Changing the Outcome With Family-Centered Care
Transforming the way we interact with families – building collaborative relationships – started as an ambitious goal in 1998, but it has become one of the defining characteristics of Cincinnati Children's and an essential link to quality improvement. It has become our culture. The realization that family-centered care means partnering with families has resulted in profound changes at the medical center – changes that can be seen and felt everywhere, from the inpatient units to the business offices to the board room.
Including families in rounds started as an experiment. Today it's an essential part of how we care for patients and families.
The way doctors at Cincinnati Children's used to make rounds was – and still is – standard procedure at many teaching hospitals: Every morning senior physicians, residents and medical students meet in a conference room to discuss how patients did overnight and develop the day's plan of care. Then they go out on the floor to visit patients, write orders and tell parents what they decided to do.
"We used to think we were doing a good job if we told families what we were doing and asked them if they had any questions," says Stephen Muething, MD, associate director of clinical services in the Division of General and Community Pediatrics at Cincinnati Children's. "Now we realize we're doing a good job when we really partner with families and they help make the decisions."
"We like being involved in rounds. We get to see what's going on with our daughter," say parents Kevin and Amanda Hemphill. "We have input. We're called the experts. We make decisions."
Spreading the Word
William Brinkman, MD, remembers an eye-opening experience during his first week as a fellow at Cincinnati Children's. He had just completed three years as a pediatric resident and one year as chief resident at another children's hospital.
"I had never made rounds where the discussions took place at the bedside, in the presence of children and parents. I was so focused on what the resident was saying, I didn't pay any attention to the parent."
He was surprised and more than a little embarrassed when Uma Kotagal, MD, senior vice president for Quality and Transformation, who was rounding with the team, pointed out that the patient's mother looked terrified. "Dr. Kotagal redirected everyone's attention to meeting the needs of the mother," Dr. Brinkman recalls. "It was a startling and clarifying moment."
That experience led Dr. Brinkman to think about making a video as a teaching tool. Along with Dr. Muething, Jeff Simmons, MD, and Michael Vossmeyer, MD, they created a video that includes the key lessons they had learned and addresses the most common objections from physicians: Families won't want it. It will scare them. It will take too long. Teaching won't be as good because we won't be as open. The decisions we make won't be as good.
"Most physicians can't even picture family-centered rounds because they've never seen them," comments Dr. Muething. "But I know I'm a better physician because I partner with families. They help me make better decisions."
The video they produced consists of a series of short vignettes. Each situation is enacted once to demonstrate common pitfalls – and again to show a family-centered approach.
The video has been so successful it was presented as a workshop at the 2005 and 2006 national meetings of the Pediatric Academic Society, and physician groups from other teaching hospitals have visited Cincinnati Children's to learn about our family-centered rounds.
