, as well. As staff, we can….
Patients and families want information and support for
handling transitions in health care. As staff, we can….
Toolkit v1.0
Page 32
2/26/2007
discussion outline
dignity and respect
Definition: Healthcare providers listen to and honor patient
and family perspectives and choices. Patient and family
knowledge, values, beliefs, and cultural backgrounds are
incorporated into care planning and decision making.
Discussion Topics:
• What does “dignity and respect” mean to you? If you or a
family member were a patient, how would you see it
demonstrated?
• How do we orient patients and families to the unit in ways
that are helpful to them, based on their needs?
• A patient on a family advisory panel said, “ It’s hard to be
an independent adult who suddenly can’t even go to the
toilet without help. It’s embarrassing.” How can we
return a measure of dignity to this patient? What are
some other situations where we could improve the
patient’s sense of dignity and control?
• Provide staff with a copy of the Press Ganey Priority
Index. Discuss how each of those items (usually
“personal/emotional needs”) relate to PFCC concepts.
Discuss the staff behaviors that will contribute to a “very
good” patient/family experience in these dimensions.
• Discuss how your unit currently handles patient privacy
and confidentiality. Ask “How can we do a better job of
meeting our patients and family needs?”
• Use the information provided in this Toolkit to talk about
HIPAA and its relationship to Patient/Family-centered
care.
Toolkit v1.0
Page 33
2/26/2007
discussion outline
information sharing
Definition: Healthcare providers communicate and share
complete and unbiased information with patients and families
in ways that are affirming and useful. Patients and families
receive timely, complete, accurate information in order to
effectively participate in care and decision making.
1. Discuss the following in terms of your unit’s practice.
Eight things every patient and family
member wants to know
1.
2.
3.
4.
5.
6.
7.
8.
What is wrong?
What is causing it?
What will happen next?
What are you going to do?
Why are you doing that?
How will I know if it’s working?
What do I do if it does not work?
When can I go home?
2. Ask the question “How can we improve the process of
information sharing?”
Include patients, former patients and their families in coming up
with the priorities to work on. Some aspects to look at in terms of
information sharing:
•
•
•
•
•
•
•
Upon admission
At discharge
During the healthcare experience
At transition points
During Rounds
In relationship to HIPAA
Patient/family education resources used on the unit
3. What about the way we provide information in terms of eye contact,
body language, attitude (in a hurry vs. “I have the time.”)? How
can we improve?
Toolkit v1.0
Page 34
2/26/2007
discussion outline
participation
Definition: Patients and families are encouraged and
supported in participating in care and decision-making at
the level they choose.
1. What policies and practices on our unit provide patients
and families with choices and alternatives?
2. How could we improve our practices in terms of
offering choice, flexibility, options to patients and their
families?
3. What does “family presence” mean in our unit?
4. How do we distinguish “family” from “visitors” on our
unit?
5. How can we facilitate families being involved on rounds
if they choose to be?
6. How does our unit environment support participation in
care – for example, in terms of signage, room set-up,
information for patients and families?
Toolkit v1.0
Page 35
2/26/2007
discussion outline
patients and families as allies
You can use the checklist on the next page as a discussion starter with
staff to explore the dynamics of working with patients and families in a
way that is inclusive, participative, and collaborative.
•
Use the checklist on the next page as a springboard for discussion
and reflection about real attitudes towards collaboration.
•
Ask staff to identify the benefits of a more collaborative relationship
with families. 7 For example:
BENEFITS FOR
FAMILIES
•
•
•
•
•
•
•
•
•
•
Improves services for
own family
Provides opportunity
to affect meaningful
change
Feels good to make a
contribution
Provides opportunities
to network with other
families and providers
Builds knowledge and
skills
Models community
involvement and
empowerment for own
children and family
Become less passive
recipients of care and
services
Can make things
better for other
families
BENEFITS FOR
PROVIDERS
•
•
•
•
•
•
•
•
Enhances
relationships
between families
and providers
Enhances providers’
ability to do their job
Develops providers’
knowledge and skills
Increases
responsiveness to
family-identified
needs
Provides a reality
check
Develops fresh
perspective on how
services could be
delivered
Increases empathy
and understanding
of families
Shares responsibility
BENEFITS FOR
ORGANIZATION
• Improves quality of
programs and services
• Increases responsiveness
of programs and policies
• Keeps programs relevant
and realistic
• Brings fresh perspectives,
creative solutions,
limitless creativity
• Increases visibility of
program in community
• Increases cohesiveness
and collaboration between
agencies
• Helps save money
• Better able to accomplish
mission
• Have a constituency that
can advocate for
program/agency
Ask staff to discuss what they think “Family” means in the context
of their work with patients.
Discuss how staff will ask patients to designate “family” differently
from “visitors.”
7
Jeppson, E.S. & Thomas, J. (1997) Families As Advisors: A training guide for collaboration. Bethesda,
MD: Institute for Family-Centered Care.
Toolkit v1.0
Page 36
2/26/2007
AS A HEALTHCARE PROVIDER, WHAT DO I BELIEVE
ABOUT PATIENTS & FAMILIES?
YES
NO
NOT
SURE
Do I believe that patients and their family
members bring unique expertise to the
healthcare encounter?
Do I believe in the importance of patient
and family participation in decision making
in care decisions and care planning?
Do I believe that patient and family
perspectives are as valid to consider as
those of professionals?
