Changing the Concept
From Families as "Visitors" to Families as Partners
Below are profiles of hospitals and/or health care systems that successfully have changed "visiting" policies. These hospitals differ in type, size, and geographic location. Each short profile describes key steps and strategies in the process of changing the policy from viewing families as "visitors" to families as partners.
Anne Arundel Medical Center (AAMC)
A regional not-for-profit hospital founded in 1902, AAMC provides acute inpatient and outpatient care to residents of four counties in Maryland. A 380-bed facility, AAMC has a Cancer Institute, Heart & Vascular Institute, Joint Center, Spine Center, and a Women's and Children's Center. In April 2011, the hospital completed a $424 million expansion project, which included a pediatric emergency room, an expanded general emergency room, 50 new patient beds, and eight new operating rooms.
With valuable input from its patient and family advisors, Anne Arundel Medical Center is now actively promoting family presence. Patients have the power to choose who they want to stay with them – 24 hours a day, 7 days a week. According to AAMC's policy, each patient determines who is defined as "family." New signs decorated with the pineapple (a universal symbol of hospitality) and the words, "Welcome Families," replace old ones displaying the former visiting-hour policy.
The "Revisiting Visiting" Task Force, comprised of staff, providers, and patient and family advisors, directly influenced the new family presence policy. In implementing patient- and family-centered care, AAMC worked to include the voice of patients and their families in everything from visiting hours to changing directory signs around the hospital.
AAMC is also a recipient of a Picker Institute "Always Event" grant. Patients and families, staff, and providers developed a simple universal checklist of five items as a SMART Discharge Protocolsm. (SMART is an acronym for: Signs, Medications, Appointments, Results, and Talk with Me.) In its work, the SMART Team built on current evidence; created urgency and expectation for use with patients, families, and caregivers; disseminated findings; and will promote the protocol as a national standard.
Contra Costa Health Services
Contra Costa Health Services includes Contra Costa Regional Medical Center, Health Centers, and Detention Health. Its 164-bed public hospital and ten health centers and clinics, offers a complete array of patient-centered health care services for county residents. Constructed in the 1990s, the Medical Center is equipped with the most-up-to-date seismic-safety features and high-tech medical apparatus as well as a sophisticated and energy-efficient climate control system designed to maximize the comfort of patients and staff. Its services include a nationally recognized Cancer Program, perinatal and pediatrics units, and inpatient Rehabilitation Therapy.
Dedicated to offering health care services that are welcoming, accessible, safe and respectful for everyone, CCRMC has engaged patients, families and community representatives and leaders as active partners to ensure that their voices are heard and included in every area of its operations. Patients, family and community partners are actively represented on the Behavioral Healthcare Partnership, Hospital Operations, Executive and Improvement Teams, Patient Experience Partnership Council and Spiritual Care Partnership Council, as well as a variety of other key workgroups.
Because of its emphasis on patient- and family-centered care, the hospital dramatically transformed its existing visiting policy into a Welcoming Policy, focused on the belief that access to a robust support system is a key ingredient in healing.
Contra Costa's CEO Anna Roth says that getting hospital staff and physicians to go along with its innovative patient- and family-engagement changes has been a relatively smooth process. "It wasn't as tough a sell as people might think," she says. "It does help that our leadership team, including the CEO, see themselves as accountable to the community for delivering safe, high quality service and a welcoming experience across our system." Roth expects the process to continue now that the engagement process is underway. "The key," she says, "is that recognizing patients and families as partners in care is not my strategy, it's our strategy – one we are building together."
Essentia Health, headquartered in Duluth, MN, is an integrated health system serving patients in Minnesota, Wisconsin, North Dakota, and Idaho. Essentia began fully integrating operations in the summer of 2010, bringing together the resources of its member organizations - SMDC Health System, Innovis Health, Brainerd Lakes Health, and the Essentia Institute of Rural Health. In 2013, Essentia was accredited as an Accountable Care Organization by the National Committee for Quality Assurance. Essentia includes 18 hospitals, 67 clinics, eight long-term care facilities, two assisted living facilities, four independent living facilities, and one research institute.
Essentia Health is committed to partnering with patients and families to improve the care it delivers, the services it provides, and the outcomes of its patients. As an important way to achieve these goals, in 2008, Essential Health created its Patients and Families as Partners Program, which now includes more than 25 patient and family advisory councils in primary and specialty care as well as four patient-to-patient mentor programs. In addition, patient and family partners are engaged in more than 30 organizational committees and task forces across the health system.
