Chronic Care Clinic
The Chronic Care Clinic is an integrated, collaborative initiative created to address the holistic needs of patients with over-utilization of emergency department services. The 9-12-month intervention examined social determinants of health and targeted increasing health literacy, developing self-management skills via behavioral health intervention, community resource connection and successful health system navigation along with a focus on disease-specific goals. Patients who successfully engaged and achieved at least 50% of their established goals participated in a graduation ceremony.
One patient wrote, “They helped me with my health, they helped me find a job, they helped me find a place to live. When I joined this clinic, I felt like I wasn’t lost in the world anymore.”
Arts & Integrative Medicine (AIM)
New York, NY
Led by Founding Director Dr. Jenny Seham, AIM is a program in Montefiore Medical Center’s Department of Psychiatry and Behavioral Science with initiatives in the Child Outpatient Division (COPD) and the availability for consultation, assessment, intervention, and training throughout the Montefiore Healthcare systems. AIM offers arts and integrative interventions including music, dance, photography, drawing, poetry, yoga, gardening, and technology. AIM begins with a foundation of evidence-based psychiatric practices, engages with the community with goals to create positive change in the environment of care and in the mental wellness of patients, their families and hospital staff.
One colleague noted, “…I watched these youths develop newfound confidence, improved self-esteem, and a sense of worth in a way I have never witnessed.”
The 3 Wishes Project (3WP)
Hamilton, Ontario, Canada
The 3 Wishes Project (3WP) was developed to bring peace to a patient’s final days and to comfort families. The goal of this end of-life program is to improve the quality of the dying experience for patients, their families and clinicians, by dignifying the patients and honoring their lives in order to ease the grief for others left behind. This is achieved in the 3WP by initiating conversations to learn more holistically about patients and their families, then eliciting and implementing wishes that are important and meaningful to them. These acts of compassion have been classified in 12 categories: facilitating connections, celebrations involving food/beverage, humanizing the patient, personalizing the ICU room, family care, music, religious rituals and spiritual ceremonies, preparations and final arrangements, word clouds, keepsakes and tributes, organ and tissue donation, and “paying it forward.”
As a daughter of a dying patient posted on Facebook an image of the card with dozens of notes from clinicians caring for her father, “This is what kindness looks like.”
Transition Support Program
The Center for Resiliency
The Center for Resiliency supports physicians, medical residents, medical students, advance practice providers and all associates in the pediatric setting, including some who work with families in the adult setting. Over 90% of the active medical staff at the Dell Children’s Medical Center have participated in at least one experience with the Center for Resiliency; some have participated in multiple, including retreats, a six-session resiliency course, monthly Resiliency Rounds, resiliency research (four IRB studies are currently running), the Professional Boundaries and Burnout course, individual counseling or coaching, and Schwartz Rounds. The Center addresses not simply the personal practices of mindfulness or self-care, but hospital-wide processes around difficult conversations, conflict management, and considerations around 24/7 coverage for resource-limited practice groups; resiliency is not limited to individual transformation but is a systemic transformation that supports the whole person, team and community.
Oregon Burn Center
Mentoring and Professionalism in Training (MAP-IT)
Great Neck, New York
The Mentoring and Professionalism in Training (MAP-IT) program at Northwell Health is designed to bring together an interprofessional healthcare team to address the importance of highlighting humanism as a core skill for healthcare professionals, especially in their teaching and mentoring roles with all levels of students, trainees and early-career colleagues. Led by interprofessional facilitators, participants meet in small groups once a month for 90 minutes; this time is a unique opportunity for clinicians who work in very busy time-driven environments to informally come together to share stories about seminal experiences and enhance their humanistic skills. The goal of MAP-IT is to give clinicians, business leaders and researchers a greater ability to self-monitor during patient and colleague encounters and to apply the positive aspects of one situation to a more challenging situation.
