Profiles of Change
Cincinnati Children’s Hospital Medical Center
Cincinnati Children's Hospital
In its 2008 annual "America's Best Hospitals" survey, U.S. News & World Report ranked Cincinnati Children's Hospital Medical Center third in general pediatrics out of 50 American children's hospitals included in the survey. Additionally, the survey ranked it among the top ten children's hospitals for it's expertise in digestive disorders, respiratory diseases, cancer, neonatal care, and cardiac care.
Cincinnati Children's Hospital Medical Center received the 2008 Picker Award for Excellence in the Advancement of Patient-Centered Care, given by the Picker Institute. The Picker Awards for Excellence, established in 2003, recognize individuals and organizations committed to improving the patient experience. In making the selection, the Picker Institute identifies and promotes "best practices" that will lead to the advancement of patient-centered care, and in selecting Cincinnati Children's to receive this award It recognized that the hospital's work best exemplifies the goals and philosophy of Picker Institute.
Cincinnati Children's Hospital Medical Center also received the 2006 American Hospital Association-McKesson Quest for Quality Prize®, acknowledging the hospital's leadership and innovation in quality, safety, and commitment to patient care. Award criteria include demonstration of organizational commitment to achieving the Institute of Medicine's six quality aims-safety, patient-centeredness, effectiveness, efficiency, timeliness, and equity. The award honors organizations that have made successful quality improvements and that offer models that can be replicated by others in the hospital field.
A Bit of History
In the spring of 1998, Cincinnati Children's Hospital Medical Center brought a team to the Institute for Patient- and Family-Centered Care's "Hospitals Moving Forward with Family-Centered Care" intensive seminar. This team's purpose was to learn how to improve the care experience for patients and families as an integral step towards achieving the hospital mission, "to be the leader in improving child health." The President/CEO, Chairman of the Board of Trustees, Chief of Staff, a trustee from the Board's Patient Care Committee, Chief Nursing Officer, and a staff nurse were among those chosen to participate.
In the years since that seminar, this hospital has come far in its journey towards family-centered care. Cincinnati Children's is a learning organization that actively seeks out opportunities to work with others to achieve major goals. Each year since 1998, the hospital has sent interdisciplinary teams of families and professionals to the Institute's seminar creating a cadre of more than 150 change agents to further engrain patient-and-family-centered care practices within this academic medical center.
In April 2002, Cincinnati Children's received a $1.9 million grant from the Robert Wood Johnson Foundation to participate in Pursuing Perfection: Raising the Bar for Health-Care Performance. Cincinnati Children's was one of seven health care organizations, and the only pediatric center, to receive a Pursuing Perfection grant. Participants are expected to produce compelling examples of how health care organizations can significantly improve. Families were an essential component of this grant-funded initiative from the outset.
Cincinnati Children's has made major strides in patient- and family-centered care; it uses evidence-based guidelines, strives to address racial disparities in the community, and uses data effectively. The hospital's governing board, medical staff, and executive management are aligned in their goals and closely collaborate on quality improvement initiatives. The vision of Cincinnati Children's is to be the leader in improving child health. The dynamic partnerships between family members and medical center staff listed below are a few examples of how the concept of family centered-care acts as a catalyst for Cincinnati Children's to move towards perfection.
The Family Advisory Council
Family Advisory Council
In 2001, Cincinnati Children's created the Family Advisory Council (FAC). The Family Advisory Council advises Cincinnati Children's administration and medical leadership on patient needs and hospital priorities from a family perspective, participates in hospital-wide decision-making processes, and is a valuable resource for educating families and employees about family-centered care. Members also serve on hospital committees that influence patient care.
"Family-centered care is a collaboration that puts the family first, not just when it's convenient but all the time" says Patty Wells, RN, director of Cincinnati Children's Family Resource Center and the staff liaison to the FAC. "Family-centered care acknowledges that families are experts in their children's care. Families deserve to be partners in all aspects of their children's care, and the FAC ensures that this happens."
The Family Advisory Council empowers families and gives them a voice in decisions that affect patient care and family experiences. The mission of the Family Advisory Council is to promote the concepts of family-centered care and to advise Cincinnati Children's Hospital Medical Center administration, faculty, and staff on patient needs and medical center priorities from a family perspective.
The Council consists of 18 adult family volunteers and 11 Cincinnati Children's employees. Two parent coordinators co-chair the Family Advisory Council.
Ad Hoc members include two members of the Cincinnati Children's Board of Trustees, appointed by the Chairman of the Board; a member of the Cincinnati Children's website team, and a chair of the Cincinnati Children's Patient Advisory Council (for more info, see below). In addition, the Family Advisory Council's staff liaison and a Senior Vice President are representatives to the Cincinnati Children's Hospital Medical Center Cabinet. Family members receive reimbursement for travel and childcare expenses.
