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The philosophy of patient and family-centered care is founded
on the belief that health outcomes are improved by partnering among
health care providers, patients, and their families. This belief
permeates the health care system and does not represent a specific
therapy that is applied as part of a treatment plan. The
patient/family-centered care (P/FCC) approach
affects nearly every interaction and decision in our health care
system. In the literature, there is no uniform definition
of patient and family-centered care. Therefore, it is best described
by its fundamental principles: respect and dignity, information,
participation, collaboration, and flexibility.
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Treat each family with respect. Although individual physicians
and nurses typically are respectful in their interaction with patients,
the health care system was not designed to afford dignity and respect
to patients. The system often values providers’ needs and
time over that of patients (waiting rooms, double-booked schedules,
etc). Patients are often referred to by numbers or diagnoses. Patients
in a hospital setting are often asked to wear uncomfortable clothing
and are subject to rules beyond their control. Many of the routine
policies and procedures that seemingly disregard patients’ comfort
and dignity are now changing. Treating patients and families with
honor, addressing them as they wish to be addressed, asking permission
to examine, and learning about their strengths and human history
in addition to their medical history exemplifies this core principle
of respect and dignity. Consideration must be given to physical
comfort and modesty of patients and families. Families must be included
in discussions regarding their care and treatment plan. This was
successfully accomplished at one major children's hospital by instituting
a system of “family-centered rounds” that included
the family in all discussions and planning decisions regarding diagnosis
and care. Family and care team satisfaction improved.1
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Access to health information is a basic right of patients. Implementing
the patient and family-centered care philosophy involves transfer
of control of information from the health care system to the patient
and family. Respecting the absolute confidentiality of information
as it is used by the health care system is imperative.
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Traditional paper charts kept separately by each provider and
hospital are being replaced by interconnected electronic health
records and databases. As the electronic system is implemented,
designers are faced with the decision of who “owns” the
information. Many hospitals now give patients complete access to their
charts during a hospital stay. Some give the patient control of
all information, and the patient or family grants access to hospitals
or physicians. This is particularly helpful for families of children
with chronic conditions who previously needed to wait for busy professionals
to contact them with test results. They worried about delays in
care and information being overlooked. Access promoted improved
self-management and interaction with providers.2 The
Internet allows patients to have nearly the same access as physicians
to the health literature. Patients and their ...