Do I believe that patients and families
bring a critical element to the team that no
one else can provide?
Do I consistently let others know that I
value the insights of patients and families?
Do I work to create an environment in
which patients and families feel supported
and comfortable enough to speak freely?
Do I listen respectfully to the opinions of
patients and their family members?
Toolkit v1.0
Page 37
2/26/2007
discussion outline
HIPAA and PFCC
To discuss HIPAA in the context of your unit or
department operations and PFCC principles:
Review the HIPAA material on the next pages, on the
MHS Intranet, or with the hospital’s HIPAA experts.
Discuss the topics that follow:
What is “Incidental Disclosure?”
How can we help the patient and/or family define their
“family” for purposes of communicating information about
care?
How can we facilitate communication with distant relatives
especially with patients who are not capable of articulating
their wishes?
How can we encourage families to be present on rounds and
still maintain privacy in a semi-private area?
Concerned about HIPAA in semi-private rooms or multi-bed areas?,
Think about providing headphones to the roommate!
Toolkit v1.0
Page 38
2/26/2007
de-mythologizing HIPAA at the
bedside
“I am HIPAAnoid and HIPAAtized. What this abbreviation really stands for is
Highly Intricate Paperwork in Abundant Amounts and the Huge Increase in
Paperwork and Aggravation Act. I am a HIPAAchondriac who complains
about HIPAA all the time. I am routinely in a state of HIPAAhypoglycemia
because of my low level of understanding about HIPAA regulations. I did a
HIPAAectomy for my patients, which required me to remove all their PHI
from the medical records, and I definitely have a case of HIPAAitis, which I
got from getting too much HIPAA in my system).” 8
The Shared Purposes of HIPAA & PFCC
Both HIPAA and Patient- and Family-Centered Care (PFCC) focus on
giving consumers more control over their care. The law does allow
for flexibility and for professional judgment.
PFCC principles acknowledge:
• The importance of respect for patients and their choices
• The need to empower patients and their families through
information, participation, and collaboration
• The importance of involvement patients and their chosen family
members in all aspects of health services delivery
HIPAA focuses on patients’ rights to confidentiality and to
access information.
• Patients have the right to decide who will be involved in their care,
and the right to define the word “family.”
• This creates an environment that can facilitate and support
collaboration among patients, families, and health care providers.
Shared objectives between PFCC and HIPAA
• Restore and strengthen trust among patients, families, and health
care professionals
• Enhance patient rights
• Improve efficiency and effectiveness of care
• Enhance the patient’s experience of care
8
Harman, Laurinda B., PhD, RHIA. “HIPAA: A Few Years Later.” Online J Issues Nurs. 2005; 10 (2)
Kent State University College of Nursing Posted 7/21/2005
Toolkit v1.0
Page 39
2/26/2007
PFCC Core Concepts
HIPAA Core Concepts
Dignity and Respect
Respect privacy
“Family” as part of team,
defined by patient
Obtain patient approval about discussing
medical info with family/friends
Empowerment
Control over personal information (PHI);
protect and enhance patient rights re
access/use of PHI
Information sharing
Integrity, confidentiality, and availability of
data 24/7, accessible to those needing it
when it is needed; reliable and accurate
Collaborative, empowering
relationships among
patients/families/caregivers
Improve quality by restoring trust
in the commitment to safeguard their
information
Enhance quality & outcomes of
patient care
Improve efficiency and effectiveness
through a national framework
HIPAA and PFCC: things we can do
•
Understand the common bonds, the intent of the law, the areas of
flexibility and discretion.
•
Continue to behave in ways that insures the patient’s rights to
confidentiality and privacy.
•
Understand the distinction between HIPAA “Privacy” and HIPAA
“Security” issues.
•
Insure that we provide the patient and family the opportunity to
define “the family” and how they will be involved. Ask patients and
families for their permission for others to be involved.
•
Remember that HIPAA allows for professional judgment
•
Establish the importance of maintaining confidentiality and privacy
with patients and families as part of preadmission orientation or
admission procedures.
When patients and families understand the measures that we take
to maintain privacy, and how they can assist us, then they can
become strong partners in helping to protect their confidentiality.
Toolkit v1.0
Page 40
2/26/2007
discussion outline
the words we use
Much research has been done on the power of words to shape
perceptions. For example, what is the difference between:
Allow………………………………….Encourage
Permit………………………………………Support
Becoming aware of the affect of words we use unconsciously is
a key PFCC skill. Here is a quick staff meeting exercise that focuses
on the differences between words that empower and disempower. A
blank worksheet is on the following page.
Identify the words on your unit that are jargon,
disempowering, negative, or create a cold and technical
approach to the emotional experience of healthcare.
EXAMPLE
The Power of Words
(Created by an Obstetrics Unit)
Words to Eliminate
Prohibited
Inform
Allowed
Delivery
Cesarean Section
Estimated date of confinement
Incompetent cervix
False labor
Discharge
Toolkit v1.0
Page 41
Words to live by
Encouraged
Communicate
Welcomed or encouraged
Birth
Cesarean Birth
Estimated date of birth
History of prematurity
Prolonged labor
Going Home
2/26/2007
THE POWER OF WORDS
Identify the words on your unit that are jargon,
disempowering, negative, or create a cold and technical approach
to the emotional experience of healthcare.
Substitute words that are more positive, empowering, and
meaningful for the patients and families on your unit.
WORDS to Eliminate
Toolkit v1.0
WORDS to Live By
Page 42
2/26/2007
