Patient- and family-centered care (PFCC) has become one of the core aspects of a nursing profession since nurses must have a fundamental understanding of this approach and its effect on patient satisfaction. The Institute for Patient- and Family-Centered Care defines PFCC as “an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care professionals, patients, and families” (“Project background,” n.d., para. 1).
PFCC allows changing the traditional interpretation of health care by creating the opportunity for collaboration between patients, healthcare providers, and patient’s families. Such close cooperation at different levels of health care ensures that the values of patients and their family members are taken into consideration when making important decisions related to patients’ health (“Project background,” n.d.). The PFCC principle enables patients to define who their family is and choose how they will engage in the decision-making process. PFCC promotes the idea that patients and families are important partners for the quality and safety of health care (“Project background,” n.d.). Hence, it is crucial to understand business practices, regulatory requirements, and reimbursement practices affecting PFCC.
PFCC incorporates several fundamentals that enable effective collaboration among all the stakeholders of the healthcare process. The components of the PFCC structure include the principle of respect and dignity, information and knowledge sharing, empowered participation and shared decision making, and collaboration and engagement (Mastro, Flynn, & Preuster, 2014). Each of these elements would be impossible to arrange without a clear understanding of professional requirements and practices. Concerning business practices that influence patient care, first of all, one should speak of visiting hours.
Additionally, such aspects as access to one’s medical records and family presence during resuscitation should be taken into consideration. Allowing patients to express their preferences related to these business practices enhances the level of respect for patient autonomy (Millenson, Shapiro, Greenhouse, & DiGioia, 2016). Research indicates that a family’s presence during codes offers valuable benefits for patients’ health (Porter, Cooper, & Sellick, 2014). Thus, PFCC serves as a means of patient advocacy in this respect.
Regulatory requirements affecting PFCC within a healthcare organization involve the measures of protecting patient safety and increasing patient satisfaction. These incorporate the Centers for Medicare and Medicaid Services (CMS) hospital value-based purchasing (VBP) (“The hospital value-based,” 2019). The VBP purchasing programs offer incentive payments for hospitals providing a high quality of care. With the help of this regulatory requirement, hospitals are encouraged to pay more attention to efficiency and quality improvement. Additionally, healthcare institutions strive to eliminate adverse events and implement evidence-based practices (EBPs) to gain the best patient outcomes (“The hospital value-based,” 2019).
Overall, VBP purchasing programs significantly increase the level of care in hospitals. Another regulatory requirement concerns the state nursing licensure, which presupposes a certain level of education, the National Council Licensure Examination, and registration with the state. By demanding the fulfillment of these requirements, hospitals make sure that their healthcare employees are highly qualified, and that patient care within the institution is arranged at the best level possible. Nurses who have appropriate education and bear a license realize the responsibility of the job they have and strive to gain patient satisfaction by all means available to them.
Finally, it is necessary to discuss reimbursement practices affecting PFCC. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has been introduced by the CMS to measure patients’ opinions on hospital care (“HCAHPS: Patients’ perspectives,” 2019). By using this survey, reimbursement practices in healthcare organizations are determined. Patient satisfaction is the most important element of this process (Rawson & Moretz, 2016).
However, some healthcare professionals do not agree that this measure is objective. They consider preventable readmissions and financial penalties to be crucial measures of reimbursement, but they view patient satisfaction as an insufficiently objective way of evaluating the reimbursement practices (Mehta, 2015). Still, as practice shows, patient satisfaction plays a crucial role in this respect since, without a good reputation, a hospital cannot count on new clients (Mehta, 2015). Thus, PFCC is directly linked to reimbursement practices, as well as to professional requirements and business practices.
Patient- and Family-Centered Care (PFCC) Tool
With the help of the PFCC tool, the elements of hospital-based PFCC and examples of current practice with patient and family partnerships at the University of Chicago Medical Center were assessed. The tool is a subjective measure of services available at the healthcare institution under analysis. The PFCC tool covers such domains as operations, mission, vision, and values, advisors, quality improvement, personnel, environment and design, education, diversity and disparities, documentation, care, and care support.
