2What is Patient- and Family-Centered Care? Patient- and family-centered care is an approach to the planning,delivery and evaluation of health care that is grounded inmutually beneficial partnerships among patients, families, andhealth care practitioners. It is founded on the understandingthat the family plays a vital role in ensuring the health and well being of patients of all ages.The ultimate goal of patient- and family-centered care is to create partnerships among health care practitioners, patients and families that will lead to the best outcomes and enhance the quality and safety of health care.
3Four Core Concepts D I G N I T Y A N D R E S P E C T Health care practitioners listen to and honor patient and family perspectivesand choices. Patient and family knowledge, values, beliefs and culturalbackgrounds are incorporated into the planning and delivery of care.I N F O R M AT I O N S H A R I N GHealth care practitioners communicate and share complete and unbiasedinformation with patients and families in ways that are affirming and useful.Patients and families receive timely, complete and accurate information inorder to effectively participate in care and decision-making.PA R T I C I PAT I O NPatients and families are encouraged and supported in participating in careand decision-making at the level they choose.CO L L A B O R AT I O NPatients, families, health care practitioners, and hospital leaders collaboratein policy and program development, implementation and evaluation; inhealth care facility design; and in professional education, as well as in thedelivery of care.
4Patient- and Family-Centered Care: Why Is It Needed? “ Care must be delivered by systems that are carefully and consciously designed to provide care that is safe, effective, patient-centered, timely,efficient, and equitable.Such systems must be designed to serve the needs of patients, and to ensure that they are fully informed, retain control and participate in care delivery whenever possible, and receive care that is respectful of their values and preferences. “Institute of Medicine, Crossing the Quality Chasm (2001)
5Crossing the Quality Chasm 1. Safe – avoiding injuries to patients from carethat is intended to help them.2. Effective – providing services based on scientificknowledge to all who could benefit andrefraining from providing services to those notlikely to benefit.3. Patient-centered – providing care that isrespectful of and responsive to individual patientpreferences, needs and values, and ensuring thatpatient values guide all clinical decisions.4. Timely – reducing waits and sometimes harmfuldelays for both those who receive and thosewho give care.5. Efficient – avoiding waste, in particular wasteof equipment, supplies, ideas, and energy.6. Equitable – providing care that does not varyin quality because of personal characteristicssuch as gender, ethnicity, geographical location,and socioeconomic status.
6Patient CenterednessThe real business of health care is about preventing illness, healing those who are ill, meeting the needs of people who must live their lives with disabilities or chronic disease, and helping people in our communities achieve better health.Patient-centered care includes:respect for patients’ values, preferences,and expressed needs;coordination and integration of care;information, communication, and education;physical comfort; emotional support;and the involvement of family and friends.
7R U L E S TO R E D E S I G N A N D I M P R O V E C A R E 1. Care based on continuous healing relationships.Patients should receive care whenever they need it and in many forms, not just face-to-face visits.2. Customization based on patient needs and values.The system of care should be designed to meetthe most common types of needs, but have thecapability to respond to individual patientchoices and preferences.3. The patient should be the source of control.Patients should be given the necessary information and the opportunity to choice over their health care decisions.
84. Shared knowledge and the free flow of information 4. Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.5. Evidence-based decision making.Patients should receive care based on the best availablescientific knowledge.6. Safety as a system propertyPatients should be safe from injury caused by their care system.
97. The need for transparency 7.The need for transparency. The health care system should make information available to the pts and family that allows them to make informed decisions when selecting a health plan, hospital or clinical practice, or choosing among alternative treatments.8. Anticipation of needs.The health system should anticipate patient needs, rather than simply reacting to events.9. Continuous decrease in waste.The health system should not waste resources or patient time.
1010. Cooperation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.Adapted from Crossing the Quality Chasm: A New Health Care System for the 21st Century, 2001.
19PATIENT-FAMILY CENTERED CARE TEAM Team Leader: June SharkeyDebbie KaszyckiMinnie FrazierJulie SiggelkowJudy DowneyKate MartinKrista GarnerRay Quintero
20CHARTER SUMMARY Project Date: November 13-16, 06 Champion: Susan Grant Opening 2D ICU-Patient Family Centered CareProject Date: November 13-16, 06Champion: Susan GrantObjectives:To coordinate the flow for the family in 2D ICUIdentify relationship between family, staff and physician (Rounding, Dr. 99 presence, MD discussion w/ families)Develop a plan for tools to facilitate communication for families including scripting and pt./family literatureDevelop standards of care utilizing best practices (EB) for patient family centered care(Pastoral care, social services, Public safety)Developing protocols for family room utilization (Facility management)Sponsor: Ray QuinteroSensei: Sonia BergmannTeam Leader: June SharkeyTeam MembersDebbie KaszyckiMinnie FrazierJulie SiggelkowJudy DowneyKate MartinKrista GarnerScope:2D ICU-from initial contact with family and patient to D/C from ICU.