Ideas and Strategies for Applying PFCC Concepts
Return to Main Menu
Toolkit v1.0
Page 43
2/26/2007
assuring respect & dignity
Patients are likely to feel particularly vulnerable when they are admitted to a
hospital, but many simple things can be done
to make them feel more at ease.
Kind words and a friendly smile go a long way
to alleviate initial anxieties.
More specifically, asking patients about their preferences and needs (or their
family members, if the patient is too ill to interact) has a dual benefit,
reassuring patients and families that we want to know what their needs are,
and giving the nurse or healthcare provider firsthand information about how to
individualize care.
There are many aspects to this important initial conversation. It builds
understanding, relationships, and trust.
Toolkit v1.0
Page 44
2/26/2007
During the initial assessment, it’s standard to ask the following questions.
Introductions
Mr. or Mrs.? Or first name?
Religious or cultural concerns Special dietary needs, observances, etc.
Unit and room orientation
How the unit works – shift change, how to
call in, check in, order food, etc.
o Who is on your healthcare team
Contacts
Timetables for typical days
Facilities
o What their roles and responsibilities are.
o How the doctor works and what to expect
in terms of visits and rounding.
Useful telephone numbers and contact
information
Meal delivery, etc.
What’s available in the hospital for patients
and family member (cafeteria, chapel, etc.)
Additionally, it’s important for the patient and family to get answers
to questions like these:
•
Semi-private rooms
Q: How will you try to maintain my/our privacy?
Q: What should I/we do if we feel uncomfortable
about it?
• Family/Visitor Preferences
Q: What does our family needs to know about
being here?
Q: What do my friends and visitors need to know
about being with me?
Toolkit v1.0
Page 45
2/26/2007
Cultural competence is important in a patient-and family-centered
environment. Best practices from other hospitals in with significantly diverse
patient populations suggest other information to solicit soon after admission,
described below. Add other questions that are specific to the typical patient
population served by your unit.
Cultural Assessment
Language
•
•
What language do you speak?
Is there a specific dialect?
Family/Social Structure
Q: Are their certain members of your family that we need to involved directly in
your care?
• Describe the members of your family who will be involved in your care.
Q: Who is the most important person to help with your care?
Health and Illness beliefs
Q: Tell me what you think caused your illness?
Q: Have you sought assistance from individuals in
your community to help with your illness?
Q: How can I include them in your healing and care
now?
Q: Are there foods that you want to have while you
are here in the hospital that will help you get
well or heal?
Q: How would we know if you are having pain?
Can you tell me what you might say or do if you were having pain?
Q What is your usual routine when you take your medicines? What is the best
way for you to take medicines – oral, pill, crushed?
Toolkit v1.0
Page 46
2/26/2007
Families and visitors
A family
member on a
faculty panel
said:
THE FAMILY
“Families are not visitors
– we have the RIGHT to
be near our loved one.”
The patient defines a patient’s family.
Family members are not “visitors.” They
are, according to the patient’s preference,
integral members of the patient care team
and treatment plan.
VISITORS
Visitors are guests of the patient and family.
The key: Who is “family?” Help patients define their
“family” by asking:
Q: Who will be with you during your hospitalization?
Q: Who is your surrogate, advocate, and spokesperson to others?
Q: Who will care for you after discharge?
Q: With whom do we share information?
Toolkit v1.0
Page 47
2/26/2007
Some Considerations about Families and Visitors
Source: Dana-Farber/Brigham And Women’s Partners, Cancer
Care, Institute for Family-Centered Care Conference
Most patients and families, at different times and in different
ways, require support from people important to them. This support may involve
someone to assist in decisions about medical care, to provide transportation to
appointments, to provide care in the home after treatment, or someone to be
there for companionship.
For some people, their primary support may come from immediate family
members. For others, they may include other relatives, neighbors, friends, coworkers or clergy.
Staff members can help family members and friends offer effective assistance and
emotional support to the patient. Clear explanations from staff members about
what families or friends can do to help the patient, where they can be on the unit,
and any limitations on their participation are helpful.
In semi-private rooms, it is important to be respectful of each patient’s different
needs and preferences. Visiting guidelines should be flexible in order to respond to
the diverse and changing needs and preferences of each patient and family.
Time and treatment alter what patients want. Patients and families may need help
in modifying the visiting schedule or expectations about visits.
GUIDELINES FOR PRACTICE
Provide information and support to patients so they can be their own advocate in
making the right choices about family and visitors spending time with them.
Let people know that there may be fluctuation and change in relation to their
comfort with visiting in the course of their hospital stay.
Offer information to family members and visitors so they can become
knowledgeable about how they can be most helpful to the patient. Use positive,
welcoming, and respectful wording to communicate these guidelines through
signage, brochures, and other materials.
Build understanding of the importance of family and visitors to the patient’s health
and well-being. Learn how to intervene in the patient’s best interest when family
members or visitors are not respectful of the patient’s needs or mediating
differences such as those that may arise between roommates. Individualize these
guidelines to the patient’s and family’s needs and preferences.
