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Dartmouth-Hitchcock Medical Center

Posted By Matthew P. Martin, Tuesday, January 15, 2013



This post is the third
in an ongoing series
highlighting hospitals
across the United
States that offer
family-centered care.


A young man walks into a hospital room where a patient lies on the bed waiting for breakfast. The bright sunlight streaming through the large window shows that it’s morning time. The young man walks over to the bed and smiling at the patient says "Hi, I’m Brian and I work as part of the housekeeping staff here. I will be taking care of your room during your hospital stay. Is there anything I should know right now about your room?” The patient blinks in surprise and looks up at the young man. The patient thinks for a while and then replies "Well, I guess you could clean up the spill I made last night. I dropped my juice on the floor.”

Brian nods his head in acknowledgement and then goes about locating and cleaning the sticky pool of juice. Once done he continues his cleaning routine by emptying the trash and cleaning the bathroom. Before he leaves, the young man asks the patient "Is there anything else I can help with?” The patient thinks again and then says "My two sisters are coming today. Can you make sure that there is an extra chair in here?” Brian nods his head, smiles, and then leaves.

Although the above scene is fictional, it is very likely a scene that could take place at Dartmouth-Hitchcock Medical Center (DHMC) in New Hampshire. Patient- and family-centered care (PFCC) is not just a passing slogan at DHMC; it’s a culture they are working towards that will inform almost every level of care and service there. Most recently there is an initiative to train housekeepers about patient family centered care principles and empower them as part of the team. They are trained to introduce themselves to patients and ask for feedback on their service. Patients and family members are being given, an opportunity to help providers and hospital leaders understand how they can improve the hospital service and experience.

Licia Berry-Berard, MSW, LICSW, the Manager of PFCC at DHMC, first learned about PFCC when she attended a conference held by presenters from the Institute of Patient- and Family-Centered Care. She and other colleagues at DHMC who were in attendance became very excited about what they heard and returned to work with a commitment and a vision to further this model of care. Although some PFCC was already being practiced in pediatrics and palliative care, Licia and colleagues wanted to make PFCC an organization-wide reality.

They joined forces with other like-minded colleagues, formed the Steering Committee which included patients and families, and began holding meetings and forums to share the principles of PFCC and create a vision for what patient partnership could mean. Patients, who were handpicked because of their hospital experiences and their ability to share and connect with others, attended these meetings, some of which were held early in the morning before the regular work day started.

Over time, the word spread. "It was a lot of work” says Licia. "We knocked on many doors … and took every opportunity to find colleagues who were willing to include patients in their committees and projects”. The work paid off as hospital leaders became aware of how patients and families were involved and how valuable their input could be. "We were given the sanction to move forward with PFCC in a working model which meant educating 10,000 people about the principles of PFCC and what this model of care means and looks like”. 

She states that the biggest challenge in training has been helping staff to understand that PFCC is not just introducing yourself, explaining your role at the hospital and being nice and inclusive at the bedside. It is about empowering patients and family members, including them in decision-making processes, allowing them to push back with questions and respectful disagreement, and inviting them to create new ideas and services at the hospital.

Initially, Licia, her colleagues, and patient family volunteers moved this change forward even on top of their normal responsibilities. Today, she has given up her clinical work and now works full time with a core team, including Linda C. Wilkinson, Coordinator and Jon Huntington, MD Director. They have a team, comprised of staff and patient family advisors who help to hold the institution accountable to the mission of PFCC, supporting movement and decrease in barriers. Licia works alongside several other colleagues and more than 120 Patient Family Advisors who are involved in numerous key strategic committees, interviewing patients about their hospital experience, grant writing projects, simulation training of nurses, and even interviewing job candidates.

Licia shares a story about talking with a colleague who was expressing appreciation for the role that Patient Family Advisors had played in designing a new hospital building. He then wondered out loud how he might involve the Advisors in finding nurses for a new service project. Licia extemporaneously said "Why not give them an active role in the interview process?” Her colleague replied "Can we do that?” She replied, "Why not?” That anecdote is a sample of the boldness and commitment that Licia and her colleagues have demonstrated in bringing about change at DHMC.

Matt Martin is a licensed marriage and family therapist and is currently working as a post-doctoral fellow with the Chicago Center for Family Health and the Illinois Masonic Family Practice Residency Program. He received a master’s degree in Marriage and Family Therapy from Brigham Young University and just recently a doctoral degree in Medical Family Therapy from East Carolina University. His interests include integrated primary care, behavioral health, and family medicine residency education.



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