Pulse
Family Values
By establishing a patient and family advisory council, St. Joseph’s Hospital is putting its money
where its mouth is regarding better care. But filling the roster hasn’t been easy.
Several years ago, Robert Moravec, M.D., medical director of St. Joseph’s Hospital, noticed that hospitals around the country were involving patients and families in decisions about services, care, and even the design of buildings. Moravec was intrigued and wondered if his downtown St. Paul hospital should do the same.
At the time, St. Joseph’s was evolving from a community hospital to a tertiary care center, and Moravec believed it needed to better attend to its changing patient and family population.
Moravec and Melissa Gatten, director of guest relations, took the idea of forming a patient and family advisory council to the hospital’s leaders. Moravec said the council would be “a set of eyes and ears to question why things are the way they are, to raise the bar for care, to raise the whole water level.” Then-CEO Scott Batulis gave the go-ahead.
The plan for the group quickly took shape. It would consist of a handful of staff and patients who would meet every other month to provide feedback on policies and services, voice complaints, and offer ideas for making care more compassionate. Moravec and Gatten had no trouble filling the staff slots on the council. Finding family members and patients has been another story.
Coalition of the Willing
Moravec says they wanted participants who were willing to advocate for patients without using the committee as a forum to air their own complaints. They also looked for people who would represent different populations and perspectives, speak honestly, and present themselves in a professional manner.
Taking part in such an endeavor is a commitment not all people are willing to make, says Moravec, who notes children’s hospitals have been more successful at involving parents in decision-making. “I think parents of children with chronic diseases who are in and out of the hospital a number of times over a period of time are quite willing to be on a parent advisory council. But these are adult patients. When they’re not sick, they don’t want to come back to the hospital for meetings.”
That was certainly a consideration for retiree Lawrence Beard, who was asked by Gatten to serve on St. Joseph’s committee just over a year ago. Already a member of the St. Anthony Society, a local VFW, his parish men’s club, and the Knights of Columbus, the lifelong Frogtown resident initially thought he was too busy to join another group.
He also was concerned he was being asked to be a booster. Although he likes St. Joseph’s—they should “bottle the chemistry that’s in that hospital,” he says of the staff’s positive attitude—he’s realistic. “It’s not perfect,” he says. “I told them, ‘If you want somebody to be a yes-man, you’re looking at the wrong person. I’m going to tell it as I see it.’ They said, ‘That’s what we’re looking for.’”
Beard ultimately decided he wanted to give back to the hospital where he had his open-heart surgery in 2000, where his wife was treated for congestive heart failure, and where his children and parents have received care. So he agreed to participate.
In doing so, Beard draws from his experience both as a patient and a family member. He’s brought up the fact that the cafeteria, which serves visitors, didn’t have salt-free or low-sodium menu options. That became an issue for his wife last year when the couple was spending long hours at the hospital visiting Beard’s father in the ICU. Beard, a diabetic, also pointed out that a bathroom near the ICU lacked a sharps disposal and wasn’t wheelchair accessible. He’s also noted problems with parking and communication between patients and staff.
The Needs of Family
Kyle Nelson, now a fourth-year medical student at the University of Minnesota, says studying the care conference process at St. Joseph’s Hospital in St. Paul during his second year in medical school opened his eyes to the needs of family. “When you’re busy doing the work,” he says, “you forget there’s a family member there wondering about what you are doing, what’s the prognosis. You have those answers, and you assume that they’re being conveyed, but they may not be.”
Nelson says a care conference offers family members a chance to see how providers communicate. “To see how they sit down and think through a problem together, this is something that families greatly benefit from.”
Nelson says he’s been more cognizant about talking with patients’ families since he completed the project. He hopes other doctors do the same. “If you see a family member, just go in there and let them know what’s going on, what tests you’ve done that day. Keep them updated,” he says. “They want to hear something from a doctor.”—C.P. |
Beard believes his ground-level perspective is appreciated. He knows his idea for the salt-free menu selections, for example, is “in the pipeline.” But he adds, “Nothing comes quick. … [A new idea] has to go to other people. There are unions involved, cost factors.”
Gatten says the hospital takes seriously every recommendation from the council. But, she says, implementing them requires a methodical approach. “To my discouragement, some changes go much more slowly than I as an advocate would like to see,” she says. But then she adds, “If we didn’t have them [patients and family members] on the council, think where we’d be.”
Turning Ideas into Action
Moravec says that hospital staff listen to the council’s family and patient members “with a different ear” than they would a colleague. “When they suggest something, there should be a good reason why we shouldn’t do it,” he says. But he notes that the advisory council can’t do the hundreds of hours of work necessary to implement change.
One of the ways Moravec has put legs on some of the council’s bigger ideas is to partner with medical students at the University of Minnesota. Twice, he’s turned council ideas into projects for second-year medical students.
The first, done in 2006, was on family care conferences. Prior to the students’ involvement, care conferences at St. Joseph’s were done only in response to a complaint. And rarely were they a satisfactory experience for patients or family members. Moravec proposed that the medical students make suggestions on how to improve the care conferences based on an assessment of the problem and a literature review.
The students recommended criteria for when to hold the conferences, established goals for them, and then piloted the new approach with patients. One of their recommendations was to hire a staff person dedicated to scheduling the care conferences.
Gatten says the conferences are becoming standard practice at the hospital. And although the hospital hasn’t hired a new staff person just for scheduling them, individuals within different departments have taken on that role. A nurse practitioner in the cardiology unit, for example, schedules them for cardiac patients.
This year, a group of students worked with St. Joseph’s on its discharge process. The medical students attending the patient and family advisory council meetings got an earful. “There’s a feeling that care is not always coordinated, that discharges are rushed, that doctors and nurses aren’t on the same page, that medications are missed, that medication reconciliation is not accurate, that patients aren’t given enough instruction about what to anticipate or do,” Moravec says of the patients’ and families’ concerns.
In their final paper, the students noted that the most important aspect of discharge was something the hospital was already promoting: Asking every patient what they were most concerned about. They also recommended making a follow-up phone call to every patient, creating new discharge forms to send home with patients, and thinking of discharge education as something that begins at admission. “Small adjustments can make a big impact on discharge satisfaction and understanding,” the students wrote.
In many ways, St. Joseph’s patient and family advisory council focuses on issues that might seem small to hospital administrators and medical staff. But there’s a growing awareness that small matters can make a big difference in patient outcomes. The Institute for Family-Centered Care, for example, is promoting patient and family councils, arguing that patient and family feedback is critical to safety and quality of care.
Peter Stiles, a medical student who worked on the discharge planning project at St. Joseph’s, says he thinks such concern for the experience of the patient and the family will become the norm as his generation of doctors gets into practice. “The winds of change are blowing” toward more patient- and family-centered care, he says. “I’m being trained in an environment where that’s the norm and expected.”—Carmen Peota