Attachment D -- Component 3_materials

Attachment D -- Component 3_materials.pdf

Development of the Guide to Patient and Family Engagement in Health Care Quality and Safety in the Hospital Setting

Attachment D -- Component 3_materials

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Component 3
Topic Area 1:
Making the Case for
Patient and Family
Engagement and the
Guide

How Patient and Family Engagement
Benefits Your Hospital
The Guide to Patient and Family Engagement in Hospital Quality and Safety (the Guide) is an
evidence-based resource to help hospitals develop effective partnerships with patients and family
members, with the ultimate goal of improving multiple aspects of hospital quality and safety.1
The goal of patient and family engagement is to create an environment where hospital leaders,
clinicians, hospital staff, patients, and families work together as essential partners in improving
the quality and safety of hospital care.
Patient and family engagement is not a new or separate initiative. It is a critical part of what your
hospital is already doing to improve quality and safety.

As shown in Exhibit 1, Patient and family engagement helps your hospital:
•

Improve quality and safety.

•

Enhance market share and competitiveness.

•

Improve financial performance.

•

Improve staff recruitment and retention.

•

Improve CAHPS® Hospital
Survey scores.

•

Respond to the Joint Commission standards.

•

Improve patient outcomes.

Exhibit 1. Patient and Family Engagement Improves Multiple Aspects of Hospital
Performance

How Patient and Family Engagement Benefits Your Hospital

What are the Benefits of Patient and Family Engagement?
Overall improvements in quality and safety. Engaging patients and families translates into

measurable improvements in quality and safety.(1) With a patient- and family-centered approach
to care, patients and families are allies for quality and safety through “informed choices, safe
medication use, infection control initiatives, observing care processes, reporting complications,
and practicing self-management.”(2) MCGHealth Medical Center saw measurable improvements
as a result of changes to their visitation policy. This move to promote family presence and
engagement led to a 62 percent reduction in medication errors, a 40 percent reduction in falls,
and a 50 percent decrease in length of stay.(3)
Improved financial performance. Research from the Gallup Management Journal shows that

patient and family engagement “consistently predicts hospital performance on an array of crucial
business outcomes, including EBITA (earnings before the deduction of interest, tax, and
amortization) per adjusted admission and net revenue per adjusted admission.”(4) Patient- and
family-centered care and engagement also decreases litigation and malpractice claims, with
fewer complaints and lawsuits against health care providers.(5) It leads to lower costs per case
due to fewer complications and shorter length of stay.(6, 7) It can improve patient flow, improve
bed capacity, and reduce overcrowding, with engaged patients and families serving as an early
warning system for potential bottlenecks in care processes and helping to identify areas for
improvement.(8) On the other side, a lack of patient- and family-centeredness and patient and
family engagement can have negative financial consequences in the form of delays and waste
due to higher call volume, repetitive patient education efforts, increased diagnostic tests, and a
greater need for referrals.(9, 10)
Improved CAHPS® Hospital Survey scores and patient experiences of care. Many of the

CAHPS® Hospital Survey measures reflect key elements of patient and family engagement—
particularly those related to patient-provider communication, pain management, medications, and
the provision of discharge information. Hospitals that have implemented strategies to improve
patient engagement have seen subsequent improvements in patients’ ratings of care.(11) At
MCGHealth Medical Center, implementing patient and family engagement strategies on one unit
led to an increase in patient satisfaction scores from the 10th to the 95th percentile.(3)
In 2012, Medicare will institute the national hospital value-based purchasing program. Under this
program, achievement and improvement on patient experiences of care scores (based on the
CAHPS® Hospital Survey) will be used to calculate value-based incentive payments.(12, 13)
This means that financial reimbursement will be tied to benchmarked performance on the
CAHPS® Hospital Survey, and hospitals will be financially rewarded or penalized based on their
performance on specific CAHPS® Hospital Survey measures.
Better patient outcomes. Engaging patients and families through improved communication and

other practices has a positive effect on patient outcomes – specifically, emotional health,
2

How Patient and Family Engagement Benefits Your Hospital

symptom resolution, functioning, pain control, and physiologic measures such as blood pressure
and blood sugar levels.(14, 15) In addition, strategies that promote patient and family
engagement can help hospitals reduce their rate of preventable readmissions.(16)
Enhanced hospital market share and competitiveness. For many hospitals, establishing a

brand identity around patient and family engagement becomes a competitive differentiation in
the marketplace. In survey of over 2,000 patients, 41 percent indicated they would be willing to
switch hospitals for a better patient experience.(17) By incorporating patient- and familycentered care into their business model, Cleveland Clinic increased their market share with
increases in both new and returning patients. Similarly, as a result of patient and family
engagement strategies, Griffin Hospital in Connecticut saw growth in both inpatient and
outpatient volume.(7)
Increased employee satisfaction and retention. Patient and family engagement strategies also

help improve employees’ satisfaction with their work. This, in turn, leads to higher levels of
retention and an improved ability to recruit quality talent. At Bronson Methodist Hospital,
implementing patient- and family-centered care practices led to a decrease in the average nurse
turnover rate (from 21.3 to 7.3 percent). The organization estimates that higher nursing staff
retention has led to a savings of $3 million over 5 years.(18)
Better response to the Joint Commission standards. Patient and family engagement helps

hospitals respond to the Joint Commission standards that recognize the need for patients and
families to be “active and informed decision makers throughout the course of care.”(19) Exhibit
2 provides the Joint Commission standards that relate to patient and family engagement.
Exhibit 2. The Joint Commission Standards that Relate to Patient and Family Engagement
PC.02.01.21* The hospital effectively communicates with patients when providing care, treatment, and
services.
PC.02.02.01 The hospital coordinates the patient’s care, treatment, and services based on the patient’s
needs.
PC.02.03.01 The hospital provides patient education and training based on each patient’s needs and
abilities.
PC.04.01.05 Before the organization discharges or transfers a patient; it informs and educates the
patient about his or her follow-up care, treatment, or services.
R1.01.01.03* The hospital respects the patient’s right to receive information in a manner he or she
understands.
R1.01.02.01 The hospital respects the patient’s right to participate in decisions about his or her care,
treatment, and services.
*New standard in January, 2010. Compliance will be included in the accreditation decision no earlier than January 2012.
For more information: The Joint Commission. Advancing effective communication, cultural competence, and patient- and
family-centered care: A roadmap for hospitals. Oakbrook Terrace, IL: The Joint Commission; 2010.

How Patient and Family Engagement Benefits Your Hospital

Key Take-Aways
Efforts to increase patient and family engagement and patient- and family-centered care at your
hospital can improve multiple aspects of your hospital’s performance. Benefits associated with
increased patient and family engagement include improvements in financial performance, patient
outcomes, and overall improvements in quality and safety.

The Guide was developed for the Agency for Healthcare Research and Quality (AHRQ), in the U.S. Department of
Health and Human Services, by a collaboration of partners with experience in and commitment to patient and family
engagement, hospital quality, and safety. Led by the American Institutes for Research (AIR), the team included the
Institute for Patient and Family-Centered Care (IPFCC), Consumers Advancing Patient Safety (CAPS), the Joint
Commission, and the Health Research and Educational Trust (HRET). Other organizations contributing to the
project included Planetree, the Maryland Patient Safety Center (MPSC), and Aurora Health Care
4

