Amy Cohen, Program Manager of Patient- and Family-Centered Care at the UVM Medical Center talks about the new Welcoming Policy allowing for elimination of visiting hours and what else the Patient and Family Advisers are working on at the hospital.
Listen to the interview by clicking on the link below, or read the transcript that follows.
Learn more about Patient and Family-Centered Care at the University of Vermont Medical Center and how you can become a patient or family advisor.
UVM Medical Center: When you or your family members are in the hospital, you want your environment to be as stress-free as possible. In an effort to reduce stress for families, the UVM Medical Center has just removed traditional limitations on visiting hours in favor of giving patients control over who comes to see them and when. Research indicates that patients do better when they’re allowed to choose how and when their family and other supporters can be present and involved in their care. This is part of a broader initiative to change the way things are done at the hospital so that they are grounded in understanding the patient’s point of view. Here to explain more about the decision to remove traditional visiting hours and tell us about what else patient- and family-centered care has helped us accomplish is Amy Cohen, Program Manager of Patient- and Family-Centered Care at UVM Medical Center. Thanks for being with us, Amy.
Amy Cohen: Thanks so much for having me.
UVM Medical Center: Can you give us some background about this removal of visiting hours? How did it come about?
Amy Cohen: Well, we, as an organization, have made a commitment to patient- and family-centered care over the last two and a half to three years, and patient- and family-centered care is really a unique approach to health care that’s based on the idea of building mutually beneficial partnerships between patients, families, and healthcare providers. There are four sort of core concepts. The first is the idea of dignity and respect: That we treat all patients and their family members with dignity and respect, and that we value their preferences, their beliefs, their customs, and that we really attempt to incorporate them into the delivery of our health care. The second is that we commit to information sharing with patients and families in a way that’s transparent, and affirming of the kind of information they need to make healthcare decisions.
And then that we also commit as an organization to developing policies and procedures that allow patients and their family members – when they choose for their family to be involved – to really be able to participate in all aspects of healthcare decision-making and planning. Finally, there’s this concept of collaboration. The idea that we, as you said, are collaborating with patients and families as an organization around the way that we design our system. So, if you think about those concepts, one of the recognitions nationally is that in order to create an environment where patients really feel like they can participate in their healthcare planning and decision-making, and can have their family be a participant in healthcare planning and decision-making, we realize that we have to stop setting up kind of arbitrary restrictions around when families can be present and how they can be involved, and we really needed to open up our healthcare system.
In addition, I think you already referenced it, but part of the recognition for this change was just understanding that the literature doesn’t really support the benefits of restrictive visitation. I think, initially, people thought that it’s helpful to patients if we restrict the time that visitors can be there so we can assure that they get rest, and that the environment is quiet, and that they have some downtime away from the stress of having people come in and out, but the research literature doesn’t really support that. In fact, it shows that when we open up our environment and allow patients to be the ones to decide who’s involved and when they can be present, that patient’s health outcomes really do improve. They have a shorter length of stay. Their families are more prepared to care for them when they’re discharged from the hospital. They report having less stress and less agitation, and they’re just generally more satisfied with their hospital stay. So, all of those have really driven us to think about making a change.
UVM Medical Center: Does this change impact the whole hospital? Different parts of the hospital? Who will benefit from it?
Amy Cohen: One of the things that we really wanted to do when we were creating a new policy was to provide a consistent experience and consistent expectations for our patients and their families, and I think one of the things that we noticed when reflecting on our previous practices was that we thought we had a liberal visitation policy, and we certainly tried to be generous and welcoming to patients and families, but each unit worked a little bit differently. So, if you would visit our website, there would be a list of different practices on different units. What we wanted people to experience was a consistent flow if they were moved from unit to unit while they were in the hospital. As of May, we’ve now implemented the policy on all inpatient units throughout the medical center. That means that the patients who receive care here will have a consistent experience, and that their family will have consistent expectations of how and when they can be involved unit by unit regardless of where their loved one is at any point in time.
UVM Medical Center: Have you heard any reaction so far from patients and families? Maybe on the units that removed the rules earlier?
Amy Cohen: We certainly have heard feedback from patients and families that they believe it’s important to have the right to be at their loved one’s bedside when they feel like they need to be, and many people are excited about it. We have also heard plenty of stories about the challenge of being in a semi-private room, and either wanting your loved ones there while the other person wants more quiet, or that person having loved ones when you had wanted more quiet. That’s certainly going to be the area where we have the most continued work as the new policy is implemented to make sure that we can balance the needs of both patients in a shared room. However, we’re really excited about the new Miller building that’s being built at our organization, and the fact that once that building is opened most of our patient rooms will be private rooms, and it will really allow us an even better opportunity to kind of welcome people to the bedside, and also make them comfortable when they’re here supporting their loved one. Those new patient rooms will have a family area with more comfortable accommodations to be able to stay.
UVM Medical Center: Are there any other limitations that you can think of?
Amy Cohen: I did mention the idea of the shared room, and really what we are doing in those situations is working with nursing staff to try and be sure that we can understand the needs of both patients, and attempt to help them get their wishes met in the best way possible. Also, we will certainly hear from people who say, “The last thing I want is all of my family by my bedside when I’m not feeling well,” or, “Please don’t tell my mother she can stay around the clock,” and so it’s really important for people to hear that this new policy welcomes family according to the preferences of the patient. Some of our patients are very clear that they appreciate some time away from their loved ones, or that there are certain family members that would not be helpful to be at their bedside, and so we really have worked with our nursing staff to assure that they’re checking in with patients, that they’re learning about their preferences, and that they’re comfortable in the role of advocating for the patient when they do feel like they need a little bit of a break.
