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Profiles of Change

Family-Centered Care in a Pediatric Hospital
Vanderbilt Children's Hospital, Nashville, Tennessee

Vanderbilt hospital staircaseTwelve years prior to opening a beautiful new facility in 2004, Vanderbilt Children's Hospital began work to change the culture of its organization.

In 1992, the Vanderbilt Medical Center appointed a Collaborative Organization Design Team and charged it with developing a plan that would enable the hospital to meet the complex challenges of the changing health care climate. The team came up with a set of 10 recommendations. One recommendation focused on culture, values, and the need to re-engineer the hospital as a continuous learning organization. Vanderbilt Children's Hospital, a 161 bed pediatric specialty hospital within the Vanderbilt Medical Center, decided to take the lead in implementing this recommendation. Their pilot initiative, which would eventually spread to the entire medical center, involved the following steps:

Defining core values. Using a process described in Stephen Covey's book, The Seven Habits of Highly Effective People, hospital staff began by encouraging members of the hospital community to define their vision. They asked physicians, patients, and families two questions: "What does it look like when care is going well?" and "What does it look like when care is not going well?" These two questions yielded rich data. The hospital's leaders spent more than a year analyzing the responses and organizing the information into a useful framework.

A list of values representing the responses of the entire hospital community was formulated. This list was given the acronym, FOCUS, which stands for Family-Centered Care, One team, Continuous improvement, Unique environment for children, and Service excellence. Within this framework, the leaders began to restructure hospital policies and processes in a way that would reflect these new values.

Vanderbilt hospital lounge

Reorienting human resources. Vanderbilt made a commitment to ensure that each employee understood FOCUS values and integrated them into his or her daily activities. This initiative began with staff recruitment and hiring policies were modified to incorporate FOCUS values. For instance, members of the human resources department explain FOCUS to prospective employees, then ask them how they have used such values in previous places of employment. All new employees sign a statement indicating their commitment to FOCUS values. FOCUS has been integrated into the hospital's orientation program. The program, in which parents participate as trainers, presents guidance on how to translate FOCUS values into specific behaviors.

To introduce FOCUS values to the staff employed at the time FOCUS began, the administrator met in small groups with more than 900 employees over a four-month period. Managers met with individual employees and secured their written commitment to FOCUS values. Each employee participated in a three-hour training, a major portion of which was presented by families. The performance-appraisal system has also been revised: now each employee is asked to describe an example of how he or she has applied a FOCUS value during the previous year.

Establishing a Family Advisory Council. In 1995, the hospital established a 20-member Family Advisory Council chaired by a parent. The hospital administrator is a member. The committee developed a master plan that listed critical issues and ranked them in order of priority. A major activity of the council was to develop the training program for staff described above. Another objective was to create educational resources for families. For example, the council developed an Admissions and Patient Information Guide that is distributed by referring physicians. A second packet, providing information about hospital and community resources, is now in preparation and will be available in each patient room.

Serving Children with Special Needs. A significant percentage of children hospitalized at Vanderbilt have chronic conditions. To better serve these patients and families, the hospital established the Junior League Center for Chronic Illnesses and Disabilities of Children. The Center has an active Parent Advisory Committee. The Center sponsors Community Participatory Forums that are planned by families, health providers, and school personnel.

Expanding Access to Information. Vanderbilt opened a Family Resource Center in 1993 under the Junior League Center for Chronic Illnesses and Disabilities of Children. This facility, which has recently been relocated to a convenient location in the Outpatient Center, is open to community members as well as families whose children are being treated at the hospital. In addition to books, pamphlets, and audiovisual materials, the Center maintains an electronic database of more than 2,000 organizations of interest to persons caring for a child with special needs. Staff help family members learn how to use the software, which enables them to visit the websites of these organizations. The Center also has hard-copy back-up files that may be photocopied.

Enhancing Professional Education. The Parent Advisory Committee of the Center for Chronic Illnesses and Disabilities of Children participated in the development of Families as Classroom Teachers (FACT), whose purpose is to ensure that students in Vanderbilt's health professionals training programs, as well as in its schools of law, divinity, education, and business management, have an opportunity to learn from families. A directory of families who are willing to participate in this program is distributed to faculty each fall. Faculty plan appropriate parent-as-teacher sessions for their particular courses. Parents receive a modest compensation for their service.

Working with staff and families, the Center developed a pocket booklet that is distributed to all new residents. It describes the need for a collaborative approach to health care delivery and sets forth the roles and responsibilities of residents, physician faculty, staff, and families. This booklet is available on each unit and through the hospital's electronic communication system.

For more information, check out the Vanderbilt Children's Hospital website