How Patient and Family Engagement Benefits Your Hospital

References
1.
Johnson B, Abraham M, Edgman-Levitan S, Sodomka P, Schlucter J, Ford D. Partnering
with patients and families to design a patient-and-family-centered health care system. Bethesda,
MD: IFCC; IHI; 2008.
2.
Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving
patients. BMJ. 2007;335(7609):24-7.
3.
Connor M, Marshall R. Changing the view that families are visitors in adult hospital
settings. Presented at Hospitals Moving Forward with Patient- and Family-centered Care
4.
Robison J. What is the "patient experience"? Hospitals are becoming increasingly
frustrated - and wasting money - trying to hit the wrong target. Gallup Management Journal
Online. 2010:1-3.
5.
Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient
complaints and malpractice risk. JAMA. 2002;287(22):2951-7.
6.
Stone S. A retrospective evaluation of the impact of the planetree patient-centered model
of care on inpatient quality outcomes. HERD. 2008;1(4):55-69.
7.
Charmel PA, Frampton SB. Building the business case for patient-centered care. Healthc
Financ Manage. 2008;62(3):80-5.
8.
Hall MF. Looking to improve financial results? Start by listening to patients. Healthc
Financ Manage. 2008;62(10):76-80.
9.
Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The
impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796-804.
10.
Conway J, Johnson B, Edgman-Lefitan S, Schlucter J, Ford D, Sodomka P, et al.
Partnering with patients and families to design a patient- and family-centered health care system:
a roadmap for the future: a work in progress. Bethesda, MD: Institute for Family-Centered
Care2006.
11.
Iacono S. A study on the relationship of patient satisfaction and utilization of a Planetree
model in care delivery. PlaneTalk Newsletter. 2001.
12.
HCAHPS fact sheet (CAHPS hospital survey). Centers for Medicare and Medicaid
Services; 2010 [updated 2010/09/15/]; Available from:
http://www.hcahpsonline.org/files/HCAHPS%20Fact%20Sheet,%20revised1,%203-31-09.pdf.
13.
Centers for Medicare and Medicaid Services. Plan to implement a Medicare hospital
value-based purchasing plan. Washington, DC: U.S. Department of Health and Human Services;
2007.
14.
Epstein RM, Street RL, Jr. Patient-centered care for the 21st century: physicians' roles,
health systems and patients' preferences. Philadelphia: American Board of Internal Medicine
Foundation; 2008.
15.
Roter D. Which facets of communication have strong effects on outcome: a metaanalysis. In: Stewart M, Roter D, editors. Communicating with medical patients. Newbury Park,
CA: Sage; 1989.
How Patient and Family Engagement Benefits Your Hospital

16.
Steffens L, Jaeger S, Herrmann S, Thomas K, Barker K, Eggleston A. Hospital
readmission: the move toward pay for performance. J Nurs Adm. 2009;39(11):462-4.
17.

Grote KD, Newman JRS, Sutaria SS. A better hospital experience. McKinsey Quarterly.

18.
McCarthy D. Case study: achieving a culture of patient- and family-centered care at
Bronson Methodist Hospital. Quality Matters. 2007.
19.
The Joint Commission. Advancing effective communication, cultural competence, and
patient- and family-centered care. 2010 Prepublication edition - not for distribution.

How Patient and Family Engagement Benefits Your Hospital

Component 3
Topic Area 2:
Organizational
Assessment Tools
&
Topic Area 3:
Implementation
Strategies

How to Use the Guide to Patient and
Family Engagement
The Guide to Patient and Family Engagement in Hospital Quality and Safety (the Guide) is an
evidence-based resource to help hospitals improve quality and safety by engaging patients and
family members.1 The goal of patient and family engagement is to create an environment where
clinicians, hospital staff, patients, and families work together as partners to improve the quality
and safety of care.
This document outlines three steps to help hospitals start the process of using the strategies and
tools in the Guide:
•

Step 1: Get commitment from and the support of hospital leadership.

•

Step 2: Form a multi-disciplinary team to identify specific areas for improvement and
select the Guide strategies to implement.

•

Step 3: Implement and evaluate the strategies.

It is important to remember that there are multiple pathways for implementing the Guide, and
that hospitals will need to work within their individual environments and contexts.

Step 1: Get Commitment From and the Support of
Hospital Leadership
Having leaders who can advocate for and participate in change initiatives significantly increases
the likelihood of learning, innovation, and sustainability.(1, 2) Hospital leaders communicate the
importance of partnering with patients and family members, provide resources, and set the tone
for effective partnerships.
In some cases, the impetus for patient and family engagement originates from the top leadership
level (i.e., the hospital board, the C-suite, or clinical leadership). In other cases, the impetus
comes from unit leaders or other key individuals. In all cases, organizational change for patient
and family engagement requires strong leadership at multiple levels:
•

Boards of directors play a critical role in “setting the tone” for the entire
organization.(3)

•

Senior leaders (e.g., members of the C-suite) ensure that the organizational
transformations required for patient and family engagement efforts occur.

•

Clinical leaders such as the Chief Medical Officer (CMO) and Chief Nursing Officer
(CNO) assume responsibility for the ongoing program, set expectations for superior
performance, model behaviors, and mobilize improvement efforts.(4-6)

•

Other hospital leaders such as unit managers ensure that engagement efforts occur on a
daily basis.

How to Use the Guide to Patient and Family Engagement

How to bring senior leadership on board
You can reach out to leaders using a variety of methods to promote, reinforce, and sustain the
message about patient and family engagement. For example, you can talk to hospital leaders in
meetings, conduct leadership “rounds,” or ask hospital leaders to accompany patients and family
members on a “walk-about.” Knowing your leadership audience and what issues are likely to be
most compelling (e.g., financial, personal stories) will help you make the argument. Also
remember that building a base of support and obtaining buy-in is not a one-time occurrence.
Regular communication emphasizes the ongoing opportunities for and benefits of patient and
family engagement.(7)
Talk to hospital leaders in meetings. Ask for time on the agenda at regular senior leadership

and board meetings, at clinical leader meetings, or at clinician staff meetings. If possible, ask a
patient or family member who has received care at your hospital to attend the meeting with you.
One of the most powerful ways to convince senior leaders of the merits of patient and family
engagement is to create connections with patients and family members.(8, 9) If a patient or
family member cannot attend in-person, solicit and share a few stories.
When talking to hospital leaders, keep your arguments short and sweet. Consider the following
issues:
•

How does patient and family engagement relate to and help achieve your hospital’s
strategic goals? How does patient and family engagement relate to performance
“dashboards” that include metrics related to key strategic areas outlined in the mission
statement, vision statement, and strategic plan?

•

How can patient and family engagement help your hospital realize quality and safety
improvements (for example, improvements in CAHPS® Hospital Survey scores)?

•

How can patient and family engagement help differentiate your hospital from other
competitors? What are these competitors doing with regard to patient and family
engagement?

•

How does patient and family engagement relate to issues of local or regional importance?
For example, have there been any high profile stories about hospital quality or safety
issues? Are there existing or proposed legislative mandates related to patient and family
engagement (such as Massachusetts’ mandate that hospitals create patient and family
advisory councils)?

•

What do you want leaders to do? How are you asking them to help support patient and
family engagement at your hospital?

How to Use the Guide to Patient and Family Engagement

Guide Resources in Component 3

The Guide to Patient and Family Engagement: What Is It, and How
Does It Benefit Our Hospital? is a PowerPoint presentation with
talking points about the benefits of patient and family engagement and
the support that is needed.
How Patient and Family Engagement Benefits Your Hospital contains
more detailed information about why patient and family engagement is
important.
Supporting Patient and Family Engagement: Best Practices for
Hospital Leaders provides specific advice and suggestions about how
senior leaders can create a supportive environment for patient and
family engagement.
Have leaders conduct “rounds” with patients and families. Leadership rounds are regular

announced or unannounced visits in which leaders interact directly with patients and families,
either by visiting current patients on specific units, or by inviting patients and family members to
scheduled “chat sessions.” Leadership rounds offer the opportunity for leaders to observe staff,
clinicians, patients, and family members and talk with them in a non-threatening way about
quality, safety, and other related issues. Rounds often include personal discussions with patients
and staff that allow leaders to hear firsthand what is happening on the front lines of care and
solicit suggestions for improvement.(10-12) These conversations can give leaders a good sense
of the potential value of patient and family engagement and help inform dialogue in the board
room.(13) A good way to get board members involved is to hold leadership rounds before
regularly scheduled board meetings.
Invite staff and leadership to do a “walk-about.” Walk-abouts help hospital leaders explore

the hospital experience through the eyes of patients and family members. If possible, invite
several patients or family members to participate in this activity. Begin at the first point of entry
into the hospital (e.g., the parking lot), and continue to the inpatient unit and throughout the unit,
including the patient room, treatment rooms, admitting area, family lounge, and other areas
visible to patients and families. At each point, observe how the hospital welcomes, engages, and
supports patients and families. These findings will give a different context for meetings and
discussions.
Guide Resource

Component 2, Implementation Handbook: Organizational Partnership
Materials has detailed information about how to conduct a walk-about.
See Appendix A, Strategy 1: Working With Patient and Family
Advisors.

How to Use the Guide to Patient and Family Engagement

Step 2: Form a Multi-disciplinary Team to Identify
Areas for Improvement and Select the Guide
Strategies to Implement
The goal of patient and family engagement is to create an environment where hospital leaders,
clinicians, hospital staff, patients, and families work together as partners to promote
improvements in care. Therefore, it is helpful for all of these groups to be represented on a
multi-disciplinary team that has responsibility for planning and implementing your patient and
family engagement efforts. As an initial step, this multi-disciplinary team can help identify areas
for improvement and select Guide strategies to implement.

