New Jersey success stories

NJ Local Success Stories
Quality improvement endeavors can often feel overwhelming, but chances are, you can learn from the experiences that another physician, hospital or nursing home has had in a similar situation. Coupled with support from Quality Insights Quality Innovation Network, learning what has worked for others — and what didn't — is a valuable strategic planning component. View local stories about the Everyone with Diabetes Counts (EDC) program


Creating Culture Change at The Valley Hospital: An Interview with Pam Bell

1/14/2016
PFCC Group PhotoThe Valley Hospital in Ridgewood, New Jersey, has taken action in integrating and incorporating patient and family-centered care (PFCC) into its patient care and culture. PFCC is an approach to the planning, delivery and evaluation of healthcare that is grounded in mutually beneficial partnerships among healthcare providers, patients and families.  Moreover, PFCC is The Valley Hospital’s approach to healthcare that shapes policies, programs, facility design and day-to-day staff interactions.
 
 

The approach leads to better health outcomes and wiser allocation of resources, as well as greater patient and family satisfaction. According to the Institute for Patient and Family-Centered Care (IPFCC), the four core elements of PFCC are: dignity and respect, information sharing, involvement/participation and collaboration.
           
Ann Marie Leichman, the Chief Nursing Officer at Valley, initially brought the PFCC concept to the hospital after attending a conference and identifying the relevance and opportunity to improve patient-centered care and outcomes at Valley. She realized the deep commitment involved with the potential to transform the care they were providing.
           
Valley’s journey is ongoing, but is marked by milestones. The first step involved creating roles and formalizing a steering team. The team named Pamela Bell, MDiv, BA (former Director of Pastoral Care), as the Director of PFCC. The team conducted a full-day retreat to identify specific areas that PFCC would address and performed a soft launch with a communication plan.
           
“It really is about creating a culture change,” Bell said.
 
Realizing the importance of buy-in and sustainability, Bell realized it was imperative to get everyone on the same page. She knew that wasn’t necessarily going to be an easy task, but she was dedicated.
 
The hospital had three goals to achieve: fully implement a bedside shift report, develop a communication plan of the elements of PFCC, and create a hospital-based Patient and Family Advisory Council (PFAC).
           
The bedside shift report promotes positive communication between nurses and patients/families, thus enhancing their understanding of the treatment plan as well as providing opportunities for the patient/family to participate in their care. The communication plan was demonstrated through a hospital newsletter that featured stories and examples of the success of PFCC. After developing a process and application and performing one-on-one behavioral-based interviews, Valley created its first PFAC in 2012. It consisted of staff members, former patients and family members of patients. Each member was called an advisor.
 
The next step was orientation and establishing culture change. The Valley Hospital created a four-hour curriculum that was mandatory for nurses, patient care associates, and other employees who have direct patient interaction. The class went into detail about the core elements of PFCC and included examples and videos of inspiring advisor stories. There was also a PFCC fair and the establishment of a consultant role.
           
“We want this to speak to people’s hearts as well as their concerned minds,” Bell said regarding the PFCC approach.
           
The approach was initially received with some pushback from clinicians. The concerns consisted of causing confusion for patients, making errors, patient privacy or a perceived lack of clinical control. Valley handled these fears and hesitations through ongoing coaching and support, off-site leadership training, continuous success stories and examples, and by focusing on patient outcomes. 
           
The Valley Hospital’s commitment to PFCC has been acknowledged statewide by the New Jersey Hospital Association (NJHA) and nationally, having received ‘Exemplar’ status from the IPFCC Changing the Concept of Families as Visitors program. Valley’s patient satisfaction scores have also been stellar. According to the most recent public release by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Valley was tied for first place for Nurse Communication, Physician Communication, understanding your care when you left, and receiving an Overall Rating of 9/10 among general acute care hospitals in NJ.
 
To ensure that PFCC is implemented into patient care, Valley revised its Mission, Vision and Serve Standards, developed a Welcome Policy, incorporated PFCC language in job descriptions and evaluations, produced a series of videos, facilitated council meetings and more. One way Valley measures their success is through patient surveys, inclusion of PFAC training sessions and the number of hours PFAC advisors contribute to the hospital. The number of PFAC advisors throughout Valley Health System has increased from 30 in 2013 to 70 in 2014, with 2015 breaking the 100 mark for volunteer advisors.   Among other metrics, the hospital is now measuring the number of overnight incidents with family members – pre- and post-implementation of the Welcome Policy - which have declined by almost 100 percent.
 
"The Valley Hospital has always had a rich history and strong performance related to our ability to deliver an exceptional patient experience,” Peter Diestel, Senior Vice President of Administration and Chief Operating Officer, said. “However, we began to recognize that we were missing out on perhaps the biggest opportunity to drive improvements in quality and patient safety and the overall patient experience. In order to reach the highest levels of performance, we had to truly engage patients and their families and make them an integral member of their care team. Our new Welcome Policy makes that possible."
 
Bell recognized that Valley was an exemplary facility for implementing culture change when a married couple in the hospital for orthopedic surgery wanted to be roommates.
 
“Prior to PFCC practice, staff would have naturally thought, ‘We can’t do that!’” she said. “But after truly realizing what Valley is trying to achieve with PFCC and its changing culture, staff instead thought, ‘Why can’t we do this?’ True PFCC means partnering with patients and families to meet their needs. In this case, the patients wanted to be roommates, so they ended up being roommates. The team worked together to make it happen. We call it the Valley patient and family experience. We truly partner with our patients and their families to meet their needs and exceed their expectations.” 
           
Valley continues to form advisory councils and incorporate PFCC into the hospital’s culture. If you are interested in learning more, visit http://www.valleyhealth.com/FastFacts.aspx?id=5552.  

Working with Quality Insights to Engage Patients and Families

Quality Insights Quality Innovation Network works with facilities like The Valley Hospital to improve quality of care and will soon be in the process of recruiting patient and family advisors that want to improve patient and family engagement (PFE). If you want to learn more, contact Mitzi Vince at (800) 642-8686 ext. 3253 or mvince@wvmi.org