Essentia Health also recognizes that family participation in care is critical to achieving its goals - that families or primary supports are not "visitors" but instead are integral to care, especially of the most vulnerable patients. Therefore, the ICUs in Essentia's East Region led the way in creating guidelines and practices ensuring that family members and other designated primary supports have unrestricted access to their hospitalized loved ones. According to Tim Rich, MD, section chair for Essentia's critical care units, "It's in critical illness that patients are most scared and vulnerable, and we want families to be at the bedside to ensure that our patients can get through critical illnesses with the best possible outcomes." In the fall of 2011, after involvement from patients, families, and staff, the Guidelines for Participation of Patients' Primary Supports Guidelines for Visitors in the Adult ICUs went into effect. Accompanying the new guidelines, support access badges were instituted to allow families and other primary support persons to be admitted to ICUs at any time, without having to ring a buzzer or make a phone call. At Duluth Children's, another part of Essentia's East Region, families are also welcomed 24/7. Over time, guidelines welcoming family presence and participation will be implemented in other parts of the extensive Essentia Health system.
Kingston General Hospital
Kingston General Hospital (KGH) is a center for complex-acute, specialty care, and trauma services, and is also home to the Cancer Centre of Southeastern Ontario. KGH services almost 500,000 people who live in a 20,000 square kilometer [more than 7700 square mile] predominantly rural area, as well as some communities on James Bay in Ontario's north. Fully affiliated with Queen's University, KGH is a teaching hospital with 2,400 health care students from 34 educational institutions across Canada who rely on KGH to provide the learning environment needed to become health care professionals. KGH currently operates 450 inpatient beds with 3,750 KGH staff, 565 medical staff, 850 volunteers, and more than 60 patient experience advisors.
Building upon its commitment to create and foster a patient- and family-centered environment, KGH began the process to move from its then existing "Visiting" policy to a "Family Presence" policy in early 2009. The Patient and Family Advisory Council supported this change and played a key role, emphasizing the need for patients to have family (as defined by the patient) present to increase patient satisfaction and safety. Many staff, especially at the leadership level, also understood the benefits of the change. "I think both patients and staff benefit from family members being present with their loved ones in the hospital. There is less anxiety for patients and families when they know family and designated friends are welcome at any hour," says Suzanne Bashall, Charge Nurse.
Communication was a key element for making a smooth transition. Along with internal communications, KGH also notified partner hospitals in the vicinity, released a FAQ sheet for staff, and updated the patient guide and internet site. KGH also placed notices on patient food trays and made public service announcements. After several months of preparation, KGH selected November 2009 to implement the new policy successfully across the organization. Since that time, KGH has made minor changes and twice updated the policy.
"Initial concerns about increased noise and risk of infection, safety and staff being able to get their work done did not materialize-common sense prevailed," says Leslee Thompson, KGH CEO and Board Chair of the Canadian Foundation for Health Improvement. "We see that patients and families are experiencing greater satisfaction during their time with us. Families are able to participate in care team discussions, monitor their loved one's condition, and provide comfort."
Methodist Le Bonheur Healthcare
Methodist Le Bonheur Healthcare is an integrated, not-for-profit healthcare delivery system based in Memphis. The eight-hospital system, with more than 1,700 licensed beds, includes home health services, outpatient surgery centers, minor medical centers, diagnostic centers, sleep centers and a hospice residence. Areas of expertise at Methodist include the Brain and Spine Institute, The Transplant Institute, The Cancer Center, The Cardiovascular Institute and pediatrics at Le Bonheur Children's Hospital. Affiliated with The United Methodist Church since 1918, Methodist Le Bonheur Healthcare combines a dedication to clinical excellence with a faith-based commitment to care.
Because Methodist Le Bonheur Healthcare is committed to equal partnerships with patients and their families, the system enlists advisors, called Patient and Family Partners, to provide guidance and input. These partners participate in work groups on special projects, sit on hospital steering committees and provide input during patient- and family-centered care meetings.
