Patient-and Family-Centered Care
Putting the Patient in Patient Safety
Hollis Guill-Ryan, program coordinator, Patient and Family Centered Care Program,
University of Washington Medical Center
In this interview, we discuss the core values of patient- and family-centered care and how they can be implemented in various areas of healthcare, including the lab.
Nancy Sasavage, PhD, conducted this interview.
What is patient- and family-centered care?
It is an approach in which the healthcare organization partners with patients and their families to design policies, programs, and facilities that improve all aspects of the healthcare experience. We think it leads to better outcomes, better use of resources, and enhanced patient and family satisfaction. The core concepts of our Patient and Family Centered Care Program are communication, partnership, information sharing, choices, and respect. At the University of Washington Medical Center, these core concepts are embodied in the logo of our program.
What do you mean by partnership between healthcare organizations and patients?
Partnership means that we view all aspects of patient care as collaboration between patients and the healthcare staff. Obviously, it includes patient interaction with the direct-care team. But it goes beyond that, too. It also includes incorporating the patient’s point-of-view into essential services—nutrition, radiology, and lab—as well as administrative functions like billing. Overall, we want to allow patients and their families to contribute to the policies, programs, facilities, and quality improvement initiatives of the entire organization, and we want to be held accountable to patients.
How do you define “information sharing” as a core value?
Information sharing includes transmitting information in a way that is rapid, accurate, usable, and complete. This is directly relevant to laboratory testing, both in terms of instructions to patients undergoing testing, as well as in the formatting of lab test reports that patients and their care providers read. We want to give patients the information they need so they know what is happening.
When did this program start at your institution?
We started in 2002. The chief nursing officer at the time was one of the key forces driving the program. The university hired the Institute of Family Centered Care in Bethesda, Maryland to assess our readiness for such a program, and their analysis indicated we were ready. We were a relatively early adopter for adult medicine. The program started by recruiting patient and family advisors to serve on a steering committee. Since that time the initiative has grown to include three staff members and 60 patient and family advisors.
What patients and families are eligible to participate in your program and how do they participate?
Patients who have received care at the medical center are eligible to participate as patient advisors, as are their family members. They sign privacy agreements and agree to volunteer, usually about 2 hours per month. Patient and family advisors can participate in one or more ways. They can serve on advisory councils for specific care areas, serve on committees, review and improve educational materials and forms that are regularly used by patients and their families, teach medical students and residents, and participate in special projects like facility design. Currently, we have about 60 patient and family advisors who are serving in these various capacities.
What is a council?
A council is a group consisting of about 50% patient or family advisors and 50% staff, which often includes doctors and nurses. The purpose of a council is to improve care in a specific area. Examples of councils include the neonatal intensive care unit council, the adult intensive care unit council, the inpatient oncology council, and the rehabilitation council. Typically, councils ask questions like: “What would be helpful for patients and their families to know about this area of care before they arrive?” or “What are some key items they need to know once they are located within this care unit?” Clearly, patient and family advisors who have been through an area of care are ideally suited for answering these questions.
What are some specific accomplishments of the councils?
I will use the inpatient oncology council as an example. They developed a guide to services that orients oncology patients to the medical center and to the oncology units, specifically. They helped edit a patient safety document on preventing falls, and they were important consultants regarding some improvements in inpatient identification policies and procedures for patients receiving blood products. They were instrumental in changing food service delivery to “on demand”. They also developed care team posters that allow patients and families to identify the various medical providers taking care of them.
What are some of the committees that include patient and family advisors?
Patient and family advisors participate in a number of standing committees such as the Patient Safety Committee, the Grievance Committee, the Ethics Committee, and the Customer Service and Satisfaction Committee.
Have you used patient advisors to help hire staff?
Yes. We have patient advisors on the selection committee for resident physicians in one of our departments. Patient advisors have also helped hire nurse managers and hospital administrators, including medical directors and the chief nursing officer. This is a particularly good use of family advisors as it helps select employees who reflect the core values of patient- and family-centered care.
What do you think of using patient advisors to help improve quality in clinical laboratory services?
It is a very good idea. Clearly, patient and family advisors could help clinical laboratories in a number of ways that are analogous to some of the examples we just discussed (see box). In fact, we are just starting to explore laboratory services. For example, over the last few months we collaborated with our Department of Laboratory Medicine to pilot a program in which patient advisors attend selected lab meetings.
Can you give examples of how patient advisors could help improve lab services?
Patients could help design systems that would encourage patients to contact care providers if lab results were overdue. Similarly, they could help design systems that would encourage patients to participate actively in patient identification and specimen collection.
Do you have any final thoughts about incorporating the values of patient-and family- centered care into quality improvement initiatives?
One way to incorporate these values is to ask the following question: “Would this quality improvement initiative benefit from the patient’s voice?’’ If the answer is yes, then there are a number of ways to hear that voice. One is to have patient or family advisors participate actively in the quality improvement initiative.
What could patient and family advisors do to help lab leaders improve quality and enhance patient safety?
- Help plan facilities that patients visit, such as phlebotomy centers.
- Help design systems for communicating lab results that enhance patient understanding and enhance patient interaction with their care providers.
- Help develop systems that encourage patients to participate in patient safety.
- Participate in quality improvement committees and staff meetings.
- Help develop policy and procedures related to how best to deliver an apology to patients and their families in cases of harmful lab errors.
- Participate in developing educational materials about lab testing for patients and their families.