Empowering consumers and providing quality service are guiding principles in the health care practice of person-centered care. Person-centered care is a holistic approach to delivering care. It means the care is respectful and individualized, allowing for negotiation of care and offering choice through a therapeutic relationship. It empowers patients or family members to be involved in health decisions at whatever level they desire. This approach places significant focus on the patient’s involvement in their care.
At the University of Iowa Stead Family Children’s Hospital in Iowa City, service rounds were leveraged in the pediatric bone marrow transplant inpatient unit to provide person-centered care to patients experiencing multiple stressors. Given the complexity of care and the potential for long length of stay for this population, these patients and families are at risk for a high-stress hospital experience.
For one patient and family, that stress was evident during daily interactions with staff. These negative and at times confrontational interactions created barriers for staff to provide the highest quality care. The patient’s parents became verbally aggressive and agitated with nursing interventions and questioned the need for certain requests, such as patient bathing and vitals.
This led to a strain on interactions with the family, who would perseverate on the previous night’s experiences. To address this, the care team established a weekly meeting with the parents and the patient to listen to their concerns and reiterate the care expectations on the unit. The team found service rounds had several purposes.
They facilitated the discussion of patients’ and families’ expectations. This leads to a discussion of what the health care professionals on the unit expect while the patient is hospitalized.
Also, service rounds allow staff to address myriad concerns related to the patient’s experience. Based on a foundation of patient- and family-centered care, service rounds help maximize patients’ and families’ overall hospital experience using a multidisciplinary team approach.
Implementing service rounds
Prior to the implementation of service rounds, it’s crucial to identify key stakeholders. There must be an overall commitment from the hospital and key members of the health care team to provide service rounds. What’s more, multiple factors need to be considered in the decision-making process, including the recognition of service rounds’ overall perceived benefits as well as the commitment to follow through with and the fulfillment of action plans that may be created because of the process.
In addition, staff members’ time and availability must be established and protected to ensure consistency. Implementing service rounds at University of Iowa Stead Family Children’s Hospital initially took the commitment of primary team members, which included a member of unit nurse management, a child life specialist, a social worker and a patient representative.
The team members discussed when they would meet and the amount of time they anticipated service rounds would take per patient. While this time commitment was hard to predict, team members generally tried to keep service rounds to one, 15-minute visit per week per patient, with the understanding that if a specific issue needed further attention, the representative would circle back to continue the dialog.
The team decided they did not want anyone from the medical team to be involved in service rounds, as the team wanted patients and families to feel they could share their concerns or frustrations with-out feeling their care would be negatively affected.
The team also stressed that confidentiality would be respected within the constraints of resolving issues as needed and any discussions would not negatively affect patient treatment or care. Finally, a plan for communication of all outcomes was identified. Patients and families were assured that each member of the service rounding team would be available outside of meeting times should needs or further questions arise.
How service rounds work
During the initial visit, service round team members explain to the patient and family the intended goal of the process, and this goal is reiterated at each subsequent meeting. The team also identifies any current needs or concerns the patient or family may have.
Any identified needs or concerns not addressed immediately are addressed by the appropriate service team member, who is then responsible for follow through. This includes sharing outcomes with the patient and family at the next meeting. If the patient and family do not voice any concerns, no action is taken.
In addition to sharing concerns, patients and families can identify any strengths in their care and identify positive interactions with their health care team. The service round team shares that positive feedback with nursing management, who disseminates it to the involved team members directly or in team meetings.
Weekly service rounds allow staff to supplement any patient care directives identified by the medical team or unit leaders to maximize patient and family care delivery. This may include reiterating or explaining unit guidelines, repeating care expectations or identifying psychosocial support needs. Service delivery is improved by addressing patient-family needs prior to the escalation of emotions.
In addition, patients and families feel empowered and have an increased feeling of control over medical care when they participate in service rounds. Hospitalized patients often feel some loss of control. Participating in service rounds increases a patient’s and family’s level of control and empowers them to participate in their overall health care.
This empowerment occurs when patients and families play a more active role in identifying problems, improving care and building relationships. Family issues may include problems related to food quality and environmental issues to issues related to direct patient care, medical communication and overall quality of service.
While each concern deserves equal attention, the benefit is that the team can recognize the importance to the issue—no matter how big or small—as it is perceived by the patient and family. This indicates an equal commitment to patient care as well as a commitment to patient and family satisfaction. In addition, the follow through of a plan to address a concern provides reinforcement of the team’s commitment and serves as a basis of trust building with the family while improving satisfaction.
Expanding the concept of service rounds
Service rounds have been expanded at the hospital to include other services and units. Service rounds are now facilitated weekly on most of the pediatric inpatient units as well as in the pediatric intensive care unit. Each inpatient unit has a similar team that consist of the unit’s nursing management, the unit-based social worker, and, on some units, a child life specialist. This team meets with all families on the unit who are present on a set day each week.
While the hospital has conducted service rounds for several years now, and the program has expanded to other units, some challenges persist. These include staff turnover and the need for constant re-education and juggling parent and staff availability.
To evaluate the effectiveness of service rounds, the patient satisfaction survey the hospital uses has provided some metrics. For example, one question on the survey asks how well the staff worked together. The results, which indicate a “very good” response, show patient responses and an upward trend line since service rounds were initiated. While this survey question does not directly mention service rounds, it helps support the continued use of this approach.
As the hospital continues with service rounds, it will be helpful to further refine the metrics for ongoing improvement. Perhaps the best indicator of success has been the feedback from patients and families. Many have said just being asked for their input and what can be done to improve their care is helpful and appreciated. Families have also said they value team members taking the extra time to meet on a regular basis.
The health care environment continues to stretch and flex with changing focuses of care. As hospital initiatives change, the service rounds approach allows for the flexibility to incorporate new initiatives into scheduled patient and family meetings. This may include the onset of discharge planning as soon as possible to meet length-of-stay initiatives or the explanation or reiteration of unit visitor guidelines during the pandemic.