Patients and families are considered an active part of the care team. As outlined its Family Presence and Guest Policy, patients are encouraged to choose up to two partners in care—family or friends who will be listed on their medical record and will be present and involved during their hospital stay. Partners in care are authorized to share and receive information about the patient's condition in cooperation with the medical team. They are welcome to stay with patients 24/7.
Providence Health Care
British Columbia, Canada
Providence Health Care (PHC) is one of the largest faith-based health care organizations in Canada, operating 16 sites in Vancouver, British Columbia. PHC includes three acute care facilities, five residential care sites, one assisted living facility, one addictions clinic, one hospice and seven community dialysis units. Providence Health Care serves a diverse population of people and welcomes the challenge of caring for some of society's most vulnerable people. Populations served by PHC include people living with heart and/or lung diseases, kidney disease, mental illnesses, HIV/AIDS, urban health issues (homelessness, drug & alcohol-related issues & malnutrition) as well as seniors. PHC has 6000 staff, 1000 medical staff & physicians, 1600 volunteers, and 200 researchers, and sees more than 500,000 people every year.
Providence Health Care is dedicated to providing culturally safe and socially just patient- and family- centered care across all of its sites. In 2010, the Senior Leadership Team made a commitment to embark on a journey toward patient- and family-centered care. To begin, PHC integrated patient and family partners in more than 40 committees, working groups, and project teams. One of the key issues Providence tackled was changing the view of families as visitors. Through the collaborative efforts of six patient and family partners, eight leaders, and many clinicians throughout the organization, the Family Presence Policy was created, disseminated, and implemented throughout PHC.
Candy Garossino, Director of Professional Practice and Nursing stated, "Creating and implementing a Family Presence Policy was an incredible journey of conversations, stories, challenges, and successes. I heard from patient partners, families, employees, medical staff, and volunteers about the need to embrace our culture and further our partnership with patients and families."
The policy underscores the importance of family in all areas of the organization. PHC recognizes that families are essential to the health and well being of all of its patients and residents. At Providence, "family" is defined by the patient and can extend beyond the traditional boundaries of blood or marriage relationships. Families are welcomed 24/7 in all areas, and patients and families are encouraged to collaborate with their care teams to ensure that care can be delivered safely and easily by the staff.
According to Leanne Heppell, Vice President, Patient Safety & Innovation, and Chief of Professional Practice & Nursing, "Embracing a family presence policy is an important part of our strategic plan and is vital to improving the care experience for our patients and families."
Rochester General Hospital
Rochester, New York
Rochester General Hospital (RGH), a 528-bed tertiary-care facility is the "flagship" of Rochester General Health System. RGH offers a full array of services including specialty programs in Cardiac, Cancer, Orthopedic, Vascular, Surgical, Women's Health, Bariatrics, Stroke, and Diabetes. To further meet the health care needs of upstate New York residents, RGH has strong referral relationships with several regional hospitals, as well as affiliations with nationally renowned institutions including Cleveland Clinic and Roswell Park Cancer Institute.
About 10 years ago, RGH began the process of changing its "visiting" policy. A nurse brought the evidence about the positive impact of family presence and participation on patient outcomes to the Nurse Council. The council represents frontline nurses from all patient care areas in the hospital. With leadership support and approval, the information was disseminated to all Unit Councils for discussion. These councils include all staff—clinicians as well as secretaries, housekeeping, etc. Patients and families also provided input about changing the policy.
A number of factors contributed to a smooth transition: support by the executive leadership team, physician involvement from the beginning of the process, the emphasis on evidence, and opportunities for staff to share concerns and barriers (e.g., very few private rooms) and to work together to find solutions.
According to Cheryl Sheridan, SVP and CNO, "At RGH, we respect our patients and their loved ones as active participants in care. Loved ones not only provide comfort to patients but they are a valuable resource to the health care team because they have knowledge and insight about what is important to patients. Partnership and open communication support more informed decision making, improve the quality and safety of care, and lead to better patient outcomes."
RGH's policy is reviewed periodically and has evolved since its inception. For example, in 2013, the word "family" was expanded to include other care partners, acknowledging that patients may designate someone other than a blood relative. New staff members are always oriented about family presence and participation as a vital part of RGH's philosophy of care.
In the 2012 report, Sick, Scared, and Separated from Loved Ones, Rochester General Hospital was one of a few hospitals in New York State receiving a "9" in a 10-point rating of visiting policies.
