Running Head: PATIENT FAMILY CENTERED CARE 1

Organizational Leadership and Interprofessional Team Development C158

Patient and Family-Centered Care

Western Governor University

12/15/19
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Patient Family Care

Business practice

Healthcare requires that the demands of the patients are met as well as the needs of the

family through the collaboration of different professionals in the healthcare practice. The patient

and family-centered care strive to serve triple objectives that have to be accomplished in the

event of giving care. One of these objectives is to improve the patient experience of care. To

improve the patient experience of care the healthcare team has to collaborate to improve on

individual health outcome not just the health outcome of the population (Sidani, & Fox, 2014).

The patients are empowered to be able to participate in their care while the family has to be

active in giving care to their loved ones. Another objective is to improve the health outcome of

the community, and the other is to reduce the per capita cost of healthcare.

The involvement of the patient and family in making critical decisions regarding the

health of the patient in terms of physical and psychological fitness is the key driver of the patient

and family-centered care. Policies need to be designed to cater for this goal to give the patient

and family to collaborate well with the healthcare team towards achieving care delivery goals

(Wittenberg-Lyles, Goldsmith, & Ferrell, 2013). The family must be granted more visitation

hours and the healthcare representative to be with the patient throughout while in the intensive

care unit.

The regulation of the healthcare system is of importance since it ensures smooth delivery

of care services to the patient. The regulation is done by relevant bodies such as centers for

Medicare and Medicaid services and joint commission healthcare companies. Other

organizations are responsible for designing policies, while others are set to oversee the
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implementation of such policies. The policies that are designed to ensure the achievement of this

goal is to have patient-family centered care while practicing patient safety in the system (Uhl,

Fisher, Docherty, & Brandon, 2013). The cost of attaining healthcare services is also of

paramount importance, and this has been achieved through the affordable care act of 2010.

The reimbursement should be reflected in the experience of the patients and the family as

a result of care delivery services. The healthcare services must reflect the ability of the healthcare

facility to satisfy the needs of the patient by giving quality and safe care. The healthcare facility

should be reimbursed depending on the performance they portray in dealing with patients. The

reimbursement should be determined from the feedback from the patients and family about the

healthcare services experience of both, which must be satisfying (Bell, 2013). The

reimbursement program should be initiated by the bodies responsible for formulating the policies

that guide on the care program, which are centers for Medicare and Medicaid Services (CMS)

and joint commission together with other relevant bodies.

Patient and Family-Centered Care Tool (PFCC)

Please the separate attached document for the completed PFCC tool.

Setting descriptions

The healthcare setting is a local, not profit-oriented in general and acute care having 380

in-patients beds and with a combination of 40 primary and specialty physician officers who

handle the needs of the patients and the family. The healthcare facility is situated in an urban

area making it busy due to the rapid growth of the area. The facility is a level III Trauma center

having 20 critical care beds, a medical-surgical, orthopedic unit, a pediatric ER, monitored

telemetry units, a neurological unit, and a psychiatric unit. The Gaston County, where the
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facility is situated, has a mix of ethnic groups that comprise a total population of 222,000 people.

The population has a record of 84.1% of people aged 25 years and above who are having high

school diplomas while 20.5% are bachelor holders. 15.1% of the population in 2017 was

recorded to be living below the national poverty level, where the median household income was

$46,626.

Strengths and weakness of the organization

Domain Strength weakness

Leadership/operations There is a clear statement of There is a less explicit expectation

commitment to patient family- from the patient and family

centered care with the family without the inclusion of both in

partnership. policy development.

Mission, vision, and The patient bill of rights and Despite the patient being at the

values responsibilities is friendly to the forefront of the mission and vision

patient and family. The mission, of the healthcare facility, the

vision, and values enhance a family is not included.

collaborative approach to care

for the whole community

(Wittenberg-Lyles, Goldsmith,

& Ferrell, 2013).

Advisors The patient and family do not The family and patients are not

serve on the hospital encouraged to participate in quality

committees making the system and safety rounds and there are

to remain relevant. minimal advisory councils.

Quality improvement The opinions of patients and Patients and families are not part of

family inform operational goals. quality improvement teams, and

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their opinions are not considered.

Patient and family not considered

in the walk-rounds.
Personnel The staff and physicians are Minimal participation of patients

prepared and supported fully to and families in performance

participate in patient/family- appraisal policies.

centered care. The patients and

family do not participate in

search committees and

interview teams which can

compromise the level of

integrity of the facility (Lusk, &

Fater, 2013)
Environment and The environment is set to The patients and families not

Design accommodate patient and family allowed to participate in clinical

presence and participation. design projects.

