Wednesday, July 6, 2011

Future Patient Care Delivery Committee: Patient and Family-Centered Care

In its recent landmark report, the Institute of Medicine (IOM, 2010) envisioned the future of care delivery as patient-centered. They also indicated that healthcare should be “seamless, affordable, quality care that is accessible to all and leads to improved health.” This certainly seems to be in direct agreement with AONE’s Guiding Principles for Future Care Delivery.

Not only are healthcare providers to base care on a safe environment, but also we must individualize that care to the needs and circumstances of the patient and family (AONE, 2010). The Guidelines call upon us to recognize ourselves as “guests” in that environment, whether this is in the hospital or in the home. One might wonder how care givers will shift their views from that of “hosts” to that of “guests”. This idea calls to mind the image of a bow in those cultures where it is customary to bow when greeting. The late philosopher, Joseph Campbell, indicated that the bow is to acknowledge the deity within the greeted individual.

Inherent in care based on a patient and/or family focus, one might immediately think of the concept of Relationship-Based Care. Delivery of this type of care is obtainable only when we are able to understand what patients and families see as the most important aspects of their care (Person, 2004). Indeed we see that the development of a therapeutic and trusting relationship with the professional caregiver results in better patient satisfaction. Furthermore, nurse satisfaction and quality outcomes have shown improvement in this model.

As we look to the future (and does it not seem like the future is now?), we must consider the transition from acute care to home as not only seamless but also coordinated. Even more importantly our primary care model must shift to one of integrated from home and throughout the system (Birk, 2011). Birk points out that having fewer patients per PCP allows more time on the front end for care management. Think about our trends on the nursing floors. Are not many of our institutions trying to move to an increased patient assignment for the nurses? Does an increase in the number of patients for whom a professional nurse must develop a plan of care not reduce the amount of time that nurse has to provide for the management of care and to develop those trusting relationships? What IS that magic number? How will we support and institute changes to our care delivery models in this challenging financial climate?

Please consider using the resources and exemplars in the Future Care Delivery Toolkit as you navigate in the coming months. While the questions above are meant to be rhetorical, it does seem pertinent for leaders who have the opportunity to move towards effective, integrated, and coordinated care that keeps the patient and family at the center of all decisions.

Annelle Beall, MSN, RN, CNN, NE-BC

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