The Challenge
When families are welcome to visit their loved ones in healthcare facilities, patients tend to do better. A growing body of evidence indicates that traditional visiting hours limiting the presence of family members can have negative effects on quality,
costs and outcomes.
Patient- and family-centred care is an approach to the planning, delivery and evaluation of healthcare that recognizes the importance of partnerships between healthcare providers, patients and families. It redefines relationships by emphasizing collaboration
at all levels of care and in all healthcare settings. The family presence policy innovation is a practical step healthcare organizations can take to deliver more patient- and family-centred care.
Better Together: Partnering with Families is a campaign that began in the United States when the Institute for Patient and Family Centered Care encouraged hospitals to review their visiting policies and recognize the key role families play in improving
patient outcomes – rather than viewing families simply as visitors.
CFHI has championed the Better Together movement in Canada,
bringing together a coalition of leading quality, safety and patient organizations to spread the family presence innovation across Canada. In 2015, CFHI released a study revealing that fewer than one-quarter of Canadian hospitals had accommodating
visiting policies. CFHI also launched the Better Together: Partnering with Families e-Collaborative to support organizations as they develop and implement new family presence policies. From May 2016 to March 2017, the e-collaborative supported
11 healthcare organizations from across the country in their policy development; conservatively, more than 62,600 patients per year stand to benefit from this change. It provided educational content, coaching and access to a pan-Canadian network for
organizations as they pursued changes to family presence policies and patient-centred practices.
Health PEI, a provincial health authority, took part in the collaborative. It has seven hospitals across the island, including a provincial palliative care centre and several long-term care facilities. Visiting policies varied across the province. Some
sites followed established hours, others were relaxed in their approach, and still others accommodated clients and their friends and families based on individual situations.
Marion Dowling is Chief of Nursing, Allied Health and Patient Experience for Health PEI. “Ours is a small community,” she said. “People would arrive at the hospital to see someone, and then go from room to room to see if there was anyone
from their community or parish who might need a visit.”
Recognizing the growing importance of standard approaches to care, Health PEI aimed to establish a provincial visiting policy. Even more crucial was the need for a true understanding of the significance and importance of family presence – including
the difference between families as partners in care and families as mere visitors.
The Solution
When CFHI launched a call for applications for its Better Together e-collaborative, Health PEI leadership was in the midst of discussing strategies for implementing patient-experience initiatives. The group had recently completed a series of presentations
to its facilities on patient- and family-centred care.
Karen McCaffrey, Quality and Risk Manager for Health PEI, recognized the e-collaborative as an opportunity to effect positive change in the patient experience. She spearheaded the application process for Health PEI, including a scan of all seven hospitals.
McCaffrey assembled a team for the e-collaborative that modelled patient and family partnership: two patient and family advisors were embedded as full members of the improvement team, and pre-implementation surveys of patients and families were conducted,
with results guiding the development of a communications strategy.
Among Health PEI’s objectives for the collaborative were to introduce a family presence policy that supports building partnerships with families and caregivers, and to introduce one or two concrete practices that support patient- and family-centred
care at seven hospital sites.
Early education was key. The team visited the province’s seven hospital sites, looking to prompt meaningful discussions on the difference between families as visitors and families as partners in care. The team provided each of the sites with survey
responses from its own organization so the site knew the specific needs and wants of the patients and families they served.
Overall, there was a positive response to making the change for family presence. Representatives from all departments were present at education sessions, including administration and management, nursing and interprofessional staff, directors and staff
from support services such as housekeeping and nutritional services. Staff engaged in discussion, garnering support and facilitating understanding of this new initiative.
It was easier to achieve buy-in from smaller community hospitals, while some larger sites expressed apprehension. Staff at the larger hospitals were concerned about the potential impact of increased family presence on hospital operations. “There
was a lot of apprehension and worry, especially when it came to family presence during morning care,” said Shari MacDonald, Clinical Educator at Kings County Memorial Hospital. “And staff were worried about people coming in during the
middle of the night.”
