Better Together

The History of Better Together

Hospitalization can be a major life event for patients and their loved ones. Not only are patients unwell, they may feel their mental and emotional well-being could be compromised. Patients need the support of the people who know them best. Establishing family presence policiesFamily presence policies enables patients to designate family members and loved ones who can stay by their side 24 hours a day, seven days a week. This approach creates a welcoming environment that enables family and caregivers to fully participate in patient care, provide emotional support, and to enable continuity of care through communication with the care team and through transitions in care. is an essential step to enable the engagement of patients, families, and caregivers as partners in care, and to improve care experiences and outcomes.

The evidence is clear that family and caregiver presence and partnership in care reduces medication errors, falls and hospital re-admissions, and improves patient care experience, emotional well-being and staff satisfaction.1,2

In 2015, the Canadian Foundation for Healthcare Improvement launched the Better Together Campaign, in partnership with the Institute for Patient and Family-Centered Care in the United States and supported by other leading healthcare organizations across Canada. Through the campaign, healthcare delivery organizations were supported to adapt and improve family presence policies with a change package and tools and resources.

In 2016, we launched a quality improvement e-collaborative where 12 healthcare delivery organizations were supported by our faculty and coaches to develop, adopt and implement family presence policies.

To maintain momentum, in 2017, we hosted a pan-Canadian Policy Roundtable to spread best practices for family presence across regions, provinces and territories – shifting the notion of families and caregivers as visitors to essential partners in care.

By 2019 and through the Campaign and e-collaborative, more than 50 organizations and entire provinces from across Canada publicly pledged to review and improve their family presence policies. An expert advisory group was convened to build on family presence policies, including through patient and family partnered policies in inter-professional bedside rounding, planning and decision-making, and transitions in care.

In early 2020, a follow up study was conducted to assess family presence policies in Canadian hospitals and showed a marked increase from 32 percent of hospitals with accommodating visiting policies in 2015, to 73 percent in early 2020.

Download Report Summary >

Responding to COVID-19

In March 2020, as a result of the pandemic, and to minimize and control the risk of COVID-19 cases, many hospitals across the country reacted quickly and made significant changes to their family presence policies. With the exception of patients near the end-of-life, pediatrics and women giving birth, a vast majority of healthcare organizations instituted blanket visitor restrictions or zero visitor policies, which also included essential partners in care.

As the pandemic continues to evolve, we are supporting healthcare organizations to shift from considering families and caregivers as visitors, to recognizing them as essential partners in care. This patient-and family-centred care principle should be applied in times of a crisis, and beyond.

How organizations have developed and implemented restrictions has varied, with some taking creative approaches that enable families and caregivers to remain partners in care through virtual means, including phone calls, texts and emails – even offering tools such as iPads.

In April 2020, we held a Spotlight Series webinar to share these innovative approaches during this pandemic. We also hosted a discussion with the National Healthcare Engagement Network  that focused on maintaining families and caregivers as essential care partners during COVID-19.

We have convened a rapid response expert advisory group to develop a considerations document for healthcare organizations and jurisdictions, to guide the reintegration of family caregiver presence and partners in care. The advisory group includes a broad range of perspectives – clinicians, public health, organizational and system decision-makers, legal experts, bioethicist, academics, and patient, family and caregiver partners.

CFHI and the Canadian Patient Safety Institute have partnered to deliver a virtual policy lab that will bring together a diverse range of perspectives, building on the strong evidence that supports family caregivers as essential partners in safe care. We will collectively develop policy tools to help organizations and governments embed/incorporate patient safety and family-centered care principles in a time of crisis. 

Subscribe to our newsletter to be kept up to date on this work, including the publication of the considerations document and tools and resources from the Policy Lab.

How Better Together Contributes to Better Healthcare in Canada

The essence of family presence recognizes the valuable role that families and caregivers take on to support the care and well-being of their loved ones. Family presence policies enables patients to designate family members and loved ones who can stay by their side 24 hours a day, seven days a week. This approach creates a welcoming environment that enables family and caregivers to fully participate in patient care, provide emotional support, and to enable continuity of care through communication with the care team and through transitions in care.

During the time of pandemic, a considered reintegration approach is needed that identifies one to two family/caregivers as essential partners in care.

Family and caregivers often support minor medical procedures, feeding, ambulation, cognitive stimulation, patient hygiene, medication adherence and are often essential in coordination and continuing of care. They are allies for improving quality and safety and essential members of the care team.

Timeline

  • 2015

    Better Together Campaign launched
  • 2016

    Better Together E-Collaborative
  • 2017

    Better Together Roundtable
  • 2018

    Better Together Campaign concluded with more than 50 organizations pledging
  • 2019

    Expert Advisory Group convened
  • 2020

     COVID-19 Rapid Response Expert Advisory Group and Policy Lab established

Tool / Resource

Better Together Change Package
Read more >

Blog

Family Caregivers as Essential Partners in Care: More Than Just A Visitor
Read more >

Webinar Series

Patient Partnership in a Time of COVID-19
Register to attend > 

1Canadian Foundation for Healthcare Improvement (2015). Much More Than a Visit: A Review of Visiting Policies in Select Acute Care Hospitals. Ottawa. Accessed from: https://www.cfhi-fcass.ca/PublicationsAndResources/ResearchReports/ArticleView/2015/11/09/much-more-than-just-a-visit-a-review-of-visiting-policies-in-select-canadian-acute-care-hospitals

2Institute for Patient-and Family-Centered Care. (n.d.) “Facts and Figures” About Family Presence. Retrieved from: https://www.cfhi-fcass.ca/sf-docs/default-source/patient-engagement/better-together-facts-and-figures_eng.pdf