Recruit team members
The composition of this team will vary depending on what works best for your hospital. Consider
including hospital leaders, clinician and hospital staff “champions,” other key staff, and patient
and family advisors.
•

Hospital leaders. To be effective, patient and family engagement must be integrated into
organizational culture. Therefore, involving hospital leadership is critical to promote and
support change. Hospital leaders (e.g., board members, CEO, CMO, CNO) may not need
to be involved on an everyday basis, but consider ways that the committee can report to
and engage senior leadership on an ongoing basis. Also think about other leaders to
involve (e.g., unit directors, nurse managers).

•

Clinician and staff “champions.” Respected by their peers within their area of
expertise, “champions” help achieve buy-in by engaging their peers on a different level
than top management.(3, 4) Over time, these champions can help convince their peers of
the quality and safety benefits of patient and family engagement, and also model best
practices and behaviors.(14) Look for individuals who have an interest in working with
patients and family members, who are respected by their peers, and who have the passion
and skill set necessary for planning patient and family engagement efforts.

•

Other key staff. Think about including other staff members who can help promote and
support patient and family engagement. These staff members will depend on your
organization, but may include child and family life specialists; social workers; heads of
quality and safety committees; and staff from patient affairs, family services, patient- and
family-centered care, or quality improvement departments.

•

Patient and family advisors. If your hospital already works with patient and family
advisors, ask several advisors to sit on the multi-disciplinary committee. If your hospital
does not have experience working with patient and family advisors, look for several
patients or family members who have had recent care experiences at your hospital and
who are interested in helping to make improvements.

How to Use the Guide to Patient and Family Engagement

Guide Resource

Component 2, Implementation Handbook: Organizational
Partnership Materials has detailed information about how to
identify and recruit patient and family advisors.

Identify areas for improvement
Ask the multi-disciplinary team to gather and review a variety of information to help prioritize
areas for improvement. This information will provide insights about your hospital’s strengths
and indicate areas where changes may be needed.
Review quality information and data related to core hospital processes. Look at how your

hospital is doing and where you need to improve. For example, many of the CAHPS® Hospital
Survey measures reflect key elements of patient and family engagement—particularly those
related to patient-provider communication, pain management, medications, and the provision of
discharge information. You may also want to examine recent events at the hospital, both positive
and adverse, to help identify priorities.
Review the hospital’s mission statement and strategic plan. Mission statements and

strategic plans serve as tangible, ongoing reminders of your hospital’s priorities and where it
would be most appropriate to focus your efforts. Look for ways in which the Guide can help
further the hospital’s mission and short- and long-term strategic goals.
Get input from clinicians, hospital staff, patients, and families. Gathering information about

experiences, ideas for changes and improvements, and questions or concerns from these different
parties can help define the care experience at your hospital. It can also help create a shared vision
of what the ideal experience would look like, which can then assist you in identifying which of
the Guide strategies to prioritize.
Assess the degree to which your hospital’s current policies and practices reflect best
practices for patient and family engagement. Conducting an initial assessment of your

organization’s patient and family engagement and patient- and family-centered care policies
helps you understand where your organization can make improvements. It also provides you with
baseline data by which to assess improvements.
Resources

Strategies for Leadership – Patient- and Family-Centered Care
Hospital Self-Assessment Inventory assists hospitals in defining and
evaluating engagement efforts. From the American Hospital
Association and the Institute for Patient- and Family-Centered Care.
Available at: www.aha.org/aha/content/2005/pdf/assessment.pdf

How to Use the Guide to Patient and Family Engagement

Patient- and Family-Centered Care Organizational Self-Assessment
Tool is a checklist developed to help hospitals evaluate whether
specific aspects of their organization have a patient- and familycentered focus. From the Institute for Healthcare Improvement and the
National Initiative for Children’s Healthcare Quality. Available at:
www.patientsafetyinstitute.ca/English/toolsResources/GovernancePati
entSafety/AssessImprovePatientSafetyCulture/Documents/Organizatio
nal%20Assessment.pdf
AMA Ethical Force Program Toolkit is designed to help organizations
assess how effectively they communicate and identify how to target
resources for improvement. From the American Medical Association’s
Ethical Force Program.® Available at: www.amaassn.org/ama/pub/physician-resources/medical-ethics/the-ethicalforce-program.shtml
It is important to realize that your organization cannot be truly “patient- and family-centered” if
families are restricted in their presence. Therefore, another critical step is reviewing (and
changing if needed) your organization’s policy related to visitation and family presence. The
term “family” has many meanings. It includes bonds created by marriage, ancestry, close
friendships, shared child rearing, and romantic relationships. It should be up to the patient to
define who their “family” is and how they want them involved. Furthermore, families should be
"respected as part of the care team— never visitors— in every area of the hospital, including the
emergency department and the intensive care unit."(15)
In November 2010, the Centers for Medicare & Medicaid Services (CMS) and the U.S.
Department of Health and Human Services (DHHS) announced a new rule granting patients the
right to choose their own visitors during a hospital stay. Under this rule, hospitals are required to
explain to all patients their rights to choose who may visit them during an inpatient stay and to
note that “visitors” may include family members, friends, or any other type of visitor. For
hospitals, the consequences of not adhering to this broad definition of visitors could include
being barred from participating in the Medicare and Medicaid programs.(16)
Resources

Are Families Considered Visitors in Our Hospital or Unit? A checklist
from the Institute for Patient- and Family-Centered Care designed to
help hospitals examine their practices and infrastructure to assess how
well patient and family presence and participation is supported.
Available at: www.ipfcc.org/advance/arefamiliesvisitors.pdf
Changing Hospital Visiting Policies and Practices: Supporting Family
Presence and Participation: Executive Summary provides guidelines
with respect to changing hospital visitation policies and practices,
including examples of policies. Available at:
www.ipfcc.org/visiting.pdf

How to Use the Guide to Patient and Family Engagement

Select the Guide strategy or strategies to implement
After collecting and reviewing information to identify needs, select the Guide strategy or
strategies that your hospital will implement. The Guide is designed to be a flexible set of
strategies and tools. Hospitals can implement as many or as few of the strategies as desired,
although incremental investment leads to increasing benefits. If hospitals choose to implement
multiple strategies, they can be implemented together or in sequence.
In selecting initial strategies to implement, consider how you can provide opportunities for
success. For example, select one strategy to implement on a small scale (e.g., on a single unit).
Use the lessons learned from the single-unit pilot implementation to refine your approach, and
then spread to more units. In this way, you can build on your successes as a pathway to broader
dissemination and wider-scale change.
Included in the Guide are:
Component 2: Organizational Partnership Materials. Tools to help hospitals begin working

with patients and family members as organizational-level advisors, by providing a mechanism
for involving patients and family members in policymaking; facility design; and the planning,
delivery, and evaluation of care.
Component 3: Hospital Stay Active Involvement Materials – Working with Patients and
Families at the Bedside

•

Strategy 2: Communication Packet: Communicating to Improve Quality. Tools to

improve communication between patients, family members, clinicians, and hospital staff
from the point of admission, including giving patients a clearer understanding of how to
ask questions, who to go to for information or help, and how to participate in their care.
•

Strategy 3: Bedside Change of Shift. Tools to support the safe handoff of care between

nurses by involving the patient and family in the change of shift report for nurses.
•

Strategy 4: Discharge Plan: IDEAL Discharge Planning. Tools to engage patients and

family members in the transition from hospital to home, with the goal of reducing
medication errors, adverse events, and preventable readmissions.

Step 3: Implement and Evaluate the Strategy
Implementation
An implementation handbook accompanies each of the four strategies included in the Guide.
These handbooks contain information, guidance, and specific instructions to help your
organization plan and implement the strategy. Use your multi-disciplinary team to provide
additional input about how to adapt the strategies and tools in the Guide to ensure effective use at
How to Use the Guide to Patient and Family Engagement

your hospital. Hospitals that are top performers in quality, safety, and patient and family
engagement set time-specific goals, establish measures of improvement, use a standardized
process for implementation, measure progress toward goals, and provide timely feedback about
that process.(4, 17, 18)
Hospitals may wish to begin by implementing the Guide strategies in units where the strategies
are most likely to succeed. This allows you to convey the successes and lessons learned to units
where implementation may encounter more resistance.
Resource

For more information about planning, implementing, and evaluating
quality improvement strategies, visit the Institute for Healthcare
Improvement’s “Improvement Methods” Web site. Available at:
www.ihi.org/IHI/Topics/Improvement/ImprovementMethods

Evaluation
Organizations engaging in patient and family engagement initiatives need to create structures and
metrics to evaluate their impact. Ongoing evaluation:
•

Assesses the effectiveness of interventions and whether they should be continued,
expanded, or made permanent.