South Health Campus
Opened in 2012, South Health Campus (SHC), part of Alberta Health Services, is a full-service hospital and health care facility. The SHC has about 2,700 full-time staff and 180 physicians who provided 92,000 patient care days and 200,000 outpatient visits annually. The 269-bed campus serves Calgary and surrounding areas and is also a referral center for southern Alberta.
Patient- and family-centred care is one of the four foundational "pillars" of SHC. Patients and families are regarded as full partners on their care teams, and in the planning, delivery and evaluation of health services. Before SHC was built, family presence was already an "embedded philosophy." Early buy-in and strong support by operational and medical leadership were the key elements that drove this cultural change. In planning for the new campus, SHC established a Patient and Family Advisory Council early on to bring the voice of patients, families, and community members to both facility design and program planning.
In developing new guidelines to support family presence, the Council and the interdisciplinary clinical design team worked collaboratively. The team shared perspectives on visiting policies at other hospitals in Alberta Health Services and consulted with clinical project managers, senior leaders, and physician leads. As an example, because of input from patients and families themselves, SHC's guidelines now differentiate between unrestricted "family presence" for key family members and support persons identified by the patient and visiting hours for "visitors."
Following approval of the new guidelines, SHC implemented a plan for staff orientation, including training about patient- and family-centred care and the family presence philosophy. Ongoing educational sessions about potential challenging situations provide support to staff.
"Although we are still in the early days of this innovative new health care facility, we have seen a positive shift in care delivery in which the patient and their family are actively and respectfully involved in the decisions that affect their care and health. It is recognized that family and friends are integral to the patient's healing process. Family and primary support providers are welcomed as essential members of the health care team; they are not "visitors" in the lives of patients, but full partners in care as desired by the patient."
~ Lori Anderson, Senior Operating Officer, South Health Campus
Grand Rapids, Michigan
Spectrum Health is a not-for-profit health system, based in West Michigan, offering a full continuum of care through the Spectrum Health Hospital Group, which is comprised of 11 hospitals including Helen DeVos Children's Hospital; 170 ambulatory and service sites; Comprehensive post-acute care services; 1,080 advanced practice providers and employed physicians including members of the Spectrum Health Medical Group and West Michigan Heart physician groups; and Priority Health, a health plan. Spectrum Health is West Michigan's largest employer with 21,300 employees.
The health system engages patients and families to help improve all aspects of their health care experience. In 2004, the Spectrum Health Hospital Group executive leadership team designed a culture of excellence committed to improving care from the patient's perspective. The organization is dedicated to empowering patients and families through understanding the experience of care, sharing information, and encouraging true partnerships with caregivers.
In 2006, the health system went one step further and embarked on a significant culture change. Hospital leadership, with support, advice, and participation from the Patient and Family Advisory Council, established a fifty-member team to move away from "visiting hours" and established policy and processes to encourage and manage "family presence" and participation in care.
With clarity of purpose, Spectrum Health evaluated its visiting practices and gathered multidisciplinary groups of employees to redesign the process. Leadership listened intently and engaged in dialogue about the concerns and barriers identified by staff. They convened multiple work groups with patients, families, and members from every department in the hospital.
All departments were made aware of the change and mapped out the steps and processes needed for a successful roll out. They identified what training would be necessary and what new policies/procedures would have to be written. Management took down the "Visiting Hours" signs throughout the facilities. And in ninety days Spectrum Health changed hospital "visiting" policies and practices to supporting family presence and participation.
"We support and work with each individual patient in determining when the family and other partners in care will be present," James Bonner, Director, Patient Experience, explains. "Proactively addressing questions and concerns helps patients and families have a better hospital experience and become more involved in their care."
The Valley Hospital
The Valley Hospital is a fully accredited, acute care, not-for-profit hospital serving more than 440,000 people in Bergen County, New Jersey, and adjoining communities. Its current licensed capacity is 451 beds. In 2014, Valley admitted 47,534 individuals, treated 74,416 in the Emergency Department, and delivered 3,424 babies.
For ten consecutive years, J.D. Power and Associates has recognized Valley for service excellence under its Distinguished Hospital ProgramSM In 2003, Valley was designated a Magnet facility for nursing excellence, and was redesignated in 2008 and 2013. In addition, Valley earned the Gold Seal of Approval from The Joint Commission.
