Family Presence and Participation: Pediatrics Leading the Way
Family Presence and Participation: Pediatrics Leading the Way
The University of Michigan Health System (UMHS) is large academic medical center and health care system that opened the first university-owned medical facility in the United States in 1869. Located in Ann Arbor, Michigan, the University of Michigan Medical Center (UMMC) is the main complex for patient care at UMHS. UMMC embodies three hospitals housing 990 beds, 40 outpatient locations with more than 120 clinics, and an extensive home care program. UMHS staffs more than 26,000 faculty, staff, students, trainees, and volunteers, and handles 1.9 million patient visits and 45,000 hospital stays each year. Seventy percent of patients travel from communities or regional hospitals outside of the Ann Arbor area.
For nearly a decade, Patient and Family-Centered Care (PFCC) has been the cornerstone of policies, programs, services, and spaces at UMHS. PFCC principles have guided decision-making at all levels by engaging and empowering family presence, participation, and partnership, both at the point-of-care and in the boardroom. As evidence of their Patient- and Family-Centered vision, UMHS has over 30 advisory councils, including quality-safety, research, and "dad" advisory councils; advisor memberships on hospital committees, including executive-level, operations, facility design, ethics, and adverse event review groups; multiple peer mentor programs; dozens of educational venues; and an active e-advisor group.
In 2008, UMHS C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital successfully transitioned from a "Visitation Policy" to a "Family Presence Policy." After years of breaking a restrictive visitation policy, it became clear that it was time to move forward. Their discussion moved from, "Should we change our policy?" to "How do we change our policy?" The new policy is comprehensive and addresses family presence overnight, in trauma bays, during codes and procedures, and during shift-change and medical rounds, as well as family identification allowing patients/parents to identify whom they consider to be family members. In 2013, the Family Presence policy was adopted system-wide when UMHS adult care areas implemented this policy.
Another expansion of the policy occurred in 2014, when the Child and Adolescent Psychiatric Unit at C.S. Mott ushered in its family presence policy that included elimination of visiting hours, a welcoming environment for parents/legal guardians to spend the night as well as attend medical rounds, and a communication plan to help families understand the limits for safe care. As a result, both patient/family and staff satisfaction increased, and there were notable improvements in the understanding of family dynamics, care coordination and discharge planning, empowerment to advocate for needs, and successful self-management.
According to Kelly Parent, the UMHS Patient- and Family-Centered Care Program Manager for Children's, Women's and Psychiatric Services, "As with any change, there have been bumps along the way. At times, it seems that we have taken two steps forward and one back, but we have always stayed the course" (Kelly Parent). Staying the course has meant providing leadership and employee assistance support, as well as policy revision and the creation of supplemental guidelines that address special circumstances. "Especially in crisis, we owe it to our families to do everything possible to keep them together" (Kelly Parent).
Compassionate Accommodations is one example of a supplemental guideline that was developed to support the Family Presence Policy following its original implementation. Like many institutions, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital struggled with issues surrounding overnight sibling presence when parents were spending the night with their hospitalized child. Concerns ranged from patient and sibling safety to infection control issues. Additionally, there were inconsistent practices from unit to unit and nurse to nurse. The intent of Compassionate Accommodations is to recognize and "accommodate" unique circumstances when it is in the best interest of the patient/family to allow a sibling (under 18 years of age) to spend the night. With few exceptions, a Compassionate Accommodation is a one-night contract with the goal of solving the sibling care concerns the following morning. The decision to activate a Compassionate Accommodation most often occurs through discussion among the bedside nurse, nurse manager, and social worker as they work through a decision-making algorithm. The parent/legal guardian must sign a waiver and remain present with the sibling(s), providing care for them at all times.
University of Michigan Health System
The University of Michigan Health System (UMHS) is large academic medical center and health care system that opened the first university-owned medical facility in the United States in 1869. Located in Ann Arbor, Michigan, the University of Michigan Medical Center (UMMC) is the main complex for patient care at UMHS. UMMC embodies three hospitals housing 990 beds, 40 outpatient locations with more than 120 clinics, and an extensive home care program. UMHS staffs more than 26,000 faculty, staff, students, trainees, and volunteers, and handles 1.9 million patient visits and 45,000 hospital stays each year. Seventy percent of patients travel from communities or regional hospitals outside of the Ann Arbor area.
For nearly a decade, Patient and Family-Centered Care (PFCC) has been the cornerstone of policies, programs, services, and spaces at UMHS. PFCC principles have guided decision-making at all levels by engaging and empowering family presence, participation, and partnership, both at the point-of-care and in the boardroom. As evidence of their Patient- and Family-Centered vision, UMHS has over 30 advisory councils, including quality-safety, research, and "dad" advisory councils; advisor memberships on hospital committees, including executive-level, operations, facility design, ethics, and adverse event review groups; multiple peer mentor programs; dozens of educational venues; and an active e-advisor group.
In 2008, UMHS C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital successfully transitioned from a "Visitation Policy" to a "Family Presence Policy." After years of breaking a restrictive visitation policy, it became clear that it was time to move forward. Their discussion moved from, "Should we change our policy?" to "How do we change our policy?" The new policy is comprehensive and addresses family presence overnight, in trauma bays, during codes and procedures, and during shift-change and medical rounds, as well as family identification allowing patients/parents to identify whom they consider to be family members. In 2013, the Family Presence policy was adopted system-wide when UMHS adult care areas implemented this policy.
Another expansion of the policy occurred in 2014, when the Child and Adolescent Psychiatric Unit at C.S. Mott ushered in its family presence policy that included elimination of visiting hours, a welcoming environment for parents/legal guardians to spend the night as well as attend medical rounds, and a communication plan to help families understand the limits for safe care. As a result, both patient/family and staff satisfaction increased, and there were notable improvements in the understanding of family dynamics, care coordination and discharge planning, empowerment to advocate for needs, and successful self-management.
According to Kelly Parent, the UMHS Patient- and Family-Centered Care Program Manager for Children's, Women's and Psychiatric Services, "As with any change, there have been bumps along the way. At times, it seems that we have taken two steps forward and one back, but we have always stayed the course" (Kelly Parent). Staying the course has meant providing leadership and employee assistance support, as well as policy revision and the creation of supplemental guidelines that address special circumstances. "Especially in crisis, we owe it to our families to do everything possible to keep them together" (Kelly Parent).
Compassionate Accommodations is one example of a supplemental guideline that was developed to support the Family Presence Policy following its original implementation. Like many institutions, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital struggled with issues surrounding overnight sibling presence when parents were spending the night with their hospitalized child. Concerns ranged from patient and sibling safety to infection control issues. Additionally, there were inconsistent practices from unit to unit and nurse to nurse. The intent of Compassionate Accommodations is to recognize and "accommodate" unique circumstances when it is in the best interest of the patient/family to allow a sibling (under 18 years of age) to spend the night. With few exceptions, a Compassionate Accommodation is a one-night contract with the goal of solving the sibling care concerns the following morning. The decision to activate a Compassionate Accommodation most often occurs through discussion among the bedside nurse, nurse manager, and social worker as they work through a decision-making algorithm. The parent/legal guardian must sign a waiver and remain present with the sibling(s), providing care for them at all times.
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