Toolkit v1.0
Page 48
2/26/2007
Guidelines Drafted by the MRH 5 WEST STAFF
Don’t get intimidated by having the family
around! Don’t ignore them. Involve them from the
beginning. They can be your best ally. You are a team!
On admission, ask:
•
•
•
•
Are you the surrogate? The family caregiver? The
family spokesperson?
Verify on chart.
Explain HIPAA to the patient/family.
Explain that you will be working with the patient and the
surrogate/spokesperson, and ask them to be the liaison
with other family and friends.
Make sure you talk with the other patient in the room about privacy,
how they feel about visitors, sleep time, etc., so you can work with both sets of
patients/families and their visitors to meet their needs.
Manage patient and visitor expectations. Make sure that the patients and
families are aware of the expectations regarding visitors. Ask them to talk to
their visitors about these guidelines:
•
“Our rooms are semi-private, and small.”
•
“Our patients need you to be respectful of their privacy and need for a quiet, healing
environment, so we ask you not to have more than two visitors in the room at a time.”
•
“Please time your visits – for example, it probably isn’t a good idea to visit the patient the
first day after surgery. They won’t be feeling too well. It’s best to call before you come.”
•
“Always check with the nurse before you go to the patient’s room. They might not be
feeling up to visitors, but don’t want to be rude to you. And their roommate might need
some special privacy at the moment. You may stay in the Family Lounge near the elevators
while you wait.”
•
“We do not limit visiting hours for families, and we are flexible about visiting hours for
friends. However, our patients need as much rest as possible, so we ask that you limit
visits after 9 pm. If you must visit later than that, please respect that it is Quiet Time.
Patients are sleeping, so be extra careful about noise.”
•
“If you do visit after 9 pm, please be aware that it is necessary for you to stop at the Unit
Desk before you enter the patient’s room.”
•
“Our patients are extra-susceptible to infections when they are in the hospital. Please do
not visit if you have any symptoms of a cold, flu, or other contagious illness. You can call
the nurse for an update on the patient.”
•
“Please HELP US CONTROL INFECTION! WASH YOUR HANDS before going into the room
and when you leave it. Handwashing is the best way to prevent infection. Please don’t use
the unit pantry facilities without washing your hands.”
Toolkit v1.0
Page 49
2/26/2007
Is your unit family-supportive
and visitor-friendly?
Involve your patients and families! Ask them! Asking and listening does not
mean you have to do everything they suggest.
As an alternative, you can ask members of the JDCH/MRH patient/family
advisory councils for assistance.
You can use questions similar to those described below to gather information
and input. You could also construct a checklist for a task force made of
advisors and staff members to use in a “walk through” approach. Encourage
them to take “before” and “after” pictures!
FIRST IMPRESSIONS
UNIT:
Imagine you are entering this unit for the first time as a family
member or visitor. You exit the elevator and ……
Entering the unit:
Q: What is available?
Q: What do you need?
Q: What would you like to have?
Q: What is your first impression?
Q: What do you need to see?
Q: What would you like to see?
Entering the patient room:
Q: What is your first impression?
Q: What do you need to see?
Q: What would you like to see?
Family Support Spaces:
Q: What is available?
Q: What do you need?
Q: What would you like to have?
Visitor Support Spaces:
Toolkit v1.0
Page 50
2/26/2007
enlisting physicians in PFCC change 9
Dr. William Schwab, Professor, Department of Family Medicine, University of
Wisconsin, says:
Dr. Schwab
“We are all working hard on behalf of patients
and their families. We are doing our “biomedical
best.” It is the way we show our caring for
patients. It wasn’t that we were asleep during
Patient- and Family-Centered Care classes.
There weren’t any! But when there’s a
disconnect between physicians and patient/
families, the staff say “Oh, the docs won’t
change.” But we do! We’re always working with
new equipment, new pharmaceuticals, and new
clinical methods. Stereotyping physicians won’t
further the process of change. We need to focus
on mutual interests.”
Dr. Schwab notes that “mutual interests” include quality, safety, technology, staffing,
patient satisfaction, costs, growth, and community. Administrators, physicians, patient
care staff, and patients and their families all share these interests. Through discussion
and dialog, says Dr. Schwab, we learn that we’re all actually aligned around these
interests. What we need to do is define them together, as partners.
Work with each physician as an individual. Begin with physicians who
express a positive interest in patient- and family-centered care. Offer a
range of opportunities for involvement in planning PFCC initiatives.
Provide a context of quality and innovation that includes information
about how PFCC is being implemented around the country.
Create an environment where patient- and family-centered care
approaches are the norm.
9
From a presentation by William E. Schwab, MD, 1994, adapted by the Institute for Family-Centered Care, 1998
Toolkit v1.0
Page 51
2/26/2007
applying the concepts
bedside rounds10
The way rounds are conducted is changing. Increasingly staff and faculty are
including patients and families in the process of rounds. The following are
guidelines for conducting rounds to accomplish a variety of purposes
successfully within a context of respect and support for patients and their
families.
Develop practices for the process of rounds that respect
privacy and confidentiality.
Think through the definitions of privacy and confidentiality and
the implications for rounds.
To comply with HIPAA regulations, especially when conducting rounds in
semi-private or multi-bed rooms, a hospital or a clinical unit should have
a written philosophy of care that acknowledges the importance of patient
