Safety Culture & Virtue 3: Families (9 mins)

Everyone wants to believe that we treat our patients like family. But is it possible to prove it? Today's episode provides a quick auditing method to identify whether you have a family-friendly organization.

Key Points:

-Family Support Systems

-Humanizing Healthcare

-Family Furnishings

References:

-Goldfarb, MJ; Bibas, L; Bartlett, V; Jones, H; Khan, N (Oct. 2017). Outcomes of Patient- and Family-Centered Care Interventions in the ICU: A Systematic Review and Meta-Analysis. Critical Care Medicine 45(10): 1751-1761. DOI: 10.1097/CCM.0000000000002624.

Transcript

A patient lay dying in the ICU. She was there with complications after childbirth, and the doctors did not have much hope. The young woman’s organs were shutting down, and she was terribly weak. Suddenly, her husband showed up. They had been married less than a year, and he had brought their days-old baby with him. The nurses surrounded him.

“You can’t bring that baby in here. It’s not safe. We have lots of germs here in the ICU and he is too small to be visiting his mother.”

It was all true. It was a terrible risk to bring an infant to the ICU.

But her husband insisted, saying “She needs to see her son. If she doesn’t see the baby, she won’t fight to stay alive. She needs to know that we need her. She needs a reason to live.”

In his other hand he held a McDonald’s cheeseburger and a romantic comedy from a Redbox booth. It was crazy and against everything they knew, but the nurses relented and her husband nestled their son in the patient’s arms, waited for a food tray to come so they could eat together, held her hand, and created a date night in the ICU. 

Miraculously, the young mother survived. And thrived. She was a fighter. And while I’m sure the medical care she received helped tremendously, that moment when her husband showed up reminding her of why she needed to get better was a pivotal turning point in her recovery. Families are so important.

Another patient awoke from a stroke and shouted, “How long have I been out?! My dogs, my dogs!” He had been in a coma for 24 hours and was utterly distraught that his two dogs could be starving and stressed along at home. The nurses worked with his landlord to ensure the dogs received care and took video of them to provide proof of life. The patient said, “How much longer will I be here? I’ve got to get home to take care of them, you know.” And he did. He improved so fast that doctors were stunned, all because he needed to see his dogs.

In fact, in my experience, patients with families and responsibilities improve faster than those without. You might think that the stress of those responsibilities and relationships could cause problems, but it’s actually the opposite. It’s not just a benefit, but the sense of urgency that someone is needed at home can drive a patient to push and fight harder to survive. It’s an incredible thing to watch, and I have witnessed the transformation in my patients many times. That is why it’s vitally important to celebrate families, relationships, and responsibilities.

In fact, families and responsibilities are a critical part of the healthcare organization’s support system. I have seen entire departments crumble because a key leader was going through a divorce. We think that there is a clear dividing line between work and personal life, but in reality, even stoic, private people see their work affected by family issues or the death of a beloved pet. And on the flip side, when coworkers celebrate your child’s 3-pointer in a basketball game, or ask to see a picture of your daughter’s quinceañera dress, it transforms the workplace to a highly effective team. In the words of Han Lue from the Fast and the Furious movie series, “It’s trust and character that I need around me. You know, who you choose to be around you lets you know who you are.” Allowing employees to be human beings instead of cogs in a healthcare machine helps them treat patients like human beings. If we don’t care about our own families, then no one is important enough to care about. And when our personal lives are dehumanized, we have a tendency to treat others with less dignity. 

One of the places where this can be observed is to look at how birth is celebrated and protected in the workplace. Over the years I worked in healthcare, I have attended dozens of baby showers in the workplace. At one small community hospital, they played the Brahm’s lullaby over the loudspeaker every time a baby was born, and the Neonatal ICU had a graduation party celebrating the growth and development of babies who had graduated out of the NICU to become healthy school children. Other workplaces posted pictures of graduations, anniversaries, and other special moments from their employee’s families. We celebrated scholarship recipients and beauty pageants and kids who won bikes in the school fundraiser. We lit 100 candles on a giant cake to celebrate centenarian birthdays and hosted chili cook-offs. Staff members would volunteer to take patient assignments that would be unhealthy for pregnant coworkers (even though it often meant more work and isolation gear for them), simply because it was the right thing to do and because human beings are valuable.

On the other hand, I have also worked in places where pregnancy was greeted with a judging glance because everyone else would have to pick up the slack during maternity leave. The subject of birth was greeted with resentment and disapproval. Families were seen as a distraction from work, and employees were asked to work late during important family events. Employees were rewarded for staying late into the night, giving up time with their families, rather than for the quality of work they completed.

That anti-family culture can be reflected with our patients as well. Those same workplaces treated patients’ family members like they were the enemy – more of a source of trouble and irritation, or a distraction from the patient rather than a blessing and a type of care. To be fair, some of that concern form healthcare workers is valid – I have seen family members lie, cheat and steal to try to get ahold of someone’s inheritance before they died. But those are the exceptions, not the rule.

And families are so valuable to a patient’s care. We should value their contribution to the patients’ care because they knew the patient best. On family asked a question about a patient’s skin and heart rate, and checking into it led to the discovery of a rare anomaly, which when treated led to the recovery of the patient. If the family members hadn’t been valued, that patient would have died.

Evidence shows that involved families are crucial for safe healthcare. The presence of involved family members is an integral part of safety culture, yet it has never been assessed to my knowledge. In one study, the presence of family in the ICU improved length of stay by 1.21 days and improved ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes.[1] And even if we find families troublesome, it does not mean that they are the problem. Instead, it reveals a weakness in our professional work that can be improved.

So how can you measure if your organization values families? 

For starters, it’s worth asking how well you know your own coworkers. Do they have families? What activities do they enjoy together? What is their favorite vacation spot? If you don’t know, it might be a good time to start a lunch club, take a 15-minute break by the water cooler, or brush up on the techniques in Carnegie’s How to Win Friends and Influence People. Make a game out of it. How well do you know each other? If everyone knows that your office mate’s 15-year-old loves soccer, then you can pat yourselves on the back for being awesome people to work with.

Now, if you want an organizational approach, one of the single best measures is to stroll through some of the hallways outside patient rooms and glance at the furniture inside. Are their chairs for family members to visit? Are there comfy recliners for a family member to stay the night with an anxious relative? If you have furniture for families, you can give yourself a point on this assessment item. If there is no place to sit and the recliner looks like a cat clawed it to pieces, then there is work to do: Is there a committee or leader for patient engagement or community relations that could assist with a family-centered project? You could create a campaign to sponsor furniture drives and get the organization involved in supporting efforts to provide a safe, comfortable place for families. Just bringing those chairs into the room will communicate a great deal about true safety culture, the importance of speaking up and listening well, and of course, human dignity. Plus, when you visit your own friends or family members when they need care, you’ll finally have a nice place to sit.

[1] Goldfarb, Michael J.; Bibas, Lior; Bartlett, Virginia; Jones, Heather; Khan, Naureen (Oct. 2017). Outcomes of Patient- and Family-Centered Care Interventions in the ICU: A Systematic Review and Meta-Analysis. Critical Care Medicine 45(10): 1751-1761. DOI: 10.1097/CCM.0000000000002624  https://journals.lww.com/ccmjournal/abstract/2017/10000/outcomes_of_patient__and_family_centered_care.20.aspx.