Danbury Hospital, Danbury, CT
Goldstone Caregiver Center
Holland Bloorview Kids Rehabilitation
Hospital, Toronto, ON
A System Wide Approach to Transform
Kaiser Permanente Baldwin Park
Medical Center, Baldwin Park, CA
Improving Communication with
Patients/Families in the ICU
The Corman IMPACT Honors are made possible through the generous support of Stephen Corman in memory of his late wife, Betsy. Mr. Corman’s underwriting of the IMPACT Honors reflects his belief that leading by example is the most effective way to inspire others. It is his sincere hope that healthcare organizations are inspired by these honorees to find ways to make compassionate care a priority at their institution.
Goldstone Caregiver Center
The Goldstone Caregiver Center, made possible by donors Liz and Steven Goldstone, promotes the well-being of patients, family caregivers and staff through compassionate support and a healing environment. It is a warm, home-like environment where patients’ families can find a quiet space for respite, privacy and reflection while still being close to the person they are caring for. Caregivers can meet with a Licensed Clinical Social Worker, whose office is conveniently located within the Center, to find welcomed guidance and support. Meetings with spiritual care professionals or other members of the health care team can also be arranged in this comfortable area. Caregivers are able to enjoy healthy snacks and beverages, use public access computers and a printer/copier/fax machine, borrow from a lending library of caregiver books and browse our collection of local resources. All services and amenities are free of charge.
The Caregiver Center is more than just a beautiful space; it is a program. This program is comprehensive, designed to meet the multifaceted needs of the caregivers it serves. It provides a unique form of outreach by volunteer Caregiver Coaches trained by the Center’s Director and Manager in compassionate communication, cultural competence, self-care and boundary setting. These coaches seek out families to provide compassionate support by the bedside, where families often prefer to be, and as well as support families who come into the Center. A monthly program calendar is created and distributed not just to caregivers throughout the hospital, but also to those who are caregiving in the community so as to reduce the isolation that caregivers quite often experience. It includes a Caregiver Support Group, the Grief Recovery Method® Grief Support Group, educational programs, meditation sessions, stress management workshops, and more. The Caregiver Center recognizes that the staff across all departments are constantly in a caregiving role, both professionally and very often personally. Therefore, the Caregiver Center offers special self-care programming to staff both in the Center and on the units, while also being available to provide individual support when traumas occur.
The Goldstone Caregiver Center is helping to positively change the culture of Danbury Hospital. It promotes collaboration between hospital departments, working together in the best interest of the patients and their families through more effective and compassionate communication. It’s also changing the definition of patient care, with support wrapping around the whole patient, notably including those who are responsible for the caregiving. This model of compassionate support in health care ought to be the rule, rather than the exception.
The program is advertised in the staff e-newsletter, local newspaper, social media, network-wide emails, brochures displayed on patient units, and by word-of-mouth. The Center’s Director and Manager attend staff meetings to make the Caregiver Center known throughout the campus.
Holland Bloorview Kids Rehabilitation Hospital
A System Wide Approach to Transform Compassionate Care
Grounded in a partnership between the collaborative practice service, human resources/organizational development division, teaching and learning institute, client and family integrated care and nursing departments, this multi-pronged program casts a system-wide approach towards embedding compassionate, collaborative care throughout clinical practice and beyond. With a shared vision of improving experiences of care and outcomes for health professionals, patients and families, five strategic initiatives were established to create a culture of care and collaboration.
As the first Canadian hospital to implement Schwartz Rounds, Holland Bloorview Kids Rehabilitation Hospital has experienced Schwartz Rounds as an essential tool for strengthening relationships and compassion among staff, patients and families.
Within this program, the hospital is developing a “Strengths-Based Leadership and Management” training program to change nurses’ work-life environment by focusing on enhancing, developing and working with strengths to bring out the best in the person and the workplace.
The mandatory interprofessional orientation for new, existing and returning staff is an effective method to educate, remind and update staff of Holland Bloorview’s values, culture and strategic priorities through the use of simulation and team-building activities. Together, the team is successfully (re) orientated and (re) integrated into a collaborative team practice and instills understanding and compassion in client and family-centered care.
The innovative arts-based narrative nursing initiative is a promising method for enhancing nursing empathy as it builds a cohesive, collaborative team that is essential to excellent patient care and a dynamic nursing culture.
The “Walk in Their Shoes” pilot initiative brings the lived experience of front-line clinicians to the leadership team as one leader shadows a front-line clinician for a full week to experience the day-to-day delivery of care. This program unites hospital leadership with its frontline caregivers to make impactful strategic decisions.
All five strategic initiatives are implemented with the aim of enhancing the patient and family experience, instilling the principles of patient and family-centered care, and collaborative learning to ensure a strong culture of care and compassion.
Kaiser Permanente Baldwin Park Medical Center
Baldwin Park, CA
Improving Communication with Patients/Families in the ICU
The intensive care unit (ICU) is a challenging place for families having to make decisions for a loved one who cannot speak for themselves. Decisions need to be made in a timely fashion, even though prognostic outcomes are hard to predict. After recognizing communication conflicts in the ICU, an interdisciplinary team at Kaiser Permanente Baldwin Park devised an organized strategy to improve communication with families when decision-making was difficult or when there was a wide discrepancy between clinicians and family members regarding which treatments were non-beneficial or overly aggressive care.
The goals of the intervention were to improve the overall communication with patients and families in the ICU setting, improve communication among the care team members, promote greater consistency between various providers’ communication with a given family to ensure better continuity of care, improve support for physicians and healthcare providers communicating with families in the ICU, and decrease moral distress for the providers.
Components of the intervention included a designated social worker for the ICU. The social worker conducted an interdisciplinary discussion of family needs, stratifying support needs as “A”, “B” or “C”. The social worker then assigned a letter to each family on their first day in the ICU to indicate their support needs. Level “A” families had adequate understanding of ICU procedures and were handling their loved one’s illness with greater ease, level “B” families were more anxious or flustered by ICU protocols, and level “C” families were experiencing a higher level of emotional distress. All “C” level families were scheduled for a family meeting within the first three days of ICU admission.
Additionally, a set of educational series were conducted with all ICU clinicians. There was a pre-trial education session for nurses and doctors to understand the coping styles and decision-making needs of families, as well as a separate pre-trial education session for doctors to enhance their use of empathetic language with patients and families. Lastly, staff created “Family Friendly Materials,” which included an “Intro to the ICU” pamphlet to orient families to routines and processes in the ICU. Nurses offered family members an opportunity to complete a story board to humanize caregivers’ understanding of their loved one, who was now incapacitated. The board had space for pictures of their loved one and places to write about their loved one’s interests and care preferences.
Because of these interventions, there was significant improvement in the honesty and consistency of communication with family members. Families’ written comments lauded increased positive experiences communicating with providers and greater incidents of receiving kind, compassionate and comforting care. In addition, the ICU nurses showed significant decrease in stressors from communicating with families, and significant improvement in communication between providers. These positive results occurred for day-shift nurses as well as night-shift nurses. Our ICU physicians’ comments confirmed better communication with families and greater support in addressing family concerns.