Patients Helping High Reliability

Hospitals are instituting patient & family advisory councils in order to Improve their cultures

Patient-centered care is an idea that seems simple, but can often be difficult to implement in practice. Building the kind of mutual respect and understanding that leads to a truly collaborative partnership requires a fundamental shift in healthcare culture.  

It’s also become increasingly important to regulatory agencies and accrediting bodies, like CMS (Centers for Medicare and Medicaid Services) and The Joint Commission, who have keyed in on patient engagement as critical to not only improving the hospital experience but also creating better health outcomes and care delivery systems.  

That’s why many hospitals have begun implementing Patient & Family Advisory Councils in their efforts to create stronger and more robust practices that take stock of all facets of the patient experience.

The drive behind creating these councils comes in part from the statewide commitment South Carolina hospitals have made to become highly reliable organizations. The concept of high reliability is more often associated with air flight than healthcare, but the same principles apply: operating in a complex, high-risk environment while delivering exceptionally safe and consistent results over a long period of time.

Roper St. Francis was one of the first hospitals in the state to embrace this idea with their Patient & Family Experience Council. The council was organized with the explicit goal of improving communication with patients in an effort to ensure high-quality experiences in their system.

“Instead of us sitting around the table asking what the patient needs, we have patients right there at the table,” points out Marion Martin, the director of Quality Improvement Services at the hospital. “It really helps us improve our high reliability culture.” 

The primary function of Roper’s council is to provide a mechanism for the direct exchange of ideas and suggestions between patients and representatives from the system, with a focus on identifying best practices as well as recommending new policies, programs, strategies, or services to address patient needs. Each meeting also features an educational component on anything from finances to pharmacies so council members can gain a better understanding of how hospitals work – and can help develop ideas on how to improve those processes. 

Martin says hospitals can often be a bit fearful about being so open about behind-the-scenes actions with patients and families, but that the shift is critical to changing to the kind of culture necessary for high reliability.

“You just have to be brave and do it,” she says. “We talk transparency, but are we really ready to talk about infection, to talk about falls, with patients? But I think that the tide has turned.”

While Roper St. Francis now has a well-established council, other hospitals, like Tidelands Health, are just beginning.

Gary Life, the manager of service excellence at Tidelands who has been in charge of organizing the hospital’s Patient & Family Advisory Council, echoes some of Martin’s concerns about recruitment. 

“We asked nursing leadership in each unit and all our outpatient areas to provide us with names of patients who might be willing to participate, both those that were very satisfied with their experience and those that weren't, necessarily, but were constructive in their criticism,” he recalls. 

From 60 names, they ended up with only five patients at one meeting and four at another, roughly half of their goal. Because Tidelands has two hospitals and split its meetings up, travel time was a huge barrier for the council.

“We're going back to the recruitment drawing board,” Life says. “We had two meetings, both of which were very successful for those that were there, but it just wasn't a sufficient amount of people.”

Despite such logistical problems, Life remains confident about the future role of the council in improving the quality of care.

“We really want to involve patients,” he says. “We're going to be doing some major construction at our north hospital, so we want to get their perspective on what the results of that construction could mean for them as consumers of our healthcare services. We're also working towards transparency, so we want to involve some of them in root cause analysis meetings. We just started our journey to transparency with our emergency department and their physicians. So, as we see things that happen there, we want to involve those patients that are appropriate in the process.”

Going forward, Life hopes to switch up the recruiting process and mitigate the distance problem somehow. His words of advice for other hospitals looking to start a council, aside from careful attention to recruiting and logistics? 

“Make it interactive rather than didactic. Don't just tell them what the hospital is doing and ask for questions. Actually involve them,” he concludes.