and family access to information and affirms that their participation in
care planning and decision-making is essential to the best clinical
outcomes and to quality, safe health care. This statement documents
that family participation in rounds is standard operating
procedure.
Ask the patient at the beginning of a hospital stay to identify
family members who should or should not be included in these
discussions. For patients who are not able to participate in planning and
decision-making, family members should be asked.
Ask the patient and family if there are key issues that should be
protected.
Include information about the hospital’s policy regarding patient and
family participation in rounds on routine consent forms. This provides an
opportunity to encourage patients and families to take an active role in
health care decision-making and to tell them of the possibility of
incidental disclosures.
10
Hospitals Moving forward with Patient- and Family-Centered Care Seminar 2006
Toolkit v1.0
Page 52
2/26/2007
Consider adaptations in the
configuration of the unit or patient
rooms that might enhance privacy.
At the time of admission, have
patient/family consultants or other staff
help prepare patients and families for
the way that rounds are done. Written
or audiovisual materials may be helpful
as well.
Consider the process of rounds as an
opportunity to model open
communication and clear and
supportive language with patients,
families, and health professionals from all disciplines.
Decide and clarify whether this is the primary time for the patient or
family to ask questions and obtain information.
• If this is not the primary time for this communication, determine the
alternatives.
• If this is the primary time for communicating with patients and families,
consider the timing of rounds and its convenience to families.
With the primary purpose for the rounds clear:
Choose the appropriate language, topics, and level of detail to use at the
bedside. Set a tone from the beginning that everyone is a learner.
Convey respect for the individuality, capacities, and vulnerability of each
patient. Avoid language that is patronizing
Convey respect for patients and families and recognize them as members
of the care team.. Affirm the positive contributions that patients and
families can make to care planning and decision-making.
Do not use a family’s participation or choice not to participate in rounds as a
way to evaluate “family involvement.” Rather, offer the choice and respect
their decision.
Toolkit v1.0
Page 53
2/26/2007
bedside rounds
(continued) 11
THE ROUNDING INTERACTION
Greet the patient and family upon entering the room. Introduce yourself.
When necessary, remind students and professionals-in-training to greet
the patient and family.
Briefly explain the purpose of rounds to the patient and family —
clarifying whether the purpose is primarily teaching or the coordination of
clinical care or both.
In discussions with the rounding team,
Refer to the patient or family by name, rather than as a disease or room
number, or Mom or Dad. Avoid discussing the patient in the third person
– “this 63-year old patient….”
When the patient’s condition permits,
Help the patient in bed to be at eye level with the rounding team.
Ask for insights and observations from the patient, when the patient’s
condition permits, and from the family. These questions could relate to
the patient’s condition and treatment or they could focus on other kinds
of issues, such as their experiences at the hospital and any suggestions
for improvement.
When examining the patient during rounds,
Respect privacy needs. Ask the patient and/or family if this is an
appropriate time.
Provide patients and families with an opportunity to debrief or process
what they have heard on rounds.
When leaving,
Ask if the patient or family have questions. If they do, either respond to
them then or have a plan as to how to respond to them later.
11
Toolkit v1.0
Page 54
2/26/2007
supporting family presence:
key questions to ask12
Q: What are the hospital’s policies/guidelines that encourage (or discourage)
the presence of families during procedures?
Q: Do families have the opportunity to decide for themselves whether or not
they
–
–
–
–
remain present for:
Painful procedures?
Anesthesia induction?
Recovery room experience?
Resuscitation or codes?
Q: Do medical, nursing, and allied health staff support patients’ and families’
decisions for being present or not being present with their family member
during procedures?
Q: Are there plans in place to support families before, during, and after
procedures? Have specific staff members been designated or are there trained
volunteers available to support families before, during, and after procedures?
Q: How are staff prepared and supported in working with families who wish to
remain present with their family member during procedures?
Q: Are there plans to hold debriefing sessions for staff for support and
reflection on how the process worked?
KEY POINTS
12
•
Look for opportunities to include, not exclude.
•
Offer the choice to be present.
•
Set the ground rules or expectations.
•
Have a support person available.
Toolkit v1.0
Page 55
2/26/2007
Return to Main Menu
Toolkit v1.0
Page 56
2/26/2007
coaching staff about PFCC
PFCC represents a change in thinking for everyone, leaders included.
PFCC takes our commitment to Safety, Quality, Satisfaction and Service
Excellence to a new level.
PFCC approaches ask healthcare professionals to substantively change their
practice habits and consciously to include families in care discussions, provide
more clinical and non-clinical information, and maintain and encourage family
presence in all aspects of the care experience.
For some staff members, this is what they got into healthcare for in the first
place, and they will embrace it, run with it, and never look back. For others, it
is a very big change and will be very difficult.
At MHS, we understand that individual staff members will adopt new
approaches at different rates and to differing degrees. We are on a journey of
