Profiles of Change
Vidant Health/University Health Systems of Eastern Carolina
University Health Systems of Eastern Carolina (UHS) is a regional health system serving 29 counties in eastern North Carolina. UHS includes eight hospitals, a free-standing ambulatory surgery center, physician practices, hospice and home health care and other independently operated health services. Pitt County Memorial Hospital (PCMH), an 851-bed tertiary care center, is the flagship teaching hospital for the Brody School of Medicine at East Carolina University.
The Beginning of Patient- and Family-Centered Care at UHS
Successful efforts to advance patient- and family-centered care began at PCMH during the late 1990s at its Children's Hospital and Regional Rehabilitation Center. However, these efforts, though valuable in the areas where they occurred, did not advance patient- and family-centered care throughout PCMH and UHS. These "small tests of change" drew attention to the inconsistencies in experiences of care for patients and families and the variations in culture across patient care areas.
Hearing the Inconsistencies of Care Firsthand-The Power of Storytelling
Personal accounts of employees as patients or family members of patients highlighted the vast differences of experiences across service lines at PCMH. Some employees worked in clinical units that embraced patient- and family-centered care, yet had personal experiences of care in clinical areas that did not. These employees began to work to embed patient- and family-centered care into the fabric of the hospital. They believed best practices in patient- and family-centered care should be "hard wired" into daily performance rather than dependent on individual staff members or units committed to patient-family partnerships. Initial efforts concentrated on building support from the executive team, Board of Trustees, senior leadership, and the medical and nursing staff. Additionally, this group of employees shared data with the executive team about the positive outcomes for patients and families that could be realized when hospitals fully embrace and deliver patient- and family-centered care.
A defining moment in this evolution occurred in May 2007. A PCMH employee, Christie Odom, and her family shared their story with senior leaders at PCMH and UHS, describing their experience of being treated as "visitors" instead of partners in care. During her brother's hospitalization in one of the adult ICUs, Christie's family experienced a lack of access and information due to the restrictive visitation policy that allowed the presence of the family for only fifteen-minute segments, six times a day. Because of these restrictions, her brother's anxiety increased every time his family had to leave, and he died alone with no family by his side.
Leadership: Support and Commitment Across the Corporation
After hearing Christie's story and understanding the inconsistencies in experiences for patients and families across the system, the Executive team, Board of Trustees, medical staff and senior leadership committed to transforming the organizational culture across PCMH and ultimately across UHS. Key to the transformation was the opening of the PCMH Office of Patient and Family Experience in October 2008 dedicated to educating leaders and staff on the best practices. This office organized staff champion teams, led the efforts to implement a hospital-wide family presence policy, and provided substantive education to PCMH and other UHS hospitals. Speakers from the Institute for Patient- and Family-Centered Care, Institute for HealthCare Improvement, and IDEO provided educational opportunities for leaders across the hospital system. These education sessions increased awareness of best practices in patient-and family-centered care and expanded interest and motivation to change practices and attitudes. Several UHS hospitals, including Bertie Memorial, Chowan, and Roanoke-Chowan Hospitals, began to identify new ways to engage patients and families to improve performance and change policies.
Over the next year, UHS leaders realized the need to spread patient- and family-centered practices across the corporation and opened the UHS Office of Patient and Family Experience in October 2009. This office provides support for the on-going transformation, while respecting the local culture and community of each UHS entity. Further evidence of the commitment to transform the entire corporation is the inclusion of patient- and family-centered care as one of the five key areas of focus on the UHS strategic framework. The focus statement "partner with patients and families to achieve safe, high quality care and exceptional experiences" is now a key tenet of the corporation's strategic plan and its five-year quality plan.
Because transparency drives quality improvement and enhanced patient-family engagement, UHS implemented a variety of measures to ensure transparency. Patients and family members helped develop flyers describing what patients should know about IV lines and urinary catheters, as a measure to help decrease infection. These flyers are posted throughout the health care system. Hospital and unit-specific data about hospital-acquired infections are posted on the family and visitor doors to the ICUs. Patients, families, and visitors are provided information about how they can assist in preventing these infections. This information is also posted on the UHS website.
Patient- and Family-Centered Staff Champions: From Vision to Reality
The fall 2008 PCMH Shared Governance Council meeting adopted patient- and family-centered care as the nursing model of care. Forty-nine staff members stepped forward to lead this organizational change. There are now over 200 patient- and family-centered care staff champions across UHS. These champions represent multiple disciplines, including nursing, social work, allied health professions, and guest and pastoral services. Patient- and family-centered care staff champions and patient leaders model patient- and family-centered care behaviors and provide ongoing education and mentoring to foster peer-to-peer accountability. The patient- and family-centered care staff champions are instrumental in leading organizational change. Many of these staff leaders attend training seminars on patient- and family-centered care and independently read and research to expand their knowledge and understanding.
