Much More Than Just a Visit: A Review of Visiting Policies in Select Canadian Acute Care Hospitals

Better Together is a three-year campaign launched by the Institute for Patient and Family-Centered Care (IPFCC) – a non-profit organization located in the US to change the concept of families as ‘visitors’ to families as partners in care in hospitals across North America. In 2014, the Canadian Foundation for Healthcare Improvement (CFHI) partnered with IPFCC to spearhead the Better Together campaign in Canada. Family presence policies enable patients to designate family members or other caregivers to participate in their care and have unrestricted access to them while hospitalized. Thus, family presence policies differentiate between ‘family’ – who have unrestricted access – and other ‘visitors’ for whom visiting policies apply.

This report offers a snapshot of the visiting policies at select Canadian acute care hospitals and is representative of hospitals sampled between February and April 2015. In total, 114 eligible acute-care hospitals across all Canadian provinces and territories were included in the review. The sample included 55 large community hospitals, 55 teaching hospitals, two medium-sized community hospitals, one community acute care hospital and one small hospital. As there were no large hospitals in Canada’s territories, one medium-sized hospital was included from Yukon and Northwest Territories, and one small hospital was included from Nunavut.

The survey method was selected in order to identify and evaluate information that is publicly available to families wishing to visit their loved one in hospital. Adapting the methodology of an existing study1, hospital web sites were scanned and scored based on how accommodating their policies were for family members and visitors; and the availability and usefulness of information on visiting hours and visiting policies. Two phone calls were made to each hospital to validate data posted on web sites; no new information or clarifications were sought via the phone. This review establishes for the first time:

  1. The openness of visiting policies in Canada’s acute care hospitals, as communicated to patients, families and citizens on hospital web sites;
  2. Whether these visiting policies are communicated on hospital web sites and whether this information is useful for family members and visitors; and
  3. Validates whether the information conveyed by a switchboard operator over the telephone or obtained from the hospital’s audio recording is consistent with the visiting hours communicated on the hospital’s web site.

A total of 36 Canadian hospitals with ‘accommodating’ visiting policies were identified. Although these visiting policies may not all rise to the level of full ‘family presence,’ their leadership in this area is commendable and demonstrates a commitment to creating environments supportive of patient- and family-centred care. However, current visiting policies, including open policies, may not be well communicated to staff, visitors and families, and thus, may be inconsistently implemented. Consistency in visiting policies across hospitals could reduce and ultimately eliminate disparities in care experiences as well as the need for staff to make exceptions to less accommodating visiting policies on a case-by-case basis.

However, changing visiting policies is not a simple task. For more accommodating policies to be accepted, a dialogue among staff, patients, families and caregivers, and the broader community is required. Fundamental change is necessary to recognize the key role that patients’ families, friends or designated care partners can play in the care of patients and to shift away from the view that families are only ‘visitors’ rather than partners in care and allies for quality and safety.

CFHI encourages Canadian hospitals to consider implementing and communicating family presence policies as one practical step towards delivering more patient and family-centred care. Hospitals that are beginning to contemplate changing policies are encouraged to take CFHI’s Better Together pledge, as are hospitals that have already begun the change process and are moving to adopt family presence policies.

For more information, please visit http://www.cfhi-fcass.ca/BetterTogether.