1. Lack of Outcome Measure for Family Satisfaction
How do we measure satisfaction at NMH?
Staff satisfaction is assessed using the Gallup Survey Q12 measures. Until
now, there was no way to directly measure family satisfaction with care given
given in the critical care setting. The existing Press Ganey survey only
measures satisfaction based on the unit from where the patient is discharged
(e.g., to home, to another healthcare facility).
Comments from both staff and visiting families have revealed a level of
dissatisfaction within both groups. An extensive review of the literature on
family systems theory, family needs, visiting and family involvement in care was
conducted. Based on this review, it was determined that a change in practice
was needed.
A new model of care was developed that provides a framework for the sharing of
patient care responsibilities between the family and healthcare team. This model has
been named the Patient and Family Access Model of Care.

2. Healthcare Team Connection Trust Connection Trust Community Family
ACCESSIBILITY
OPENNESS
COMMUNICATION
INFORMATION
Trust
Patient
Family
Defined
Healthcare
Team MD
Nurse
Trust
Connection
Henderson Framework
Environment

3. The Family Side The model consists of 2 intersecting circles.
Healthcare
Team
The Family Side
The model consists of 2
intersecting circles.
The circle on the left side
represents the family, as
defined by the patient
and the family itself.
The family is responsible
for nurturing and
supporting each of its
members, with the
family structure based on
the interrelationship of
its individual parts and
unique shared
experiences.
ACCESSIBILITY
OPENNESS
COMMUNICATION
INFORMATION
Patient
Family
Defined

4. The Healthcare Team Side The circle on the right signifies the diverse
membership of
the healthcare team,
which supplies
specialized expertise in
the support of the
patient and family during
illness and
in promoting wellness.
ACCESSIBILITY
OPENNESS
COMMUNICATION
INFORMATION
Healthcare
Team MD
Nurse
Henderson Framework

5. At the top intersection of the two circles is the patient,
the primary focus for both the family and healthcare team.
ACCESSIBILITY
OPENNESS
COMMUNICATION
INFORMATION
Patient
Nurse
Henderson Framework
At the bottom intersection is the nurse, who as the coordinator of care, is the primary link
between the patient, family and healthcare team. The nurse advocates on the behalf of
the patient by fostering a relationship between the family and other members
of the healthcare team. The nurse’s practice is grounded in the Henderson Framework,
assisting the patient and family to gain independence in their healthcare decisions.

6. ACCESSIBILITY
OPENNESS
COMMUNICATION
INFORMATION
Patient
Family
Defined
Healthcare
Team
Nurse
Included in the middle of the intersection is a two-directional arrow. The arrow indicates
accessibility, openness, communication and information that should flow back and forth
between the family and the healthcare team, guided by the nurse and inclusive of the patient.
Based on the literature on family needs, family members desire access to the patient,
openness and transparency with the healthcare team, frequent nurse/physician
communication, and information about the ill family member that is easy to
understand. Members of the healthcare team also require accessibility, openness,
communication and information from the family in order to promote holistic patient care.
The healthcare team and family work together with the patient in developing goals and
deciding treatment options, always in the best interest of the patient.

7. Healthcare Team Connection Trust Trust Connection
Community
Connection
ACCESSIBILITY
OPENNESS
COMMUNICATION
INFORMATION
Trust
Patient
Healthcare
Team
Family
Defined MD
Nurse
Trust
Connection
Environment
When there is a two-way flow of access, openness, communication and information, then a mutual
atmosphere of trust and a shared connection should exist between the patient, family and the
healthcare professionals, all working together for the benefit of the patient. This is indicated by a
dotted line that interconnects each individual. This line is dotted because many things can upset the
delicate 2-way balance between trust and doubt for the family and healthcare team.
This collaborative effort is accomplished through the utilization of resources within the surrounding
community or immediate environment, or that of the patient and family’s home base.

8. Using the Model to Initiate Change
In order for the Patient and Family Access Model of Care to work in the ICU
at NMH, several changes to the current nursing practice are required:
Family visiting and patient access
Based on patient/family request and patient status
Improved communication between patient, family and healthcare team
Consistent access to verbal/written information, ICU journal
Sharing of information between patient, family and team
White boards in patient rooms or cork board in waiting areas, family rounds
Structured patient and family involvement
Participation in family rounds and mutual goal setting, assisting with patient care as desired

9. Core Concepts for Patient and Family Centered Care
Creating an environment that is centered around the patient and family is not unique to
Northwestern Memorial Hospital. Other hospitals and organizations across the country
recognize the importance of family in patient care. The Institute for Family-Centered Care lists
four principles when adopting care practices around patients and their families:
Dignity and Respect:
“Healthcare providers listen to and honor patient and family perspectives and choices…”
Information Sharing:
“Healthcare providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful…”
Participation:
“Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.”
Collaboration:
“Patients, families and providers collaborate in policy and program development, implementation and assessment…as well as in the delivery of care.”
We need to be attentive to families and involve them
because it is the right thing to do!

10. References
American Heart Association. (2006). Patient- and Family-Centered Care: Partnership for Quality and Safety.
Berwick, D. Institute for Healthcare Improvement. Retrieved from the World Wide Web on March 2, 2009.
Boss, P. (1992). Primacy of perception in family stress theory and measurement. Journal of Family Psychology,6(2),
Bradbury, N. (2008). Hospitals are no place for sick people. Retrieved from the World Wide Web on March 2, 2009.
Brown, P. (2008). Patient and Family Access Model of Care. Northwestern Memorial Hospital, Chicago, IL.
Institute for Family-Centered Care. (2009). Advancing the Practice of Patient –and Family-Centered Care. Retrieved from the World Wide Web on March 2, 2009.
Jeppson, E. S., & Thomas, J. (1995). Essential allies: Families as advisors. Bethesda, MD: Institute for Family Centered Care.
Tolbert, G. (2001). Family advocates: Caring for families in crisis. Dimensions of Critical Care Nursing, 20(1), 36.
Howard, J. (1999). Families. Somerset, NJ: Transaction Publishers.
Levine, C., & Zuckerman, C. (1999). The trouble with families: Toward an ethic of accommodation. Annals of Internal Medicine, 130(2),
Illinois Guardianship and Advocacy Commission. (2009). Healthcare Surrogate Act #755 ILCS 40/1 Short title. Retrieved from the World Wide Web on March 24, 2009.
Molter, N., & Leske, J. (1983). Critical Care Family Needs Inventory.