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Does Hospital Environment, Culture Affect Family Engagement?

While hospital environment fixes are important to meaningful family engagement, a cultural shift and clinician buy-in are the keys to success.

Cultural shifts and hospital environment key for family engagement.

Source: Thinkstock

- Considerations about the hospital environment are an oft-forgotten variable factoring into a positive patient experience and meaningful patient and family engagement. After all, shouldn’t hospitals prioritize quality of care over how “pretty” or amenable a space is?

Perhaps not, said Michelle Ossmann, RN, Director of Healthcare Environments at Steelcase Health. Patient engagement and family involvement in the hospital environment are intrinsically linked, Ossmann explained in an interview with PatientEngagementHIT.com. And as of right now, most hospitals are falling short of meeting family member needs in the physical room.

Steelcase Health recently investigated how patient rooms affect family experiences. Through patient observation, executive interviews, and room assessments, Ossmann and her team found that family members were missing out in five key areas.

“What has been lagging is the physical environment to help family involvement happen,” said Ossmann, who has also received her PhD in architecture and design. “What we’ve primarily found is that there is diminished ability to support sharing meals together, to be able to work, to carry on with activities of daily living, to be able to rest and receive support from clinical staff, and to be able to work.”

Leaving these shortcomings unchecked would be inadvisable, Ossmann said. Ensuring a positive experience for both patients and family members will be key as the healthcare industry becomes more patient-centric.

Research shows that strong family involvement can cut hospital readmissions by up to 25 percent. Many industry leaders, such as CMS, are forging initiatives to drive a better experience for the family.

Most healthcare professionals are aware of the benefits of family involvement in care, Ossmann contended. But if so many clinicians and hospital leaders know that family involvement is both beneficial and something that patients want, why do so few support it in the hospital room?

Integrating families into patient care is difficult, and creates significantly more work for clinicians whose workflows are already extensive, Ossmann explained.

“It’s like having a second patient, because you must educate families, treat them, teach them, and support them the way you would a patient,” Ossmann noted.

Clinicians must educate family members, keep them informed of their loved ones’ prognoses, and meet their emotional needs. These duties can complicate an already complex care plan, Ossmann said.

There are also physical barriers to meaningful family involvement. Having the family in the hospital room can be crowded and create clinician navigation issues, Ossmann explained.

Calls for family presence in the hospital room are going to keep coming and hospitals should prepare, Ossmann asserted.

“As we recognize that experience of care measures – not necessarily satisfaction measures – are more important, hospitals are recognizing the value of designing spaces that support a patient,” Ossmann explained. “When you support a patient, you support their family.”

“There is also a marketing aspect,” she continued. “People are now going to choose where they’re going to receive their care, and can go on tours and see what kind of care they’ll get and what kind of support their family will get. Will my family be in a little chair on the side of the room, or will they be there supporting me?”

When considering hospital room and environment improvements, hospital leaders don’t need to resort immediately to a construction overhaul. However, they do need to conduct a careful assessment of hospital room needs.

“Hospitals must assess their space,” Ossmann said. “Where can they be flexible? Where can they do double duty? Is it possible to have a chair that can be something where the patient can get out of bed and use that chair for themselves, and then the family member sleeps in it at night? Or are we able to think about how we can use a single surface for teaching, eating, documentation, various therapies?”

Hospital leaders should also place outlets in logical places so patients and family members can charge phones and laptops without disrupting medical equipment or workflow, Ossmann suggested.

Most importantly, hospital leaders need to incorporate their clinical staff into these overhauls. Many meaningful family involvement barriers are cultural, Ossmann explained. Physical improvements will not be beneficial until hospital leaders can get clinical staff to buy into stronger family presence in patient care.

“Hospitals should think about what policies and procedures they have for including family members at the bedside,” Ossmann advised. “We can design whatever we want. However, people and policy and culture will override any built environment solution. Leaders must assess how clinicians feel and believe family members should be incorporated into the process of care.”

Determining how clinicians feel about family involvement will allow hospital leaders to get to the root of their apprehensions. From there, all parties can assess policies that will be conducive to both quality healthcare and a strong family presence.

“It is much more than an environment,” Ossmann said. “Process and policy make all of the difference in the world. You can build whatever you want, and a nurse can still kick a family member out if they feel so empowered.”

To keep clinicians from negating any efforts to improving the hospital environment for families, executive leadership must ensure their priorities are coordinated with clinical staff.

“That’s where you must have good alignment and bring people along in the process,” Ossmann asserted. “Educate and give nurses the support they need. In fact, if we know that it’s important to have families at the bedside, and the administration wants doctors and nurses to do this, then let us design spaces that make engagement easier.”

Ultimately, hospital leaders must remember that simply building a space that is bigger and better is not a cure-all, Ossmann suggested.

“Information technology and the built environment are not a panacea,” she said. “We have this idea that if something is bigger, somehow our lives change. That is not the case.”

“The people and the culture will override most anything you try to build in the environment if you haven’t brought clinicians along,” Ossmann concluded. “Leaders must make sure their workers are aligned with what they’re trying to do in the environment, and then have the environment designed as best as possible. That is the best formula for success. You can’t have one without the other.”