•

Identifies and addresses any needed problems to stimulate ongoing improvement.

•

Keeps key stakeholders apprised of progress in meeting key priorities related to patient
and family engagement.

•

Keeps individuals engaged and enthusiastic by demonstrating whether goals and
objectives are being met.(7)

Evaluation of patient and family efforts can also inform the annual performance review,
compensation, and determinations of awards and recognition for both individuals and
departments. Hospitals can incorporate patient and family engagement measures into existing
performance “dashboards” that include metrics related to key strategic areas outlined in the
mission statement, vision statement, and strategic plan. Initially, such measures may relate to
processes, such as having a patient or family advisor on a short-term project. Over time, metrics
included on dashboards may evolve into more outcomes-oriented measures, such as CAHPS®
Hospital Survey scores, including overall scores and scores on questions that relate more directly
to the patient and family experience and level of patient and family engagement.
Exhibit 1 on the next page provides an example of how two hospitals used survey questions to
assess issues related to patient and family engagement.

How to Use the Guide to Patient and Family Engagement

Exhibit 1. Hospital Examples: Adding Questions to Patient Experience of Care Surveys to
Assess Patient and Family Engagement Strategies
Valley View Hospital in Glenwood Springs, Colorado, added survey questions to their experiences of care
survey to address five issues related to patient and family engagement:(13)
• Staff effort to include patients in decisions about treatment.
• Extent to which patient and family are educated on how to report concerns related to care,
treatment, services, and patient safety.
• Extent to which patient and family are educated on how to request additional assistance if an
urgent response is needed.
• Extent to which staff check two forms of identification before giving medications, drawing blood,
or transporting for a test.
• Extent to which staff cleaned/sanitized their hands before examining the patient.
The University of Washington Medical Center added these questions to its survey:(13)
•
•
•
•
•

Degree to which patient and family could participate in care decisions.
How well staff explained their roles in care.
Degree to which staff supported family members throughout the health care experience.
Degree to which the patient’s choices were respected to have family and friends present during
care.
Degree to which staff respected the family’s cultural and spiritual needs.

Key Take-Aways
Hospitals will need to work within their specific environments to implement the Guide. Although
organizational change is not easy, it is also important to remember that implementing the Guide
is no more difficult than making other improvements in the hospital. It takes time to implement
and expand new initiatives, but hospitals cannot do things the way they have always been done
and expect radical improvements. A careful process of getting commitment from leadership,
obtaining multi-disciplinary input, identifying areas for improvement, selecting Guide strategies
to implement, and evaluating efforts can help ensure success and help hospitals reap the
maximum benefits.

References
1.
Institute for Healthcare Improvement NICHQ. Elements of hospital-based patient- and
family-centered care. IHI; NICHQ; 2009.
2.
Weiner BJ, Shortell SM, Alexander J. Promoting clinical involvement in hospital quality
improvement efforts: the effects of top management, board, and physician leadership. Health
Serv Res. 1997;32(4):491-510.
3.
Liebhaber A, Draper DA, Cohen GR. Hospital strategies to engage physicians in quality
improvement. Issue Brief Cent Stud Health Syst Change. 2009(127):1-4.
4.
Draper DA, Felland LE, Liebhaber A, Melichar L. The role of nurses in hospital quality
improvement. Res Briefs. 2008(3):1-8.
5.
Mastal MF, Joshi M, Schulke K. Nursing leadership: championing quality and patient
safety in the boardroom. Nurs Econ. 2007;25(6):323-30.
6.
Conway J, Nathan D, Benz E, Shulman L, Sallan S, Ponte P, et al. Key learning from the
Dana-Farber Cancer Institute's 10 year patient safety journey. American Society of Clinical
Oncology 2006 Educational Book. 2006:615-9.
7.
Curtis JR, Cook DJ, Wall RJ, Angus DC, Bion J, Kacmarek R, et al. Intensive care unit
quality improvement: a "how-to" guide for the interdisciplinary team. Crit Care Med.
2006;34(1):211-8.
8.
Conway J. Getting boards on board: engaging governing boards in quality and safety. Jt
Comm J Qual Patient Saf. 2008;34(4):214-20.
9.
American Hospital Association, Institute for Family-Centered Care. Strategies for
leadership: advancing the practice of patient- and - family-centered care. American Hospital
Association; Institute for Family-Centered Care; 2004.
10.
Graham S, Brookey J, Steadman C. Patient Safety Executive Walkarounds tools and
products. 2005 Feb.
11.
Frankel A, Grillo SP, Pittman M, Thomas EJ, Horowitz L, Page M, et al. Revealing and
resolving patient safety defects: the impact of leadership WalkRounds on frontline caregiver
assessments of patient safety. Health Serv Res. 2008;43(6):2050-66.
12.
Frankel A. Patient safety leadership walkarounds. Institute for Healthcare Improvement;
2004.
13.
Frampton S, Guastello S, Brady C, Hale M, Horowitz S, Smith S, et al. Patient-centered
care improvement guide. Picker Institute; Planetree; 2008.
14.
Milne, Judy, Patient Safety Officer at Duke University Hospital. Interviewed by
American Institutes of Research project staff. 9 July 2010.
15.
Leape L, Berwick D, Clancy C, Conway J, Gluck P, Guest J, et al. Transforming
healthcare: a safety imperative. Qual Saf Health Care. 2009;18(6):424-8.

How to Use the Guide to Patient and Family Engagement

16.
Walker EP. CMS releases final rule on same-sex hospital visits 2011 [updated
2011/01/26/]; Available from: http://www.medpagetoday.com/Washington-Watch/WashingtonWatch/23496.
17.
Keroack MA, Youngberg BJ, Cerese JL, Krsek C, Prellwitz LW, Trevelyan EW.
Organizational factors associated with high performance in quality and safety in academic
medical centers. Acad Med. 2007;82(12):1178-86.
18.
Silow-Caroll S, Alteras T, Stepnick L. Patient-centered care for underserved populations:
definition and best practices. Washington, D.C.2006.

How to Use the Guide to Patient and Family Engagement

Insert hospital logo here

The Guide to Patient and Family
Engagement in Hospital Quality
and Safety:
What Is It, and How Does It Benefit Our Hospital?
[Insert hospital name, presenter name and
title, date of presentation]

Today’s presentation





What is patient and family engagement?
Benefits of patient and family engagement and costs
of not pursuing it
Guide to Patient and Family Engagement
Moving forward: What do we need to do?

Patient and family
engagement: Improving the
care we provide

Hospital quality





Patients get care that is safe



No differences in treatment based on race,
ethnicity, income, education, or social status



Care is patient- and family-centered

Patients get the right care for their condition
Patients get care they need when they need it
Patients get care that makes wise use of
resources

What is patient and family engagement?


Critical component of patient- and familycentered care



Patient and family engagement means
involving patients and family members as:
♦

Members of the health care team

♦

Advisors working with clinicians and leaders
to improve policies and procedures

Goal of patient and family engagement


To create an environment where hospital
leaders, clinicians, hospital staff, patients, and
families all work together as partners to improve
the quality and safety of hospital care

Benefits of patient and family engagement




Overall improvements in quality and safety
♦

Reduction in medical errors

♦

Decreased length of stay

Improved financial performance
♦

Better earnings and revenue

♦

Decreases in litigation and malpractice
claims

♦

Improved patient flow and increased bed
capacity

Benefits of patient and family engagement







Improved CAHPS® Hospital Survey scores
Better patient outcomes
Increased market share and competitiveness
Increased employee satisfaction and retention
Better response to the Joint Commission
standards

Benefits of patient and family engagement
Patient and family engagement:



Is consistent with our mission and vision
[Insert mission statement]



Helps us meet our strategic priorities
[Insert relevant priorities, such as reputation,
CAHPS® Hospital Survey scores, the Joint
Commission standards]



Is the right thing to do
[Share story from patient or family, or have
them share their story]

Costs of not pursuing patient and family
engagement
Potential negative effects on:
 Market share
 Ability to hire and retain quality staff
 Reputation
 Financial incentives based on CMS mandates
and health care reform (e.g., value-based
purchasing)

The Guide to Patient and
Family Engagement
What is it?
What do we want to do?

