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Dome - Including Patients and Families in the Conversation

Dome, Nov. 2009

Including Patients and Families in the Conversation

By: Karen Blum
Date: November 9, 2009

Elizabeth Flury urges a partnership approach
When it comes to patients’ needs, Elizabeth Flury urges a partnership approach, which begins with active listening.

Aiming to make the care that will be delivered in Johns Hopkins’ new clinical towers on the East Baltimore campus every bit as advanced as the structures themselves, administrators and clinicians are embracing what’s called patient-family centered care. The philosophy is simple: Care revolves around the preferences and needs of each patient, families are viewed as a patient’s source of strength, and patients and families are included in treatment discussions.“We need to not just talk at patients,” says Elizabeth Flury, senior director of clinical integration and transformation support for the Johns Hopkins Health System. “We need to listen to them, educate them, and allow them to have a voice in their own care.”

In developing care models for the different patient units, Flury and colleagues interviewed some 1,800 staff, patients and family members.

The official conversion to this model started last fall in a Weinberg Building unit serving pancreatic cancer patients. Nurses, physicians, patients and families participate in “huddle rounds” at the bedside, where daily goals are written on a white board in patients’ rooms. The unit offers extended visiting hours for family and a visitor lounge with coffee and Internet access.

This concept was first introduced several years ago, however, on the Nelson Building’s cardiac surgery unit. Nurse practitioners and physician assistants remain on the unit and are available to answer patient questions any time. There’s also a social worker assigned to the unit, and physical and occupational therapists come to patients’ rooms.

Including patients and families in all communications “sounds simple, but it’s a very difficult thing to do,” says Deborah Baker, director of nursing for the Department of Surgery, noting that through typical chains of command, a resident passes information to the attending physician without necessarily including others.

Yet when patients and families are included, the results speak for themselves. Baker says patients who have stayed on the Weinberg unit ask to return there because of the customer service. Hospital lengths of stay are down, and there’s little turnover among the staff. Nelson 6 has the highest patient satisfaction score in the hospital and the lowest perioperative mortality rates.