22Current Model vs. Family-Centered Approach Historical models of patient care have been organized around the needs of healthcare professionals.Traditional methods of patient care delivery rarely involved family in medical management.A family-centered approach has been referenced to achieve high levels of quality care and increased patient satisfaction.Family-centered care encourages a collaborative team approach.Many aspects of patient and family centered care are cost-efficient and simply require a paradigm shift.Implementing a family centered approach to care is an ongoing commitment.
24AccomplishmentsLean exercises: Value streams, spaghetti charts, NVA / VA identification.Met with various individuals / ancillary staff:Pastoral services, Rollins DD, nutrition, day surgery advocate, ER patient administrative liason, patients’ family members.Family Process: Quick Sheet for admission and guidebook.Staff Education for new culture of family centered care.
25Examples of Accomplishments Rough drafts of admission quick sheet for individual family members as well as for laminated guidebooks to remain in family waiting areas.Generated ideas for the job description of the “family coordinator”Developed plan for staff education to promote a smooth transition into family-centered care.Listed ideas for “signage” throughout the “mothership/2DICU”
27Key Metrics for the Unit Patient & Family SatisfactionICU SurveyBaseline 11/20 through December - Ray & AaronEmployee SatisfactionGallup Poll SurveyBaseline next week and then in Feb & Apr ’07 – Ray & MarilynStress StudyGeorgia Tech. TBDMD Satisfaction – ICU Admitting Surgeons & NeurologistsObtain a validated survey – MarilynFamily Member time spent with patientFamily sign in/outBaseline units 2&3 11/20 thru Dec ‘07; Future collection Feb-Apr ‘07Julie will create a formLindsay
28Lessons LearnedFamily-centered care relies upon COMMUNICATION amongst all members involved in the care of the patient.Family-centered care is a multidisciplinary group endeavorWe can change the schematics of an ICU and upgrade with all the fancy stuff in the world but if we don’t upgrade the way we practice, change will never occur for the good of the patient.The LEAN project has encouraged us to network ideas with ancillary staff throughout EUH to successfully merge and create an innovative approach to patient care in the neuroscience ICUs.FONT STYLE AND SIZEHelvetica (Postscript)/Arial (Non-postscript) is the standard font for all slides. All headline and body text is recommended Bold.The headline text is set at black 30 point in UPPERCASE or UPPER lower case. Body copy is black UPPER lower case. The first and second level body copy text is 24 point. The third and fourth level is 20 point. Text should not drop below 18 point for readability. Create more than one slide if necessary to drop below 18 point.BULLETSThe standard shape for first level bullets is a square from the Monotype Sorts drop down box under Format, Bullet. It is located in the third row, the sixth symbol from the right. It should be 60% of the size of the text. The second level bullet is a dash selected from the normal menu. It is located in the fifth row, eighth from the left. For second level text, this dash is used at 70% of the size of the text, all other levels are set at 60% of the size of the text. All are the same red as the title bar and ROCKWELL.
29ExpectationsThe current model of patient care will be transitioned to a family-incorporated approach.May be difficult at firstIn-services and continued staff education should assist with integration of family-centered values into the unit’s standards and policiesFamily-Centered care is an ongoing journey.FONT STYLE AND SIZEHelvetica (Postscript)/Arial (Non-postscript) is the standard font for all slides. All headline and body text is recommended Bold.The headline text is set at black 30 point in UPPERCASE or UPPER lower case. Body copy is black UPPER lower case. The first and second level body copy text is 24 point. The third and fourth level is 20 point. Text should not drop below 18 point for readability. Create more than one slide if necessary to drop below 18 point.BULLETSThe standard shape for first level bullets is a square from the Monotype Sorts drop down box under Format, Bullet. It is located in the third row, the sixth symbol from the right. It should be 60% of the size of the text. The second level bullet is a dash selected from the normal menu. It is located in the fifth row, eighth from the left. For second level text, this dash is used at 70% of the size of the text, all other levels are set at 60% of the size of the text. All are the same red as the title bar and ROCKWELL.