Children’s Hospital Colorado (CHCO) engages families as essential partners in achieving our missions of clinical care, education, advocacy and research. From the bedside to the board room, family members contribute to the care and experience that all children receive at our hospital. Over the past year, family members have played central roles in the implementation of Target Zero: Eliminating Preventable Harm, our over-arching patient safety initiative. In addition, our Family Advisory Council focuses on empowerment and advocacy, and families engage in numerous efforts to improve both clinical outcomes and the patient/family experience. Together, we are achieving outstanding results.
Children’s Hospital Colorado (CHCO) has been increasingly focused on creating a consistent and cohesive partnership between CHCO and families in order to improve both patient/family experience and health outcomes. The focus for staff this past year has been to incorporate the Institute for Healthcare Improvement’s Triple Aim framework to optimize health system performance. The Triple Aim highlights population health, experience of care and per capita cost. The primary drivers of the experience of care per IHI are leadership, hearts and minds, respectful partnership, reliable care and evidence-based care, all of which promote family engagement and define CHCO’s focus.
Parents are now active members on more than 30 different hospital committees and project teams at Children’s Colorado, including the Quality and Safety Committee of the Board of Directors, Nursing Quality and Preventable Harm Committee, Patient-Family Experience Council, Patient Safety Committee, and Quality, Safety and Performance Improvement Council. In addition, family members serve on quality/safety committees for clinical service lines and programs (e.g. Emergency Department, Heart Institute), and improvement teams that address specific hospital-acquired harm (e.g. catheter-associated urinary tract infections, pressure ulcers, etc.) Families have been particularly integrated in efforts to reduce code events outside the ICU, including the development and implementation of our family-activated, Rapid Response Team and Speak Up programs. The involvement of families has contributed to a drop in the rate of codes outside the ICU by more than 50% over the past few years. As active and equal members of these committees, families are involved in driving decisions that impact patient and family care across the organization.
The hospital has a long-standing Family Advisory Council (FAC). The 2013 goals of the FAC included:
1. Defining and implementing a marketing program to include more families in the Family Advisory Council, as well as families contributing to committees and organization initiatives.
2. Continuing to actively engage in hospital processes and procedure development.
3. Continuing ongoing efforts related to training parents to be effective advocates for their child and for themselves inside the health care setting and/or in policy development settings. In working on achieving this goal, the Family Advisory Council delivered two patient advocacy seminars for both staff and families, as well as created a brochure on how to advocate for your child’s health which is now given to families as they initiate their care at Children’s Hospital Colorado. One tremendous collaborative success was the revision and implementation of a new DNAR (Do Not Attempt Resuscitation) policy. The new policy is especially sensitive to the needs of patients and families when making this difficult decision, and family engagement was instrumental in the processes for both developing and disseminating this policy in both inpatient and outpatient settings.
Families also partnered with specific units at Children’s Hospital Colorado by participating in educational efforts focused on improving the effectiveness of communication. Family members began each staff training session by telling a story on how effective communication helped them through difficult challenges during their child’s hospitalization. This enabled staff to hear the impact they have from the families, themselves, through their every-day communication and inclusion. Another unit-based family work group contributed to the use of white boards in patient rooms. Family members provided input on the type of information that was most useful on the white boards and how to best use the boards to engage and inform patients and families. This enabled CHCO to create a communication tool that serves both family members and the care team.
While directly measuring the impact of patient and family participation in improvement efforts is difficult, we have seen significant improvements in a range of efforts that have included patients/families in the improvement teams dedicated to these initiatives. Graphical representation of the following results are available upon request.
1. Patient and family satisfaction: Families participate on the Patient-Family Experience Council and specific initiatives such as communication training, communication through the white board, and many quality and safety initiatives. In 2013, 75.3% of families rated their overall quality of care as excellent, a steady increase from 2008, with 93.1 percent of families rating CHCO as either excellent or very good. The percent of families rating of overall quality of care as excellent has increased over the past six years:
- 2008 – 72.3
- 2009 – 73.4
- 2010 – 73.8
- 2011 – 75.0
- 2012 – 75.1
- 2013 – 75.3
2. Reducing hospital-acquired harm is a central objective of the hospital’s quality and patient safety program. Families participated in a range of committees and project teams as well as on the steering team and as educators. In 2013, there was a 21% reduction in eight types of hospital acquired harm, from 197 events to 156.
3. Clinic efforts to improve on time starts involved faculty, staff and families. This effort was driven by patient satisfaction responses to “What could be done to improve your clinic/visit experience?” Reducing waits and delays in clinic was identified as the top opportunity. From an on time starts baseline of 33% in 2012, the Ambulatory clinics saw a two-fold improvement to 77% by the end of 2013.
4. In the absence of the ability to measure the direct impact of family participation on improvement, CHCO surveyed families participating on hospital committees as well as hospital staff to evaluate their perceptions of family involvement.
CHCO surveyed families participating on hospital committees to gain their perception of value of participating in these groups, as well as their feelings of the impact they had and satisfaction with the groups themselves. Their response was overwhelmingly positive. Similarly, CHCO surveyed staff and board members and received the same overwhelmingly positive response as to the impact families had and the urge to continue the collaboration.