The facility evaluated in the PFCC tool is the University of Chicago Medical Center, which is also referred to as UChicago Medicine. This facility, which dates back to 1927, is a “non-for-profit academic medical health system based on the campus of the University of Chicago in Hyde Park” (“About the University of Chicago Medicine,” n.d., para. 1). The UChicago Medicine also incorporates hospitals, physician practices, and outpatient clinics in Chicago and its suburbs. As of 2017, the facility had 811 licensed beds (“UChicago Medicine at a glance,” n.d.). 9,331 employees and 848 attending physicians, and 2,623 registered nurses were employed at the hospital in 2017.
During the same year, 780,582 outpatient encounters (clinic visits, observation stays, surgeries, procedures) and 96,094 emergency room visits (32,587 pediatric and 63,507 adults) were recorded (“UChicago Medicine at a glance,” n.d.). The operating revenue constituted $1.7 billion, community benefits and services amounted to $425.2 million, and uncompensated care equaled $337.8 million in 2016. The National Institutes of Health funding was measured as $168 million in 2017 (“UChicago Medicine at a glance,” n.d.). 30,097 hospital admissions, 31,678 surgeries, and 2,442 births were recorded in 2017.
The facility’s mission, vision, and values are directed toward gaining the best quality of care and patient satisfaction. The UChicago Medicine mission is to “provide superior health care in a compassionate manner, ever mindful of each patient’s dignity and individuality” (“Vision 2025,” n.d., para. 5). The hospital’s vision is to aspire to become a prominent health system “at the forefront of discovery, advanced education, clinical innovation and transformative health care” (“Vision 2025,” n.d., para. 3). The values of the UChicago Hospital include respect, diversity, participation, excellence, and integrity. These values are driven by the commitment to serving the facility’s patients, employees, and providers.
The services performed by the facility are diverse, including the treatment of such conditions as cancer, gastroenterology issues, metabolic disorders, neurology and neurosurgery problems, endocrinology, heart and vascular diseases, transplant, and gynecology issues. The hospital serves diverse ethnic groups, with a special prominence on the African American population. In 2018, UChicago Medicine earned a spot on BlackDoctor.org’s list of Top Hospitals for Diversity (Dodd, 2018). The facility was one of 55 American hospitals included in the 2018 list, which was a great privilege and honor.
As the hospitals’ director of diversity, inclusion, and equity mentioned, the award indicated the continuous commitment of each healthcare specialist to patients from diverse ethnic groups, specifically African Americans (Dodd, 2018). The hospital strives to provide culturally competent care to each patient and arrange an inclusive environment for every staff member. UChicago Medicine delivers the highest quality of care and makes inclusion and equity its top priorities in all services, programs, and operations.
Strengths and Weaknesses of the Organization
| ||no weaknesses|
|Mission, Vision, Values||PFCC is incorporated in the facility’s mission, vision, and values |
Patient- and family-friendly Patient Bill of Rights and Responsibilities
|Advisors||patient and family advisory councils|| |
|Quality Improvement|| || |
|Personnel||physicians and staff members are prepared for and supported in PFCC practice|| |
|Environment & Design||the environment supports patient and family presence and participation, as well as interdisciplinary collaboration||patients/families do not participate in clinical design projects|
|Information/Education|| || |
|Diversity & Disparities|| ||there is a lack of careful collection and measurement of ethnic and language disparities|
|Charting & Documentation|| ||no weaknesses|
|Care Support|| || |
|Care|| ||no weaknesses|
Area of Improvement
The selected area to improve refers to the care support domain. Namely, the weakness concerning the lack of opportunity for families to stay and join in rounds will be used as a factor that needs enhancement. Currently, families’ access to participation in rounds is evaluated as low. However, patients’ families express their concern in relation to this fact. Namely, they feel deprived of the opportunity to listen to their close ones’ diagnoses directly from health care specialists, as well as observe the daily changes to their family member’s health timely. As a result, families do not feel confident in their choice of a facility since they are not permitted to take part in some of the most crucial procedures.
Participation in rounds is viewed as one of the core components of PFCC. Family-centered rounds have benefits and limitations that need to be considered when introducing such a practice. For instance, an evident advantage is a possibility for families, especially in pediatric care units, to feel themselves as members of a team focused on quality improvement and care coordination (Mittal, 2014).