Guide to Patient and Family Engagement



Evidence-based strategies that reflect critical
opportunities for engagement



Tools for hospital leaders, managers,
clinicians, patients, and families to encourage
patient and family engagement at a hospital
level and in their direct care

Guide to Patient and Family Engagement
Includes 4 strategies to support engagement:
1. Working With Patients and Families as
Advisors
2. Working With Patients and Families at the
Bedside: Communicating to Improve Quality
3. Working With Patients and Families at the
Bedside: Nurse Bedside Shift Report
4. Working With Patients and Families at the
Bedside: IDEAL Discharge Planning

Moving forward
What do we need from you?

What do we need from you?



Staff time to [implement strategy] OR



[Note: Be specific of what support you need
and who will be responsible for the initiative]

Staff time to form a multi-disciplinary team to
assess our hospital and decide which strategy
to implement

What else can you do?


Communicate the hospital’s vision and values
related to patient and family engagement



Model collaboration and communication with
patient and family members



Support the necessary infrastructure and
resources




Involve and support clinicians and hospital staff
Integrate patient and family engagement with
personnel practices and policies



[Note: you may wish to end the presentation in
one of the following ways:
♦

Download and show the AHA Video: Patientand Family-Centered Care: Partnerships for
Quality and Safety

♦

Ask a patient or family member to speak to
leadership about their experiences receiving
care at your hospital]

Thank you!


For questions or more information:
[Insert contact name and information]

Supporting Patient and Family Engagement:
Best Practices for Hospital Leaders

The Guide to Patient and Family Engagement in Hospital Quality and Safety (the Guide) is an
evidence-based resource to help hospitals improve quality and safety by engaging patients and
family members.1 The goal of patient and family engagement is to create an environment where
clinicians, hospital staff, patients, and families work together as partners to improve the quality
and safety of care.
This document is for hospital leaders and describes what they can do to set the contextual
environment for change.
Strong hospital leadership is essential for creating and sustaining a supportive environment for
patient and family engagement.(1-5) Leaders who advocate for and participate in change
initiatives significantly increase the hospital’s ability to innovate and sustain change.(4, 6)
Leaders help to:
•

Communicate the hospital’s vision and values related to patient and family engagement.

•

Model collaboration and communication with patients and family members.

•

Provide the necessary infrastructure and resources.

•

Involve and support clinicians and hospital staff in patient and family engagement
initiatives.

•

Integrate patient and family engagement into personnel policies and practices.

Supporting Patient and Family Engagement: Best Practices for Hospital Leaders

Communicate the Hospital’s Vision and Values Related to Patient and
Family Engagement
Leaders who establish and communicate the vision for patient and family engagement help
ensure that all hospital staff recognize the importance of patient and family engagement for
improving safety and quality of hospital care.
Align the hospital’s mission and vision statements to support patient and family
engagement. Mission and vision statements are tangible representations to clinicians, staff,

patients, and families of your hospital’s commitment to patient and family engagement. They
create a pathway for change, and foster a shared sense of purpose by prioritizing critical
elements.(7) Ideally, your hospital’s mission statement will articulate a clear commitment to
patient and family engagement; reflect the perspectives and input of all involved parties,
including clinicians, staff, patients, and family members;(8) and clearly articulate simple
elements that can be easily repeated and embedded in routine activities.(9) Exhibit 1 provides an
example of a hospital mission statement which shows a commitment to patient and family
engagement.
Exhibit 1. Cooper University Hospital’s Mission Statement
•

A patient is an individual to be cared for, not a medical condition to be treated.

•

Each patient is a unique person with diverse needs.

•

Each staff member is a caregiver, whose role is to meet the needs of each patient.

•

Our patients are our partners and have knowledge that is essential to their care.

•

Our patients’ family and friends are also our partners in our patients’ well-being, and we
welcome their involvement.

•

Access to understandable health information is essential to empower patients to participate in
their care, and it is our responsibility to provide access to that information.

•

The opportunity to make decisions is essential to the well-being of our patients. It is our
responsibility to maximize patients’ opportunities for choices and to respect those choices.

•

Our patients’ well-being can be enhanced by an optimal healing environment.

•

In order to effectively care for our patients, we must also care for each other.

•

Patient- and family-centered care is the core of a high quality health care system and a
necessary foundation for safe, effective, timely, and equitable care.

Incorporate patient and family engagement into the strategic plan. As a mechanism to

implement concepts from the mission statement, your hospital’s strategic plan can lay out how
patient and family engagement fits into organizational priorities and processes on a daily,
2

Supporting Patient and Family Engagement: Best Practices for Hospital Leaders

operational basis. For example, as part of a process to integrate various entities under a common
organizational umbrella and identity, the University of Wisconsin Health (UWH) revised its
strategic plan, adding “service excellence” as a formal strategic pillar. In defining what service
excellence meant, the strategic plan clearly emphasized the organization’s focus on patient- and
family-centered care, with patient and family engagement being a major part of that effort. To
make that plan a reality, organizational leaders supported several specific initiatives, including
allowing family members on hospital units 24 hours a day, creating patient and family advisory
councils, and integrating patients and families on various quality and safety committees.(10)
Repeatedly communicate your organization’s mission, vision, and commitment to patient
and family engagement. An essential role for senior leadership is disseminating clear messages

about the importance of patient and family engagement. As the former CEO of Cincinnati
Children’s Hospital notes, sometimes one has to “be pushy” about expectations. In every talk,
leaders should reinforce your hospital’s vision for patient and family engagement, and note that
patient and family engagement is not a choice, it is an expectation. Find ways to communicate
with staff on a regular basis (for example, via email or audio/video messages). For example, the
CEO of UWH sends out a weekly one-page communication to each staff member that focuses on
the organization’s key strategic priorities, including patient and family engagement.(10)
Likewise, the CEO or another senior leader at Enloe Medical Center in Chico, California, sends
out messages about patient and family engagement-related issues each week that can be accessed
on a dedicated phone line by any employee. E-mails encourage staff to listen to the messages;
messages are also posted in hard copy in areas where employees and physicians congregate.(1)
Incorporate patient and family stories whenever possible. Leaders can use patient and

family stories to convey the type of care your hospital is striving to provide. In discussing
successes or failures, tell stories about patients, not just statistics. Some organizations have
created a policy whereby every meeting begins with a “mission moment” during which a staff
member shares a story about a particular patient or reads a patient letter. The patient story
establishes the tone for the meeting and serves as a reminder to discuss issues with the patient
and family in mind.(1)
Share outcomes related to patient and family engagement. Top performing hospitals

monitor, report, and share data about quality, safety, and patient satisfaction measures with
clinicians and staff. By sharing data about your organization, it helps staff identify areas for
improvement. It also allows them to see where the hospital is doing well – by sharing positive
experiences, you can celebrate successes and help hospital staff learn from each other.

Supporting Patient and Family Engagement: Best Practices for Hospital Leaders

Model Collaboration and Communication With Patients and Family
Members
By “talking the talk” and “walking the walk,” hospital leaders emphasize the importance of
patient and family engagement and model how to engage in best practices on a daily basis.(11)
Conduct leadership rounds regularly with staff, patients, and family members. Rounding

connects senior leaders and board members with patients and families, and also sends a clear
signal to staff that leadership is committed to patient and family engagement. For example, at
Alegent Health at Midlands in Nebraska, the COO regularly conducts leadership rounds, often
taking pictures of things that he finds inspiring and then sharing the photos in presentations and
newsletters to celebrate and reinforce patient- and family-centered practices.(1) Including
patients and family members on leadership rounding teams can send an even stronger message
about the importance of patient and family input and insight.
Establish channels for direct communication with patients and family members. Senior

leaders can communicate and interact directly with patients and family members in ways that
publicly emphasize two-way communication. For example, the former CEO of the University of
Colorado Hospital started a program whereby patients and family members could send him
feedback about their experience via email. He responded to each email personally and often
forwarded relevant messages to appropriate staff so that they could see the feedback, whether
positive or negative.(2) This program sent a strong signal to the entire organization about the
importance of listening to patients and families.
Involve patients and families in the development of policies and procedures. Leaders can

involve patients and family members as hospital-level advisors and enforce the authentic
involvement of these advisors. For example, you can require that any planning initiative include
patients and family members as part of the team before they can move forward.
Attend meetings of Patient and Family Advisory Councils to discuss hospital priorities
and seek input from council members. At hospitals within UWH, the CEO, CMO, and Senior

Vice President for Patient Care Services periodically attend meetings of the patient and family
advisory councils.(10) At Duke University Health, the chancellor of the health system, senior
leaders from the system’s hospitals, the system-level patient safety officer and chief nursing
officer regularly attend meetings of Duke’s Patient Advocacy Council.(12) The chancellor of the
health system and other senior leaders also participated in the original interviewing and selection
process for the Patient Advocacy Council.(12)

Provide the Necessary Infrastructure and Resources
Although hospitals do need not to make major investments to effectively implement patient and
family engagement strategies, moving forward does require resources to create and maintain
opportunities for patient and family engagement.
4

Supporting Patient and Family Engagement: Best Practices for Hospital Leaders

Create an organizational structure with a place for patient and family engagement.