cultural change that will unfold over many years. Thus, our approach to staff
performance related to PFCC must be patient, perseverant, and focus on
teaching/coaching, not counseling.
ROUNDING IS THE KEY
How do good sports coaches let their players
know how they are doing?
•
•
•
They watch the play.
They get specific about what works, what
doesn’t work.
They feed it back to the player as soon as
possible after the play is made.
Toolkit v1.0
Page 57
2/26/2007
coaching staff about PFCC
CATCH THEM DOING IT RIGHT!
•
Thank them.
•
Tell them specifically what you saw
and
how it is important.
•
Thank them again.
IF YOU SEE IT DONE NOT SO WELL:
•
Take the employee aside and say “In the situation just now, I see you
didn’t ask the family what they’d observed. Was there a reason why you
didn’t?
•
You know, we’ve made a commitment to bring families into partnership
with us in the care of the patient, and although I know Mrs. XXX is
sometimes way too talkative, we have to honor that commitment. Here’s
how I think it can work better for you next time…..
Toolkit v1.0
Page 58
2/26/2007
staff who role model
patient-and family-centered care
• Actively incorporate into their practice a respect for patients and
families as individuals with their own traditions, beliefs, and value
systems.
• Acknowledge that the word “family” can be defined in many
ways.
• Respect patients’ and families’ beliefs, experiences, and
backgrounds.
• Explicitly encourage patients’ and families’ participation in health
care decision- making.
• Encourage patients and families to share their observations,
ideas, and suggestions for the plan of care.
• Acknowledge the expertise of patients and families.
• Listen and learn from patients and families.
• Provide information in ways patients and families prefer and find
useful and affirming.
• Make written, electronic, and audiovisual resources available to
enhance patients’ and families’ access to information and support.
• Use language (verbal and non-verbal)that reflects an emotional
connection with the patient and family even when explaining the
technical aspects of a disease or treatment.
Toolkit v1.0
Page 59
2/26/2007
The following Standards of Performance for Family-Centered Care have been adopted by Joe
DiMaggio Children’s Hospital and are practiced, role modeled, and discussed in performance
coaching situations.
FAMILY-CENTERED CARE
STANDARDS OF BEHAVIOR
Involve patients and families in all aspects of the planning, delivery, and
evaluation of health care services.
Recognize families as important members of the healthcare team.
Encourage and support them in care planning and decision-making.
Support patients in involving their families in their healthcare experience
in ways that they choose
Welcome family members at all times, regardless of rounds, change of
shift or other events on the unit.
Encourage and support family members to be present during procedures
and treatments, if this is the preference of the patient.
Provide information in ways that patients and families find helpful,
empowering, and supportive in nurturing, care-giving, and decisionmaking.
Provide easy and accessible opportunities for patients and families to ask
questions of doctors and nurses.
Provide care that respects patients’ values, preferences, and expressed
needs.
Coordinate and integrate the care for the patient – coordinate services
(i. e. tests, consultations, or procedures)
Toolkit v1.0
Page 60
2/26/2007
PFCC REQUIRED ORIENTATION FOR MRH
& JDCH STAFF MEMBERS
An overview of Patient – and Family-Centered Care has been provided to all
new MRH/JDCH staff hired since October of 2005.
In order to assure that all staff are acquainted with our hospitals’ commitment
to the philosophy and key concepts of patient- and family-centered care, the
PFCC team will provide one-hour mandatory training sessions during the
months of September, October, and November, 2006.
ALL STAFF HIRED PRIOR TO OCTOBER 2005 are required to
attend.
A complete schedule of dates and times, class locator numbers, and registration
information is published in the quarterly Memorial Academy Class Schedule. You may
access it online at through the MHS Intranet at:
http://intranet/corporate/mhs/academy/update.asp
NEW HIRES: MRH/JDCH NEW EMPLOYEE ORIENTATION: Bi-weekly, Fridays at
2:15, all new hires receive a presentation that briefly outlines the organizations’
commitment to Patient- and Family-Centered Care. The presentation faculty includes
members of the Patient/Family Advisory Councils.
Toolkit v1.0
Page 61
2/26/2007
staff development opportunities
MEMORIAL ACADEMY CLASS
An Introduction to Patient-and Family-Centered Care
6.5 Contact Hours
This workshop introduces staff with patient and family contact to the principles
and skills of providing Patient- and Family-Centered Care. By the end of the
session, participants will be able to:
Describe and define Family-Centered Care
1. Distinguish between FCC and System-centered vs. Family focused interactions
2. Identify how FCC principles are integrated into an organization, e.g. families as advisors,
policies/procedures, other best practices
3. Distinguish between family-centered and non-family centered language in the healthcare
setting (words that empower vs. words that create dependence).
4. Identify the family-centered care principles that can assist staff to handle stressful
situations. – identify “scripts” that might be used.
5. Apply family-centered care principles to typical case scenarios, and generalize to the
workplace.
Identify what they can do to create FCC in their areas of responsibility
1. Identify 2 steps they can take in their units in the next 3 months
2. Identify some resources to assist them in taking next steps
PFCC Lunch & Learns:
Periodically throughout the year, PFCC Lunch & Learns are scheduled on topics of special
interest, and are open to all employees. The schedules for these programs are
communicated to all JDCH/MRH department leaders via the MRH email list.
Annual PFCC Symposium:
A continuing education symposium is held annually to highlight internal best practices,
