Aligning Leadership Agendas for Quality, Safety, and Patient- and Family-Centered Care
An Executive Leadership Forum was held October 26, 2008, prior to the official beginning of the Hospitals and Communities Moving Forward with Patient- and Family-Centered Care Intensive Training Seminar in Calgary, Alberta, Canada. Jim Conway, Senior Vice President, Institute for Healthcare Improvement, concluded the forum with his thoughts on "Aligning Leadership Agendas for Quality, Safety, and Patient- and Family-Centered Care."
Jim told the forum that patient- and family-centered care has arrived! Because of a growing realization by consumers that the current system must be overhauled to achieve quality and safety goals, patient- and family-centered care is much more than a conversation about care at the bedside or in the exam room-not an "if" but a when and how discussion.
He prevailed upon administrative leaders to acknowledge that we can't fix the healthcare system until we build it around patients and families. He cited the growing business case for patient and family inclusion in quality and safety. Asserting that patient experience is strongly correlated with other key outcomes, including clinical, financial, service, and patient and staff satisfaction, Conway referenced the work of Uhlig, Charmel and Frampton, Gerteis, and Weingart, and colleagues.*
Patients and families can contribute materially to outcome improvements because of their knowledge of their illness and the actual experience of care. Patients know what works for them and what doesn't; they bring another set of eyes, brain, voice and a passion to achieve the same goals we want. Jim reminded the audience, "It's about them."
Referring to the Massachusetts Health Reform legislation that was signed into law in 2006, Conway told executive leaders that consumers were involved at every level, driving the legislation. He informed the audience that patient- and family-centered care has moved past "nice but not necessary."
In August 2008, Massachusetts' Governor Deval Patrick signed Chapter 305 of An Act to Promote Cost Containment, Transparency and Efficiency in the Delivery of Quality Health Care into law. The law contains several health care quality priorities, including:
- The establishment of Patient and Family Councils at hospitals, thus involving patients and family members in improving the quality of care; and
- The establishment of rapid response methods at hospitals, allowing medical staff and patients and family members to request immediate assistance when a patient is deteriorating.
What will it take for patient- and family-centered care to be the norm? Conway is certain that it will take leadership at every level and it will take partnership. Governing boards and executive leaders must demonstrate that NOTHING is more important in the culture than patient- and family-centered care, practiced everywhere in the hospital, on an individual, microsystem, and organizational level.
In words and actions, leaders must communicate that the patient's safety and well-being is the critical decision guiding all decision making. Patients and families must be treated as partners in care at every level-institution-wide to individual care. Additionally patient- and family-centered care is publicly verifiable, rewarded, and celebrated by assuring that there is sufficient staff available with the tools and skills to deliver the care that patients need when they need it.
And, Conway concluded, "there must be relentless focus on measurement, learning, and improvement with transparent patient feedback at all levels."
*References:
Uhlig, P. N., Brown, J., Nason, A. K., Camelio, A., & Kendall, E. (2002). System innovation: Concord Hospital. The Joint Commission Journal on Quality Improvement, 28(12), 666-672.
Frampton, S. B., Charmel, P. A., & Planetree. (Eds.). (2008). Putting patients first: Best practices in patient-centered care (2nd ed.). San Francisco: Jossey-Bass Publishers.
Gerteis, M., Edgman-Levitan, S., Daley, J., & Delbanco, T. L. (Eds.). (1993). Through the patient's eyes: Understanding and promoting patient-centered care. San Francisco: Jossey-Bass Publishers.
Weingart, S. N., Price, J., Duncombe, D., Connor, M., Sommer, K., Conley, K. A., et al. (2007). Patient and family involvement: Patient-reported safety and quality of care in outpatient oncology. Journal on Quality and Patient Safety, 33(2), 83-94.