Creating an organizational structure with a place for patient and family engagement helps ensure
responsibility and accountability for progress. The specific organizational structure for patient
and family engagement and patient- and family-centered care varies from organization to
organization. For example, Cincinnati Children’s Hospital created a core corporate function,
housing patient- and family-centered care under the Senior Vice President for Quality and
Transformation. Some organizations elect to set up a small, dedicated office or department to
support patient- and family-centered care, such as MCGHealth’s Center for Patient and FamilyCentered Care.(2) Other organizations have created a Steering Committee for Patient- and
Family-Centered Care or a Patient Experience Team with responsibility for these functions.
Provide resources for staff positions to support patient and family engagement.

Additional staff may be needed to develop, implement, integrate, and coordinate various
initiatives, such as recruiting, selecting, and training patient and family advisors or establishing
patient and family advisory councils. Important roles here include staff “champions,” patientand family-centered care coordinators, or staff liaisons to patient and family advisors (for more
about staff liaisons, see the Component 2, Working With Patients and Families as Advisors:
Implementation Handbook). These key staff members at the operational level help translate the
vision you articulate into practical programs and procedures. These individuals are often existing
employees, such as nurse leaders, with institutional memory and the necessary connections at
both administrative and clinical levels to “get things done.”(2) Patient and family engagement
activities can take up a meaningful portion of the champion’s time. For example, at SUNY
Upstate in Syracuse, NY, the champion spends roughly three-quarters of her time on activities
related to patient- and family-centered care, including integrating such activities throughout the
organization.(2)
Provide opportunities for ongoing education and training. Training and education needs

will vary by institution. For some organizations, investing in temporary or permanent “coaches”
helps with the transition to patient and family engagement. For example, the University of
Washington Medical Center’s Office of Medical Affairs employs a nurse who serves as “MD
Coach.” The coach observes residents as they conduct patient interviews and assessments, and
provides feedback on their skills in communicating with and engaging patients and family
members.(1) Other organizations prove opportunities for formal education, training sessions, or
retreats. MCGHealth held a series of 4 hour, offsite retreats that focused on patient- and familycentered care, after which staff were required to develop an “action plan” tailored to their
sites.(2) Mid-Columbia Medical Center in Oregon hosted a 5 day cultural orientation process for
all employees featuring an “experience center” that allowed staff to act as a patient.
Build in longer-term resources for the expansion of activities. Longer-term, investment in

new resources or the upgrading of existing resources may be necessary to further your
organization’s commitment to patient and family engagement.(13) For example, hospitals may
Supporting Patient and Family Engagement: Best Practices for Hospital Leaders

wish to invest in information technology and create patient portals and Web sites that facilitate
the ability of patients and family members to access vital information about the hospital and their
own care (e.g., about facilities and services, clinical information), communicate with physicians,
make appointments, view personal health information, or retrieve test results. As another
example, hospitals may invest in the built environment. Because the quality of the physical
environment in which care is provided represents a critically important component of patientand family-centered care, hospitals may wish to dedicate resources to physically alter patient
rooms or common spaces in accordance with patient- and family-identified needs(9).

Involve and Support Clinicians and Hospital Staff in Patient and
Family Engagement Initiatives
Changing to a culture of quality, patient safety, and patient and family engagement will be more
likely to succeed if senior leaders include hospital staff and physicians in the change process
from the beginning, listen to and address their concerns, and support them throughout the
process.
Offer a range of opportunities for involvement in planning, implementation, and
evaluation. These opportunities should complement the availability and schedule of clinicians

and hospital staff so that it is not seen as “one more thing to do.” By including staff in all phases
of initiatives, you can help address staff concerns and create buy-in for patient and family
engagement. For example, involve staff in the development of statements of core values and new
practices, ask nurses to help revise job expectations, or invite front line staff to participate in the
planning process for new patient and family engagement initiatives.
Communicate regularly and openly with staff. During face-to-face dialogue, you can reiterate

your organization’s commitment to patient and family engagement and make sure staff has the
support they need to continue in these efforts.(1) Some leaders set aside specific times to be
available to staff through “fireside chats,” “town-hall” meetings, breakfast sessions, and other
venues, creating a systematic process that gives every employee this opportunity at least once a
year. During conversations with staff, it is important to be open about challenges. Emphasize that
patient and family engagement is a journey, not a destination, and acknowledge that your
organization will continue to learn from both successes and failures.
Create opportunities for peer-to-peer learning. Creating mechanisms to bring together

physician and other clinical staff leaders gives staff the opportunity to problem-solve about
potential challenges associated with your hospital’s patient and family engagement journey. For
example, a Physician Advisory Council at Aurora Health Care in Milwaukee, Wisconsin gives
physician leaders an opportunity to discuss the challenges of implementing changes throughout
the system. To further leverage this peer-to-peer approach, several Aurora physicians produced
video modules that tell fellow physicians how they incorporate patient and family engagement
into everyday practice.(1)
6

Supporting Patient and Family Engagement: Best Practices for Hospital Leaders

Integrate Patient and Family Engagement Into Personnel Policies and
Practices
Integrating patient and family engagement into personnel policies and practices transforms
patient and family engagement from something that is “nice to do” to something that is
necessary.
Incorporate patient and family engagement into job descriptions. Senior leaders can make

sure personnel policies create clear expectations for behavior and hold employees accountable by
revising job description responsibilities. Even minor tweaks can serve as a reminder to staff that
patient and family engagement is a part of their everyday jobs. Job descriptions that incorporate
patient and family engagement can guide recruitment and hiring processes within the
organization and serve as a template for evaluating and rewarding performance.(2) Physician
contracts also can be revised to specify patient and family engagement practices. Exhibit 2
provides a job description that incorporates patient- and family-centered care practices.
Exhibit 2. Job Descriptions That Incorporate Patient- and Family-Centered Care Practices
Revising job description responsibilities
The University of Washington Medical Center in Seattle, Washington, revised job descriptions for frontline clinical staff to incorporate patient- and family-centered care practices. (1)
Original text (related to one responsibility):
“Assess patient pain interfering with optimal level of function or participation in rehabilitation.”
Revised text:
“In discussion with patient and/or family, assess patient pain interfering with optimal level of function or
participation in rehabilitation.”

Set expectations during the hiring and orientation process. Hiring and new employee

orientation processes are opportunities to set appropriate expectations about patient and family
engagement. Having patient and family members interview potential hires and take part in new
employee orientations is one way to send a particularly powerful message to new staff. At
MCGHealth, new employee orientation includes a session on patient- and family-centered care
principles, standards, and practices, and the role of Patient and Family Advisors.(2) Exhibit 3
provides an example of how patient and family engagement can be incorporated into the hiring
and orientation processes.

Supporting Patient and Family Engagement: Best Practices for Hospital Leaders

Exhibit 3. Incorporating Patient- and Family-Centered Care in the Hiring and Orientation
Process
Translating vision into expectations
Vanderbilt Children’s Hospital makes patient and family engagement an integral part of both the hiring
and orientation process. As part of the process of defining core values, hospital leaders created a
framework for continuous learning known as FOCUS (Family-centered care, One team, Continuous
improvement, Unique environment for children, and Service excellence). Using FOCUS, leaders
restructured hospital processes and policies, including recruitment and hiring, to reflect these values.
Prospective employees now learn about FOCUS during the application and interviewing process and
discuss if and how they have used such values. Once hired, employees learn more about FOCUS during
orientation, learning how to translate FOCUS values into individual behaviors. New employees also sign a
statement indicating their commitment to FOCUS values.(2) These efforts serve to set very clear
expectations for all new hires about the importance of patient- and family-centered care and patient and
family engagement within the organization.

