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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Issue 7


Susan Wisniewski

Patient and Family-Centered Communication

By Susan Wisniewski, CPHQ - Manager, Accreditation and Regulatory Compliance


Although widely practiced at Children’s Hospital
for many years, many of today’s health care leaders are just now recognizing the importance of including the patient/family perspective as key to safe and high quality patient care. This means including the family in all aspects of care, from planning to delivery to evaluation of services. The family works in collaboration with health care professionals to improve outcomes, reduce costs and increase patient/family satisfaction.
1

Patient- and Family-Centeredness can be defined in many ways, but all definitions include the patient’s/family’s perspective and how it helps drive decision making, coordination and continuity of care, and most importantly, effective communication. It includes timeliness, the provision of emotional and physical comfort, and involves the patient/family as much as they want to be involved.2

Culturally and linguistically appropriate standards are attracting the attention of many health care organizations as well. Since The Joint Commission (TJC) has deemed status from the Centers for Medicaid and Medicare Services (CMS), compliance with TJC  Standards means compliance with CMS Conditions of Participation. Beginning this year, The Joint Commission has incorporated regulations into their standards that support patient- and family-centered care. These standards focus on communication and cultural competence, elements that must be incorporated into staff behavior as a core activity in the delivery of care. Patient- and family-centered care is more than “a-nice-thing-to-do” and no longer a stand-alone initiative.3

The Joint Commission considers culturally and linguistically appropriate health care services key to quality of care and patient safety. Children’s Hospital has integrated the components of patient- and family-centered care – dignity and respect, information sharing, participation and collaboration – into its patient care philosophy for many years.  We have long recognized that family involvement in the patient’s care is not only a patient right, but also the right way to care for the patient. The family’s involvement may also be significant in determining the best care option for the child.     

In addition to standards regarding demographic data collection (race and ethnicity) and addressing communication needs, new or revised standards include:

  • Addressing qualifications for language interpreters and translators
  • Patient access to chosen support individual
  • Inclusion of health literacy needs in learning needs assessment

The Joint Commission seldom mandates content or a method of implementation. However, it recommends that hospitals adopt a variety of strategies that best meet their care delivery model and the patients/families served. Although the standards were published this year and will be surveyed in 2011, they will not contribute to the overall accreditation decision until 2012.

The Joint Commission requires an organizational assessment which includes:4

  1. Identification of patient communication needs across the continuum
  2. Language access services and auxiliary aids
  3. Assessment of patient understanding and health literacy
  4. Accommodation of patients religious/personal beliefs and spiritual practices
  5. Non-discrimination in care
  6. Patient’s rights to language access and patient advocate services
  7. Staff training on cultural sensitivity and use of communication tools

What is Children’s Hospital doing to meet these requirements?

The Hospital’s policies are steeped in the language of patient- and family-centered care. For example, consider our patient care philosophy and core values. (Excellence, Compassionate Care, Integrity, Innovation, Collaboration and Stewardship)

  • The Hospital collects demographics for our patient care catchment area that can be used
    to hire staff that represents the cultural diversity of our patients.
  • Staff receives an initial orientation and ongoing education regarding ethical behavior
    with patients as well as with each other.
  • The care provided is patient/family focused, collaborative and interdisciplinary.
  • CLAS-A (Cultural and Linguistic Access Sub-committee in Action), a multidisciplinary committee, was established to complete a gap analysis regarding compliance with the new standards. The committee assessed our compliance to the standards and identified areas requiring additional education.
  • The new standards have been shared with chapter leads and directors involved in their implementation.

How do these requirements impact patient care?  It has been reported that miscommunication is the root cause of most sentinel events.5 If staff respects the family’s right to effective communication, provides services in a language that the patient/family understands, and respects patient/family personal and cultural beliefs and preferences, serious errors are less likely to occur. It is well recognized that patient/family involvement in care decisions is not only an identified right, but also a necessary source of accurate treatment and care information. Each and every one of us must assimilate patient- and family-centered care practices into the core activities of our daily work to truly meet the needs of our uniquely diverse population.

For additional information, you can access “Advancing the Practice of Patient- and Family-Centered Care at www.familycenteredcare.org.  Other resources include The Joint Commission Standards related to Patient-Centered Communication (accessible through the George Page/Complete Quality Webpage/E-dition Compliance Monitor) and Hospital policies 1.3113, Patient’s Rights and 1.3161, Organization Plan of Care. You may also contact the Department of Accreditation and Regulatory Compliance (X35661), Tony Yamamoto (X35273) or Susan Lea Sturgill (X36320) with questions or comments.

 

References

  1. Institute for Family Centered Care, “Advancing the Practice of Patient- and Family – Centered Care, How to Get Started; p1 www.familycenteredcare.org.
  2. Id. p 14
  3. Id.  p 8
  4. From The Joint Commission Perspective: Excellence in Communication, Cultural Competence and Patient Centered Care: slides 21, 22, 23 (2010)
  5. Id. Slide 10

Additional References

  • Wilson-Stronk, A., Lee, Karen K., Cordero, Christina L., Kopp, April L., and Galvez, Erica.  One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations.  (2008)
  • The Joint Commission Comprehensive Standards Manual, 2010 Edition.
  • The Center for Medicaid and Medicare Services, Conditions of Participation, 42CFR Public Health, Conditions of Participation: Patient Rights

 

In This Issue

A Walk On The Family Side

Patient Family Satisfaction

Family-Centered Medical Care

Family-Centered Communication

Nursing and Child Life

Spiritual Care

Perspective

Family-Centered CARE

Pediatric Diabetes Care

Supporting Teens on Dialysis

Patient Satisfaction Comments