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Profiles of Change

University of Washington, aerial University of Washington, aerial view
(courtesy of University of Washington)

University of Washington Medical Center
Seattle, Washington

Patient- and Family-Centered Care

Patient- and family-centered care at the University of Washington Medical Center (UWMC) is a culture change movement started in 2002 to improve the delivery of health care for patients and families.

UWMC defines patient- and family-centered care as a philosophy of care that:

  • recognizes the importance of patient and family involvement in health care decision-making;
  • emphasizes the strengths, priorities, and preferences that are unique to each family; and
  • encourages a spirit of partnership between patients, families, and health care professionals.

At UWMC, patient- and family-centered care embraces six concepts: communication, information sharing, choices, respect, partnership, and strengths.

University of Washington Medical Center University of Washington Medical Center
(Courtesy of Clare McLean/University of
Washington)

According to Stephen Zieniewicz, UWMC's Executive Director, patient- and family-centered care is "foundational to the success of providing quality care in a safe and partnership-based environment." Stephen believes that patient and family involvement in health care greatly increases patient safety by reducing the number of falls, ensuring that patients understand care plan instructions, and contributing to reduced medical errors. Suggestions and insights provided by patient and family advisors improve the patient care experience and facilitate navigating the care process.

"Foundations," UWMC's employee orientation process, dedicates time and resources to educate all new staff in the concepts of patient- and family-centered care. Everyone, whether or not she or he has direct patient contact, participates in this orientation, and UWMC recognizes that all employees are essential to this patient care approach.

The discussion about the effect of every employee's attitude and behavior on the patient experience begins at orientation. For example, the actions and attitude of the person responsible for billing affects the patient experience, as does that of the employee responsible for materials management. The simple act of introducing oneself every time one enters a patient's room makes a huge difference to patients and family members. Such introductions set a tone of respect and facilitate direct communication. New employees are also educated about the role of patient and family advisors.

Patient and Family Advisors

UWMC's Patient- and Family-Centered Care Advisory Councils provide a structure for ongoing program monitoring and enhancement. Patient and family advisors are vital to the partnership between health care providers, patients, and families. Advisors include patients (former and current) and family members who work voluntarily with UWMC to improve the health care experience for everyone, and to foster the philosophy of patient- and family-centered care.

More than 70 patient and family advisors collaborate with UWMC staff in several ways. They:

  • serve as members of advisory councils;
  • work in program and policy review—designing, implementing, and evaluating health care programs and policies;
  • serve on a dozen hospital committees;
  • interview candidates for resident positions in obstetrics and gynecology;
  • provide input on educational materials;
  • teach staff and professionals; and
  • participate in discussion groups focused on a particular department or service.

In all these avenues of partnership, patients and family members provide their distinct perspective and insights for improvements of the care experience.

Advisory Councils

Advisory Council Meeting Advisory Council Meeting
Courtesy of Gavin Sisk / University of Washington

UWMC has six advisory councils, three of which are described below in detail. In addition, the medical center has a Neonatal Intensive Care Unit Advisory Council, Intensive Care Units Advisory Council, and an Outpatient Advisory Council (launched in March 2009).

Patient and family advisors out-number staff members on the councils, and frequently share leadership responsibilities. Council members recommend changes, establish work plans, and implement and monitor the impact of the changes. Improvements in practice may be specific to a particular hospital unit or may be piloted in one unit before being implemented hospital-wide. For example, room service at UWMC—introduced in 2007—is one of numerous initiatives that originated in an advisory council.

Outlined below are examples of the work of the three most experienced advisory councils:

The Perinatal Advisory Council

The Perinatal Advisory Council is involved in many projects to improve the quality of perinatal care and to advance the practice of patient- and family-centered care. Advisors are integral decision-making members of the Resident Selection Committee in the School of Medicine that interviews candidates and selects OB/GYN residents. Questions about patient- and family-centered care are an important part of the interview process. Family advisors have continued involvement with the residents, assisting them to improve their communication skills.

Additionally, the Council works with UWMC educators to revise and update educational materials. For example, some advisors have shared their experiences as patients learning to breast feed, to determine what changes would improve the quality of care for, and education of, new mothers. The advisors, in conjunction with the educators, revised written materials to produce a new and improved booklet on breast-feeding.

The Inpatient Oncology Advisory Council

Welcome Bags Welcome Bags

The Inpatient Oncology Advisory Council produced a 20-page booklet, The Patient and Family Guide, which explains the experience of care, provides navigation tips and strategies, offers information about the teaching hospital staff, and encourages the involvement of patients and families by explaining the role and importance of rounds. The guide also includes information that would have been useful to the advisors when they or family members were patients.

This Council established the Welcome Bag and Greeting Card programs, coordinated caregiver retreats to support family members of hospitalized patients, and designed care team posters with names and photographs of each patient's care team to help patients identify staff. Using existing technology and equipment, the council implemented a voice mail system for oncology patients, so that patients could receive messages when they were unavailable to take phone calls.

The Rehabilitation Services Advisory Council

The Rehabilitation Services Advisory Council created Rehab and Beyond: Maximizing Your Potential, a booklet that provides an in-depth look at what to expect in rehabilitation, including available resources, specific information for patients and families, what people with serious injuries can expect from the rehabilitation program, and what to expect when they go home. The booklet also includes brief messages of hope from staff and patients, who share their experiences.

Advisory Council Meeting Advisory Council Meeting
Courtesy of Gavin Sisk / University of Washington

The Council revised job descriptions for rehabilitative therapists to include patient- and family-centered care language for job standards and competencies. A sub-group of the Council first reviewed job descriptions and competencies and made recommendations to the full council. The changes then went to the human resources department, which accepted them and incorporated them into formal job descriptions.

