Organization-Wide Adoption of Patient- and Family-Centered Care Leads to Consistently High Levels of Patient Satisfaction

Problem Addressed

• Negative impact of non–patient-centered approach: Most systems and processes today are organized around the needs of physician and staff rather than the patient and family members. This non–patient-centered approach to health care can have an adverse effect on patient outcomes.^1,2
• Unrealized potential of patient- and family-centered care: To help address these problems, the Institute of Medicine has singled out patient- and family-centered care as one of six critical quality aims for improving the nation's health care system.¹ This model encourages the patient and family members to collaborate with the health care team in making clinical decisions and encourages providers to elicit, understand, and respond to patient and family member preferences and values. Although the approach holds great promise for improving patient satisfaction and outcomes, relatively few providers have adopted it thus far. 

Description of the Innovative Activity

• Policy and process changes to ingrain patient- and family-centered care into culture: Bronson has revamped policies and processes in an effort to make patient- and family-centered care a core part of the organizational culture. For example:
  • Incorporating core principles into standards: The three core principles of patient- and family-centered care: dignity and respect, participation and collaboration, and information sharing have been formally embedded in Bronson's behavioral standards referred to as the "Bronson Standards for Excellence." The Bronson Nursing Professional Model of Care includes the principles of patient- and family-centered care as well, with a focus on partnering with patients and families during daily patient care processes.
  • Adopting patient- and family-centered care philosophies: Bronson has adopted specific philosophies for staff to follow that support the provision of patient- and family-centered care, including the following: (1) Recognize that the family unit is a constant in a patient's life; (2) believe the patient's family should be an important part of the health care team; (3) view families as partners who contribute to the well-being of patients; (4) support quality of care and patient satisfaction by partnering with patients and families for all levels of care; (5) respect the diversity of families; (6) support patient's rights to define their family as they choose; (7) share complete and unbiased information with patients and families, with the patient's consent; (8) empower all physicians and employees to provide patient- and family-centered care; and (9) include patient- and family-centered concepts and strategies in employee orientation and training.
  • Mandatory training on behavioral standards: In 2008, Bronson began providing mandatory training to all employees on the behavioral standards related to patient- and family-centered care. To date, 100 percent of staff (representing 5,013 individuals) have completed the training, which is known as "Teaming Up For Patients and Families." This 4-hour workshop emphasized the patient- and family-centered care philosophies outlined previously, along with the importance of strong communication and high-performing teams. Key leaders scheduled their staff for the training sessions through an online registration process, with followup for "no shows." The training used a variety of adult learning principles and delivery methods, including video, television and movie clips, role play vignettes, story telling, and small group activities.
• Operationalizing patient- and family-centered care: Bronson has operationalized patient- and family-centered care in a variety of ways. Examples include the following:
  • Patient and Family Advisory Council: The Patient and Family Advisory Council serves as a formal group of former patients and family members who work collaboratively with Bronson staff to enhance patient care and service. The council consisting of patient and family members initially had 12 members who served in this role in 2006. It was expanded in 2008 to include members from patients and their families who have experienced adult health care. The council, which currently consists of 42 patients/family members, hospital staff, and administrators, meets monthly to offer guidance on a wide variety of issues related to the patient and family experience, such as the design of public and family space in a new birthing center and policies on hospital visitation hours. The council also participates in rapid process improvement projects (Kaizen events), focus groups, and organizational committees. In addition, patient/family members of the council periodically act as "faculty," educating staff, physicians, hospital leaders, and others by reliving their stories as patients. In 2007, patient/family representatives to the council logged 158 hours on council activities; by 2008, this figure rose to 479.5 hours. Similarly large increases have occurred in special project hours (which rose from 48 to 119.5), meeting hours (96 to 342), and hours where patients serve as "faculty" (14 to 18). 
  • Patient relations representative: A representative is available 24 hours a day, 7 days a week to assist patients and family members. The department consists of four full-time staff who can be reached via pager to assist with any issues/concerns.
  • Monthly rounds to solicit input: Hospital executives and patient relations staff conduct monthly hospital rounds to solicit input from staff, patient, and family members. 
  • Patient safety newsletter: Bronson produces a monthly newsletter about patient safety for staff, patients, and family members.

References/Related Articles

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Results

• Consistently high patient satisfaction: Bronson's overall patient satisfaction ratings have consistently been quite high, ranging between 95 and 100 percent in the obstetrics and neonatal intensive care units where this initiative was first implemented. The hospital as a whole has consistently ranked in the top 5 percent in Gallup Organization's national hospital survey database. A 2008 Gallup survey found that 97 percent of Bronson patients were satisfied with their role as a partner in care and treatment. In 2009, Bronson began using Press Ganey to measure patient satisfaction. Bronson's overall patient satisfaction scores position them in the 97th percentile of the top 3 percent of the Press Ganey database compared to other hospitals of similar size. For the patient- and family-centered care questions related to family participation and decisionmaking and staff support of the family, Bronson is in the top 3 percent of the entire Press Ganey database of almost 1200 hospitals nationwide.
• High levels of staff engagement: Surveys of those undergoing the training show that 96 percent  understand why Bronson is focused on patient- and family-centered care and teamwork, while 83 percent believe that the training was worthwhile and enjoyable.

Evidence Rating (What is this?)

Context of the Innovation

Planning and Development Process

• Developing strategic plan: Bronson's "Plan for Excellence" focuses on three strategies: clinical excellence, customer service, and corporate effectiveness.
• Engaging senior leadership: After becoming convinced of the merits of patient- and family-centered care, senior leaders decided to focus the entire organization on the concept and to incorporate key principles into existing policies, processes, and philosophies. 
• Developing training content and materials: Training content and materials were developed and pilot tested on approximately 250 leaders and staff at Bronson and then refined and retooled based on their input. 
• Pilot testing and expansion: Patient- and family-centered care initially began in maternal and child health, with the lessons learned from those experiences now being adapted and spread to all areas of adult care.

Resources Used and Skills Needed

• Staffing: Implementing patient- and family-centered care required no new staff, with the exception of the Patient and Family Centered Care Coordinator, a new role created in September 2008. This individual leads all training initiatives, in collaboration with staff from the Customer Service as well as Education Departments and is the liaison to the Patient and Family Advisory Council. 
• Costs: Expenses were moderate, consisting primarily of the salary/benefits for the aforementioned Patient and Family Centered Care Coordinator and incidental costs related to training materials.

Funding Sources

Getting Started with This Innovation

• Develop strategic plan to guide cultural and organizational transformation: As noted earlier, Bronson's "Plan for Excellence" focuses on three strategies: clinical excellence, customer service, and corporate effectiveness, with patient- and family-centered care being a critical tactic for achieving success in these areas.  
• Cultivate senior leadership support: Without strong leadership support, this type of transformational change is not possible. 

Sustaining This Innovation

• Implement specific efforts on an incremental basis: The cumulative impact of a critical mass of small, concrete changes can be much greater than the sum of the parts.
• Keep learning and raising the bar: Continually identify and learn from best practices and benchmarking. Think of patient- and family-centered care as a way of conducting business, and constantly focus on improvement. 

Additional Considerations and Lessons