STAR Program: An Approach to Stress, Trauma and Resiliency: Brief Emotional Support and Behavioral Emergency Response Teams
The Stress Trauma and Resilience (STAR) Program at the Ohio State University Wexner Medical Center began in the psychiatry department in an effort to understand the impact of toxic stress on the lives of patients seeking treatment for mental health issues. The STAR Program has now developed and trained Brief Emotional Support Teams (BEST) to assist healthcare professionals in mitigating the impact of negative outcomes and the associated emotions of shame, guilt, hurt, and loss that lead to burnout and compassion fatigue, and has also introduced a Behavioral Emergency Response Team (BERT) to provide 24/7 competent, trauma-informed care to patients requiring behavioral health support throughout the medical center. The BEST and BERT programs are shaping the foundation of how safe and competent trauma informed care and mental healthcare can be delivered in multi- specialty hospital organizations.
Bridgeport Hospital Palliative Care/Burn Center Collaboration
The Palliative Care Team at Yale New Haven Health’s Bridgeport Hospital has developed a unique collaboration with the Connecticut Burn Center to provide the best possible patient care for patients with burn injuries.
Since its beginning in 2011, the Palliative Care Team has grown substantially to focus on the reduction of suffering for patients, families and staff, and became increasingly involved with patients of the Connecticut Burn Center. As a result of the clinical collaboration, the time from patient admission to a consultation order decreased from an average of 26 days to an average of only 4 days, indicating excellent trust and partnership along the entire continuum of care, even for patients expected to survive their burn injuries.
Goldstone Caregiver Center
The Goldstone Caregiver Center, made possible by donors Liz and Steven Goldstone, promotes the well-being of patients, family caregivers and staff through compassionate support and a healing environment. It is a warm, home-like environment where patients’ families can find a quiet space for respite, privacy and reflection while still being close to the person they are caring for. Caregivers can meet with a Licensed Clinical Social Worker, whose office is conveniently located within the Center, to find welcomed guidance and support. Meetings with spiritual care professionals or other members of the health care team can also be arranged in this comfortable area. Caregivers are able to enjoy healthy snacks and beverages, use public access computers and a printer/copier/fax machine, borrow from a lending library of caregiver books and browse our collection of local resources. All services and amenities are free of charge.
The Caregiver Center is more than just a beautiful space; it is a program. This program is comprehensive, designed to meet the multifaceted needs of the caregivers it serves. It provides a unique form of outreach by volunteer Caregiver Coaches trained by the Center’s Director and Manager in compassionate communication, cultural competence, self-care and boundary setting. These coaches seek out families to provide compassionate support by the bedside, where families often prefer to be, and as well as support families who come into the Center. A monthly program calendar is created and distributed not just to caregivers throughout the hospital, but also to those who are caregiving in the community so as to reduce the isolation that caregivers quite often experience. It includes a Caregiver Support Group, the Grief Recovery Method® Grief Support Group, educational programs, meditation sessions, stress management workshops, and more. The Caregiver Center recognizes that the staff across all departments are constantly in a caregiving role, both professionally and very often personally. Therefore, the Caregiver Center offers special self-care programming to staff both in the Center and on the units, while also being available to provide individual support when traumas occur.
The Goldstone Caregiver Center is helping to positively change the culture of Danbury Hospital. It promotes collaboration between hospital departments, working together in the best interest of the patients and their families through more effective and compassionate communication. It’s also changing the definition of patient care, with support wrapping around the whole patient, notably including those who are responsible for the caregiving. This model of compassionate support in health care ought to be the rule, rather than the exception.
The program is advertised in the staff e-newsletter, local newspaper, social media, network-wide emails, brochures displayed on patient units, and by word-of-mouth. The Center’s Director and Manager attend staff meetings to make the Caregiver Center known throughout the campus.
A System Wide Approach to Transform Compassionate Care
Toronto, Ontario, Canada
Grounded in a partnership between the collaborative practice service, human resources/organizational development division, teaching and learning institute, client and family integrated care and nursing departments, this multi-pronged program casts a system-wide approach towards embedding compassionate, collaborative care throughout clinical practice and beyond. With a shared vision of improving experiences of care and outcomes for health professionals, patients and families, five strategic initiatives were established to create a culture of care and collaboration.
