For nearly a decade, Bronson Methodist Hospital (BMH) has promoted a culture of patient and family centered care, defined as an approach to the planning, delivery and evaluation of healthcare, grounded in mutually beneficial partnerships between healthcare providers and patients and families. The BMH Standards for Excellence engage patients and families as partners in care using the three core principles of dignity and respect, information sharing, and participation and collaboration. The Patient and Family Advisory Council and Patient and Family Centered Care Leadership team ensure that the perspectives of patients and families are represented in all performance improvement initiatives.
Since 2006, community volunteers, representing all aspects of the patient experience, have served on the BMH Patient and Family Advisory Council (PFAC), joined by staff/ leaders from a broad list of departments. PFAC is facilitated by the Manager, Patient and Family Centered Care, championed by the Bronson Methodist Hospital COO, and reports to the Board Quality Oversight Committee. PFAC accomplishments include: health literacy/patient education, communication tools, hospital design, patient/family as faculty, new employee orientation, rounding at the bedside and process improvement events. Advisors serve on 13 internal committees including Patient Safety, Quality Steering, Divisional Nursing, Medication Safety, and PFCC Strategic Planning.
The Michigan Hospital Association Keystone Center invited PFAC leadership to participate in a Patient/Family Engagement Task Force to identify best practices and develop tactics promoting patient/family engagement in MHA quality/safety initiatives and throughout Michigan.
Partners for Safety: Patient and Family Hand Hygiene BMH has consistently maintained an excellent record of staff hand hygiene and accountability, but when a patient meal tray hand-wipe program was discontinued, PFAC identified a patient safety concern. In partnership with the Patient Safety committee, a pilot study was initiated to introduce a personal size, hand sanitizer along with education about hand hygiene for patients and families/visitors. Rounding at the bedside, the team confirmed the importance of hand hygiene to patients and the barriers to access, and evaluated product preferences. This work resulted in the roll-out of an innovative hospital-wide, patient hand hygiene program, engaging patients in a significant, shared safety goal. (Poster presentations: 2012 Institute for Patient and Family Centered Care (IPFCC) International Conference & 2013 MHA Keystone Center Patient Safety and Quality Symposium)
Patient/Family Advisors and Nursing Leaders Team up to Enhance Bedside Handovers Nursing leadership observed that the best practice of handover at the bedside was not consistently practiced. To ingrain the process and obtain reliable outcomes, a nursing/PFAC task force convened to review safety actions, how to engage patients, information sharing and sources of resistance. Advisors rounded on four units to elicit the patient perspective, while nurses completed a self-administered questionnaire. The advisors interpreted the patient findings in the context of nurse self-audit data, explored disconnects, and reinforced the value of bedside report for patients/families. The team developed a revised set of Bedside Handover Expectations, scripting and communication tools. (Abstract accepted: 2014 IPFCC International Conference)
Patient and Family Advisors: Partners for Process Improvement In another innovative initiative, PFAC collaborated with Process Improvement to define and standardize the process by which the patient/family perspective shall be obtained –an important contributor to any BMH Value Stream Analysis or Kaizen Event. This initiative delineates the steps to: facilitate patient/family participation (LEAN education, FAQ’s, Standard Work pre-, during, and post-event); invite patient/family advisors; the role of a PFAC member; and tips for success. (Abstract accepted: 2014 IPFCC International Conference).
Falls Prevention Video Brainstorming to enhance fall prevention strategies, nurses observed that “no matter how good our risk assessment tool, interventions, or education for our patients, we could not prevent falls if the effort was totally one-sided….We needed a tool that invited our patients to become partners, rather than recipients of simple instructions and handouts. We decided to reach out and ask our patients and their families to partner with us to prevent falls.” Nursing and patient advisors created and “acted” in the resultant patient fall prevention video. Staff, patients/families, The Joint Commission and Magnet reviewers (on recent site visits), have uniformly praised the video for engaging patients and families.
Annually, PFAC metrics indicate 90% engagement, dozens of activities/projects, monthly education segments and over 2,000 hours of service. PFAC’s 2013 objectives, aligned with the Bronson Methodist Hospital Strategic Plan, include:
- Partner with Bronson team members to engage patients/families to decrease fall rate
- Reduce medication errors, sustain patient/family hand hygiene and advance the culture of patient and family centered care system-wide.
The Patient Hand Hygiene Team identified a patient safety improvement opportunity, developed a program, researched a product, and secured resources to place a personal hand sanitizer product within reach, for every adult (non-critical) patient, accompanied by education for patients/families about hand hygiene. Patients and staff are now partners in promoting hand hygiene.
The Enhanced Bedside Report Initiative provided the patient perspective to help delineate expectations for bedside handover, using principles of patient and family centered care, and helped identify sources of staff resistance. With clarified expectations and a focus on engaging the patient and family to promote quality and safety, supported by communication and scripting tools, the bedside report has become the standard of care for all BMH units. Patients responded positively to being spoken “with”, not “about”, as well as participating in discussions about the plan of care/daily schedule and discharge plans. The team recommended using white boards to enhance communication between patients and providers. Following a pilot of white boards in two adult units, a recent Discharge Communication Kaizen Event (with PFAC participants) recommended white boards with “prompts” to enhance communication, particularly related to shared goals for the day, patient and family questions, and discharge plans.
The Fall Prevention video was rolled out August 2013, and is shown to all patients upon admission. It is documented as a component of the fall prevention learning assessment in the BMH electronic medical record. There is evidence of a declining rate of patient falls.