According to a nurse manager, the job description changes allow for the measurement of patient- and family-centered care, and provide a way for follow-up and supervision of staff. The focus of the evaluation becomes how to best deliver patient- and family-centered care, rather than simply conducting an assessment of individual tasks and skills. Patient- and family-centered care generates discussion, and, according to the manager, "you could see the light going on."

Subsequently, with hospital administration and the human resource department support, the Council put together hospital-wide guidelines for how to incorporate patient- and family-centered care language and obtain feedback from patient and family members when revising documents. Now, a cadre of patients and family members—working as advisors—is trained to look at these human resource documents across the hospital, and to provide feedback.

The Rehabilitation Services Advisory Council, in conjunction with other advisory councils, created a Patient- and Family-Centered Care Award to recognize an outstanding staff member or volunteer. In 2009, Dr. Julian Davies received the first award—named in memory of Maria Hall, one of the founding members and first patient co-leader of the Rehabilitation Services Advisory Council, who died in December 2006. Creation of this award is an example of how councils work together or form a "cross council team" to work on projects.

Hospital Committees

Traditionally, official standing committees are comprised of staff members. Increasingly, UWMC is inviting patient and family members to serve on these committees. In addition to the committees described below, other hospital committees, such as the Ethics, Grievance, Patient Safety, Falls, and Patient Education Committees, include patient and family advisors.

The Patient- and Family-Centered Care Steering Committee oversees the work of the advisory councils. The Steering Committee is chaired by the Director of Patient- and Family-Centered Care and includes UWMC's Chief Nursing Officer and Medical Director, and leaders from the advisory councils, patient and family members from each advisory council and UWMC staff. The Steering Committee is part of the quality improvement structure of the medical center, ensuring the hospital-wide dissemination of the work and philosophy of the councils.

Family Faculty

As an academic medical center, UWMC has the added dimensions of educating future health care professionals and bringing innovative medical cures to the patient. Family and Patient Advisors serve as faculty members at the UW medical school—telling their own stories—to educate students and staff. These advisors participate in orientation, staff education days, and the education of first and second year residents. Students find it extremely helpful when advisors share stories from their own experiences as patients and family members, providing concrete examples of what works and what does not. Advisors—from the patient and family perspective—can teach students how to improve communication and handle certain situations in a more patient- and family-centered manner.

Facility Design

Patient and family members at UWMC also play a crucial role in facility design. The hospital calls upon patient and family advisors for input, even outside the committee structure. Sometimes advisors join task forces or focus groups working on particular design issues or may participate in a short-term task force.

UWMC included patient and family advisors in discussions about various aspects of the design process for the medical center expansion that is kicking off in spring 2009. After using input gleaned from patient and family members, UWMC built a mock-up of a hospital room for the new tower. This mock-up allows staff, patients, and family members to experience the room and provide important feedback. Some who visited the mock-up commented on the spaciousness of the room. Patients noticed potential problems, such as the placement of some furniture, bathroom safety concerns, and accessories. These same patients remain active participants in crafting solutions to make the room more functional for patients, families, and caregivers.

Health Information Resource Center

Health Information Resource Center The Resource Center
Courtesy of Clare McLean / University of Washington

The Health Information Resource Center at University of Washington Medical Center provides a variety of resources to help patients and family members find services or products they may need both within the medical center and in the community. The center offers the use of computers, including Internet and e-mail access, and phone, fax, copier, scanner, and printer. The center is open five days a week, and staff members are available to help patients and family find health information on diseases and conditions, support groups and classes, and community health resources.

Leadership

Key leadership plays a vital role in bringing patient- and family-centered care to any organization and sustaining it. UWMC is fortunate to have leaders such as Executive Director Stephen Zieniewicz, who has "a deep and heartfelt appreciation for the patient care experience." He believes that understanding, respecting, and involving patients in their care is essential at UWMC. Coordinating the health care team as partners with patients and their families supports thoughtful communication so that the unique and special preferences and needs of each patient are considered.

In addition to Stephen Zieniewicz, UWMC counts among its leaders Lorie Wild, Chief Nursing Officer, and Cindy Sayre, Director of Professional Practice and Patient- and Family-Centered Care. These UWMC leaders are enthusiastically continuing the work started by Susan Grant, former Chief Nursing Officer (now at Emory Healthcare) and Cezanne Garcia, then Associate Director of Patient- and Family-Centered Care and Education Services.

In 2002, Susan invited the Institute for Patient- and Family-Centered Care to assess all phases of UWMC's approach to care. Shortly thereafter, UWMC formed the Patient- and Family-Centered Care Steering Committee and launched the groundwork for the patient and family advisory councils.

Maintaining patients and families as fundamental members of the health care team is an important aspect of UWMC's current strategic goals and vision. Systems are in place at UWMC to deliver patient- and family-centered care. The leadership of the University of Washington Medical Center believes there is always room for improvement, and continues to strive to raise the bar to an even higher level in the delivery of patient- and family-centered care.

Contact Information

For more information about patient- and family-centered care at the University of Washington Medical Center, please contact:

Hollis Guill Ryan
Program Coordinator
Patient- and Family-Centered Care Program
University of Washington Medical Center
Seattle, Washington
206-598-2697
hollisr@u.washington.edu

This profile of University of Washington Medical Center is dedicated the memory of Deanna Mau, who died in 2009. Deanna—an extraordinary nurse, gifted clinician, and teacher at UWMC—showed remarkable commitment to patient- and family-centered care. She is remembered for being "the one who always said, 'why not?'" when others showed reluctance to make a change in favor of patient- and family-centered care.