Create a “compact” with medical and other staff. Virginia Mason Medical Center in Seattle,

Washington, developed a physician compact focusing on each party’s role and obligations in
promoting patient and family engagement. Signed by both parties, the document replaced an
unspoken compact that defined a relationship based on “entitlement, protection, and autonomy”
with a new one focused on the patient.(9)
Include patient and family engagement in annual performance reviews. Vanderbilt

Children’s Hospital incorporates patient- and family-centered care values into its annual
appraisal process by asking each employee to describe an example of how he or she has applied
these values in the past year.(2)
Tie compensation to patient and family engagement. Tying compensation structures,

including annual raises or bonuses, to measures of patient and family engagement sends a
powerful message about the importance of active collaboration with patients and family
members. For example, MCGHealth uses compensation to promote patient-and family-centered
care by allocating a significant portion of the $40 million available in annual staff bonuses to
performance on related competencies.(2) Any financial incentives should apply at all levels of
the organization, from senior leaders to medical staff to front-line employees.
Create non-financial rewards and recognition. Managers can use newsletters, “employee-of-

the-month” programs, and other awards or prizes to recognize and honor individuals or
departments who go above and beyond in terms of their efforts to practice patient and family
engagement.(1) For example, one academic medical center awards a “mobile” patient
satisfaction trophy each quarter to the department with the highest score on a particular Press
Ganey satisfaction survey question and to the department that shows the most improvement each
quarter. These awards have a major impact on staff morale and behaviors. Winning departments

Supporting Patient and Family Engagement: Best Practices for Hospital Leaders

receive tremendous recognition within the organization, including being featured prominently in
an internal newsletter.(14)

Key Take-Aways
Senior leaders have a tremendous role in ensuring that the hospital environment is conducive to
the success of patient and family engagement. Leaders communicate the hospital’s vision and
values related to patient and family engagement; model collaboration and communication with
patients and family members; provide the necessary infrastructure and resources; involve and
support clinicians and other hospital staff in patient and family engagement initiatives; and
integrate patient and family engagement into personnel policies and practices.

Supporting Patient and Family Engagement: Best Practices for Hospital Leaders

References
1.
Frampton S, Guastello S, Brady C, Hale M, Horowitz S, Smith S, et al. Patient-centered
care improvement guide. Picker Institute; Planetree; 2008.
2.
Shaller D, Darby C. High-performing patient- and family-centered academic medical
centers: cross-site summary of six case studies. 2009 [updated 2011/01/26/]; Available from:
http://www.upstate.edu/gch/about/special/picker_report_7_09.pdf.
3.
Liebhaber A, Draper DA, Cohen GR. Hospital strategies to engage physicians in quality
improvement. Issue Brief Cent Stud Health Syst Change. 2009(127):1-4.
4.
Institute for Healthcare Improvement NICHQ. Elements of hospital-based patient- and
family-centered care. IHI; NICHQ; 2009.
5.
Conway J. Getting boards on board: engaging governing boards in quality and safety. Jt
Comm J Qual Patient Saf. 2008;34(4):214-20.
6.
Weiner BJ, Shortell SM, Alexander J. Promoting clinical involvement in hospital quality
improvement efforts: the effects of top management, board, and physician leadership. Health
Serv Res. 1997;32(4):491-510.
7.
Keroack MA, Youngberg BJ, Cerese JL, Krsek C, Prellwitz LW, Trevelyan EW.
Organizational factors associated with high performance in quality and safety in academic
medical centers. Acad Med. 2007;82(12):1178-86.
8.
American Hospital A, Institute for Family-Centered C. Strategies for leadership patient and - family-centered care: a hospital self-assessment inventory. American Hospital Association;
Institute for Family-Centered Care; 2004.
9.

Shaller D. Patient-centered care: what does it take? n.p.: The Commonwealth Fund; 2007.

10.
Sanford-Ring, Susan, Director of Quality and Patient Safety at the University of
Wisconsin Hospital and Clinics. Interviewed by American Institutes for Research project staff.
16 Jul 2010.
11.
Weber V, Joshi MS. Effecting and leading change in health care organizations. Jt Comm
J Qual Improv. 2000;26(7):388-99.
12.
Milne, Judy, Patient Safety Officer at Duke University Hospital. Interviewed by
American Institutes of Research project staff. 9 July 2010.
13.
Devereaux MW, Drynan AK, Lowry S, MacLennan D, Figdor M, Fancott C, et al.
Evaluating organizational readiness for change: a preliminary mixed-model assessment of an
interprofessional rehabilitation hospital. Healthc Q. 2006;9(4):66-74.
14.
Confidential interview with the Deputy Director of Nursing and Patient Safety officer at a
major academic medical center. Interview conducted by American Institutes for Research project
staff. 23 Jul 2010.

Supporting Patient and Family Engagement: Best Practices for Hospital Leaders

Component 3
Topic Area 4:
Additional Resources

Ways to Learn More
Ways to Learn More
This document contains links to resources on the following topics:
•

Getting started with patient- and family-centered care and patient and family engagement

•

Assessing patient- and family-centered care practices at your hospital

•

Quality improvement

•

Patient safety

•

Working with patients and families as advisors

•

Improving discharge practices

•

Other resources for improving patient- and family-centered care practices
o Patient- and family-activated rapid response teams
o Improving informed consent practices

General resources
Agency for Healthcare Research and Quality (AHRQ)
AHRQ is a U.S. government agency that is part of the Department of Health and Human
Services. AHRQ funds, conducts, and disseminates research to improve the quality, safety,
efficiency, and effectiveness of health care. Their Web site has information to help patients,
families, clinicians, leaders, and others make informed decisions about health care.
Available at: www.ahrq.gov

Getting started with patient- and family-centered care and patient and
family engagement
Advancing the Practice of Patient- and Family- Centered Care: How to Get
Started
A guide from the Institute for Family-Centered Care that describes patient- and family- centered
care and emphasizes how hospital leaders can initiate the practice and use it to help fulfill the
hospital’s overall mission.
Available at: http://www.ipfcc.org/pdf/getting_started.pdf

Ways to Learn More

Strategies for Leadership: Patient- and Family- Centered Care
A toolkit from the American Hospital Association and the Institute for Family-Centered Care
that includes a video, hospital self-assessment tool and other materials aimed to help hospitals
partner with patients and their families in health care.
Available at: http://www.aha.org/aha/issues/Quality-and-Patient-Safety/strategiespatientcentered.html
Patient and Family Engagement
A resource from the National Priorities Partnership that explains what patient and family
engagement is and provides tools organizations can use to learn more about the concept.
Available at: http://www.nationalprioritiespartnership.org/PriorityDetails.aspx?id=596
Institute for Healthcare Improvement (IHI)
Non-profit organization dedicated to improving health care. Website contains resources and
improvement tools to promote health care quality and safety for providers.
Website:

www.ihi.org

Transforming Care at the Bedside
A resource from the Institute for Healthcare Improvement and the Robert Wood Johnson
Foundation created to establish “Safe and reliable care, vitality and teamwork, patient-centered
care and value-added care processes.”
Available at:
http://ihi.org/IHI/Programs/StrategicInitiatives/TransformingCareAtTheBedside.htm
Planetree
Non-profit membership organization focused on implementing patient and family-centered
models of care, the development and dissemination of successful practices, and the recognition
and designation of exemplar organizations.
Web site:

www.planetree.org

Ways to Learn More

Assessing patient- and family-centered practices at your hospital
Strategies for Leadership – Patient- and family-centered care Hospital SelfAssessment Inventory
An assessment inventory from the American Hospital Association and the Institute for Patientand Family- Centered Care. Designed to assist hospitals and health care staff in defining and
evaluating engagement efforts.
Available at: www.aha.org/aha/content/2005/pdf/assessment.pdf
Patient- and family-centered care Organizational Self-Assessment Tool
A checklist from the Institute for Healthcare Improvement and the National Initiative for
Children’s Healthcare Quality. Developed to help hospitals evaluate whether specific aspects of
their organization have a patient and family centered focus.
Available at:
www.patientsafetyinstitute.ca/English/toolsResources/GovernancePatientSafety/AssessImproveP
atientSafetyCulture/Documents/Organizational%20Assessment.pdf
Are families considered visitors in our hospital or unit?
A checklist from the Institute for Patient- and Family-Centered Care designed to help hospitals
examine their practices and infrastructure to assess how well patient and family presence and
participation is supported.
Available at: www.ipfcc.org/advance/arefamiliesvisitors.pdf
AMA Ethical Force Program Toolkit
The American Medical Association’s Ethical Force Program® has created a toolkit to help
hospitals assess how effectively they communicate, so they can target resources for improvement
exactly where they're needed.
Available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/the-ethicalforce-program.shtml

