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Bridging the Gap

Module 4

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Title

Patient and Family-Centered Care: The Intersection of Health and Healthcare Policy

Overview

Although the phrase “patient and family-centered care” was coined several decades ago, it entered the health policy lexicon in 2001, when it was featured as one of the six aims for high-quality health care in the landmark report Crossing the Quality Chasm: A New Health System for the 21st Century (Institute of Medicine, 2001). Recent advocacy for the creation of accountable care organizations (ACOs) and the creation of “medical homes” has focused renewed attention on patient and family-centered care with organizations such as the Commonwealth Fund proposing steps to promote this integrated model. But many in the health policy community do not have a good understanding of what “patient and family-centered care” means, or why it matters.

The IOM’s Quality Chasm report defined patient and family-centered care as care that is “respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” (IOM, 2001, p. 6) These attributes are more than just desirable. They are critical to providing the right care for the right person at the right time—a goal that has important cost and quality implications.

In this module we begin with the “what”—describing what patient and family-centered care is. We then turn to the “why”—summarizing the empirical evidence on outcomes associated with patient and family-centered care. Finally, we turn to the “how”—detailing steps that policy makers can pursue to advance patient-centered care through organizational supports.

Objectives

By the end of this module the learner will be able to:

  • Describe how patient and family-centered care can improve the quality of healthcare.
  • Discuss organizations that have taken the lead in patient centered care initiatives.
  • Understand how health policy can advance the use of patient and family centered care initiatives.
Content Outline
  1. The value of patient and family-centered care
    1. Mutually beneficial partnership between patients, providers and families
    2. Improves safety, quality and decreases cost of care
    3. Requires organizational and staff commitment for the long term
  2. How to implement patient and family-centered care
    1. Acknowledge the need for patient and family-centered care
    2. Use the Compassionate Care Framework (Dempsey & Wojciechowski, 2014)
      1. Clinical excellence
      2. Organizational efficiency
      3. Caring Behaviors
      4. Culture
  3. Understand Themes related to patient suffering and strategies to address
    1. Acknowledgement of suffering demonstrates caring
    2. Body language is as important as words in demonstrating caring
    3. Anxiety and uncertainty create suffering and must be addressed
    4. Caring is shown through coordinated continuous care, respecting patients time and providing support through a complex system
    5. Preserving Autonomy and respect for the individual helps preserve dignity
  4. Understand the viewpoint
    1. Patient’s perspective
    2. Provider’s perspective
    3. Organizational perspective
    4. Political/Policy perspective
  5. The crossroads between politics and policy in healthcare
    1. World Health Organization
    2. Centers for Medicare and Medicaid Services
    3. Agency for Healthcare Research and Quality
    4. American Hospital Association
  6. Collaboration with public and private entities to transform healthcare delivery using patient and family-centered care
    1. Institute for Healthcare Improvement (IHI) and National Patient Safety Institute
    2. Picker Institute
    3. Planetree, Inc.
    4. The Leapfrog Group
    5. Press Ganey
    6. The Studer Group
  7. Conclusions
    1. Patient and family-centered are models are needed to improve the quality and lower the cost of healthcare
    2. Healthcare organizations need to foster a culture of patient and family-centered care
    3. Political and public leadership can advance adoption of patient and family-centered care
    4. Consumers advocates can help encourage patients to be more involved in their own care
    5. Policy makers should focus on a coordinated effort to support patient and family-centered care to realize the promise of quality and value.
Links to Differentiated Essential Competencies
  1. Member of the profession
    1. Assume responsibility and accountability for the quality of nursing care provided to patients, families and communities.
    2. Promote the practice of professional nursing through leadership activities and advocacy.
  2. Provider of Patient Centered Care
    1. Synthesize comprehensive assessment data to identify problems, formulate goals/outcomes, and develop plans of care for patients, families, populations, and communities using information from evidencebased practice and published research in collaboration with the above groups and the interdisciplinary health care team.
    2. Provide safe, compassionate, comprehensive nursing care to patients, families, populations, and communities through a broad array of health care services.
    3. Implement the plan of care for patients, families, populations, and communities within legal, ethical, and regulatory parameters and in consideration of disease prevention, wellness, and promotion of healthy lifestyles.
  3. Coordinate human, information, and material management resources in providing care for patients, families and communities.
  4. Member of the Healthcare Team
    1. Coordinate, collaborate, and communicate with patients, families, populations, communities, and the interdisciplinary health care team to plan, deliver, and evaluate care.
    2. Serve as a healthcare advocate in monitor and promoting quality and access to health care for patients, families, populations and communities.
Links to Texas Concept Based Curriculum

Concepts Psychosocial

  • Diversity
  • Interpersonal Relationships

Concepts Professional

  • Communication
  • Health Promotion
  • Patient Education
  • Professionalism
  • Teamwork and collaboration

Concepts Health Care System

  • Legal and Ethical Practice
  • Evidence-Based Practice
  • Healthcare Organizations
  • Health Policy
  • Leadership and Management
  • Patient Centered Care
  • Quality Improvement
Resources

Agency for Healthcare Research and Quality, (2014). Advancing the practice of patient- and family-centered care in hospitals. Retrieved from https://innovations.ahrq.gov/issues/2014/12/17/advancing-practice-patient-and-family-centered-care-hospitals

American Hospital Association, (n.d.). Retrieved from http://www.aha.org/

Centers for Medicare and Medicaid Services (2016). National Quality Strategy. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/CMS-Quality-Strategy.pdf

Institue for Healthcare Improvement and the National Patient Safety Foundation, (2017). Person and family-centered care. Retrieved from http://www.ihi.org/Topics/PFCC/Pages/default.aspx

Planetree and the Picker Institute, (2008). Patient Centered Care Improvement guide. Retrieved from http://www.patient-centeredcare.org/

Press Ganey, (n.d.). Retrived from http://www.pressganey.com/

Studer Group, (n.d.). Retrieved from https://www.studergroup.com/

The Institute for Patient-and-Family Centered Care (2004). Strategies for leadership: Advancing the practice of patient and family-centered care. Retrieved from http://www.aha.org/content/00-10/resourceguide.pdf

World Health Organization (2017). Patient Safety: Making healthcare safer. Retrieved from http://www.who.int/patientsafety/publications/patient-safety-making-health-care-safer/en/

References
  • American Society for Healthcare Risk Management. (2010). Patient- and family-centered care: Making a good idea work [Special issue]. Journal of Healthcare Risk Management, 29(4).
  • Dempsy, C. & Mylod, D. (2016). Addressing patient and caregiver suffering. American Nurse Today, 11(11), 17-23.
  • Dempsy, C. & Wojciechowski, S. (2014). Reducing patient suffering through compassionate connected care. The Journal of Nursing Administration, 44(10), 517-524.
  • Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academies Press; 2001.
  • National Patient Safety Foundation. (2015). Free from harm: Accelerating patient safety improvement fifteen years after to err is human. Boston, MA: Author.
  • Press Ganey (2014). Compassionate connected care: A care model to reduce patient suffering. Retrieved from http://www.pressganey.com/docs/default-source/default-document-library/compassionate_connected_care.pdf
Discussion Questions

Have you heard of or read about any patient and family-centered care initiatives where you work or attend clinical rotations?

What other theorists support the concept of patient and family-centered care?

Do you think patient and family centered care intiatives really reduce cost and improve quality?

Can you think of any real life examples of how patient an family-centered care would reduce cost?

Based on the Compassionate Care Model information in this module, do you think you could adopt some of the ways to address suffering in your practice?

Questions