UVM Medical Center: You’re listening to Amy Cohen, who is the Program Manager of Patient and Family Centered Care at UVM Medical Center on HealthSource. We’re talking about the hospital’s recent decision to remove traditional visiting hours to help patients and families feel more in control of their care. Amy, can you tell us more about patient- and family-centered care?
Amy Cohen: Well, like most hospitals across the country our early work in patient- and family-centered care was really focused on pediatrics, and we have some pediatric champions who really started the movement at our organization at a very grassroots level. In particular, the Nurse Manager of our Inpatient Pediatrics Unit, Lisa Emerson, became very interested in the idea of patient and family-centered care early on – probably close to ten years ago – and she invested in training, and encouraged others in her unit and in our organization to get the training, and started early on engaging some families and asking them to advise the pediatrics unit on ways that they could become more patient- and family-centered.
Then, as I said earlier, about two and a half or three years ago our organization realized that, of course, patient- and family-centered care is not just something that we should be doing for sick kids and their families, but really the way that we should be treating all patients and their families. So, we made a transition at that time to really start thinking about patient- and family-centered care much more globally, and have really invested resources since then to develop a commitment and a shared understanding across the organization of, again, this idea of building mutually beneficial partnerships between patients and families.
I actually got involved initially as a patient and family advisor myself. I am the parent of a 10-year-old son who was born with some significant and complex health challenges, and so he has been a high-end user of health care since he was born and has spent a lot of time at our Children’s Hospital. As he was recovering from a surgery on one of the inpatient units, I saw a little sign in the corner that just said, “We’re interested in hearing from patients and families,” and I always tell the story that at the time I saw it and thought, “Yes, I probably have something to say.”
It suggested that you could go and visit the nurse manager on that unit, and I thought, “You know, I should go down there and talk to her,” and then I realized that I had probably not slept, and not showered, and probably wasn’t thinking that clearly. I think I was questioning myself, “You know, we already spend a lot of time at the hospital. Do I really want to spend more time here?” and thinking about all of these things. So, frankly, I did nothing at the time, and then I saw that same poster a couple of months later in a very different context. Of course, I was well rested, and feeling good, and feeling good about where things were for him, and I think I did the same kind of reflection and thought, “I think we have a lot to say and a lot to offer.”
I often share that I think my son has gotten really exceptional care through our Children’s Hospital which we’re very grateful for as a family, but I think like anyone who spends a lot of time in health care we also have lots of thoughts about things that could be done better, and areas that could be improved, and so I volunteered and joined our patient and family advisory council at the Children’s Hospital. Then, over time, I just increasingly became involved in some new initiatives.
One of the earliest projects that I was involved in is redesigning the way that we perform medical rounds on the Children’s Hospital Inpatient Unit, and so I was curious to sort of share our experience of rounds which is often that the medical team comes by very early. We’re often asleep, and we all jump up, and they have a quick conversation in lots of medical terms that we didn’t necessarily understand, and weren’t prepared to answer questions or ask questions about, and then the team moves on, and we sort of struggle the rest of the day to understand what the plan is and what to expect. So, I had this great opportunity to join a team that was thinking about, “How do we shift rounds to be much more family focused? How do we make the focus of that meeting the questions and the needs that families have while their children are in the hospital?” From there, it was really a great opportunity to start to think about how excited I am to see the shifts that we’re making across the organization.
UVM Medical Center: How could somebody listening get involved as they think, “Hey, I’ve got some ideas for the hospital?”
Amy Cohen: We are continually recruiting patient and family advisors. Those are the volunteers that work in partnership with us to help change health care in many different ways. Many of the advisors that we have certainly have, like my family, spent a lot of time in the hospital. Some of them have chronic conditions, or conditions that require them to access many different services throughout the organization, but other volunteers access the medical center for primary care or the occasional specialty visit, but recognize the important role of health care in our community. We really want to hear from all of those people, and the role is a very flexible one.
We have information on our medical center website about how to become involved as a patient and family advisor. Some folks volunteer for one or two hours a month by sitting on an advisory council, or joining a project, or committee work group like my example of the family-centered rounds work group. Some people provide us feedback electronically by answering questions over email or reviewing patient information, brochures, or education documents, and so there’s a lot of different ways for people to get involved. We’re excited to have people who are interested in sharing their perspective and sharing their story, reach out and get some more information.
UVM Medical Center: Great. Last question for you. How do you feel overall that this focus on patient- and family-centered care has impacted the hospital?
Amy Cohen: I’m really excited and optimistic about the progress that we have made as an organization, and the clear and measurable culture shift that we’re certainly seeing. We now have patient and family advisors on over 105 different projects or committees across the organization which is pretty exceptional, and we have a growing body of examples of how our staff are saying that hearing directly from patients or families about what’s important to them is really changing the way that they think about some of the work that’s being done. So I think it’s a really important development in health care to think about how we will continue to grow together with this kind of partnership. I’m just so impressed with our organization’s willingness to make that commitment to patients and families.
UVM Medical Center: Our guest today on Healthsource has been Amy Cohen, Program Manager of Patient- and Family-Centered Care at UVM Medical Center. Thanks very much for joining us, and telling us about the new welcoming policy.