reward and recognize staff, and provide additional continuing education. Faculty include
nationally-known speakers, members of the patient/family advisory councils, and
physicians, nurses, and other staff who have been active in PFCC initiatives in their areas.
The PFCC Times: This newsletter highlights JDCH/MRH staff activities, upcoming events,
and best practices. It is published several times each year by the Patient- and FamilyCentered Care Services department, and welcomes articles and input from all staff.
Toolkit v1.0
Page 62
2/26/2007
reward and recognize
Thank you notes
•
Patient comments
•
Thanks from the team
•
Let the Family Advisory Council know for their
•
“Has someone brightened your day?” recognition.
•
Send stories to be published in the PFCC Times or the Memorial
Matters.
•
Food!
•
Support career development – your PFCC champions will grow
through continuing education, committee membership, mentoring
roles, and special projects.
•
SHARE BEST PRACTICES – and give the credit to the staff who
are the best practitioners.
Toolkit v1.0
Page 63
2/26/2007
Hiring for PFCC
Recruiting and hiring staff who are ready and able to practice
in a PFCC environment is a key to future success. Here are
some sample behaviorally-based questions that peer
interview teams can consider:
•
Describe a situation in which a patient’s family continuously required extra
information from you. How did you handle it?
•
Tell us about a time when a patient needed something more than excellent
nursing care. What was the situation and how did you handle it?
•
Describe a time in your experience when a patient or family member
perceived that a potential medical error was about to happen. How did you
handle it?
•
Describe a situation in which the family member insisted on being present
during an invasive procedure. What did you say and do?
•
Can you think of a situation in which your patient and his/her family
contributed to the plan of care? What was the situation and what was the
outcome?
•
Describe a situation in which the patient and family’s “need to know”
appeared to conflict with your understanding of HIPAA requirements. What
was the situation and what did you do about it?
•
In your experience, how do you determine who is the patient’s “family?”
•
Describe a time when patients in semi-private rooms had conflicting needs
for having families present at the bedside. How did you approach the
situation?
Toolkit v1.0
Page 64
2/26/2007
Return to Main Menu
Toolkit v1.0
Page 65
2/26/2007
Resources
√ Read and stay current on the growing
body of literature related to Patient- and
Family-Centered Care (PFCC).
√ Relate information to your areas of
responsibility.
WEBSITES: These key websites for Patient- and Family-Centered Care
link to many other useful sites.
Institute for Family-Centered Care: http://www.familycenteredcare.org
National Patient Safety Foundation: www.npsf.org
Institute for Healthcare Improvement. http://www.ihi.org/ihi
Patient Powered: www.patientpowered.org
Family Voices: www.familyvoices.org
VIDEOS: These videos are currently available from the JDCH/MRH
Patient and Family-Centered Care departments:
Parent Participation in Rounds: Reflections of a Pediatric Intensivist.
Institute for Family-Centered Care.
Patient and Family Resource Centers: A Visual Journey. Institute for
Family-Centered Care.
Parents On Rounds. Institute for Family-Centered Care.
Strategies for Leadership: Patient and Family-Centered Care, American
Hospital Association, Institute for Family-Centered Care.
Videos of JDCH/MRH patient and family advisors speaking about their
experiences are also available. Contact the JDCH/MRH Patient and FamilyCentered Care departments.
Toolkit v1.0
Page 66
2/26/2007
PATIENT- and FAMILY-CENTERED CARE REFERENCE LIST
ARTICLES:
Ahmann, E. (1994). Family-Centered Care: Shifting Orientation. Pediatric Nursing, 20, 113117.
American Academy of Pediatrics Committee On Hospital Care, Institute for Family-Centered
Care. (2003) Policy Statement: Family-Centered Care and the Pediatrician’s Role.
Pediatrics. 112, 691-696.
Barnsteiner, J. H., Gillis-Donovan, J., Knox-Fischer, C., & McKlindon, D. (1994). Defining and
implementing a standard of therapeutic relationships. Journal of Holistic Nursing, 12, 3549.
Berwick, Donald M., MD, Restricted Visiting Hours in ICUs, JAMA August 11, 2004, 292, 736737.
Busch, CJ. On creating a healing story: One chaplain’s reflections on bereavement, loss and
grief. Innovations in End-of Life Care, 2001; 3(3), www.edc.org/lastacts.
Callery, P. & Smith, L. (1991). A study of role negotiation between nurses and the parents of
hospitalized children. Journal of Advanced Nursing, 16, 772-781.
Capitulo, Kathleen; Silverberg, Marta. (2001) Creating Patient-Focused, Family-Centered,
Maternal-Child and Pediatric Healthcare. Maternal Child Nursing, 26, 298-306.
Caty, S., Larocque, S., Koren, I. Family-Centered Care in Ontario General Hospitals: The
Views of Pediatric Nurses, Canadian Journal of Nursing Leadership, 13 (2),
May/June2001, 10-18.
Cohen, J. J. (1999). Moving from provider-centered toward family-centered care. Academic
Medicine, 74, 425-425.
Coyne, I. T. (1995). Partnership in care: parents' views of participation in their hospitalized
child's care. Journal of Clinical Nursing, 4, 71-79.
Dobbins, Norma; Hohlig Cathie; and Sutphen, James. (1994) Partners in Growth:
Implementing Family-Centered Changes in the Neonatal Intensive Care Unit. Children’s
Health Care, 23, 115-126.
Eckles, Nancy; Maclean, Susan. (2001). Assessment of Family-centered Care Policies and
Practices for Pediatric Patients in Nine US Emergency Departments. Journal of
Emergency Nursing, 27, 238-245.
Entwhistle, Vikki., M.Sc., PhD.; Mello, Michelle M., J.D., PhD., M. Phil.; Brennan, M.D., J.D.,
M.P.H. . Advising Patients About Patient Safety: Current Initiatives Risk Shifting
Responsibility. Joint Commission Journal on Quality and Patient Safety, September
2005, 31 (9): 483-94.
Toolkit v1.0
Page 67
2/26/2007
ARTICLES
Gill, K. M. (1987). Nurses’ attitudes toward parent participation: personal and professional
characteristics. Children's Health Care, 15, 149-151.
