Patients benefit greatly when visitors, such as family members and friends, are present and participate in their care.
To put our patients’ needs first and improve the patient experience, Providence Healthcare introduced flexible, patient-directed visiting hours in early 2017 for palliative patients, which was then spread to the rest of the organization in the summer of 2017. Visiting is available 24 hours per day, according to our patients’ wishes.
This quality improvement initiative is related to our 2020 strategic plan that includes a focus on achieving the best care experience possible.
Using a bottom up approach
Engaging patients and staff, and using a bottom up approach was key to this initiative. We gathered feedback from a steering committee composed of current and former patients, residents, and family members, the Patient and Family Advisory Council, staff members, managers, security/building services, risk management, and our Nursing Peer Support Group to develop a new visitation policy for staff and visitation guidelines for the public.
We also conducted an environmental scan of local hospitals and rehabilitation facilities to determine their visiting hour structure and we found that only a few hospitals had patient-directed visiting hours at that time.
Addressing staff concerns
During the process, we listened closely to staff members and managers who initially had some concerns about potential noise issues, safety at night, and the inability to identify visitors.
To address their concerns, visiting hours between 8:30 p.m. and 7:00 a.m. were designated as “quiet time”. Visitors are notified when “quiet time” starts with a friendly message over the paging system. They are also asked to register at reception to get a neon “visitor” sticker they can wear so that they are easily identifiable.
Entrances and exits require visitors to buzz in at night and a log book helps account for visitors entering and leaving the premises. Included in the new policy is a decision-making tree that clearly outlines how to manage disruptive visitors.
Feedback on the new visiting hours
Both patients and family members have positively embraced the change.
As one family member shared, “I am very thankful to Providence for allowing me or my brother to stay with my mother overnight. She is quite anxious at times and I believe this helps her quite a lot and improved her post-stroke recovery.”
Another family member shared, “I have stayed with my dad from the beginning of his recent illness, sometimes up to 24 hours. We have been to other hospitals and luckily we landed here.”
Despite some concerns from staff that there would be an increased number of visitor related incidents, we have not seen an increase being reported.
Useful resources
A number of resources were used to develop the new visitation policy and guidelines. Below is a list of these resources.
Planetree is a non-profit global organization focused on advancing person-centred care. The below are resources that you may find useful.
Lessons learned
Below are some of my lessons learned around change management
that may be of help to others looking to implement their own QI initiative.
- Communicate the “why”: Oftentimes, when trying to enact
a change, we communicate the “what” first, without sharing the “why.” The “why”
in this project has to do with the many benefits patients may receive when
loved ones participate in their care and planning. Patients may experience
decreased stress, increased social support and a decreased risk of falls, among
other benefits. Staff members heard directly from patients why this change was
so important to them, which really helped solidify our shared vision of this
initiative.
- Use data: Sharing data helped to address staff concerns
about safety. We assessed the emergency code and security reports involving
visitors 7 months before and 7 after implementation. Prior to the
patient-directed visitation, we had five incidents and after we had four. So
despite concerns from staff that there would be an increased number of visitor
related incidents, we have not seen an increase being reported. In addition,
only one call was received from a family member with a question about the
visiting hours. Staff members were also asked to share how often they
experienced dealing with a challenging visitor and realized how low the
incidences were over the last few years.
- Involve patients and frontline staff from the beginning: A
nurse staff member was the source of the idea to use neon stickers to identify
visitors during evening hours. This idea was trialled using a Plan, Do, Study,
Act (
PDSA) cycle, which was a quick win. Building on successes
like this helps to increase buy in from your stakeholders.
- Start small: The patient-directed visiting hours was
first trialled in the palliative care unit of Providence Healthcare before
spreading it to the whole organization. The policies, guidelines, processes and
communications were tested to get feedback and make any necessary changes.
- Roll out communication widely across many channels: All
stakeholders needed to be informed of this new change and required a detailed
communication plan before and after implementation of the new patient-directed
visiting hours. Education was provided to patients and families, FAQs and
guidelines were hand delivered to patients, residents, families and staff (and
were even posted in staff washrooms!), information was broadcasted on
televisions in the organization, and the initiative was discussed at a number
of staff meetings. The
guidelines are now posted on our website for the
public.
Have questions or comments about implementing patient-directed visiting hours? Add a comment below or connect with Thelma, on Quorum.
You may also be interested in:
Quorum’s Indicators & Change Ideas page. Find more information about QIP indicators and related change ideas.