Organizational Leaders and Managers

Spectrum Health: Supporting Family Presence

Spectrum Health, located in Grand Rapids, Michigan, engages patients and families to help improve all aspects of their health care experience. According to Kris White, Vice President of Innovation and Patient Affairs, "Patients and their families are at the center of the care continuum—before, during, and after hospitalization."

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 an astounding 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.

How They Made It Happen
Spectrum Health made a commitment to collaborative relationships and included family presence in all aspects of care as an ongoing strategic focus. Leadership engaged everyone in the organization in changing the antiquated and restrictive "visiting" policy to a family presence policy.

With clarity of purpose, Spectrum Health evaluated its visiting practices and gathered multidisciplinary groups of employees to redesign the process. When asked to identify their concerns, fears, and barriers to success, staff comments included, "Will we be safe here during the night?" "Do we need more staff to accommodate more visitors?" "What about infection rates, HIPPA and noise?" Leadership listened intently and engaged in dialogue about the concerns and how these barriers could be overcome. They convened multiple work groups with patients, families, and members from every department in the hospital. Each member identified how the change would affect his/her area of the hospital. For example, the Security Department would have new responsibilities, requiring new skills, and a different perspective from the previous, familiar system.

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. They developed scripts and carried out role-playing exercises with departments such as security. As family members came in after hours, there needed to be a welcoming way of greeting them and explaining the process, while maintaining safety.

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.

How It Works
"We support and work with each individual patient in determining when the family and other partners in care will be present," Kris White explains. Proactively addressing questions and concerns helps patients and families have a better hospital experience and become more involved in their care.

On admission, the nurse asks each patient who his/her family members are, and discusses how they should be involved in care. These questions are asked and the answers recorded in a prominent place in the medical record:

Who do you consider your "family?"
Can we share medical information with this person?
So we can best meet your needs, what are the best hours for this person to be here?
Will someone be staying throughout your hospital stay?

Family members and partners in care are given a nametag that says, "Hello my name is __________. I am here with ___________ in Room_______.

During the cold and flu season there is a need to screen individuals coming into the hospital. Family members, as well as guests, are screened for wellness. They are asked if they have any colds, flu, or illness. If the answer to this inquiry is "No," the individual receives a sticker stating, "I'm a healthy visitor." In addition, this allows for increased opportunity to promote hand washing and other practices to ensure the safety of patients, staff, and guests. If a family member or guest has evidence of illness, the staff engages in conversations about keeping their loved one safe, as well as ways that the family member can help them do this. Staff may provide a mask, orient the family member on ways to support their loved one, yet keep them healthy, and/or help arrange for another family member to be present. If guests, rather than family members are ill, the staff is equipped with specific scripting to thank them for coming, and encourage the guests to consider refraining from visiting at this time. Staff also makes them aware of other ways to offer support, such as phone calls, email, Carepages, etc.

At 9:00 p.m., when the hospital is winding down for the night, there is no longer an announcement stating that visiting hours are over, and that family and visitors are expected to leave. Instead this message is broadcast, "Attention staff, families and guests: At 9:00 p.m. we will be securing the hospital for the night. Those who wish to stay, please see a unit member to make arrangements. Have a pleasant evening."

After 9:00 p.m., there is only one way in and out of the hospital. Family members wear the nametags that identify who they are and the name of their loved one. If someone is in the hospital without a nametag, all hospital personnel are trained to ask, "Who are you here with?" "Do you need help to get back to the unit?" and/or "May I assist in getting proper identification for you".

Semi-Private Rooms
Spectrum Health hospitals have both private (single) rooms and semi-private (two person or double rooms). Many patients prefer or request a single room, but this is not always possible. In these cases, staff have worked to develop processes that continue to support family presence and partnership. Spectrum Health staff explain the family presence protocol to those patients who are in semi-private rooms in this way:

"Welcome to our Digestive Disease Unit. As you see, you are in a double room and I want to go over ways we will be working with you to make your stay comfortable.." At this time, things that are shared in the room are reviewed (closet, bathroom, shower, television).

When a patient wishes to have a family member stay with them, the staff are equipped with communication process to negotiate this with the roommate. In double rooms, a plan needs to be put in place to accommodate this. The lounge may be an option for a family member to stay if the roommate has concerns about a family member staying in the room at night. An example of a prompt that staff use to begin the conversation with the roommate is: "Your roommate has requested that his/her ______ spend the night in the room at their bedside. I want to ask you if that would be difficult or uncomfortable for you in any way".

Kris White indicates that the service lines that have made this change have seen vast improvement in the experience of the double rooms. "It is about managing the expectations of the patient and family in a proactive way and engaging in the conversation on how to best meet the needs of both patients. They appreciate this upfront approach."

Intensive Care Units (ICU)
High illness acuity, as experienced by those patients admitted to the ICU, increases families' anxiety and their need to be close to loved ones. Family Presence policies in the ICU are exactly the same as those throughout the rest of the hospital. If a nurse or other clinician needs to have some time exclusively with the patient, they tell care partners, "There are times when I need to be most attentive; could you please give me a few minutes? As soon as I'm finished, I'll come and get you." Kris White said that being honest and respectful with patients and their family results in collaboration and a connection to a unified purpose—engaging everyone to be on the same team.

Recognition and Awards

In 2010 Spectrum Health was named one of the nation's top 10 health systems by an annual study analyzing clinical and financial performance. Spectrum Health was the only health system in Michigan to receive the Thomson Reuters 100 Top Hospitals: Health System Benchmarks® honor.

Spectrum Health received the HealthGrades Distinguished Hospital Award for Clinical Excellence™ for the third consecutive year. This is the highest honor a health care provider can receive from the leading health care ratings organization. The distinction places Spectrum Health among the nation's top 5 percent of hospitals for clinical quality, one of only 269 of the nation's nearly 5,000 non-federal hospitals to receive this award.