AAMC Reporter: January 2007

Families Help Improve Medical Care Decisions

On their first day of medical school, students at the Medical College of Georgia (MCG) listen to a guest speaker.

"I may only be 12, but I am the one in pain" is how 12-year-old Shelby Dorsey begins her speech.

Pain is something Shelby and her two siblings have experienced more than most children. Each has at least one autoimmune disorder stemming from Celiac disease; complications have forced them to spend significant stretches of time at MCG's Children's Medical Center. That's why Shelby periodically joins her mother, Cari Dorsey, to address MCG medical students directly.

But the Dorseys hold another significant connection to MCG and its hospital system. They are involved with MCG's Center for Patient and Family Centered Care, a groundbreaking center and philosophy that is resulting in real improvements in the hospital system's quality of care.

Cari Dorsey sits on the system's patient and family advisory board, which elicits input from families who have spent a considerable amount of time in one of MCG's hospitals. MCG Health System officials use this input to improve upon the core components that support its philosophy of patient- and family-centered care: treating patients with respect and dignity, information sharing, participation, and collaboration with patients and family members. Although it may seem simple, this philosophy—spearheaded by the Center for Patient and Family Centered Care, which opened in 2004—has produced convincing results.

Dorsey is one of many parents who have partnered with MCG Health System to help optimize the patient- and family-centered care concept to which it is dedicated. She and 24 other family members of patients serve as "family faculty members" in the medical school, addressing MCG medical students directly. And along with 129 others, she is a patient adviser to the MCG health system, providing input on how to improve hospital care.

Cari Dorsey revealed the impact that MCG's practice of patient- and family-centered care has had on her family's hospital experiences.

"At MCG, I have always been allowed to be with my children during any procedure, including walking them back to the OR. The doctors are willing to look at any new research that I may bring about my kids' conditions."

Dorsey also has been impressed by how physicians at MCG Children's Medical Center have treated her children.

"Approaching the child patients like they are the best source of information about themselves gives the doctors a chance to get the best information possible about their patient.Many times,my son Brian has been more open with his doctors about his pain levels than he is with us," she said. "My children are allowed to make all age-appropriate decisions regarding their own care."

MCG physicians like Gene Fisher, M.D., a pediatric intensivis at MCG Children's Medical Center, acknowledged the clinical benefits of the approach. He recalled a situation in which a patient had a negative reaction to a nutritional additive he prescribed her.

"Her dad told me, 'I don't know anything about medicine; all I know is every time she gets it [the additive] she cries," Fisher said. "He forced me to dig a little deeper."

He added that, had this situation occurred before MCG adopted the family-centered care philosophy, the eventually positive outcome may have been far worse.

While MCG's Center for Patient and Family Centered Care opened in 2004, the health system began embracing this approach in 1993, when it initiated plans to build a new children's hospital. During development, hospital administrators invited patients and family members to participate in the planning phase for the new $53 million, 149-bed Children's Medical Center, which opened in 1998.

"Hearing the patients" and families" perspectives gave me such an 'a-ha' experience as an administrator," said Pat Sodomka, MCG's senior vice president for patientan family-centered care and director of academic affairs. "They offered simple observations about things that were so powerful."

She recalled how family members described waiting anxiously for hours to speak to a physician, then missing the opportunity.

After hearing family input, Sodomka dug in her heels and decided to effect change.

"At the executive level, I said, 'This is what we're going to do," she said. "Throughout the whole process, from the point of time when we were conceptualizing the hospital building to the actual operation of the children's hospital, 22 parents of children hospitalized at MCG were on a family advisory council. They actually helped us design the facility and how we operate."

Specific, family-friendly changes in the hospital designs included creating individual patient rooms containing sleeping arrangements for two adults.

"The patient's room is really a family room," Sodomka said.

The center also chose to abolish visiting hours so that families could come and go at their convenience and stay as long as they liked.

"It's a wonderful feeling knowing that even though we're going to the hospital, I'm going to be able to spend the night with my child," said Cari Dorsey. "Plus, I know how much it lowers my child's anxiety."

Perhaps most importantly from a clinical standpoint, families are permitted to attend in-room medical procedures, and are encouraged to participate in discussions about the patient, such as those that occur during daily rounds.

Physicians acknowledge the benefits.

"They feel more involved. It breaks down the lack of communication that can happen if the family isn't there," said Mitzi Williams, M.D., a neurologist with the MCG Health System.

While physicians admit morning rounds and patient procedures generally take longer when family members are present, they say it ultimately saves time.

"When patients' families weren't there on the ICU, there was trouble with communication. At the end of the day, you were trying to phone families, which interrupted what you were doing," Williams said. "Now families know what's going on, on a consistent basis."

Overall, the family-centered care philosophy was so successful at Children's Medical Center that MCG expanded it to its neuroscience center in December 2003. Since that time, the neuroscience center's medication errors have dropped by 62 percent, length of stay has decreased 50 percent, and satisfaction rates have consistently ranked in the 95th percentile.

Because MCG Children's Medical Center has operated under this new patient- and family-centered care model since its inception, it cannot draw comparative statistics. But patient satisfaction at the Children's Medical Center consistently receives marks in the 90th percentile from Press Ganey Associates, a firm that measures patient satisfaction. For its family-centered care, MCG Health System has been recognized by the Institute for Family-Centered Care, and was featured in the PBS health care documentary Remaking American Medicine.

Although Sodomka admitted the cultural shift did not happened overnight, she is encouraged by the gradual change she sees.

"I never stopped pushing for patient-centered care. Now I don' have to remind people to include patients in the process."

—By Elizabeth Heubeck, special to the Reporter

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