A sampling of accomplishments of the Family Advisory Council include:
- National Seminar -- Cincinnati Children's Hospital hosted the Institute for Patient- and Family-Centered Care's Hospitals Moving Forward With Family-Centered Care Seminar. Among the 86 Cincinnati Children's participants were two family members and eight staff members who presented personal perspectives.
- Inpatient Parent Handbook -- Family Advisory Council members critiqued the drafts and provided pointers and recommendations regarding content and usability during development of an inpatient parent handbook.
- Media Task Force -- Family Advisory Council members lead the change to allow only family-friendly TV stations be available in all waiting rooms.
- Surgical Waiting Room Renovation - Patients' families were a driving force in making this project a reality. Parents devoted a lot of time to making sure the waiting area was designed and built from the family's point of view. They came in after hours to meet with the architects and had amazingly creative ideas about its function and appearance. Working with Perioperative Services and construction staff, Family Advisory Council members provided input for designing the "ideal" surgical waiting room. They created a warm, welcoming atmosphere with clear signage and fresh new color schemes for families and patients. The new waiting area features brightly colored furniture arranged in clusters, LCD widescreen TVs showing soothing aquatic scenes, wood laminate flooring, a cheerful play area and a beverage station where families can get something to eat and drink while they wait. Large, comfortable consultation rooms allow families some quiet and privacy, while computer hookups provide the opportunity to work and keep in touch with other family members and friends.
- Newborn Intensive Care Unit -- Members participated in development of renovation plans for the Regional Center for Newborn Intensive Care Unit (RCNIC) Family Waiting Area, Parent Care Rooms, and a parent handbook.
- Parking Committee -- Family Advisory Council members collaborated to minimize confusion in the visitor parking garage and to make special needs parking more accessible.
- Billing Task Force -- In order to make billing statements easier to understand, Family Advisory Council members and the Billing Department collaborated to develop and launch a family-friendly billing system. The task force redesigned paper billing statements, as well as new online billing management systems. The Billing Task Force also created tips for families on how to handle and organize medical bills and information, as well as a downloadable "billing contact record."
- The Family Faculty Program was created to incorporate family-centered care philosophies and experiences into the resident teaching curriculum at Cincinnati Children's. (See below.)
- The Hispanic Advisory Committee was created as a permanent standing committee of the Family Advisory Council. (See below.)
Family Advisory Council members were instrumental in testing the Cincinnati Children's website for family-friendly navigation and terminology. This website remains a "number one" site for hospitals around the country. Members began developing content for the Cincinnati Children's website with the goal of creating a replicable model and resource for family advisory councils and institutions developing family-centered care initiatives nationwide.
The Family Advisory Council Award of Excellence in Family-Centered Care
The Family Advisory Council established The Family Advisory Council Award of Excellence in Family-Centered Care to recognize health care professionals and family members who have been exceptional in promoting family-centered care within the Cincinnati Children's community. The award, which consists of a monetary sum and an inscribed glass memento, is given to two nominees (one staff, one family member) twice each year.
The Patient Advisory Council: Advising on Patient Care
The Patient Advisory Council, started in 2002, gives patients a voice in the decisions that affect how they receive care. The Patient Advisory Council has 10 to 12 members, ages 10 to 18, and two staff liaisons. The mission of the Patient Advisory Council is to be supportive of and to be a voice for patients at Cincinnati Children's, to assist staff to understand the patient's perspective, and to identify ways to make Cincinnati Children's a better place.
The Patient Advisory Council has worked as a team to accomplish the following:
- Provide patient input on the new teen room,
- Provide input on the surgical virtual tour,
- Review and provide ideas for brochures targeting patients and children,
- Get DVD players installed in patient rooms,
- Have kid-friendly TV stations in patient rooms,
- Establish a monthly family movie night,
- Create a list of helpful hints for employees to use while working with kids,
- Create an All About Me poster for patient rooms so patients can share information about themselves with medical center staff, and
- Implement a suggestion box to let patients offer feedback.
The Family Faculty Program
The Family Faculty Program is a structured opportunity for parents to participate in the training of health professionals to ensure meaningful interactions and exchanges. The program planning committee is a mix of 14 Cincinnati Children's staff and parents who are Family Advisory Council members.
The Family Faculty Program advocates the concept of "parents as experts" in their child's care. The goal is to foster communication, mutual respect, and collaboration between parents and health care providers. Families help educate resident physicians in training by giving concrete examples of delivering compassionate health care for children and families. Participating families receive training from experienced Family Advisory Council members, who serve as mentors.
In both formal and informal settings, parent volunteers tell their stories with the objective of presenting their "family" perspectives to physicians. Each parent's presentation is about 30 minutes and allows time for questions and discussion between the residents and parents. Parents share positive experiences; however, negative experiences are used as teaching tools. For example, a parent might ask the residents to consider what they might have done to improve a particular situation.
"What better way to make us more complete pediatricians than to incorporate our families in our decision process and, most importantly, to learn from them how to care for their families?" asked Javier Gonzales de Rey, MD, Associate Director, Emergency Medicine and Director of the Pediatric Residency Program.