The transformation in the visitation policy at PCHM is perhaps the most significant change led by staff champions. Early in 2009, PCMH moved from a restrictive visitation policy to flexible guidelines that support family presence and participation. Other UHS entities are currently evaluating existing policies and are working to assure that patients and their families are no longer viewed as "visitors" but as partners in care.
In fact, UHS drafted a corporate policy to guide family presence across all corporate entities. Since this level of transformational change in an organization is often met with staff resistance and skepticism, the staff champions were instrumental in providing formal and informal influence to effect change. Staff champions are currently leading efforts to actively engage patients and their families in bedside shift report, multidisciplinary rounds, discharge planning, and end-of-life services.
Patients and Families: Partners and Advisors
UHS's goal is to have the staff demonstrate at every point of contact with patients and families that patients and families are partners in care. Currently, all UHS hospitals have teams dedicated to patient and family experience and six of the eight UHS hospitals have active patient and family advisors involved in a variety of committees and activities. Patient and family advisors are included on editorial review committees for patient and family education, interview teams for key positions, facility design and renovation teams, campus way-finding planning, the development team for the electronic medical record's patient portal, and in the development of transparency tools for quality and safety.
The use of storytelling by patients and families continues to be an effective strategy for UHS in advancing patient- and family-centered care. Personal stories shared by patients and families provide insight into experiences of care in ways that charts, graphs, and data cannot. Patient and family advisors receive frequent requests to share their experiences at staff meetings, hospital committee meetings, and formal training programs. For example, after a patient advisor shared her story about her experience with ventilator-associated pneumonia with the Quality Improvement Committee for the UHS Board of Trustees, she accepted the invitation to join the Quality Improvement Committee as an advisor. A video about a patient's experience of care that highlights the four core concepts of patient- and family-centered care is shown weekly during new employee orientation. A newly reorganized corporate employee orientation includes extensive content related to personal stories at each hospital.
The PCMH patient handbook is another example of how the views and perspectives of patients and families can be heard. Patient and family advisors edited the handbook for the first time last year. The handbook reinforces the message that patients and families are not passive recipients of care, but are allies for quality and safety.
The East Carolina Heart Institute (ECHI) opened in 2009 and was designed to have patients and families at the center of the care team. In its lobby, a banner greets patients, families and visitors.
PCMH has more than 42 official-and many more unofficial-advisors. PCMH's goal is to have one council for each clinical service line. Across the rest of the UHS hospitals there are more than 25 advisors. As volunteers, advisors participate in a wide array of projects, such as:
- Review of patient education materials and family presence guidelines;
- Design of the new facilities and renovations, including Children's hospital and new MRI and diagnostic services areas;
- Review of quality and safety materials and participation in safety rounds; and
- Design of new way finding materials and signage.
UHS is establishing a system-wide advisory council that will include a representative from each system hospital, home health and hospice subsidiary, the ambulatory surgery center, and physician practices. The long-range goal is to have patient and family advisors engaged in the work of key committees at the hospital, entity, and corporate levels.
Critical Success Factors and the Future of Patient- and Family-Centered Care at UHS
The process of change is gradual; it does not happen overnight. As individual success stories are recognized and replicated, the transformation begins first at a personal level and then expands to change behaviors at a clinical unit, hospital, and ultimately corporate level. Over time, the agents of change at UHS carefully used formal and informal influence to persuade, and to build the momentum to change the culture.
UHS is continuing its journey toward becoming a true patient- and family-centered organization and the future is full of exciting opportunities. Plans include development of advisory councils at every UHS entity and every service line at PCMH. These councils will nominate participants to serve on the corporate patient-family advisory council envisioned to be a key in the evaluation and development of system-wide initiatives. Additionally, teams are working on the rollout of a standardized patient- and family-centered care curriculum for all employees. This curriculum will be integrated with all aspects of an employee experience including interviews, selection, orientation, performance development, leadership development, and continuing education. UHS envisions all system long-range plans and joint ventures to include patient- and family-centered care principles and priorities. UHS leaders are developing a "return on investment" evaluation using both qualitative and quantitative measures to evaluate the impact of changes across the system.
Critical success factors in advancing patient- and family-centered care across UHS include:
- A clear and compelling vision of patient- and family-centered care best practices;
- Committed leadership;
- Engaged staff; and
- Meaningful partnerships with patients and families at all levels of the organization.
For more information about UHS's journey...