The Valley Hospital began its Patient and Family Centered Care (PFCC) journey four years ago, and now has 85 Patient/Family Advisors serving on more than 24 councils, committees, and teams. In 2014, growing evidence and the experiences and stories of patient and family advisors led the hospital to the conclusion that restricting family presence through visiting hours did not create a healing environment for patients.
The process to revise the hospital's policy and practice involved stakeholders at all levels of the organization. Early on, the executive leadership team bought in to the change. The PFCC Steering Team (including advisors, frontline staff, and executive leaders) as well as the Patient and Family Advisory Council participated in the development of the policy. Nursing leadership also played a key role.
Valley's Partners in Care Welcome Policy became effective in early March 2015. Four months prior to the "go live" date for the new policy, Valley implemented a communication plan that included 10 brief articles in the employee newsletter referencing data that demonstrated the need for the new policy. Seven videos, highlighting different patient/family advisor stories, were also developed. Valley developed a Partners in Care Welcoming Guide, and gave it to families when they enter the hospital at the front desk.
Among other metrics, the hospital is now measuring the number of overnight incidents with family members, pre- and post-implementation of the Welcome Policy, which have declined by almost 50%.
"Valley Hospital has always had a rich history and strong performance related to our ability to deliver an exceptional patient experience. However, we began to recognize that we were missing out on perhaps the biggest opportunity to drive improvements in quality and patient safety and the overall patient experience. In order to reach the highest levels of performance, we had to truly engage patients and their families and make them an integral member of their care team. Our new Welcome Policy makes that possible."
~ Peter Diestel Senior VP, Administration/COO
UAB Hospital is a 1,157-bed academic medical center in Birmingham, Alabama and the flagship hospital for the UAB Health System. The medical center includes a Level 1 trauma and burn center, Level IIIc regional neonatal intensive care program, and NCI-designated Comprehensive Cancer Center. UAB Hospital is home to a state-of-the art Heart and Vascular Center and one of the largest transplantation programs in the country. UAB Hospital is proud to be recognized as a Magnet nursing facility since 2002 and the only Magnet-designated hospital in Alabama. UAB Hospital includes the The Kirklin Clinic at UAB Hospital, the UAB Spain Rehabilitation Hospital, and the UAB Center for Psychiatric Medicine.
Like many hospitals, UAB Hospital embraces patient- and family-centered care. The hospital has a vibrant Patient and Family Advisory Council that is active in the life of the medical center. Prior to 2012, the hospital had restrictive visiting hours, especially in its ICUs. A courageous patient's wife, who was unable to be with her husband during precious moments at the end of his life, shared her story. As a result, the hospital transformed its culture to include families at the bedside, especially in its ICUs. With the leadership of the Chief Nursing Officer and the executive leadership team, the hospital implemented a policy of welcoming families.
With the guidance of shared governance through the Nursing Congress, the Patient and Family Advisory Council, and the Center for Nursing Excellence, the hospital developed new guidelines for family presence across all care settings. In addition, it established a Care Partner process to ensure a thoughtful approach in helping patients select family members to be with them the morning of surgery. The hospital posted the new guidelines in the ICU waiting rooms, along with welcome signs to help communicate the hospital's philosophy for family presence and partnership. The hospital also includes these guidelines on its website and in its My UAB Medicine Toolkit with a special section for family and friends.
According to Jordan DeMoss, Associate Vice President, "We are proud of the progress we have made in building a culture of family presence and partnership at the bedside. It is hard to imagine a time, not too long ago, when we excluded families from optimal partnership. It is a journey and, while we have taken the first major steps forward, we continue to refine our approach to family presence and challenge ourselves to improve."
University of Michigan Health System (UMHS)
Ann Arbor, Michigan
The University of Michigan Health System (UMHS)—a large academic medical center and health care system is located in Ann Arbor, Michigan. The Medical Center includes three hospitals housing 990 beds, 40 outpatient locations with more than 120 clinics, and an extensive home care operation. UMHS is home to more than 26,000 faculty, staff, students, trainees, and volunteers. UMHS has 1.9 million patient visits and 45,000 hospital stays each year. 70% of patients travel from communities or regional hospitals outside of the Ann Arbor area.
