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Information to Help Hospitals Get Started

Guide to Patient and Family Engagement :: 1

How Patient and Family Engagement

Benefits Your Hospital

Patient and family engagement is an area of increasing

importance for hospitals. Not only is engaging patients

and families and providing patient- and family-centered

care the right thing to do, but also the many individual

benefits of patient and family engagement work together

to contribute to improved hospital performance.

Building patient and family engagement into your

hospital’s current policies and practices can help:

• Improve quality and safety

• Improve financial performance

• Improve CAHPS® Hospital Survey scores

• Improve patient outcomes

• Enhance market share and competitiveness

• Increase employee satisfaction and retention

• Respond to Joint Commission standards

The strategies in the Guide can help achieve these

outcomes. In a pilot implementation project,

hospitals that implemented the strategies in the

Guide observed improved patient experiences of

care, increased staff satisfaction, and improved

nursing time management.

Key Takeaways

• Patient and family engagement is not a new

or separate initiative. It is a critical part of

what your hospital is already doing to

improve quality and safety.

• Patient and family engagement improves

multiple aspects of hospital performance,

including quality, safety, financial

performance, patient experiences of care,

patient outcomes, and employee

satisfaction.

• Together, the multiple individual benefits of

patient and family engagement lead to

improved hospital performance.

• The Guide to Patient and Family Engagement

in Hospital Quality and Safety is an

evidence-based resource that helps

hospitals develop effective partnerships

with patients and family members, with the

ultimate goal of improving hospital quality

and safety.*

* The Guide was developed for the U.S. Department of Health and

Human Services’ Agency for Healthcare Research and Quality by a

collaboration of partners with experience in and commitment to patient

and family engagement, hospital quality, and safety. Led by the

American Institutes for Research, the team included the Institute for

Patient and Family-Centered Care, Consumers Advancing Patient

Safety, the Joint Commission, and the Health Research and Educational

Trust. Other organizations contributing to the project included

Planetree, the Maryland Patient Safety Center, Aurora Health Care, and

Emory University Hospital.

Information to Help Hospitals Get Started

Guide to Patient and Family Engagement :: 2

What are the benefits of patient and family engagement?

Overall improvements in quality and safety

When your approach to care centers on patients and

families, they become allies in your efforts to improve

quality and safety. They contribute through “informed

choices, safe medication use, infection control initiatives,

observing care processes, reporting complications, and

practicing self-management.”1 All this translates into

measurable improvements in quality and safety.2

For example, Planetree hospitals that implemented

patient-centered strategies exceeded Centers for

Medicare & Medicaid Services national averages on

several core quality measures, including care for heart

attack, pneumonia, heart failure, and surgical sites.3

When Georgia Health Sciences Medical Center

implemented changes to its visitation policy to promote

patient and family engagement, the center saw a

62 percent reduction in medication errors, a 40 percent

reduction in falls, and a 50 percent decrease in length of

stay.4

Improved financial performance

Research from the Gallup Management Journal shows

that patient and family engagement “consistently

predicts hospital performance on an array of crucial

business outcomes, including EBITA (earnings before the

deduction of interest, tax, and amortization) per adjusted

admission and net revenue per adjusted admission.”5

Patient-and family-centered care also decreases litigation

and malpractice claims6 and leads to lower costs per case

due to fewer complications and shorter length of stay.7,8

It can also improve patient flow and bed capacity and

reduce overcrowding, with engaged patients and families

serving as an early warning system for potential

bottlenecks in care processes.9 When patients and

families remain disengaged, hospitals waste resources in

the form of delays and waste due to higher call volume,

repetitive patient education efforts, increased diagnostic

tests, and a greater need for referrals.10,11

Improved CAHPS Hospital Survey

scores and patient experiences of care

Many of the CAHPS Hospital Survey measures reflect key

elements of patient and family engagement —

particularly related to patient-provider communication,

pain management, medications, and discharge

information. In 2012, Medicare instituted the national

hospital value-based purchasing program. Under this

program, achievement and improvement on patient

experiences of care scores (based on the CAHPS Hospital

Survey) are used to calculate value-based incentive

payments.12,13 Reimbursement is tied to benchmarked

performance on the CAHPS Hospital Survey, and

hospitals are rewarded or penalized based on their

performance on specific CAHPS measures.

