• Welcoming Families as Partners in Care

    An interview with Anna Roth May 01, 2015

    Creating a culture of continuous improvement centered around patients is this health system CEO's top priority.

    Anna Roth, RN, MS, MPH, is CEO, Contra Costa Regional Medical Center and Health CentersLike most hospitals, Contra Costa Regional Medical Center (CCRMC) used to announce the end of visiting hours each evening.

    "It is a heart-wrenching experience to watch families say goodbye to each other at the end of a long day," says Anna Roth, CEO of the public hospital in Martinez, Calif., and its affiliated health centers. "They are worried. I am a nurse by background, and anybody who has ever worked in a hospital can relate to that."

    Listen to a related audio interview with Anna Roth on how CCRMC gained buy-in from staff to allow visitors into the hospital 24/7.

    In 2013, the hospital's visiting policy prohibited a young boy from being with his critically ill grandfather, who was raising him. "It prevented them from being together when he passed away so they lost the chance to say goodbye," Roth says. "As we stepped back and looked at that, we thought 'We can do better than this.'"

    Nurturing Improvement

    A leader in health system redesign and innovation, Roth focuses much of her work on doing better. She established the CCRMC Change Agent Fellowship to train frontline staff to become redesign experts and create a culture of continuous improvement within the health system.

    Every two years, a small group of staff—usually six to eight—undertake a 15-month program to learn how to apply Lean methodology and work toward the Institute of Medicine's six aims: safe, timely, effective, efficient, equitable, and patient- and family-centered care. In addition to completing a curriculum focused on leadership skills and performance improvement, each participant takes part in group performance improvement projects and undertakes an individual project supported by a mentor.

    Recipients have ranged from medical residents and pharmacists to licensed vocational nurses and nurse program managers. Projects have sought to effectively link patients to community resources, lower surgical site infection rates, and reduce surgery cancellations.

    Roth also believes patients and families should be included in delivery system redesign in a meaningful way. That's why she uses the term "partners" to include CCRMC's patient and family advisers.

    Becoming a 'Welcoming' Hospital

    Eliminating visiting hours was one way to strengthen the partnership concept, moving away from an "us" versus "them" dynamic between hospital staff and patients' family and friends. "They aren't guests in our institution," she says. "We are actually a guest in their lives. In many instances, we are together at the dawn of life and the twilight of life."

    For CCRMC staff, the new policy represents a major change because visiting restrictions are the norm in health care. More than 75 percent of hospitals have hospital-wide visiting restrictions, and nearly 90 percent have intensive care unit restrictions (Liu, V., et al., "Visitation Policies and Practices in U.S. ICUs," Critical Care, 2013, vol. 17, no. 2, p. R71).

    Some staff were concerned that the hospital would be overrun with nighttime visitors. Others worried about the medical center being unlocked throughout the night, and some feared the new policy would make it difficult to ask family members to leave if a patient wanted privacy or solitude. "It was a complete change in thinking," she says. "We had to sort through a variety of issues. It took a multi-stakeholder team several months to put together the policy and turn the policy into practice."

    During "quiet time"—between 10 p.m. and 7 a.m.—a sheriff's ranger staffs the medical center lobbies, welcoming visitors and creating nametags for them. The ranger also notifies unit staff by radio when visitors are coming up to the floor.

    In the first 14 months after the policy was implemented, more than 7,000 visitors spent at least part of the night. "We know how important the events that are going on in this medical center are," Roth says. "And we want to make sure we are including the people who are important to our patients."

    Anna Roth, RN, MS, MPH, is CEO, Contra Costa Regional Medical Center and Health Centers, Martinez, Calif. Access Contra Costa's visiting policy. 

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