For nearly a decade, Patient- and Family-Centered Care (PFCC) has been the cornerstone of policies, programs, services, and design at UMHS. PFCC principles guide decision-making by engaging and empowering family presence, participation, and partnership at all levels from individual patient care to organizational decision-making. As evidence of their Patient- and Family-Centered vision, UMHS has more than 30 advisory councils; advisor membership on hospital committees including executive-level, operations, facility design, ethics, and adverse event review groups; multiple peer mentor programs; dozens of educational venues; and an active e-advisor group.
In 2008, UMHS C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital successfully transitioned from a "Visitation Policy" to a "Family Presence Policy." For years prior to this change, staff made exceptions to the restrictive "Visitation Policy" on a case-by-case basis. Given the inconsistent application of the policy and the consistent need to make exceptions, it became clear that it was time to change the policy.
The Family Presence policy is comprehensive and addresses family presence overnight, in trauma bays, during codes and procedures, and during shift-change and medical rounds. Patients and families define their family, which can include "two or more persons who are related in any way—biologically, legally, or emotionally." System-wide adoption of the Family Presence policy occurred in 2013 when UMHS adult care areas implemented this policy.
According to Kelly Parent, UMHS PFCC Program Manager for Children's, Women's and Psychiatric Services, "As with any change, there have been bumps along the way. At times, it seems that we have taken two steps forward and one back, but we have always stayed the course." "Staying the course" means providing leadership and employee assistance support, policy revision, and the creation of supplemental guidelines that address special circumstances. "Especially in crisis, we owe it to our families to do everything possible to keep them together."
University of Washington Medical Center (UWMC)
University of Washington Medical Center (UWMC), a 450-bed hospital, is part of the UW Medicine health system, which also includes Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine, and Airlift Northwest. For specialized services, patients travel from across Washington, Wyoming, Alaska, Montana and Idaho to UWMC.
Patient- and family-centered care at the University of Washington Medical Center is a culture change movement started in 2002 to improve the delivery of health care for patients and families. According to Stephen Zieniewicz, UWMC's Executive Director, patient- and family-centered care is "foundational to the success of providing quality care in a safe and partnership-based environment." Stephen believes that patient and family involvement in health care greatly increases patient safety by reducing the number of falls, ensuring that patients understand care plan instructions, and contributing to reduced medical errors.
Because of those beliefs, UWMC administrators recognized the need to change the "visiting" policy and approached the Inpatient Oncology Council (one of three councils at the time) for input. Although Council members wanted family members to have access to patients without time restrictions, they raised a number of important concerns. In their discussions, Council members also stressed the importance of having a broad definition of "family," based on patient preference and of making a distinction between family and true "visitors." This input from the Council was invaluable in shaping the new policy.
Since that time, refinements have been made in UWMC's policy, Family and Visitor Guidelines, including elimination of any specified hours, even for visitors. And, with input from its own Council, which started in 2008, the culture in the ICU has also changed dramatically to encourage family presence at the bedside. Recently, the solid wood doors to the ICU were not only unlocked but were replaced by welcoming glass doors! UWMC's Department of Public Safety has played an important role in policy revision, including working with the Councils to develop guidelines to ensure safety for patients, families, and staff in dangerous or disruptive situations.
University of Wisconsin Hospitals and Clinics
University of Wisconsin Hospital and Clinics (UWHC), including the American Family Children's Hospital, is part of the UW Health System, which is also comprised of the UW Medical Foundation (physicians' group) and the UW School of Medicine and Public Health. Established in 1924, UWHC is a 566-bed academic medical center with 85 outpatient clinics.
According to UWHC's President and CEO Donna Katen-Bahensky, "We have been focused on building a patient- and family-centered care culture at UW Health. Delivering this kind of care is the most important thing we do and it affects everything we do on a daily basis."
Consistent with that commitment, in 2007, nursing leadership recognized that family presence and participation are essential to patient care, quality, and safety, and wanted to change the hospital's visiting policy to reflect that belief. Because some front-line clinical staff expressed concerns about the proposed change (e.g., infection control, demands on staff at night), a nurse leader planned a "design day" involving a diverse group of stakeholders—nursing leadership, front-line nurses, other clinical staff, risk management, security, and patient/family advisors. This work group reviewed the evidence about family participation, drafted a new policy, and later made revisions.