There is interdisciplinary

collaboration in giving care.

Information/educatio There is easy access to websites However, all those are not done to

n and navigation on the portals their fullest.

and resources of the hospital.

There are email

communications from the

patient and family vs. the

physicians. The families are

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utilized as educators for

clinicians
Diversity and The physician engages in There are minimal navigator

disparities careful collection and programs for minority and

measurement of race and underserved patients. The

ethnicity. The patient and family educational materials do not cater

have timely access to for all literacy levels

interpreters about the language

of the healthcare facility

(Morgan, & Yoder, 2012).

Charting and The patients and family gain full The patient and family are not able

documentation access to paper and electronic to chart

records.
Care support The families are allowed to stay, The family and patients do not get

join in rounds, and receive a disclosure and apology on error

report on the change of shifts. and harm. The patient cannot

There is an update to the patient activate the rapid response system

on medication history during in case of emergency

every visit.
Care The patient and family The level of pain management in

participate in collaborative goal partnership with patient and family

setting. The family is actively is not up to standard.

involved in care planning and

transition. Patients and families

are considered to be partners in

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the care team.

Areas of improvement

The PFCC tool provides the area that needs improvement and that require to be

maintained to the standards they are currently. The healthcare facility needs to make

improvements in the care domain and also the inclusion of patients and families in the report at

shift changes. The communication in the facility is failing due to failure to include the families in

the report at shift changes, which leads to a lack of knowledge (Lusk, & Fater, 2013). The

physicians, families and patient's lack of knowledge leads to failed patients' plans of care. There

is a need to achieve the goal of patient and family-centered care, and this can be done with the

inclusion of the patient and family in the sharing of information regarding the patient’s plan of

care. Caro Mont Regional Medical Center sets the expectation for nurses to conduct their shift

report at the bedside.

The patient and families are not included in the exchange program of the information

during the shifts when a new nurse is required to join in the medication program. Such a case

fails to transfer the relevant information about the patient and family and can result in failed

handling and management of the right case of the patient. Therefore, it is necessary to include the

patient and families in the exchange of information. The inclusion helps in the identification of

the relevant information that might be missing or incorrect health information being shared. The

changes in the information shared if there is incorrect information lead to an improvement in

handling the patients which result in patient and family-centered care (Bell, 2013). The patients

can receive improved health outcomes while the physicians are engaged fully in delivering

quality healthcare services to the patients.

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Improvement strategy

There is a need to initiate a standard work for bedside shift reports. The strategy will

ensure that the outgoing nurse awaits the incoming nurse at the bedside. The incoming nurse

needs to introduce themselves to the patient and their families. The nurse needs to observe an

overview of the patient's history while reviewing the electronic medical record to ascertain the

lab tests and medication administered. The physical assessment should be reviewed while

receiving questions from patients and families regarding the process of treatment (Kline, et al.

2015). The outgoing nurse should leave after ensuring that all the information regarding the

patient is updated.

System of change theory

Lewin’s change model for planning change gives a three-step process that involves

unfreezing, moving and refreezing. The need for change is identified in the unfreezing stage,

where a group of key stakeholders is brought together with evidence for the need for change. The

understanding of the need for change by stakeholders is the moving stage. In this case, the

change to shift report to the bedside while engaging the patient and family for satisfaction

purposes is the moving stage, which is critical in the change model (Howell, Conway, &

Rajkumar, 2015). The patient, families, and nurses involved receive the education necessary to

initiate the change and what will be expected of them. The nursing team implements the change,

and when the practice becomes a norm, the refreezing phase begins.

Financial implications

The hospital is likely to save money as a result of the change which will incur a little

cost. The change requires educational sessions, research by nurse educators and leadership,
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training of staff among other duties, will incur some cost to the hospital (Morgan, & Yoder,

2012). The implementation of the program to include families and patients in change shifts will

reflect a low cost since minimal errors will be witnessed. The hospital will get increased

reimbursements from CMS.

Methods

There will be the use of observations and audits to ascertain the effectiveness of the

program. Leadership presence is necessary during the change to ensure staff adherence to the

new change. The leadership also should conduct surveys from the patients and families to

determine the level of satisfaction towards inclusion (Ekstrand, 2015). The leadership will

investigate staff noncompliance and ensure coaching is done to improve and stick to the change.

Multidisciplinary team.

Team member Roles

Team leader Owning the project and bringing all key

stakeholders on board. Organizing meetings

and updating everyone on every move.

Unit manager Ensuring change is carried out and ensuring

all staff receives the necessary education.

