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Lessons from a children's hospital

Ridge, Richard A., PhD, MBA, RN, CENP, NEA-BC

doi: 10.1097/01.NUMA.0000470778.25354.ec
Department: Performance potential
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Richard A. Ridge is the director of Nursing Innovation and Outcomes at Texas Children's Hospital in Houston, Tex., and the coordinator of the monthly Performance Potential column.

The author has disclosed that he has no financial relationships related to this article.

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There are many lessons to be learned from children's hospitals that can be applied to other healthcare organizations. Several of these lessons are derived from an embedded commitment to the core principles of patient- and family-centered care (PFCC). Strategies adopted by children's hospitals that can be leveraged by nonpediatric hospitals include a fundamental commitment to PFCC, the use of specialists, and an overall pursuit of excellence.

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Patient- and family-centered care

As envisioned by the Institute for Patient- and Family-Centered Care (IPFCC), PFCC is exemplified by promoting collaborative and empowered relationships among patients, families, and healthcare professionals. Children's hospitals recognize the importance of encouraging patient and family strengths, choice, and independence. PFCC is embodied within the organizational culture of children's hospitals, reflected in the planning, delivery, and evaluation of services. Our family advisory boards are usually robust committees closely involved in the design of new facilities and programs, and the ongoing review of care delivery.

Core concepts of PFCC include dignity and respect, information sharing, participation, and collaboration.1 Patient and family knowledge, values, beliefs, and cultural backgrounds aren't only respected, but also actively solicited to be included into the planning and delivery of care. Providers are expected to provide timely, complete, and accurate information to effectively promote patient and family participation in the entire care process. Ensuring patient and family participation in all aspects of care becomes a fundamental tenet of care. Finally, collaboration at all levels is expected. Children's hospitals collaborate with patients and their families during the actual care delivery process, as well as in healthcare facility design and program development and evaluation.

One of the key strategies advocated by the IPFCC is the shift from families as visitors to partners.2 Embraced by children's hospitals as fundamental to the premise of care, this shift in philosophy is more than just semantics. The term visitor implies that the family member's presence is optional and at the discretion of the hospital; however, viewing the family member as a full partner in caring is the essence of PFCC. Clinicians and healthcare organizations acknowledge and accept the patient's and family's expertise and strengths, encouraging their input and preferences related to treatment decisions and goals.

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Child life specialists

At children's hospitals, child life specialists promote effective coping through play, preparation, education, and self-expression activities. These specialists play an important role within the healthcare team by providing emotional support for families and optimal development of children experiencing acute healthcare conditions and hospitalization. They provide guidance not only to the patients, but also to the parents and siblings.

An adult corollary to the child life specialist is the Hospital Elder Life Program (HELP), which focuses on improving the care of hospitalized older patients.3,4 HELP volunteers or paid staff provide a level of social and cognitive engagement beyond that provided by conventional hospital caregivers such as nurses and unlicensed assistive personnel. HELP staff members focus on preventing cognitive and functional decline and hospital falls, and promoting higher levels of independence at discharge. They promote orientation to the patient's surroundings, mobility through accompanied walking schedules, and better nutrition and fluid intake while hospitalized.

Nonpediatric hospitals should consider implementing the HELP model or similar programs that go beyond the traditional treatment focus to enhance patient satisfaction and achieve better patient and hospital outcomes. Child life specialists are present in all care areas and waiting rooms to help children cope more effectively with the burden of illness and the challenges associated with treatment. Similarly, HELP specialists can have significant impact on older patients during prolonged alone time in the hospital room, while waiting for diagnostic testing or treatment, and at other times when social isolation is counterproductive to the patient's treatment goals.

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Pursuit of excellence

The top children's hospitals pursue excellence and quality in a relentless manner. The annual ranking of the best children's hospitals by U.S. News & World Report has become very important as an indicator of excellence.5 This framework is used as a benchmark model because national public databases, which are used extensively to evaluate nonpediatric hospitals, aren't as fully available for children's hospitals.

The current methodology combines clinical and operational data, results from a reputational survey of board-certified pediatric specialists, and supplemental information from resources such as the National Cancer Institute. Specifically, the model reflects the level and quality of hospital resources directly related to patient care, such as staffing, technology, and special services. Outcomes include patient survival, infection rates, and complications. The physician reputational survey currently accounts for no more than one third of the total score.

Children's hospitals capitalize heavily on the annual results in their marketing campaigns and Internet presence. Rankings aren't only used to market services, but also to attract physicians, nurses, and other clinical staff. Improving a ranking for an individual specialty is an important goal and external validation of achievement. The usefulness of the framework extends far beyond its value as a marketing tool.

The American Nurses Credentialing Center Magnet Recognition Program® is another well-known mark of nursing excellence that's very important in the children's hospital world.6 Each of U.S. News & World Report's top 10 children's hospitals has achieved Magnet recognition. Again, Magnet attainment isn't the most important aspect; the pursuit of nursing excellence as defined by the Magnet model components is the primary objective. Top children's hospitals, like other Magnet hospitals, strive for excellence in transformational leadership; exemplary professional practice; structural empowerment; new knowledge, innovations, and improvements; and empirical outcomes.

As the Institute for Healthcare Improvement recognizes, measurement is a critical part of testing and implementing change.7 Pursuing excellence requires highly effective and efficient change processes that are dependent on accurate, valid, and reliable data. Measurement by itself may monitor movement from a past value, but benchmarks are required to evaluate the organization's level of excellence. Benchmarks for similar patient populations are selected so that the organization can compare its progress against its own historical achievements, as well as external benchmarks. Thus, excellence is defined in relative terms, with rankings and percentile scores tracked to monitor progress.

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Expanding horizons

The principles of children's hospitals can easily be adapted and translated for use in nonpediatric hospitals to achieve higher levels of organizational and patient outcomes.

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REFERENCES

1. The Institute for Patient- and Family-Centered Care. Patient- and family-centered care. www.ipfcc.org/pdf/CoreConcepts.pdf.
2. The Institute for Patient- and Family-Centered Care. Changing the concept from families as “visitors” to families as partners. www.ipfcc.org/advance/topics/profiles-of-institutional-change.html.
3. Hospital Elder Life Program. www.hospitalelderlifeprogram.org/.
4. Inouye SK, Bogardus ST Jr, Baker DI, Leo-Summers L, Cooney LM Jr. The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc. 2000;48(12):1697–1706.
5. Olmstead M, Geisen E, Murphy J, Bell D, Morley M, Stanley M. Methodology: U.S. News & World Report best children's hospitals 2015-16. www.usnews.com/pubfiles/BCH_Methodology_2015.pdf.
6. American Nurses Credentialing Center. ANCC Magnet Recognition Program. www.nursecredentialing.org/magnet.aspx.
7. The Institute for Healthcare Improvement. Science of improvement: establishing measures. www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementEstablishingMeasures.aspx.
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