The Power of Teaching through the Voice of Families
The Sala Patient and Family Faculty Program engages trained patient and family advisors as co-educators with experienced clinicians. Together, they teach best practices in family-centered care to faculty and staff at Hassenfeld Children’s Hospital across a wide array of formats including classroom discussions and immersive, clinical-based simulations.
In 2018, the Patient and Family Faculty Program experienced a purposeful maturation through the co-design of family-centered care core competencies and associated behaviors, and expansion of the program’s measurement strategy. These initiatives have increased the program’s rigor and opportunities for application at Hassenfeld Children’s Hospital.
Creating Core Competencies and Associated Behaviors
These competencies and behaviors were defined using a model of co-design and were rooted in existing family-centered care literature. The Sala Institute for Child and Family Centered Care convened multiple interdisciplinary focus groups, including patient and family advisors, National Expert Advisory Panel (NEAP) members, health providers from frontline staff to departmental leadership, and the trained professional actors who portray patients or family members in training simulations. They described elements that define the successful deployment of family-centered care principles, and conversely articulated what care looks like when it does not meet this mark.
Based on the focus groups’ output, Patient and Family Faculty Program leaders defined core competencies and associated behaviors to optimize programmatic impact and ensure consistency across all learning sessions. These competencies and behaviors are aligned with family-centered care principles and include:
- Respect and value
- Communication and information sharing
- Participation in care and decision-making
- Follow-up and next steps
- Working as a team
This work allows the teachable moments from Patient and Family Faculty members to become more defined, measurable, and aligned with a broad spectrum of realistic clinical scenarios experienced by learners of all stages.
At Hassenfeld Children’s Hospital, these competencies and behaviors have been taught to a variety of teams with diverse learning objectives. Applications in 2018 have included:
- Engaging Families in Sepsis Huddles
- Performing Bedside Shift Report
- Partnering with Families in Safety
- Building Inter-professional Communication Skills
- Having Difficult Conversations
- Partnering Through Crisis
Applying Competencies to Training at the KiDS ED
The Sala Institute deploys scenario-based immersive simulation with interdisciplinary teams of learners, professional actors portraying patients and families, Patient and Family Faculty, and clinical experts to assess and enhance the practice of family-centered care.
In the past year, the Patient and Family Faculty Program partnered with Ethan Weiner, MD, division director of pediatric emergency medicine, to foster patient and family engagement in safety huddles. These safety huddles are very brief stand-up meetings between health providers and family members of children with suspected severe infection who are receiving care at the KiDS Emergency Department.
Weiner, Patient and Family Faculty members, and the program team developed clinical role-play scenarios for doctors, nurses, and residents to practice their interactions with professional actors portraying patients and families. “We design scenarios that feel authentic to the parent,” says Jeremy Donovan, a senior family advisor in the Patient and Family Faculty Program who was deeply involved in creating the safety huddle simulation. “I help ensure that the scripts portraying parents and that the actors’ portrayals are accurate, realistic, and help meet the training goal.”
Patient and Family Faculty members partnered with experienced clinicians to observe the simulations. Together they coached the learners using the family-centered care competencies and behaviors.
Feedback from Patient and Family Faculty members coaching this simulation training led to the identification of standardized phrases and behaviors that help providers engage families more effectively in safety huddles at the KiDS ED.
“The epiphany for providers happened when they accomplished more in less than four minutes than what they couldn’t do previously in six. Those couple of minutes can make all the difference in a busy ED,” says Weiner. “The coaching from Family Faculty members drove home the importance of ‘spend time to save time.’”
Multi-pronged Approach for Measurement
The Patient and Family Faculty Program has made strides to advance a rigorous approach to the measurement of this work. Program evaluations and surveys are lending insight into the impact that this program has had on learners:
- Of 78 participants who considered the statement, “I am able to encourage family engagement during the care of a critically ill child,” 24 strongly agreed in pre-program surveys. That number jumped 145% to 59 in post-program surveys.
- Of 81 participants who considered the statement, “I am able to anticipate and recognize potential communication challenges when a family is practicing a questioning attitude,” only 23 strongly agreed in pre-program surveys. That number increased by 160% to 60 in post-program surveys.
“The great majority of doctors, nurses, and other healthcare providers and trainees who participate in the Patient and Family Faculty Program tell us that this is such a meaningful and lasting way to learn about the patient and family experience,” says Fiona H. Levy, MD, executive director of the Sala Institute. “They see it as an important adjunct to learning from textbooks or lectures about what patients and families need and how best to partner with patients and families. That said, perception of learning is important but an insufficient metric if we are to continue to grow the program and understand impact and areas of most productive intervention. This has led us to begin the creation of a more robust approach to measurement.”
Enhancement of Measurement Strategy
In a new partnership with the NYU School of Medicine’s Institute for Innovations in Medical Education, the Sala Institute is beginning to enhance the program’s measurement strategy in a number of ways including:
- Impact of patient/family faculty as an innovative intervention component
- Learner knowledge acquisition
- Most advantageous timing of this program as intervention
- Longitudinal testing to better understand dose of intervention recommended for skill retention
Looking forward, the impact of these enhancements will further strengthen the Patient and Family Faculty Program and keep the Sala Institute at the forefront of engagement between children, families, and health providers.