The worries were unfounded. “We haven’t seen that happen at our facility since the initiative started, and we haven’t seen it in other facilities either,” said MacDonald.
Eventually, the focus shifted to concerns that hospitals did not have enough space to make families comfortable. Dowling said the e-collaborative provided key guidance about such issues, as well as providing structure and timelines for developing and
implementing the new policy – all of which brought the improvement team together as a well-functioning unit. “CFHI guided our entire process,” she said. “I’m not sure we would have been successful without the collaborative.”
Results
Health PEI’s participation in the e-collaborative not only resulted in a province-wide family presence policy, but also in a policy that was adaptable to the specific needs of the organization’s seven hospital sites. This is an important outcome,
as some hospital sites had expressed concern about the application of a one-size-fits-all policy.
Once the policy was implemented at the provincial level, hospitals had the opportunity to examine their own policies and needs, and design protocols in accordance with principles of family presence. As one example, a community hospital installed a buzzer
system to preserve security at night.
Today, family presence policies span the province, and the implementation leads from all sites unanimously agree that communication between patients, their family members and the healthcare team has increased. Unique policies include one that allows family
pets to visit patients and the implementation of a therapeutic-dog pilot program in an emergency room.
At some sites, family presence is encouraged during the admission process, with staff confidently communicating with patients about the difference between visitors and partners in care. During a recent late-night admission conducted by MacDonald, a client’s
wife asked to accompany her husband to the ward. MacDonald was able to say, "You are welcome to stay." The client’s wife stayed until her husband was comfortable enough in his new settings to fall asleep.
According to Donna Gallant, a patient and family advisor who was a member of the implementation team, families “are very pleased. They feel that they are a part of the team – especially those families with loved ones in long term care, or
palliative patients waiting to be placed in a residential manor. Especially for seniors who can’t hear or interpret the doctors’ findings, it’s valuable that they have someone with them as a listening ear.”
Sustainability and Spread
Although Health PEI’s Better Together improvement team will disband, the Patient and Family Centered Care Steering Committee will continue to monitor implementation of the provincial Family Presence Guidelines. In addition, the Patient and Family
Centered Care Committees at the province’s two largest facilities will continue to monitor implementation and address barriers at the site level.
Health PEI will continue to evaluate safety indicators such as falls and medication errors. It plans to adopt the Canadian Institute for Health Information acute care patient experience survey tool, which will provide the organization with further data
specific to the patient experience of care.
The work of Health PEI has been showcased across the Maritimes. The improvement team was invited for a rapid fire presentation at the Atlantic Health Quality and Patient Safety Learning Exchange in Charlottetown in May 2017. The initiative was also profiled
in external communication to the local media and has been promoted internally to all staff in Health PEI.
In addition to having been implemented at all seven hospital sites in the province, Health PEI has extended its Family Presence Guidelines to other healthcare organizations, including long-term care facilities and the Provincial Palliative Care Centre,
which specifically asked to be included.
Meanwhile, sites such as PEI's provincial addictions treatment facility have also expressed interest in knowing more about family presence, how this might affect their own services and whether Health PEI's Family Presence Guidelines are something they
could adapt to their needs. "These institutions have unique needs with respect to the care they provide," said Dowling. "The provincial policy calls for these sites to create their own protocol and procedure."
Registered Nurse Cheri Harris and Support Services Manager Debbie Currie showcase the new Family and Partner in Care Washroom at Community Hospital West in O’Leary, PEI. The space was redesigned to give families and partners in care a place to shower
and freshen up while they are staying with their loved ones. It also includes a drop off for the laundry service
Louis McCarthy, his son Louis and daughter-in-law Maisie, who works at Community Hospital West, relax and enjoy their time together and participate actively, as a team, in care throughout the day.
Community Hospital West developed their family presence policy to be inclusive of all family members and loved ones – Doug Ferguson, his son David and daughter-in-law Carol spend time with the family dog Chloe, who is welcomed with open arms.
Entertainment for patients, family members and partners in care is made accessible, and everyone is welcomed.