Hospitals that have implemented strategies to improve

patient engagement have seen subsequent

improvements in patients’ ratings of care.14 At Georgia

Health Sciences Medical Center, implementing patient

and family engagement strategies on one unit led to an

increase in patient satisfaction scores from the 10th to the

95th percentile.4 At Sharp Coronado Hospital in California,

a medical-surgical unit that implemented patient-

centered strategies consistently demonstrated higher

overall patient satisfaction scores than a unit that had

not.7 At Anne Arundel Medical Center in Maryland,

implementing nurse bedside shift report and

communication strategies contributed to significant

increases in CAHPS Hospital Survey scores in the

domains of communication with nurses, communication

with doctors, pain management, and staff

responsiveness.15

Better patient outcomes

Engaging patients and families through improved

communication and other practices also has a positive

effect on patient outcomes — specifically, emotional

health, symptom resolution, functioning, pain control,

and physiologic measures such as blood pressure and

blood sugar levels.16,17 In addition, strategies that

promote patient and family engagement can help

hospitals reduce their rate of preventable readmissions.18

Information to Help Hospitals Get Started

Guide to Patient and Family Engagement :: 3

Enhanced hospital market share and

competitiveness

For many hospitals, establishing a brand identity around

patient and family engagement becomes a competitive

edge in the marketplace. By incorporating patient-and

family-centered care into their business model, Cleveland

Clinic in Ohio increased its market share with additions in

both new and returning patients.19 Similarly, as a result of

implementing patient and family engagement strategies,

Griffin Hospital in Connecticut saw growth in both

inpatient and outpatient volume.8 These experiences are

bolstered by findings from a survey of more than 2,000

patients in which 41 percent indicated they would be

willing to switch hospitals for a better patient

experience.20

Increased employee satisfaction

and retention

Patient and family engagement strategies also help

improve employees’ satisfaction with their work. This, in

turn, leads to higher levels of retention and an improved

ability to recruit quality talent. At Bronson Methodist

Hospital in Michigan, implementing patient-and family-

centered care practices led to a decrease in the average

nurse turnover rate (from 21 to 7 percent). The hospital

estimates that higher nursing staff retention has led to a

savings of $3 million over 5 years.21 As another example,

Bronson’s experience engaging patients and families in

nurse bedside change-of-shift report increased both

nurse and physician satisfaction, as assessed with a staff

survey.22-24

Better response to

Joint Commission standards

Patient and family engagement helps hospitals respond

to Joint Commission standards that recognize the need

for patients and families to be “active and informed

decisionmakers throughout the course of care.”15

Joint Commission standards that relate to patient

and family engagement

PC.02.01.21 The hospital effectively communicates

with patients when providing care, treatment, and

services.

PC.02.02.01 The hospital coordinates the patient’s

care, treatment, and services based on the patient’s

needs.

PC.02.03.01 The hospital provides patient education

and training based on each patient’s needs and

abilities.

PC.04.01.05 Before the hospital discharges or

transfers a patient, it informs and educates the

patient about his or her followup care, treatment,

and services.

R1.01.01.03 The hospital respects the patient’s right

to receive information in a manner he or she

understands.

R1.01.02.01 The hospital respects the patient’s right

to participate in decisions about his or her care,

treatment, and services.

Advancing effective communication, cultural competence, and patient- and

family-centered care: A roadmap for hospitals. Oakbrook Terrace, IL:

Joint Commission; 2010.

Information to Help Hospitals Get Started

Guide to Patient and Family Engagement :: 4

References

1. Coulter A, Ellins J. Effectiveness of strategies for

informing, educating, and involving patients. BMJ.

2007;335(7609):24-7.

2. Johnson B, Abraham M, Edgman-Levitan S, Sodomka P,

Schlucter J, Ford D. Partnering with patients and

families to design a patient-and-family-centered health

care system. 2008.