Ways to Learn More

Quality improvement
Agency for Healthcare Research and Quality (AHRQ): Quality Information and
Improvement
The Agency for Healthcare Research and Quality (AHRQ) in the Department of Health and
Human Services maintains a section of their Web site with tools, resources, and case studies
related to quality improvement along with links to quality information for consumers.
Available at: http://www.ahrq.gov/qual/qualix.htm
How to Improve
A resource about the Model for Improvement developed by the Associates in Process
Improvement that guides hospitals in setting goals, measuring outcomes, and implementing
changes for organizational enhancement.
Available at:
http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/
Patient-Centered Care Improvement Guide and Long-Term Care Improvement
Guide
These free, downloadable guides from Planetree include organizational self-assessment for acute
and long-term care settings, evidence for the business case for patient-family centered care, and
tools and resources for changing hospital and health care culture.
Available at: http://www.planetree.org or http://pickerinstitute.org/
Improving America’s Hospitals: The Joint Commission’s Annual Report on
Quality and Safety
A listing of annual reports from the Joint Commission that present scientific data on quality,
safety and outcomes for medical issues in hospitals nationwide.
Available at: http://www.jointcommissionreport.org/performanceresults/sentinel.aspx
The CAHPS Improvement Guide: Practical Strategies for Improving the Patient
Care Experience
A resource from the Agency for Healthcare Research and Quality that identifies the usefulness of
Patient and Family Advisory Councils and provides tips on implementing a Council within a
health care organization.
Available at: http://www.cahps.ahrq.gov/qiguide/content/interventions/PFAdvisoryCouncils.aspx

Ways to Learn More

Patient safety
Agency for Healthcare Research and Quality (AHRQ): Patient Safety Tools and
Resources
The Agency for Healthcare Research and Quality (AHRQ) in the Department of Health and
Human Services maintains a section of their Web site with research findings, tools, resources,
and training related to patient safety.
Available at: http://www.ahrq.gov/qual/pstools.htm
Consumers Advancing Patient Safety (CAPS)
Organization that envisions a partnership between consumers and health care providers to create
healthcare systems that are safe, compassionate, and just. Information and resources for patients
and providers.
Website:

www.patientsafety.org

Josie King Foundation
Information and resources about patient safety, the prevention of medical errors, and how health
care providers and consumers can work together.
Website:

www.josieking.org

National Patient Safety Foundation (NPSF)
Organization dedicated to improving the safety of patients through education and raising public
awareness. Information about patient safety issues and a variety of resource links.
Website:

www.npsf.org

Speak Up Initiatives
A national campaign launched by the Joint Commission and the Centers for Medicare and
Medicaid Services that encourages patients to take a more informed and involved role to prevent
errors. Includes brochures, posters and other materials on various patient safety topics.
Available at: http://www.jointcommission.org/patientsafety/speakup/

Ways to Learn More

Working with patients and families as advisors
Institute for Patient- and Family-Centered Care (IPFCC)
Organization that provides leadership to advance the understanding and practice of patient- and
family-centered care. Guidance, information, and resources related to multiple aspects of patientand family-centered care and involving patients and family advisors in the planning, delivery,
and evaluation of care.
Website:

www.ipfcc.org

A Patient and Family Advisory Council Workplan: Getting Started
A workplan from the Institute for Family-Centered Care that helps hospitals initiate and organize
a family advisory council.
Available at: http://www.ipfcc.org/advance/IFCC_Advisoryworkplan.pdf

Exa m p le s o f Pa tie n t a n d Fa m ily Ad vis o ry Co u n c ils in Ac tio n :
MCGHealth in Augusta, GA has more than 225 trained patient and family advisors who are
members of patient and family advisory councils, sit on quality and safety teams, and contribute
to facility design processes.
Available at: www.mcghealth.org/patient-family-centered-care/McgContentPage.aspx?nd=2546
Memorial Regional Hospital in Hollywood, FL has Patient and Family Resource Centers that
provide useful heath information to patients and the community. The hospital’s Patient and
Family Advisory Councils provide direct input on many organizational policy and engagement
efforts.
Available at: www.mhs.net/patients/pfcc/
Dana-Farber Cancer Institute in Boston, MA established the Adult Patient and Family
Council to assist patients and their families collaborate with hospital staff, become involved in
overall patient care and participate in cancer programs and services.
Available at: www.dana-farber.org/pat/pfac/adult-advisory/default.html
The Wilmot Cancer Center in Rochester, NY has a 19 member Patient and Family Advisory
Council that strengthens coordination between patients, families, and their health care provides
as well as promotes patient and family advocacy in their health care environment.
Available at: www.urmc.rochester.edu/cancer-center/patient-families/advisory-council.cfm

Ways to Learn More

Cincinnati Children’s Hospital Medical Center in Ohio has a 38 member Family
Advisory Council that empowers families to take part in their loved ones’ health care
experiences.
Available at: www.cincinnatichildrens.org/about/fcc/family/
The Children’s Hospital of Philadelphia established The Family Advisory Council to
represent patient and family perspectives during the development of organizational programs,
projects, and policies.
Available at: www.chop.edu/visitors/family-centered-care/family-centered-care-programs-atchop.html?id=88268

Improving discharge practices
Your Discharge Planning Checklist
A checklist provided by the Centers for Medicare and Medicaid Services that lists important
things patients and their families can do and be aware of during hospital discharge.
Available at: http://www.medicare.gov/publications/pubs/pdf/11376.pdf
Taking Charge of your Healthcare: Your Path to Being an Empowered Patient
This toolkit, developed by the Consumers Advancing Patient Safety organization, provides
patients and families the tools that will help smooth their transition from hospital to their next
destination, as well as encourage better communication with providers.
Available at: http://www.patientsafety.org/page/transtoolkit/
Project RED (Re-Engineered Discharge)
The RED intervention focuses on 11 discrete, mutually reinforcing components and has been
proven to reduce rehospitalizations and improve patient satisfaction. Funded by grants from the
Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health
(NIH)-National Heart, Lung and Blood Institute (NHBLI).
Available at: http://www.bu.edu/fammed/projectred/

Ways to Learn More

The Care Transitions Intervention
A 4-week program where patients with complex care needs and family caregivers receive
specific tools and work with a Transition CoachTM to learn self-management skills that will
ensure their needs are met during the transition from hospital to home. Reduced readmissions
and encouraged patients and families to take more active role in their care. Funded by the John
A. Hartford Foundation and the Robert Wood Johnson Foundation.
Available at: http://www.caretransitions.org/
BOOSTing (Better Outcomes for Older adults through Safe Transitions) Care
Transitions resource room
Materials developed by the Society of Hospital Medicine to help hospitals optimize their
discharge process. Funded by the John A. Hartford Foundation.
Available at:
http://www.hospitalmedicine.org/ResourceRoomRedesign/RR_CareTransitions/CT_Home.cfm

Other resources for improving patient- and family-centered care
practices
Patient- and family-activated rapid response teams
Developing a Patient/Family-Activated Rapid Response Team
The University of Pittsburgh Medical Center assembled a team called Condition Help that
rapidly responds to hospital patients who feel their needs are being inadequately addressed
during a medical emergency.
Available at: http://www.rwjf.org/pr/product.jsp?id=30391
Condition H Toolkit
Maryland Patient Safety Center developed a toolkit to provide hospitals and other facilities the
tools and resources to implement effective patient and family activated rapid response teams.
Available at:
http://www.marylandpatientsafety.org/html/collaboratives/condition_h/toolkit/index.html
Guide to Deploying Rapid Response Teams
The Institute for Healthcare Improvement created a “How-to” Guide for deploying rapid
response teams as part of their 5 Million Lives Campaign.
Available at: http://www.ihi.org/IHI/Programs/Campaign/RapidResponseTeams.htm

Ways to Learn More

Improving informed consent practices
A Practical Guide to Informed Consent
A guide from Temple Health that thoroughly describes informed consent and offers tips to
improve the process for health care staff and patients.
Available at: http://www.templehealth.org/ICTOOLKIT/html/ictoolkitpage1.html
Informed Consent and Authorization Toolkit for Minimal Risk Research
A toolkit from AHRQ that focuses on informed consent for research purposes. The principles
used to create and implement informed consent documents and processes can be adapted across
the hospital setting.
Available at: http://www.ahrq.gov/fund/informedconsent/ictoolkit.pdf

Ways to Learn More

File Type	application/pdf
Author	Information Technology
File Modified	2011-02-04
File Created	2011-02-04