Family-centered care, access called natural fit
Is this the next customer service frontier?
At Blank Children’s Hospital in Des Moines, IA, patients’ family members have been involved from the start in the complete renovation of the facility, leading to a cutting-edge decision, says David Alexander, MD, medical director.
"We’re probably one of the first [hospitals] in the world to have all private rooms for neonates," he says. "We knew when we started the project that we wanted a greater number of private rooms. One of the things the family members pushed on was that some of the sickest patients — with some of the most stressed families — are [infants in the neonatal unit]. Why shouldn’t they have private rooms?"
Working together for the best solutions
It’s the kind of innovative solution that arises, Alexander explains, when a hospital incorporates family-centered care. Access managers implementing customer service initiatives should heed that philosophy, he suggests. "The greatest difference between customer service and family-centered care is that solutions are not given to [patients and families] by us, but are worked on collaboratively."
Blank Children’s Hospital became acquainted with the concept when staff members attended a seminar sponsored by the Bethesda, MD-based Institute for Family-centered Care, which promulgates the philosophy and serves as a resource for organizations that wish to embrace it. (See related story, p. 101.)
"Family-centered care is an approach that’s based on a mutually beneficial partnership among family, patient, and caregivers," says Beverly Johnson, the nonprofit institute’s president and CEO. "There is a great deal of emphasis on communication and relationships and at the core of those is respect. In health care, the idea is that it is in the best interest of patients to be active participants in their care and be collaborators with the health care professionals."
Broadening patient, family involvement
What distinguishes family-centered care from good, quality health care, she explains, is that the collaboration is not only involved with how the patient participates in his or her own health care. "The patient and family also have an opportunity to collaborate with the hospital in shaping policies, procedures, and programs, and we even think there’s a third level — as advocates for changing health care policy."
Blank’s Family Advisory Council, Alexander says, let hospital administrators know that parents didn’t like being sent with their sick children to the admitting department, which is shared with the neighboring adult medical center. As a result, all direct admissions are handled on the nursing floor, he adds.
The council, which has been in place about four years and meets monthly, also was behind
a decision to make emergency department (ED) care more user-friendly, Alexander says. "We talked to families about what they don’t like
and they said they don’t want to get asked about insurance information when their child is hurt or sick. We’re going to see the patient anyway, so why get that information upfront?"
In addition to triaging the patient and doing medical evaluations before any insurance information is gathered, Blank’s ED has decentralized its process so that the paperwork is handled via individual computer terminals in each examination room, he notes.
Real live health care consumers
What is unique about family-centered care and has relevance for access services, Johnson points out, is that these patient and family advisory councils involve "real live health care consumers who sit down with the people wrestling with all these challenges and try to figure out what’s working and what’s not. It takes the traditional way of listening to customers beyond focus groups and surveys and is an opportunity for real dialogue and real problem solving." Because the patient has lived through a particular scenario, she adds, he or she can see it from a different perspective than the director of admissions can.
The institute offers a number of tools for hospitals to perform family-centered care self assessments, Johnson notes. "One of the things we would recommend for the assessment of the admitting [function] is to look at how the front-line people are oriented to their job. We recommend that as a part of that orientation, [staff] meet with patients — and their families — who have been admitted a number of times to the hospital."
Communicating the importance of being organized, helpful, and sensitive to the fact that a person may be in pain "is so much more effective" if done by the patient, she says. "No matter what kind of clerical or paperwork job it is, [employees] should realize how they communicate, verbally and with body language. If there is a computer between you and the patient, that blocks communication."
It’s not very expensive, she points out, to lower those computers so the patient is not facing a big piece of machinery. At Children’s Hospitals in Minneapolis-St. Paul, patients’ families are being included in such projects as a redesign of the billing and collection process. (See story, p. 100.)
During a recent visit to the Cancer Center at the University of Virginia (UVA) Medical Center in Charlottesville, Johnson says she was struck by the ways in which patients’ feelings were taken into account. "In the waiting and registration area, there was a low desk, fresh flowers, and a person
I could see right away — not just cold walls — behind a counter. There were no sharp edges, but rather, the counter edges were rounded."
The room had been designed, she adds, so that a space beyond the registration area, where financial issues and other sensitive matters were discussed, was out of sight. "They didn’t want that to be the first thing you see as you walk in."
Also at the UVA Cancer Center, Johnson notes, patients sit on the facility’s executive committee and operations committee.
"You can make better decisions on building a hospital and making the system work if you have the consumer as part of the process," she says. "We recommend that a hospital never do a renovation or a new construction without having patients and families be part of that process."
When the Institute for Family-centered Care was founded in 1992, much of the work was being done in pediatrics, Johnson says. "It was particularly driven by families with children with special health needs. The families needed to be more of a partner with [the caregivers]."
The focus has now expanded, she says, noting that the institute is in the process of developing a tool for evaluating geriatric care to its list of in-depth self-assessment inventories.
Anthony M. Bruno, MPA, corporate director of registration and financial services at Crozer-Keystone Health System in Upland, PA, says he
is considering incorporating the tenets of family-centered care at the facilities he oversees, one of which focuses almost exclusively on care of the elderly.
The concepts are valid whatever the patient profile, Bruno notes. "I’m interested because family-centered care is a natural segue for access and a leader in terms of customer service. It automatically leads into looking at a lot of services that are . . . customer-oriented."
A different philosophy of care’
Family-centered care, he suggests, offers a way to bring customer service — often talked about in the abstract — to a more concrete level. "Family-centered care is everything from looking at signage to ensuring patient confidentiality to involving patients in their care and treatment plan," Bruno says. "This could bind a lot of folks together — physicians, extended caregivers, [staff] at the hospital."
The concept is a natural fit, he says, with access efforts to smooth patients’ transition from the primary care physician’s office to the ambulatory care center where tests are done. It is about "making sure the services are readily available and that the patient knows how to get here," Bruno adds.
The biggest thing to remember about family-centered care, Alexander points out, is that "it can’t be a flavor-of-the-month kind of thing. It really is a different philosophy of care. You have to be willing to commit to better care and a more satisfied patient."
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