Our Journey to Family-Centered Care
Family-centered care is a philosophy that's changing the way medicine is practiced.
You may well ask: What exactly is it?
- Is it staff who are compassionate and supportive? Yes.
- Hospital facilities that are welcoming and comfortable? Yes.
- Families present and participating in care? Yes.
- Support services that meet the needs of families? Yes.
It's all of these and more. Above all, family-centered care is a new, collaborative relationship among health care professionals, patients and their families. The realization that family-centered care means partnering with families has resulted in profound changes at Cincinnati Children's Hospital Medical Center — changes that can be seen and felt everywhere, from the inpatient units to the business offices to the board room.
Getting Started
In 1998, a group of trustees and senior leaders attended an intensive seminar on family-centered care, sponsored by the Institute for Family-Centered Care. They came back inspired and determined to make Cincinnati Children's a family-centered institution.
At the same time, staff from the Regional Center for Newborn Intensive Care (RCNIC) attended a conference on newborn developmental care, where they learned about family-centered care. They, too, came back excited, recalls Kathy Dressman, RN, then outcomes facilitator in the RCNIC. They immediately launched an effort in the RCNIC to design a new model of care, where the patient and family would be at the center.
Dressman, now a senior clinical director, remembers this as a time "when we knew we wanted to do family-centered care, but we didn't really know how. We were guessing what families needed. After 18 months of planning, we realized we didn't even have a family at the table helping us. That was a big 'ah-ha'!"
Family-centered care, they realized, is not simply what we do for families. It's what we do with families.
Having Parents at the Table
The same realization was taking root in other parts of the hospital, especially among the leaders of an exciting and ambitious initiative known as Pursuing Perfection.
The impetus for Pursuing Perfection was a report from the Institute of Medicine (IOM) that called for transformational change of the health care system. The report identified patient-centered care as one of the keys to a transformed system. To kick-start a nationwide response to the IOM report, the Robert Wood Johnson Foundation announced its Pursuing Perfection initiative. When the grants were awarded in April 2002, Cincinnati Children's became one of just seven participants in the United States.
As part of the rigorous application process, we formed two quality improvement teams, one focusing on cystic fibrosis, the other on bronchiolitis. Both included parents.
Today, involving parents on improvement teams is the norm at Cincinnati Children's. But at the time, the idea of parents actually being at the planning table was new — and more than a little controversial.
Charting a New Path to Quality
"We searched the literature and did not find any model for how to include families in the design process," recalls Gerry Pandzik, RN, a specialist in organizational development. "Parents were consulted as advisors, but no one actually had parents as part of the design team."
The staff had serious concerns. Would parents understand the issues? Would staff talk openly and thrash out issues in front of parents? What would parents think if they heard about problems? Would they lose respect for the hospital? Take their children someplace else? And would they really participate, or would they be too intimidated? Would they have anything to contribute?
"Despite our fears, we knew it was the right thing to do," says Jeanne Weiland, RN, a nurse practitioner on the cystic fibrosis (CF) team. "If family-centered care was the desired outcome, families needed to be part of the team. We decided to just try it."
Within a month the CF team had recruited 13 families, and as a first step, the parents met to develop their vision of perfect care. "When we compared their vision with the priorities the staff had developed, they were very different," Weiland recalls.
"We immediately reprioritized the work. Right from the beginning we felt we needed to focus on what the families said was most important to them."
"Once you take one step," Pandzik comments, "it changes how you think about the next step." The ripples from those first steps are still spreading, encompassing an ever-larger part of what we do.
Today, family-centered care is one of the defining characteristics of our hospital and an essential link to quality improvement. "Without the insights and participation of parents who have partnered with us in the quest for quality, we would not have accomplished what we have," notes James M. Anderson, president and CEO. Indeed, our leadership in family-centered care was cited by the American Hospital Association (AHA) as a major reason for awarding Cincinnati Children's the prestigious 2006 AHA-McKesson Quest for Quality Prize.TM
This year's annual report tells the story of our quest to weave family-centered care into everything we do.