Heller, R. & McKlinton, D. (1996). Families as "faculty:" Parents educating caregivers about
family-centered care. Pediatric Nursing, 22, 428-431.
Henneman, Elizabeth.A. Family-Centered Critical Care: A Practical Approach to Making It
Happen, Critical Care Nurse, 22 (6), December 2002, 12-19.
Hostler, S. L. (1999). Pediatric family-centered rehabilitation. Journal of Head Trauma
Rehabilitation, 14, 384-393.
JCAHO Proposal for Patient-Centered Care Brings Concept to Mainstream Healthcare Settings.
The Risk Management Reporter, Vol. 24, No. 3, June 2005. ECRI, www.ecri.org
Johnson, Beverly H. (1999) When Hospitals Put the Emphasis on Patients and Families,
Everyone Benefits. Trustee, March, pp. 15.
Joint Commission on Accreditation of Healthcare Organizations. Requirements Related to the
Provision of Culturally and Linguistically Appropriate Health Care. JCAHO 2004.
Lee, Fred. (2003) Inspiring Patient Loyalty, Not Satisfaction. Trustee, April , 24-28.
Lindeke, Linda L.; Leonard, Barbara; Presler, Betty; Garwick, Ann. (2002) Family-centered
care Coordination for Children With Special Needs Across Multiple Settings. Journal of
Pediatric Health Care, 290-297.
McGahey, Patricia R (2002). Family Presence During Pediatric Resuscitation: A Focus on Staff,
Critical Care Nurse 22, 6, December, 29-34.
Massoud, M. Rashad, MD, MPH; Nielsen, Gail A., BSCHA, F+AHRA, RTR; et. Al (2006). A
Framework for Spread: From Local Improvements to System-Wide Change. Institute
for Healthcare Improvement.
http://www.ihi.org/IHI/Results/WhitePapers/AFrameworkforSpreadWhitePa
per.htm
National Patient Safety Foundation’s Patient and Family Advisory Council, National Agenda for
Action: Patients and Families in Patient Safety, Nothing About Me, Without Me, 2003,
www.npsf.org.
Nielsen, Don M., MD; Merry, Martin D., MD; Schyve, Paul M., MD; Bisognano, Maureen
(2004). Can the Gurus’ Concepts Cure Healthcare? Quality Progress, 25-34.
Romer, A (1999) Listening to Patients and Families Moves Practice Toward Family-Centered
Care. Innovations in End-of Life Care, 1(2), www.edc.org/lastacts.
Rubin, Irwin, PhD. (1999) Interpersonal Economics: How the “Soft Stuff” Affects Hard Bottom
Lines. Health Forum Journal.
Toolkit v1.0
Page 68
2/26/2007
ARTICLES
Rushton, Cindy Hylton (1990). Family-Centered Care in the Critical Care Setting: Myth or
Reality? Children’s Health Care 19 (2), 68-78.
Silow-Carroll, Sharon; Alteras, Ranya; Stepnick, Larry. Patient-Centered Care for Underserved
Populations: Definition and Best Practices. Economic and Social Research Institute,
Washington, DC. 2006 www.esresearch.org
Silverman, PR. Living with grief, rebuilding a world. Innovations in End-of Life Care, 2001;
3(3), www.edc.org/lastacts.
Silverman, PR (2000). Never Too Young to Know: Death in Children’s Lives. New York:
Oxford University Pres
BOOKS:
DeNove, Chris, and Power, James D. Satisfaction (2006) How Every Great Company Listens to
the Voice of the Customer. The Penguin Group: New York.
Diering, Scott, M.D. (2004). Love Your Patients! Improving Patient Satisfaction with Essential
Behaviors That Enrich the Lives of Patients and Professionals. Blue Dolphin Publishing,
Inc., Nevada City, CA.
Frampton, Susan, Gilpin, Laura, Charmel, Patrick, eds (2003). Putting Patients First: Designing
and Practicing Patient-Centered Care. Jossey-Bass, San Francisco.
Gladwell, Malcolm (2000). The Tipping Point: How Little Things Can Make A Big Difference.
Little Brown & Co., NY.
Institute of Medicine (2001). Crossing the Quality Chasm, A New Health System for the 21st
Century. Institute of Medicine. National Academy Press.
Kotter, John (1996). Leading Change. Harvard Business Review. Cambridge, MA.
Lee, Fred (2004). If Disney Ran Your Hospital: 9 ½ Things You Would Do Differently. Second
River Healthcare Press, Bozeman, MT.
Levine, Carol, and Murray, Thomas, eds (2004). The Cultures of Caregiving. Johns Hopkins
University Press, Baltimore, MD.
Lewandowski, Linda; Tesler, Mary, eds (2003). Family-Centered care: Putting It Into Action,
The SPN/ANA Guide to Family-Centered Care. Society of Pediatric Nurses and American
Nurses Association, , American Nurses Association, Washington, DC. nursebooks.org
Schein, Edgar (1999). The Corporate Culture Survival Guide: Sense and Nonsense About
Culture Change. San Francisco: Jossey-Bass Publishers.
Senge, Peter M (1990). The Fifth Discipline: The Art & Practice of the Learning Organization.
Doubleday, NYC, NY.
Studer, Quint (2003). Hardwiring Excellence: Purpose, Worthwhile Work, Making A Difference.
Fire Starter Publishing, Gulf Breeze, FL. 2003.
Toolkit v1.0
Page 69
2/26/2007
ACKNOWLEDGEMENTS
We wish to thank the Institute of Family-Centered Care, Bethesda, Maryland for
permission to incorporate and adapt their materials for this Toolkit.
We also
appreciate the help of Elise Bloch, Clinical Assistant Professor, Occupational
Therapy (Florida International University), and an active member of the JDCH
Family Advisory Council, for reviewing the material and providing additional
insights and ideas.
And many thanks to Jan Bourne, MHS Organizational
Development Specialist, who has been an invaluable partner, responsible for
much of the formatting, design, and production of this material.
Susan Montgomery, M.A
Director, Patient- & FamilyCentered Care Services
Memorial Regional Hospital
Toolkit v1.0
Nick Masi, PhD.
Director, Family-Centered Care
Joe DiMaggio Children’s Hospital
Page 70
2/26/2007

A Comprehensive PFCC Curriculum for Healthcare Professionals

Transcription

Similar documents

Strategies for Leadership – Advancing the Practice of Patient

Johnny Tremain by Esther Forbes Objectives

Partnering with Patients and Families To Design a Patient

Conference Brochure - Institute for Patient- and Family

Activity Kit - Draw Flynn`s Nose The Magistrate just can`t get Flynn`s

Saebo Evaluation and Treatment Kit

Gravlax Kit Guide and Information

LGOBO SALE SHEET

The wardrobe malfunction — it`s a Hollywood moment that

InBody720 Spec Sheet

design - Escola Design Thinking

HANOMAG SdKfz 251 D

DMC1229 WIRING SYSTEM SERVICE KIT For the Kaman K-Max