Another benefit is the increased level of family satisfaction and the collaborative work of healthcare specialists and family members. The most common limitations of family-centered rounds include patient confidentiality, length of rounds, and physical constraints (Mittal, 2014). The presence of advantages and disadvantages in this domain of practice makes it necessary to analyze this area closer and make the necessary alterations to the hospital’s activities. Since many patients would like their families to be present during rounds, constraints on this practice may be regarded as an obstacle to PFCC implementation within the healthcare organization.
The strategy to increase PFCC in the organization will be based on the perceptions of families and healthcare providers of the selected area of improvement. Research indicated that the attitude toward families’ participation in bedside rounds is different among family members and hospital employees. According to Au, des Ordons, Soo, Guienguere, and Stelfox (2017), healthcare providers consider families’ interest in round participation as moderate.
Meanwhile, the majority of family members report being highly interested in such participation (Au et al., 2017). Both patients’ families and healthcare professionals agree that listening and asking questions are the roles most appropriate for family members during rounds. However, the majority of doctors and nurses do not find it a good idea to let families participate in rounds. Santiago, Lazar, Jiang, and Burns (2014) remark that medical staff, especially registered nurses, are strongly opposed to family members’ attendance of rounds. The main reason for this attitude is that with such extensive participation, the rounds will take a much longer time to complete and will hinder the elimination of negative medical information.
Taking into consideration the expressed opinions, it is crucial to incorporate the element of close collaboration between patients, their families, and healthcare providers in the process of addressing the identified weakness. On the one hand, it is evident that patients would feel much better if their families could accompany them during rounds. They could discuss the doctors’ and nurses’ news and participate in the process of making vital decisions. On the other hand, however, it is necessary to bear in mind that healthcare workers have many duties, and they cannot afford to answer all the questions families might have during the round.
Thus, the main component of the strategy will be the arrangement of a discussion among the stakeholders where the core aspects of the change will be thoroughly analyzed. Additionally, the strategy presupposes the examination of potential limitations of the change addressing the identified weakness with the aim of eliminating these obstacles. Last but not least, a multidisciplinary team will be formed, the aim of which will be to implement the strategy and arrange its effectiveness. The team will be composed of a nursing leader, an intensive care unit nurse, an IT specialist, and a psychologist.
System or Change Theory
The change theory was selected for the development of the strategy to address the identified weakness in the ACE Star Model of Knowledge Transformation. The model was introduced in 2004, and it is composed of five forms of knowledge: discovery, evidence summary, translation into guidelines, integration to practice, and evaluation of process and outcome (Stevens, 2013). The application of the strategy will address the selected weakness by applying each of the forms of knowledge to the problem. The rationale behind selecting this model is that its basic purpose is to ensure the improvement of care quality (Schaffer, Sandau, & Diedrick, 2013).
Furthermore, the ACE Star change model aims at addressing both the translation and implementation of the EBP change (Schaffer et al., 2013). Thus, it is relevant to apply this approach to the identified weakness.
The initial step in applying the model will involve the development of a multidisciplinary team, which will guide the whole process of change implementation. The next phases in the process of enhancing PFCC will coincide with the elements of the ACE Star model. Thus, such phases as knowledge generation, evidence summary synthesis, translation of evidence into practice, integration, and evaluation will be performed.
The successful implementation of each of the steps included in the ACE Star model will enable the nurse leader to gain the desired positive change. The application of this change theory will enable the completion of the change faster and more efficiently.
Prior to implementing the organizational change, it is necessary to perform a cost-benefit analysis of the strategy selected. Generally, the suggested change does not involve a considerable financial contribution. Because the selected improvement strategy does not presuppose any specific devices or applications, it is viable to assume that no serious financial implications will be involved. The ACE Star model is reported to incorporate minimal resources and bring about noticeable positive results (Correa-de-Araujo, 2015). Still, there are some aspects of the strategy that will demand financial analysis.
