Training and Medical Education for Family-Centered Care

Overview

Training health care providers to understand issues from the family perspective is slowly seeping into the medical curriculum and the everyday practices of practitioners, hospitals and academic centers.

Family-centered care is light years away from the bad old days in the `50s when hospital policies and physicians' practices typically left patients and their families out of the decision-making process in health care treatments. And, though practitioners and institutions have gradually abandoned the most draconian measures, health care administrators and providers still sometimes institute policies and practices that address the needs, convenience and priorities of the health care system. Such policies and practices often do not meet the needs of families.

With the new approach, families are full-fledged partners in the patient's care. Not one discrete practice, family-centered care is based on a defined set of principles and a wide variety of practices aimed at working as partners with patients and families. The result is simply better outcomes for everyone: patients, families and institutes. Specifically, researchers have reported family-centered care results in shorter hospital stays, fewer hospital and emergency room visits, better compliance with care instructions at home and greater patient and family satisfaction. And, as one researcher noted:

“It is impossible to overestimate the power of a parent's presence. When two critically infants have the same clinical diagnosis, the one who has family present, pulling for him or her and actively participating in care, will almost always do better.”¹

But re-orienting health practitioners and institutions to the family-centered care approach requires extensive re-tooling of the medical curriculum. To do that, medical educators must understand and embrace the approach, enlist the support of faculty and other trainers in using the new approach and then go about the work of modifying the curriculum in a myriad of ways.

A key piece of family-centered medical education program must include training students how to deal with an increasingly diverse population. Cultural, religious or ethnic values can interfere with optimal health care if health professionals misunderstand or ignore them. In addition, persons who have poor literacy skills can pose a significant barrier if their literacy problems are not identified and accommodated. Fortunately, many excellent resources exist that can help health care practitioners and others deliver culturally competent care and overcome low literacy problems.

1. Lawhorn, G. In Johns, B., Newborn intensive care units pioneer family-centered change in hospitals across the country. Zero to Three , 15 (6), 11-17. 1995.

General Principles*

• Educate all health care providers to understand issues from the family perspective.
• Begin training about family-centered care in the early stages of medical education programs.
• Understand and incorporate the developmental needs of infants, children, adolescents and families in health care settings.
• Enlist family members as faculty in medical education programs.
• Emphasize multi-disciplinary experiences that include promote team concepts, eliminate “turf” and encourage family participation.
• Develop, disseminate and evaluate family-centered curriculum.
• Make family-centered care a national priority through public awareness.
• Include training in culturally competent care and meeting the needs of persons with low literacy skills.

*Adapted from Johnson, Jeppson & Redburn, 1992, Caring for Children and Families: Guidelines for Hospitals and materials from the Institute for Family-Centered Care.

Conference Breakout Session Poster:

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Key web sites

• Perspectives of Differences -- This site, based at the University of California at San Francisco, offers a primer for training health care professionals. Four pods include requirements for culturally competent care, challenges, new paradigms in medication education and practice and practical steps to improve cultural competency in health care encounters.
• Other web sites relating to cultural competency in health care
• Web sites related to low literacy
• Health Care Reengineering for Military Health Systems – This site offers a list of questions to help your facility become more patient-centered and family-centered.
• Institute for Family-Centered Care -- A non-profit organization dedicated to advancing the understanding and practice of family-centered care. The institute serves as a resource for members and health care practitioners.
• Patient-Centered Care for Better Patient Adherence – A March 1998 article published Family Practice Managementt by the American Academy of Family Physicians on the value of patient-centered care and some specifics on how to weave it into your practice.
• Understanding Patient Experience -- A quality initiative by The Picker Institute to gather information about patients' experiences and disseminate models for improvement.