Patient and Family Centered Care: Asking the Right Questions During Rounds

Patient Experience Week, which took place in late April, has prompted me to reflect on the elements of Patient and Family Centered Care.

What is Patient and Family Centered Care? I like the definition from Dr. Tony DiGioia and the leaders at the Patient and Family Centered Care Innovation Center at the University of Pittsburgh Medical Center. They say that Patient and Family Centered Care is the new Operating System for health care organizations.  It is the way to do business:

    • “Patient and Family Centered Care, as a concept, is health care that is compassionate, includes patients and families as partners and collaborators, is provided with respect, and treat patients and families with dignity.  It is care that revolves around the needs and desires of patients and families, rather than around the organizations and systems in which it is provided.”

This concept reminds me of a specific moment during my own rounding experience. I had a conversation with a patient who was frustrated that I asked about how the staff was doing, but I didn’t really ask about how he was doing.  I was puzzled.  I thought I was using caring language to see if the nurses checked in on him on a regular basis.  I thought I was empathetic when I asked if we listened to him and helped him manage his pain.  From his point of view, however, it was all about the organization and not him.  I apologized, and since then, have been wondering what I could have done differently.

Recently I have been thinking about the scripts we use for our leadership rounding on patients.  Do we ask what they are afraid of when they are in our care?  Studies show that patients are fearful – first of dying in our care and secondly of getting a debilitating and costly infection.  Do we know what our patients fear?  If we don’t ask and don’t know, how can we hope to alleviate their suffering and fears?

Are we asking what matters to the patient? Maureen Bisignono, President of the IHI, says this is the most important question to ask patients.  If we don’t know what matters to the patient, we can’t deliver on our promise of providing caring and compassionate care or to honor their preferences.  As she says, what is important to a 95-year-old is different from what is important to a 25-year-old new mom.

In the nursing assessment, patients are asked about their religious preferences, but I wonder how we incorporate that information into our ongoing plan of care for the patient.  Do we accommodate the religious customs of our patients?  Do we understand what they are?  If we don’t act on the information we have at hand regarding religious preferences, we don’t show our respect to preserve the patient’s dignity.

Sharing information about the plan of care in a way the patient can understand is an important principle of Patient and Family Centered Care.  If a patient doesn’t understand, do we simply repeat ourselves using a louder voice?  If we think about health literacy, we need to consider that many of our patients may not be able to read or understand English.  Even if they do, reading may be at the 5th grade reading level.  Our materials are typically at the 11th grade reading level.  Remembering that patients are part of a family is important as we think about how best to impact discharge education.

How can we ensure that we are asking the right questions in our rounding scripts or our post-discharge follow-up care? If your organization has a Patient and Family Advisory Council (PFAC), consider leveraging its expertise to understand if you are asking the right questions.  Do the questions effectively address patient fears or what really matters to patients and their families?  Additionally, we should involve patients and families in the development of rounding scripts. Without doing so, we may continue to focus on the organization and processes of the organization instead of on what the patient and family need from us as providers of care.

We need to involve patients and families at key decision points for our organization so we can sincerely demonstrate our commitment to Patient and Family Centered Care.

Barb Davis

Barbara Davis, MA has been involved in quality in healthcare for over 30 years, and currently serves as CipherHealth's SVP of Clinical Services. She has worked in complex health care environments, including a university health system, an HMO health plan, and multi-hospital system. Her areas of expertise include quality improvement and Lean, service excellence focusing on organizational culture and the patient experience, patient safety and reliability, regulatory issues and organizational strategic goal setting. Currently she sits on the Patient and Family Advisory Council at Saint Joseph Hospital in Denver.