UAMS’ new care model keys on patients, families

Arkansas Democrat-Gazette/MELISSA SUE GERRITS - 03/20/2014 - Fred Oliver rubs his wife, Doris' hand while she rests in a UAMS hospital room March 20, 2014. Fred has been able to stay overnight in the single patient room with his wife thanks to UAMS's new patient programs which aim at a pleasant an personal experience for each patient.

Arkansas Democrat-Gazette/MELISSA SUE GERRITS - 03/20/2014 - Fred Oliver rubs his wife, Doris' hand while she rests in a UAMS hospital room March 20, 2014. Fred has been able to stay overnight in the single patient room with his wife thanks to UAMS's new patient programs which aim at a pleasant an personal experience for each patient.

Monday, March 31, 2014

Fred Oliver smiled as a group of visitors - all dressed in suits with arms wrapped around clipboards - entered the patient room at the University of Arkansas for Medical Sciences.

He raked a hand through his gray hair before turning to fold a blanket and fluff a pillow on a built-in, padded couch below the room’s window. He gestured toward the coffee cups and half-eaten meal on a small table next to him.

“I live right over here in this corner,” Oliver said.

Oliver took up residence in the hospital room after his wife, Doris, was admitted five days earlier with a high fever. He motioned to his wife, sleeping in the hospital bed in front of him, and talked of their courtship and wedding in 1957.

“Once upon a time this was my home, too, except on a different floor,” Lynn Biscioni told Oliver as she leaned forward and shook his hand.

Biscioni - whose husband died in 2011 at UAMS after a long battle with multiple myeloma - is one of the numerous representatives on the hospital’s eight Patient and Family Centered Care advisory councils.

The councils meet regularly to visit with patients and make recommendations on improvements to services and the care environment. They are just one part of a complete overhaul by the state’s largest public employer to create a partnership among the medical team, patients and their family members.

Since last spring, major departments at UAMS have been created, merged or physically moved. All multipatient rooms have been eliminated in favor of private, family-friendly rooms. Visiting hours were eliminated; signs deemed not patient- and family-friendly were removed; and the public-address announcements were revamped. Former patients have been hired as adjunct faculty to teach the reality of patient- and family-centered care, and are included on panels interviewing and hiring new doctors.

Even the green gelatin in the cafeteria has become a casualty of the cultural shift.

And, this year, UAMS became one of the first medical schools in the nation to add the new care concept to its academic curriculum.

UAMS Chancellor Dr. Dan Rahn is so committed to changing the culture at the academic medical facility that he has decreed that any employee - doctor, nurse or janitor - not on board is invited to leave.

The new care model - which is quickly gaining momentum around the nation - was first offered at UAMS in 2011 by Dr. John Shock, professor and founding director of the UAMS Harvey & Bernice Jones Eye Institute. From there, Rahn and other administrators traveled around the nation, researching and planning to make the movement a reality for the Little Rock teaching hospital.

In May, Rahn hired Julie Moretz - the former director of special projects at the Institute for Patient and Family Centered Care in Bethesda, Md. - as the first UAMS associate vice chancellor for patient-and-family-centered care.

Coming from the standpoint of a national organization, Moretz said UAMS is rare in its unilateral and unyielding support from its top leaders.

“I really had no intention of coming here, but as soon as I stepped foot here, I knew this was where I wanted to be,” Moretz said. “I just felt that things were ripe for a change. It is unusual to have a leadership that embraces patient-and-family-centered care so completely. This has been a totally different experience for me.”

Kathy Lease - a multiple-myeloma patient and former superintendent of the Texarkana School District who was recruited by UAMS to serve on the advisory councils - said doctors and teachers at UAMS seek her out regularly for input.

“The more voices, the better. It is so very important,” Lease said. “I’m so proud of the commitment I’ve seen the leadership give to this. We’ve all seen initiatives come and go, but this is a long-term commitment.”

NEW CONCEPT?

Rahn, who began his career in 1979 at the Yale University School of Medicine, said involving the patient and the family in medical care is not a new idea. He likened the concept to his early days, when medical house calls were the norm.

“We actually did this back then. We have just gotten away from it over the years,” Rahn said.

Moretz said the UAMS culture overhaul is more than just a change in customer service.

“This is engaging patients and their families at all levels,” Moretz said.

Other Arkansas hospitals have had similar policies in practice, but none has gone to the extreme of a total overhaul of organization, policies and curriculum such as UAMS.

Baptist Health adopted the Relationship Based Care model in 2006 to train nurses to involve patients and their families in patient care. Baptist also remodeled all but 15 percent of its patient rooms into private suites.

St. Vincent Health System has moved to all-private rooms and has formed a Patient and Family Advisory Council. The group, which meets six times a year, is composed of patient and family representatives and hospital representatives to bring about changes that “make our culture more person-centered,” St. Vincent spokesman Margaret Preston said.

St. Bernards Healthcare in Jonesboro has converted the majority of its 438 beds to private rooms. The hospital has implemented “bedside shift reports” where the full medical team - doctors, nurses, therapists and/or other specialty care-team members - meets with the family each morning to discuss the patient’s care.

“The patient is always at the center of everything we do. Even in private meetings, our debates or discussions always center around, ‘Is this best for the patient?’ The bedside shift reports are a triangle with the doctor, care team and the patient,” said Kathryn Blackman, St. Bernards’ vice president of critical care, heart care and cancer services.

St. Bernards also enacted a policy that allows family members - if they choose - to be in the room during resuscitation efforts, whether it is in the emergency department after a traumatic injury or in the neonatal intensive-care unit.

“We are even inviting siblings to come in during this time if the family thinks it is appropriate,” said Dana Lands, St. Bernards’ director of nursing care in the Neonatal Intensive Care Unit. “We started this about a year ago. It is a different mindset for the nursing staff, and we have done a lot of education on it.”

Blackman said St. Bernards has been practicing patient-and-family-centered care since it was founded 114 years ago by the Olivetan Benedictine Sisters of Holy Angels Convent.

“Our mission is to provide health care and Christ-like healing. We do live our mission,” Blackman said.

EXTENDED BENEFITS

Inviting the patients and their families to be a part of the medical-care team has benefits well beyond the individual patient, Rahn said.

The model not only brings a better patient experience, but will likely also result in lower costs to the medical facilities through shorter stays, fewer errors, higher employee retention rates and decreased malpractice claims, he explained.

“We believe there are a lot of opportunities through this initiative to improve the health of the whole state, not just UAMS,” Rahn said.

Indeed, Moretz said she has been on the road several times a month visiting rural hospitals and medical facilities with Pam Brown, vice president for quality and patient safety with the Arkansas Hospital Association.

The objective, Moretz said, is to bring the patient-and-family-centered care model to medical facilities throughout the state. That, in turn, will result in fewer readmissions and more cohesive follow-through with mutual patient-care plans.

“We realize our work here is bigger than just Little Rock,” Moretz said. “It’s groundbreaking. It really is.”

Front Section, Pages 1 on 03/31/2014