As the first Canadian hospital to implement Schwartz Rounds, Holland Bloorview Kids Rehabilitation Hospital has experienced Schwartz Rounds as an essential tool for strengthening relationships and compassion among staff, patients and families.
Within this program, the hospital is developing a “Strengths-Based Leadership and Management” training program to change nurses’ work-life environment by focusing on enhancing, developing and working with strengths to bring out the best in the person and the workplace.
The mandatory interprofessional orientation for new, existing and returning staff is an effective method to educate, remind and update staff of Holland Bloorview’s values, culture and strategic priorities through the use of simulation and team-building activities. Together, the team is successfully (re) orientated and (re) integrated into a collaborative team practice and instills understanding and compassion in client and family-centered care.
The innovative arts-based narrative nursing initiative is a promising method for enhancing nursing empathy as it builds a cohesive, collaborative team that is essential to excellent patient care and a dynamic nursing culture.
The “Walk in Their Shoes” pilot initiative brings the lived experience of front-line clinicians to the leadership team as one leader shadows a front-line clinician for a full week to experience the day-to-day delivery of care. This program unites hospital leadership with its frontline caregivers to make impactful strategic decisions.
All five strategic initiatives are implemented with the aim of enhancing the patient and family experience, instilling the principles of patient and family-centered care, and collaborative learning to ensure a strong culture of care and compassion.
Improving Communication with Patients/Families in the ICU
Baldwin Park, California
The intensive care unit (ICU) is a challenging place for families having to make decisions for a loved one who cannot speak for themselves. Decisions need to be made in a timely fashion, even though prognostic outcomes are hard to predict. After recognizing communication conflicts in the ICU, an interdisciplinary team at Kaiser Permanente Baldwin Park devised an organized strategy to improve communication with families when decision-making was difficult or when there was a wide discrepancy between clinicians and family members regarding which treatments were non-beneficial or overly aggressive care.
The goals of the intervention were to improve the overall communication with patients and families in the ICU setting, improve communication among the care team members, promote greater consistency between various providers’ communication with a given family to ensure better continuity of care, improve support for physicians and healthcare providers communicating with families in the ICU, and decrease moral distress for the providers.
Components of the intervention included a designated social worker for the ICU. The social worker conducted an interdisciplinary discussion of family needs, stratifying support needs as “A”, “B” or “C”. The social worker then assigned a letter to each family on their first day in the ICU to indicate their support needs. Level “A” families had adequate understanding of ICU procedures and were handling their loved one’s illness with greater ease, level “B” families were more anxious or flustered by ICU protocols, and level “C” families were experiencing a higher level of emotional distress. All “C” level families were scheduled for a family meeting within the first three days of ICU admission.
Additionally, a set of educational series were conducted with all ICU clinicians. There was a pre-trial education session for nurses and doctors to understand the coping styles and decision-making needs of families, as well as a separate pre-trial education session for doctors to enhance their use of empathetic language with patients and families.. Lastly, staff created “Family Friendly Materials,” which included an “Intro to the ICU” pamphlet to orient families to routines and processes in the ICU. Nurses offered family members an opportunity to complete a story board to humanize caregivers’ understanding of their loved one, who was now incapacitated. The board had space for pictures of their loved one and places to write about their loved one’s interests and care preferences.
Because of these interventions, there was significant improvement in the honesty and consistency of communication with family members. Families’ written comments lauded increased positive experiences communicating with providers and greater incidents of receiving kind, compassionate and comforting care. In addition, the ICU nurses showed significant decrease in stressors from communicating with families, and significant improvement in communication between providers. These positive results occurred for day-shift nurses as well as night-shift nurses. ICU physicians’ comments confirmed better communication with families and greater support in addressing family concerns.