3. Frampton S, Guastello S. Patient-centered care: more

than the sum of its parts. AJN. 2010;110(9):5.

4. Connor M, Marshall R. Changing the view that families

are visitors in adult hospital settings. Presented at

Hospitals Moving Forward with Patient- and Family-

centered Care

5. Robison J. What is the "patient experience"? Hospitals

are becoming increasingly frustrated - and wasting

money - trying to hit the wrong target. Gallup

Management Journal Online. 2010:1-3.

6. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-

Jaeger J, Bost P. Patient complaints and malpractice

risk. JAMA. 2002;287(22):2951-7.

7. Stone S. A retrospective evaluation of the impact of the

Planetree patient-centered model of care on inpatient

quality outcomes. HERD. 2008;1(4):55-69.

8. Charmel PA, Frampton SB. Building the business case

for patient-centered care. Healthc Financ Manage.

2008;62(3):80-5.

9. Hall MF. Looking to improve financial results? Start by

listening to patients. Healthc Financ Manage.

2008;62(10):76-80.

10. Stewart M, Brown JB, Donner A, McWhinney IR, Oates J,

Weston WW, et al. The impact of patient-centered care

on outcomes. J Fam Pract. 2000;49(9):796-804.

11. Conway J, Johnson B, Edgman-Lefitan S, Schlucter J,

Ford D, Sodomka P, et al. Partnering with patients and

families to design a patient- and family-centered health

care system: a roadmap for the future: a work in

progress. Bethesda, MD: Institute for Family-Centered

Care, 2006.

12. HCAHPS fact sheet (CAHPS hospital survey): Centers for

Medicare and Medicaid Services; 2010 [updated

2010/09/15/]. Available from:

http://www.hcahpsonline.org/files/HCAHPS%20Fact%2

0Sheet,%20revised1,%203-31-09.pdf.

13. Centers for Medicare and Medicaid Services. Plan to

implement a Medicare hospital value-based purchasing

plan. Washington, DC: U.S. Department of Health and

Human Services; , 2007.

14. Iacono S. A study on the relationship of patient

satisfaction and utilization of a Planetree model in care

delivery. PlaneTalk Newsletter. 2001.

15. The Joint Commission. Advancing effective

communication, cultural competence, and patient- and

family-centered care. 2010 Prepublication edition - not

for distribution.

16. Epstein RM, Street RL, Jr. Patient-centered care for the

21st century: physicians' roles, health systems and

patients' preferences. Philadelphia: American Board of

Internal Medicine Foundation; 2008.

17. Roter D. Which facets of communication have strong

effects on outcome: a meta-analysis. In: Stewart M,

Roter D, editors. Communicating with medical patients.

Newbury Park, CA: Sage; 1989.

18. Steffens L, Jaeger S, Herrmann S, Thomas K, Barker K,

Eggleston A. Hospital readmission: the move toward pay

for performance. J Nurs Adm. 2009;39(11):462-4.

19. Anderson J. Exploring the role of board leaders in

patient- and family-centered care: a conversation.

Presented at Hospitals and Communities Moving Forward

with Patient- and Family-Centered Care: An Intensive

Training Seminar. Pinehurst, NC: Institute for Patient-

and Family-Centered Care; 2010.

20. Grote KD, Newman JRS, Sutaria SS. A better hospital

experience. McKinsey Quarterly.

21. McCarthy D. Case study: achieving a culture of patient-

and family-centered care at Bronson Methodist

Hospital. Quality Matters. 2007.

22. Chaboyer W, McMurray A, Johnson J, Hardy L, Wallis M,

Sylvia Chu FY. Bedside handover: quality improvement

strategy to "transform care at the bedside". J Nurs Care

Qual. 2009;24(2):136-42.

23. Chaboyer W, McMurray A, Wallis M. Bedside nursing

handover: a case study. Int J Nurs Pract. 2010;16(1):

27-34.

24. Anderson CD, Mangino RR. Nurse shift report: who says

you can't talk in front of the patient? Nurs Adm Q.

2006;30(2):112-22.