In July 2007, the new Guidelines for Participation of Patients' Primary Supports and Guidelines for Visitors went into effect. As suggested by the title, the policy distinguishes between "primary supports" designated by the patient, and visitors or guests; the policy also acknowledges the "unique role" of primary supports "as member(s) of the patient's health care team."
Unit champions played a key role in helping plan the details of implementation and in gaining support for the new policy. According to Helena Scherer-Jones, UWHC Director of Patient Relations and Patient-Family Partnerships, "In the end, the implementation of this policy was actually very smooth, despite the initial concerns of some staff. In large part, this was due to the fact that key stakeholders were all represented in the process."The Guidelines have been revised, including as recently as 2013. However, any changes have been operational (e.g., streamlining the badging process), not philosophical.
Vanderbilt University Medical Center
The Vanderbilt University Medical Center, serving patients throughout Tennessee and the Southeast, is home to Vanderbilt University Hospital (600 beds), Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt Psychiatric Hospital, Vanderbilt Stallworth Rehabilitation Hospital, The Vanderbilt Clinic, and Vanderbilt Health One Hundred Oaks.
Prior to 2009, Vanderbilt University Medical Center essentially had different "visiting" policies on individual units—Med/Surg Trauma, Burn, and each critical care unit. Therefore, patients might move from one unit to another on the same floor of the hospital—and their families would experience different "visiting" hours and procedures. Recognition of this lack of standardization together with growing evidence of the benefits of family presence led the Medical Center to undertake a process to develop a standard policy acknowledging the importance of family presence. At the same time, the Critical Care Tower, a nine-story addition to the Vanderbilt University Hospital, was being completed and provided the opportunity to focus on family presence, particularly on the critical care units.
With the support of the hospital's CEO and CNO, Terrell Smith, Director of Patient and Family Engagement, identified champions within each critical care unit who supported the change. A small work group, representing critical care managers, patients, and physicians, drafted a new policy, Visitor and Family Presence Guidelines. Subsequently, the full Patient and Family Advisory Council reviewed the policy. In December 2011, the new policy went into effect, throughout the Medical Center. The policy states explicitly that family members are not "visitors" but instead are members of the care team. It also distinguishes between family members and other support persons—and "visitors" or guests of the patient and family.
Hand-in-hand with the policy development, training activities were designed, including videos of patients and families talking about the need for family presence. These activities were then tailored and presented in specific critical care units.
After initial implementation of the new policy, refinements continue to be made. For example, more specific guidance and support was needed for the presence of children in the hospital. Now the Critical Care Tower has a part time Child Life Specialist who works with children who have hospitalized family members. According to Terrell Smith, this refinement process was a reminder to everyone that, "Moving to a family presence policy is a journey—not a one-time change. You may need to make revisions along the way but that absolutely does not mean that the philosophy or the policy is flawed."
Vidant Health/University Health Systems of Eastern Carolina
Eastern North Carolina
A regional health system serving 29 counties, Vidant Health includes eight hospitals, a free-standing ambulatory surgery center, physician practices, hospice and home health care and other independently operated health services. Vidant Medical Center (formerly Pitt County Memorial Hospital, PCMH), an 851-bed tertiary care center, is the flagship teaching hospital for the Brody School of Medicine at East Carolina University.
Successful efforts to advance patient- and family-centered care began at PCMH during the late 1990s at its Children's Hospital and Regional Rehabilitation Center. However, these efforts, though valuable in the areas where they occurred, did not advance patient- and family-centered care throughout the health system. Among other things, the system's "visiting" policy for families was still restrictive.
A defining moment occurred in May 2007 when a hospital employee, Christie Odom, and her family shared their story with senior leaders, describing their experience of being treated as "visitors" instead of partners in care. During her brother's hospitalization in one of the adult ICUs, Christie's family experienced a lack of access and information due to a visitation policy that allowed the presence of family members for only fifteen-minute segments, six times a day. Christie's brother's anxiety increased every time his family had to leave the ICU and he died alone with no family by his side.
After hearing Christie's story, the Executive team, Board of Trustees, medical staff and senior leadership committed to transform organizational culture across the health system. Key to the transformation was the opening of an Office of Patient and Family Experience in October 2008, dedicated to educating leaders and staff about best practices. This office organized staff champion teams, led the efforts to implement a hospital-wide family presence policy, and provided education to hospitals in the system. Several hospitals also began to identify other new ways to engage patients and families to improve performance and change policies.