Conducting audit after implementation and

give feedback and coaching (Sidani, & Fox,

2014).
Nurse educator Delivering education to the affected staff by
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making the information easy to absorb.

Developing tools such as handouts to give to

the staff.
Bedside nursing staff Giving valuable insights into their existing

daily routine. Giving relevant information to

help in implementing the new process

Patient/family Giving insights into the information they

desire to be included in the shift report.

Taking part in the development of education

for both staff, patient and family.

Team diversity

The team must engage members from different disciplines and also different age groups

with different cultural backgrounds. The age groups will bring the aspect of technology and

experience in the healthcare practice, which will improve service delivery (Wittenberg-Lyles,

Goldsmith, & Ferrell, 2013). The cultural diversity helps in developing a framework that

supports the patient and family-centered care.

Leadership theories

Transformational leadership theory is the most useful in this case since it emphasizes the

essence of interpersonal relationships and success in initiating a revolutionary change in the

organization. The transformational leadership helps in inspiring, encouraging, and motivating the

bedside nurses to adopt the change. The affected members need to be involved in the change
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process gives them the motivation to serve better towards giving the best for the patients (Uhl,

Fisher, Docherty, & Brandon, 2013).

Implementation of strategy

After the development of the standard work to be followed, the implementation of the

change should happen instantly. The educators and managers will educate nurses on respective

units. The technique to be utilized is seen one, do one and teach one technique. Each nurse

should be issued with a copy of the standard work. The nurses will be explained on what the

bedside shift report is and the expectations of the patient and families. There will be auditing to

track compliance, which should ensure the change is 100% achieved within the first three

months (Howell, Conway, & Rajkumar, 2015). The end goal of the process change is to involve

the patient and families in the treatment process and also in designing the patient’s plan of care.

Communication to organization

Communication is vital to the success of the change. There is a need for honesty and

transparency from the bedside staff which helps them to embrace the change easily.

Communication is vital to steer discussions about the need for change and also during the

implementation process to give feedback. All the staff needs to receive information about the

change to help them prepare adequately for the change (Sidani, & Fox, 2014). The nurses should

receive standard work while patients receive the bedside report handout when they are admitted.

The auditing report during implementation should be communicated together with the

compliance with the bedside shift report. The staff should be informed on coaching and

disciplinary actions to be taken for repeated mistakes. The staff should communicate on the

challenges they are facing regarding adapting to the change (Kline, et al. 2015). There should be
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continued open communication between staff and leadership to support the successful

implementation of the patient and family inclusion program.

Tools for the team

The project team will make use of Keirsey temperament sorter which will assess how the

members are likely to benefit from the project. The tool makes use of 4 different types of

different temperaments, which are artisans, guardians, idealists, and rationalists. The

personalities are important to the team and the assessment helps in identifying the weaknesses

and strengths of each personality (Ekstrand, 2015). The members are helped to know their

temperament and those of their team members. The members can work towards the improvement

of their weakness as well as maximizing their strengths, which lead to the achievement of the

changes initiated in the organization.

References

Bell, J. M. (2013). Family nursing is more than family-centered care.

Ekstrand, D. W. (2015). The four human temperaments. Retrieved on, 20.

Howell, B. L., Conway, P. H., & Rajkumar, R. (2015). Guiding principles for Center for

Medicare & Medicaid Innovation model evaluations. Jama, 313(23), 2317-2318.

Kline, R. M., Bazell, C., Smith, E., Schumacher, H., Rajkumar, R., & Conway, P. H. (2015).

Centers for Medicare and Medicaid Services: using an episode-based payment model to

improve oncology care. Journal of oncology practice, 11(2), 114-116.

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Lusk, J. M., & Fater, K. (2013, April). A concept analysis of patient‐centered care. In Nursing

Forum (Vol. 48, No. 2, pp. 89-98).

Morgan, S., & Yoder, L. H. (2012). A concept analysis of person-centered care. Journal of

holistic nursing, 30(1), 6-15.

Sidani, S., & Fox, M. (2014). Patient-centered care: clarification of its specific elements to

facilitate interprofessional care. Journal of interprofessional care, 28(2), 134-141.

Uhl, T., Fisher, K., Docherty, S. L., & Brandon, D. H. (2013). Insights into patient and family-

centered care through the hospital experiences of parents. Journal of Obstetric, Gynecologic

& Neonatal Nursing, 42(1), 121-131.

Wittenberg-Lyles, E., Goldsmith, J., & Ferrell, B. (2013). Oncology nurse communication

barriers to patient-centered care. Clinical journal of oncology nursing, 17(2).