Pediatric Healthcare Center of The Future
Down the Rabbit Hole
Of Healthcare
September 4, 2007
Gerri Lamb, PhD, RN
Emory School of Nursing
Questions to keep in mind
• What’s the problem?
What is the proposed design trying to
solve?
• Could we do it differently,
better, less expensively….
Design Model: Think Interaction
Quality
Physical
Design
Care
Processes
Patient & Family Centered Care
Technology
Culture
Safety
Pivot the Room
Who are the Stakeholders?
Institute of Medicine Targets:
The Big 6
1. Safe – avoid injury
2. Effective – evidence-based, avoid underuse and
overuse
3. Patient-centered
4. Timely – reduce waits and delays
5. Efficient – avoid waste including equipment, supplies,
ideas, energy
6. Equitable - does not vary in quality due to personal
characteristics, eg gender, ethnicity. location, SES
Crossing the Quality Chasm, 2001
What do children and their families
want from health care?
•
•
•
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Stay Healthy
Get Better quickly when ill
Live a Good Life with Chronic Illness
Die Comfortably and Supported
Foundation for Accountability
In the words of parents
“They (the nurses) would ask me “what do you want me to do?” It was like a
partnership….”
“(the nurses) were informative and they always answered all my questions”
“It was just a different situation, I think. There weren’t all the machines and
alarms going off every few minutes. The lighting was different.” (a mother
explaining why she thought it was easier to establish rapport with nurses in
a less acute area in the hospital – example of intersection of physical
design, technology, care process)
Espezel & Canam (2003). Patient-nurse interactions: care of hospitalized children. Journal of Advanced
Nursing 44(1), 34-41.
“Well, nobody really asked, how I felt… they did actually ask me if I would want
to stay and I said “I don’t want to but I will” but nobody sort of said, ‘why
don’t you want to? Nobody asked”
Sartain et al (2001). Users’ views on hospital and home care for acute illness in childhood. Health
and Social Care in the Community, 9(2), 108-117.
Patient and Family Centered Care
“to customize care to the specific needs and circumstances of each
individual, that is, to modify, the care to respond to the person, not
the person to the care.”
IOM, Crossing the Quality Chasm, p.51
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•
•
•
•
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Respect for patient values, preferences, needs
Coordination and integration of care
Information, communication, and education
Physical comfort
Emotional comfort
Involvement of family and friends
Gerteis et al, 1993
Through the Patient’s Eyes
Typical Survey Questions
• In the last 12 months, how often did the doctor
explain things about your child’s health in a way
that was easy to understand?
• How often did this doctor listen carefully to you?
• How often did this doctor show respect for what
you think?
From CAHPS (consumer assessment
of healthcare providers and systems)
Child Primary Care Survey
www.cahps.ahrq.gov/default.asp
Care Processes
• What do health
professionals do?
• How do they do it?
Assess
Intervene
Do
Plan
assess, build
relationships, plan,
intervene, coordinate,
educate, motivate,
monitor, evaluate
Evaluate
Check & Act
Patient and Family
Self Care – at home, school, …..
Diet
Exercise
Sleep
Treatments
Medication
Symptom Monitoring
Seek Care in a timely way
What should a child and family-centered
environment look like? How does it look, feel,
act differently than one that isn’t?
Quality
1.Physical
Design
3.Care
Processes
Child & Family Centered Care
4.Culture
2.Technology
Safety
Resources
What do you need to know?
• About your problem? Care processes,
technology, culture, physical design?
• For health care: Medline, Web of Science
Key Words: family, child, parent, hospital,
emergency room, home health, sickle cell
anemia, asthma, informed decision-making,
shared decision-making, patient centered care
Patient Centered Care Search
Initial search – 4047 references
Full text, humans, english, ebm review – 18
• Shields et al (2007) Family centered care for children in hospital.
Cochrane Database of Systematic Reviews (1) CD004811. State of
the science, 135 references
• Weinstein, et al. (2007). Informed patient choice: patient centered
valuing of surgical risks and benefits. Health Affairs 26(3), 726-39.
Examples of new shared decision-making software and tools from
Dartmouth Medical School
• Horne, et al (2007). Can asthma be controlled by understanding the
patient’s perspective? BMC Pulmonary Medicine, 7:8. Review –
78 references
• Butz, et al (2007). Shared decision-making in school-age
children with asthma. Pediatric Nursing, 33(2), 111-6.
Resources
• Commonwealth Foundationwww.commonwealthfoundation.com
• Foundation for Informed Medical Decisionmaking www.fimdm.org
$25,000 dissertation grant
• Robert Wood Johnson Foundation
www.rwjf.org
Resources
• Consumer Assessment of Healthcare Providers
and Systems (CAHPS)
www.cahps.ahrq.gov/default.asp
- Can download standardized surveys of
children’s primary care, hospital experience
- 8 years of national data on perceptions of
shared decision-making, communication,
education, and other aspects of patient and
family centered care