First and foremost, it is crucial to discuss the salary costs of the multidisciplinary team members. Each of the team participants is already employed in the healthcare facility. However, in order for them to work on the project successfully, they will need to stay extra hours and sometimes even work on weekends. Hence, it will be necessary to cover the additional salary expenses. A team will consist of four people, and approximate additional payment for each of them over the course of the change implementation will constitute nearly $2,000. Thus, the anticipated salary costs of the multidisciplinary team will likely amount to $8,000.
Secondly, it is important to discuss the financial costs and financial benefits of the change process. Apart from the salary costs, some other expected costs will be involved in the process. Firstly, the money will be needed to arrange a survey aimed at collecting data at a baseline and at the end of the project. These costs will incorporate paperwork, printing materials, and data analysis. Secondly, it will be necessary to discuss and disseminate the findings. Thus, one should predict the cost of a conference, article publication, and the preparation of a brief or report which will be shared with other teams within the facility and other healthcare organizations.
Finally, the cost of educating families, including materials and smartphone applications, should be taken into account. The suggested change will presuppose teaching family members how to interpret data with the aim of eliminating excessive questions to physicians and nurses. To gain this goal, educational materials will be distributed to patients and their families. Additionally, families and nurses will be recommended to upload special smartphone applications so that they could share patient data. Such applications might require additional payment, which should be reflected in the cost-benefit analysis.
The anticipated financial benefits include improved patient care and outcomes in the long run. When families are properly trained on how patient rounds are performed, they will gradually learn to help healthcare professionals rather than distract them. As a result, considerable financial benefits may develop from this situation, including the reduction of hospital stay and the elimination of readmissions. The benefits of the suggested strategy are expected to outnumber the financial costs involved eventually.
To find out whether the strategy has been successful, it will be necessary to employ some methods to evaluate its effectiveness. In relation to the selected change model, it is relevant to apply the measurement instrument created by its developer. Stevens (2013) has come up with the ACE EBP Readiness Inventory (ACE-ERI). This method assesses the confidence of a person in performing the required EBP competencies (Stevens, 2013). The ACE-ERI will be employed to reveal strong psychometric features, such as validity, reliability, and sensitivity. The method will allow evaluating nurses’ readiness to implement EBP. Additionally, the inventory will enable the nurse leader to measure the effect of the program on healthcare professionals.
Another method to use for evaluation will involve a survey following the change implementation. Both families and healthcare professionals will fill out questionnaires asking about their perceptions of collaborating with each other. Although this qualitative research method is known to have a high degree of subjectivity, it is one of the best ways of finding out people’s opinions on various issues or events (Tracy, 2019). In the present case, a survey will help to assess whether and to what extent the attitude toward family-centered rounds has changed both in healthcare professionals and patients’ families.
|Team Member||Role on the Team|
|Nurse leader||This team member is responsible for strategy creation and implementation. The nursing leader will come up with the strategy and the plan of its introduction within the organization. Additionally, the nurse leader will gather a multidisciplinary team, which will work together on the establishment of the goals set. Finally, the nurse leader will be responsible for data analysis and dissemination of results.|
|Intensive care unit (ICU) nurse||This healthcare specialist is needed in the team since frequently, family members underestimate the seriousness of their involvement in healthcare professionals’ work when a patient stays in the ICU (Santiago et al., 2014). Hence, the explanations and instructions given by this nurse to families will promote a better understanding and collaboration between the stakeholders.|
|IT specialist||The services of the IT specialist will be needed when generating surveys (along with the nurse leader and the ICU nurse). This specialist is tech-savvy, which will make it easy for him or her to arrange the questions and answer options into a well-developed computer survey. Also, this team member’s services will be resorted to when families and healthcare professionals will need to install some applications or software on their smartphones.|
|Psychologist||This member of the team will play the role of bond-creator among all the stakeholders. The experience of the psychologist will be needed to explain the negative implications of excessive involvement of family members in physicians’ and nurses’ work. Additionally, the psychologist will make it easier for healthcare providers to realize why family members want to be present at rounds. Finally, patients will benefit from the psychologist’s involvement due to the alleviation of stress associated with their temporary health deterioration.|
An important aspect of any change’s success is the presence of cultural diversity within the team. This element significantly increases PFCC and promotes culturally competent care. Since the overarching goal of the change is the enhancement of patient care, the multidisciplinary team has to take efforts and learn to understand the needs of patients from different ethnic and cultural backgrounds.
