A policy that could revolutionize the relationship between healthcare providers, patients and family members is taking hold in Canada. The results have come not from a treatment or technology but from an important administrative change: adopting family presence policies.
This welcoming of families as partners in care is happening under the banner of Better Together, which CFHI launched in Canada in November 2015, supported by a dozen leading healthcare organizations, including IMAGINE Citizens Collaborating for Health. One year later, 41 hospital and healthcare organizations across Canada, plus the province of Saskatchewan, have taken the Better Together pledge.
The Better Together campaign is an excellent fit with IMAGINE’s vision of “a health system that is designed and care that is delivered in partnership with citizens, achieving the best possible experiences and outcomes for patients.” This kind of partnership is the cornerstone of a patient and family centred health system. Family presence brings this partnership to life at the care-giving level.
By enabling patients to designate family members who can stay by their side 24/7, hospitals are creating a more welcoming and supportive environment. “It’s more than just taking down the visitor hours signs; it’s about creating a partnership in care,” says Maria Judd, Senior Director, Canadian Foundation for Healthcare Improvement (CFHI).
Better Together is a North American-wide campaign spearheaded by the Institute for Patient and Family Centered Care. As Judd notes, family presence policies are a significant move towards delivering more patient- and family-centred care. You simply can’t partner with families when they’re shut out.
She views Better Together partly as a moral imperative, in enabling families to be with their loved ones more fully during a vulnerable time. The practical impacts of family presence bolster the case further.
Early feedback shows multiple benefits when families are welcomed as part of the care team. Their participation can include: being present for physician rounds, better engaged with care professionals, and simply in the patient’s room more. Judd says these benefits include better transitions in care (between hospital and home); fewer medication errors and falls; better informed medical assessments and care planning; and reduced lengths of stay, readmissions and emergency department visits.
Healthcare organizations that have joined the campaign are transforming a culture that used to say: “You come into our hospital and we tell you what you need.” Instead, new policies ask hospitals to welcome patients’ families not just physically but as true partners. “There wasn’t always recognition of that value,” Judd says.
There was a perception too that having extra people around the patients at all hours, even around the clock, could interfere with care or distract healthcare staff. Other concerns about family presence policies revolved around security and infection control.
To help get organizations on board, CFHI debunked some of those fears and shared research on the range of advantages that benefit patients, families and staff when family presence is adopted.
In embracing Better Together, it was also important to focus on staff education, and how certain hospital practices could adapt to support and recognize family presence. For instance, the change of shift report could happen at the bedside rather than at the nursing station. Hospitals could also use whiteboards as a two-way communications tool, with information for the patient and family (like that day’s care team), as well as a section for families and patients to write down questions they might have.
Steps like that encourage communication between healthcare providers and family members, says Judd, and create even more opportunities for patients to be involved in their own care.
She says that for hospitals, regional health authorities and other healthcare organizations, there’s a movement towards greater patient engagement. You see patient- and family-centred care highlighted in all sorts of healthcare strategic plans, as well as through patient and family advisory committees. That’s encouraging, but the question is how it all translates into practice.
“If we put a stake in the ground, how do we deliver on it?” Judd says. “Family presence policies are a concrete and visible commitment.”
