To date, we have focused on measuring the challenges and successes of FCR implementation in academic settings. The emphasis on traditional teaching rounds has been at the price of the exclusion of defining what is family-centered when consultants or nonteaching hospitalists provide care, let alone nonphysician staff and outpatient providers. The emphasis on measurable data has subdued the powerful voices of patient and family stories. We have, predictably, created a hospitalist-centered agenda.
PFCC’s broad umbrella involves working with families at every juncture, from the design of your unit to the format of rounds to the outcomes of your study. True PFCC is measured by culture change and is successful when patients and families are surrounded by continuous healing relationships. By focusing efforts squarely on the implementation of FCR, I fear we may lose sight of a tremendous opportunity.
Pediatric Calling
Adult HM has turned a focus on quality and safety into a building block for the growth and acceptance of the field. Pediatrics invented and advanced the medical home concept, now a core principle of healthcare reform. PFCC is a central yet underdeveloped component of both of these parent organization efforts. Meanwhile, federally mandated public reporting of patients’ and families’ experience of care is under way, and hospitals are at varying stages of funding relevant initiatives.
These winds of change have created a fertile climate from which pediatric HM should blossom and lead. We can build upon our strong start in FCR, but we also must expand our efforts to lead in all directions. We must align our goals with administrative leadership, extend our work laterally to all other physicians and healthcare personnel, and elevate patients and families from subjects to collaborators.
FCR becomes a speed bump only if it is seen as a distinct and removable piece of PFCC. FCR accelerates change when it is embedded in the continuum of PFCC. Translating this vision into the language of strategic planning, a mission statement for the future of pediatric HM might look something like this:
Our strategy is to demonstrate our value to healthcare by leveraging FCR knowledge and expertise to generate a strong leadership presence at the forefront of the PFCC movement.
- We will seek partnership with institutional, community, and national leaders to promote a unified and collective vision for change.
- We will continue to accumulate not only data, but also powerful stories with which to effect change.
- We will use our experience in interdisciplinary partnerships with families to engage early adopters from other domains of the healthcare system.
- We will maintain a central focus on relationships and communication to effectively model culture change. TH
Dr. Shen is pediatric editor of The Hospitalist and medical director of hospital medicine at Dell Children’s Medical Center in Austin, Texas.