To reach such a goal, it is crucial to arrange interprofessional training for healthcare specialists (De Los Santos, McFarlin, & Martin, 2014). The issue is gaining more and more significance since hospital clients may come from diverse social groups, which can eliminate the possibility of communicating their needs. As a result of the lack of understanding, precious time may be wasted, and a patient may not receive help promptly. Hence, it is crucial to develop the cultural competence of healthcare workers by incorporating such domains as knowledge, skill, and awareness in their preparation (Young & Guo, 2016). By promoting these aspects, the team leader will gain better collaboration within the team and between the team and other stakeholders.
One of the best ways of teaching the multidisciplinary team about cultural diversity is making this team culturally diverse. That way, team members will understand how important it is to understand one another’s ethnic, racial, and cultural peculiarities, as well as those of patients and their families. When a nurse realizes not only the need to provide patients with care but also the need to support their beliefs and traditional views, he or she will reach the best patient outcomes.
The preferable leadership style to utilize in developing the team is transformation leadership. The rationale behind choosing this style is that it is the most future-oriented. This leadership style empowers and encourages employees to gain outstanding outcomes while going beyond their own interests (Ross, Fitzpatrick, Click, Krouse, & Clavelle, 2014). Transformational leadership is especially relevant in health care since it is known to create a “highly engaged” organizational culture (Ross et al., 2014). The use of transformational leadership in team development will promote excellence in practice.
With the help of this model, the nurse leader will be able to minimize the burnout rate and create a positive disposition among the team members. Unlike other types of leadership, transformational one will focus on a shared vision and common work toward the set goals.
Implementation of Strategy
Firstly, it will be necessary to generate knowledge on the selected problem. This phase will incorporate collecting data both from patients and their families and healthcare employees. Since the main problem with allowing families to be present during rounds seems to be in physicians’ and nurses’ resistance, it is necessary to gather their feedback on the planned change. Additionally, it is relevant to collect data on why patients and their families want rounds to become family-centered and how they are ready to cooperate in order to minimize intrusion into the healthcare process. Each of the team members will play an important part during this phase.
The second step of the ACE Star model involves the synthesis of researched data into a meaningful evidence-based summary. At this point, the main role will belong to the nurse leader, who will evaluate consistencies and inconsistencies in the materials found in order to incorporate the best of them in the change process (Stevens, 2013). The third phase will involve translation and integration of evidence into practice. At this point, the nurse leader will inform all the team members about the concrete strategies to employ. Also, the gathered information will be translated into guidelines that patients’ families and healthcare specialists will receive.
The next step will incorporate the integration of the guidelines into practice. During this phase, all team members will be actively involved, teaching healthcare workers and patients’ families about the need for effective collaboration and the benefits it will bring for patients. This will be the step where all efforts will be maximally involved in order to gain the expected outcome. Finally, the last phase of the strategy implementation, according to the ACE Star model, is the evaluation of process and outcome (Stevens, 2013). At this point, the nurse leader will gather and analyze the data obtained from the stakeholders.
Communication to Organization
It is important for the team leader to communicate the progress of change and its outcomes to the healthcare organization. The significance of such communication is related to the fact that PFCC incorporates transparency as one of the core elements (Rippin, 2016). Therefore, the nurse leader’s responsibility is to communicate the team’s progress clearly and openly to the hospital’s leadership, colleagues, and the public. Each of these communication types has its own purpose, and for each of them, a specific team member will be responsible. The leader of the group will report to the hospital’s leadership by preparing a brief, which can later be transformed into an article. The ICU nurse will explain the findings to co-workers at a general meeting. The psychologist will prepare a report for the public with detailed explanations of benefits gained through such practice.
Tools for the Team
The tool to be used for better team development is the Jung Personality Test. This test allows evaluating a person’s personality type based on a series of questions that one has to answer about oneself (“Jung personality test,” n.d.). The important thing is to respond to prompts quickly and without lengthy consideration. That way, it will be possible to identify the team members’ personality types accurately. Knowing the type of each team member, it will be easier to share the duties and arrange the work.
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