Hispanic Advisory Committee
The Hispanic Advisory Committee, a standing subcommittee of the Family Advisory Council, has accomplished much since its inception in 2002. The new Welcome Center signage includes the Spanish question mark (¿), as well as the Spanish word "información."
- All patients registering for Cincinnati Children's services are asked to specify their primary language.
- There are full-time in-house interpreters fluent in English and in Spanish and medical interpreters are available in other languages.
- The telephone switchboard is answered in both English and Spanish. Spanish-speaking callers are automatically transferred to a bilingual customer service representative.
- A telephone in the Outpatient Pharmacy assists families by connecting to telephone company interpreters for three-way calls between the pharmacist and the family member.
Most hospital documents (including the Surgery Guide, HIPAA forms, Patient Rights and Responsibilities, surgical materials, and billing) have been or are being translated into Spanish. Hispanic Advisory Committee members examine website information and printed materials to make recommendations about translation needs.
The Family Resource Center
Family Resource Center
The Family Resource Center at Cincinnati Children's Hospital Medical Center provides a serene environment for patients, families, and staff. The Family Resource Center offers families a supportive, relaxing atmosphere and many ready-to-use services. A Parent Business Center, computer work stations, access to local and national resources, and a private video room offers families a wide array of options. The Family Resource Center is staffed by a group of interested and knowledgeable parents and professionals who listen to families' concerns and offer individualized comprehensive, up-to-date information about each child's diagnosis or condition.
The Jack Rubinstein Library at Cincinnati Children's Hospital Medical Center provides extensive information services on developmental and behavioral issues, children's health conditions and topics ranging from well-child care and parenting to acute and chronic illness. Open to the public, parents, patients, staff, professionals, trainees, and students, the library was created to ensure access to accurate, up-to-date information about pediatric illnesses and conditions.
Patient and Family-Centered Rounds
Cincinnati Children's administrative and clinical leaders have embraced the concept that families are not visitors in their children's lives and encourages parents or guardians to stay with their child at all times on the general units. Parents, guardians, or a parent designee (18 years of age or older) may stay overnight. Brothers, sisters, and close relations who are 18 months of age or older may visit depending upon the patient's condition.
Patients, families, doctors, residents, nurses, pharmacists, and social workers make rounds together to ensure that care is transparent, coordinated, and collaborative. Family documentation in the medical record was one of the innovations piloted in this project. Families have the option to choose to round at the child's bedside, outside the room, or not at all. Most clinicians, after working collaboratively with families in a more transparent way, realize that some of the load is off of their shoulders. It gives them more optimism and more energy; with families part of the rounding process, discussion is focused on what families want to know, less time is wasted, and improvements in the flow of care is visible.
Chronic Condition Clinical Portals
The Chronic Condition Clinical Portals help patients and parents manage a child's condition by providing information essential to be active, informed members of the health care team. Patients and families at Cincinnati Children's Hospital Medical Center can log on from anywhere in the world and get essential medical information from their health care providers. Each Chronic Condition Clinical Portal is a secure website designed to help improve the quality of patient care by providing accurate, up-to-date medical record information, such as lab results, medications, procedures, admissions, and demographics. They also include a "Question and Answer" section to allow patients and family members to ask non-urgent questions. The portals are currently available for children with a liver transplant, juvenile rheumatoid arthritis, diabetes, or cystic fibrosis.
A process of change began ten years ago at Cincinnati Children's Hospital Medical Center. It began with the Board of Directors creating a new vision statement for the organization - "Cincinnati Children's will be the leader in improving child health." In order to achieve this vision, hospital leadership recognized there had to be a fundamental change in the culture, transformational change, and change in fundamental systems supporting the hospital.
Parent and Child
James Anderson, President and CEO of Cincinnati Children's knows that partnerships must begin with a shared understanding of the problems, and a shared commitment to work together to solve them. Only then can an action plan for redesigning the health care system be developed and implemented. Upon accepting the 2006 McKesson award he said:
"Critical to this transformational change was leadership support, consistent long-term visible leadership..willing to provide resources to make this change. Transformational change takes courage and confidence. Staff and faculty need to know that leadership will be there for them."
Uma Kotagal, MD, Director of Health Policy and Clinical Effectiveness at Cincinnati Children's Hospital Medical Center and Senior Research Associate at The Institute for Health Policy and Health Services Research at the University of Cincinnati, reiterates: "The easiest way to make transformational change happen is to have families part of the process because:
- Having families included in this process gives energy and urgency for improvement.
- Having patients and families on teams helps focus on the key priorities.
- Having families involved means that you don't spend time on things that are unimportant."
At an October 2005 celebration, the Board of Trustees honored family members who serve on committees and provide invaluable insights into what families want and need when bringing their children to the medical center for treatment. Board Chairman Lee Carter put in it plain words when he said that family involvement is the most important reason Cincinnati Children's is considered a leader in child health care.