Patient-and family-centredness: growing a sustainable culture

Elements of a sustainable culture that nourishes patient- and family-centredness (PFC) in healthcare are elegantly simple, but achieving PFC poses profound challenges for healthcare systems and policy. Healthcare organizations and policy makers often identify tactics and tools that they believe enhance PFC, but they fail to involve the very people who use healthcare services: patients, their families and community members. A way of viewing the journey to a sustainable PFC culture is by examining those elements of leadership, partnership and infrastructure that are necessary for its achievement.

Tapping into the wisdom in the room: results from participant discussion at the 7th International Conference on Diagnostic Error in Medicine facilitated by a World Café technique

The patient safety literature is full of exhortations to approach medical error from a system perspective and seek multidisciplinary solutions from groups including clinicians, patients themselves, as well as experts outside the traditional medical domain. The 7th annual International Conference on Diagnostic Error in Medicine sought to attract a multispecialty audience, and attempted to capture some of the conversations by engaging participants in a World Café, a technique used to stimulate discussion and preserve insight gained during the conference. We present the ideas generated in this session, discuss them in the context of psychological safety, and demonstrate the application of this novel technique.

A Challenge to Aim Higher and Bolder

The paper "The Patient Experience in Ontario 2020: What Is Possible?" provides useful context setting, definitions that frame the essential principles of good relationships and challenges for outcomes by 2020 for the people of Ontario. The question - Is it ambitious enough to achieve a patient-centred healthcare system by 2020? Does it build on the deep strengths already evident in Ontario to achieve the outcomes essential to a thriving region? Will the challenges accelerate dramatically improved outcomes in better health, better care and lower costs? The risk of aiming too low is that it allows for an incremental, comfortable-for-us-in-healthcare pace when what is required is ambitious, disruptive moves. This commentary offers suggestions for Winning Conditions that build on those proposed and takes steps beyond - Winning Conditions 2.0 - to assure a health system the citizens of Ontario expect and deserve.

Creating a Team That Thrives: An Annotated Conversation With Marlene Williamson, MSN, RN, NE-BC

How do successful leaders do that? In this interview with Marlene Williamson, director of Inpatient Nursing Services at Winchester Hospital in Winchester, MA, she describes the leadership behaviors that created a float team that thrives, provides highly valued care, continually improves their individual performance, and usually has a waiting list of internal applicants. Barbara Balik’s analysis of Marlene Williamson’s comments are in indented paragraphs.

Appropriate design takes input from all corners

The design of a children's hospital requires more than just putting schematics on paper and opening the doors. It requires detailed planning to meet not only the needs of children, but their family members as well. In the following article, members of the medical and design team involved in a Minneapolis hospital outline the important factors.

When the patient requires observation not hospitalization

Developing alternative health care delivery systems that successfully meet the needs of multiple consumers in a cost-efficient manner is essential. Minor revisions of long-standing programs are frequently inadequate in the face of escalating demands for a more efficient health care system. The SSU Observation Area has met the primary objectives by providing a quality, cost-efficient alternative to the use of existing inpatient and emergency department services. Alternatives, such as the SSU, require three major components to succeed: A risk-taking environment. Innovative nursing leaders, especially at the department head level. Staff nurses who demonstrate flexibility, enthusiasm, and pride in expanding their professional roles. The SSU was not developed without difficulty or some conflict. As the program was developing, full-time night coverage was not warranted so an on-call system was used. Increased use of the SSU resulted in the on-call person frequently being called in rather than just occasionally being called. Staff discontent grew as this continued. Additional night staff were added and use continued to increase, which ensured financial viability. Nursing leaders are developing alternatives in every setting. As we learn from each other, the opportunities for change grows.

Operationalizing a nursing philosophy

A traditional philosophy statement can be transformed into a positioning statement that articulates a "vision" for a department of nursing and provides a framework when planning to thrive rather than merely survive in today's changing and competitive health care environment. Internal and external forces appropriately assessed enable nurse executives to empower staff to respond proactively to change and prepare for the future.

Community-based diabetes education: an outreach program

State-of-the-art educational and clinical management services for chronic illness are generally found in referral centers. In Minnesota, those referral centers are based in metropolitan areas and are not easily accessible to people living in small communities or rural areas. In 1979, a pro gram was developed to work with community health pro fessionals to provide and support pediatric diabetes care in nonmetropolitan areas. In the past five years, the Minne sota Diabetes in Youth Program (MDYP) has provided an innovative approach to community-based care for children with diabetes. It emphasizes education for families to help them deal more effectively with diabetes management.