The Road to Transformation: What Adult Medicine Can Learn from Pediatrics

Added on May 7, 2019

unsplashAchieving and sustaining transformational change in health care requires an organizational culture that supports true patient centeredness by delivering safe, high-quality, compassionate care that reflects the needs, values, and expectations of patients and their families. While this is an overarching goal across health care settings, children’s hospitals have an edge, as the practice of designing care models and processes with—rather than for—patients and families has long been embedded into the fabric of pediatric care.

At Children’s Hospital of Philadelphia (CHOP), for example, where I served as senior director of Patient and Family Services and in various other roles for more than 15 years, patients and family members are invited to join the Patient Safety Committee and lead family advisory councils. They also actively participate in the care planning process, family-centered rounds, outpatient appointments, and research studies to share their expertise on what works for them both in the hospital and at home. Such input is invaluable to the health care team’s efforts to provide exceptional care experiences and develop shared plans of care for them as individuals, as well as drive effective and sustainable improvements across the system that enhance the care of all patients and families. To this end, family consultants and partners in collaboration with CHOP’s clinical and administrative staff have developed patient safety programs, facility design improvements, policy changes, marketing collateral, and more.

By partnering with patients and families in this way, children’s hospitals are able to decrease the fear and anxiety of hospitalization, improve the patient and family experience, and optimize the transition from hospital to home. This not only fulfills the caring mission of pediatric providers. It accelerates performance excellence. For example, patient- and family-centered care in the pediatric setting is associated with a reduction in medical errors, decreased inpatient length of stay, enhanced patient and family loyalty, and a greater market share, among other outcomes.[1]

Correlations between patient- and family-centered care and decreased utilization of medical services in the primary care setting,[2] as well as improved patient experience and quality of care in the acute care setting,[3] have also been found, adding urgency to the mission of adult care organizations to truly embrace patient and family centricity.

As these organizations continue to make strides in their transformational journeys, they can learn and adapt strategies for providing patient- and family-centered care from leading pediatric hospitals. Following are some areas in which pediatric systems can lead the way to transformation.

  • Care coordination—Due to the nature of pediatric care, collaboration across care teams is essential. Children’s hospitals excel at organizing health care services across multiple settings to maximize resources and achieve the best possible outcomes. This is especially true around care transitions from inpatient to outpatient and from pediatric to adult care, but it is also evident in individual care experiences. For example, in the neonatal intensive care unit, interventions are often done at the same time to allow newborns the most rest. This best practice could be carried over to the adult care setting so that, instead of waking a patient on three separate occasions—first to check their vital signs, then to draw blood, and then to administer medicine—clinicians could complete all three tasks in one visit.
  • Facility design—Pediatrics has placed an emphasis on providing an age-appropriate environment that also broadly appeals to the children, adolescents, and adults who comprise the patient’s support network. Children’s hospitals often include a dedicated family space, kitchen facilities, laundry units, storage space, work surfaces, Internet access, and other amenities to create a “home away from home” that recognizes and supports family members whose personal and professional lives must continue while their child receives care. The principles that guide pediatric facility design—healing, accessibility, efficiency, privacy, safety—can and should inform the design of other care environments. Sleeping accommodations for family members, bright and cheerful décor, and interactive touchscreen displays and other technology enhance the overall care experience of pediatric and adult patients and families alike.
  • Integrative medicine—Pediatric hospitals have advanced a holistic approach to patient care, helping to shift the industry toward value-based care. Focused on improving the health and wellness of the child rather than treating the disease, these hospitals offer nutrition services, child life professionals, clinical social workers, and more to serve as a bridge between the hospital setting and the patient’s home. When adapted to other care settings, these resources benefit adult patients as well. For example, child life professionals provide developmentally appropriate interventions and programs to address the psychosocial concerns that accompany hospitalization and other health care experiences for pediatric patients and families. This role could be redesigned in the adult care setting to use healing methods beyond pharmacologic agents, such as art and music, to reduce the fear and anxiety of adult patients and families.

In these and many other ways, pediatric health systems are setting an example for all health systems to follow. By integrating some of these patient-centered practices and behaviors into their operations, adult care hospitals and health systems can make meaningful progress along their transformational journeys.

[1] “Leadership Strategies for Family-Centered Pediatric Care.” 2015 Performance Insights white paper. Press Ganey Associates, Inc.

[2] Bertakis, KD, and R. Azari. “Patient-centered care is associated with decreased health care utilization.” J Am Board Fam Med 24(3): 229–239.

[3] Wolf, D.M., L. Lehman, R. Quinlin, et al. “Effect of patient-centered care on patient satisfaction and quality of care.” J Nurs Care Qual 23(4): 316–321.