Fierce Q&A: NYU Langone VP on why a hospital is not a hotel

As the industry moves toward patient-centered care, more hospitals are embracing a "patient-first" mentality with better patient engagement and shared decision making.

In honor of October being Patient-Centered Care Awareness Month, FierceHealthcare spoke with Michele Lloyd (pictured), vice president for Children's Services at NYU Langone Medical Center about implementing a patient-centered approach and the importance of using both qualitative and quantitative factors to understand patients' experiences.

FierceHealthcare: How has the industry's approach to patient-centered care evolved over the years?

Michele Lloyd: Twenty years ago, this was a model and philosophy of care that was just beginning to emerge in pediatrics.

What's really evolved quite significantly since the Institute of Medicine report is that this has expanded to include all healthcare--adults, children. And it's no longer just how people think about caring for children and families but directly tied to patient safety and health outcomes in our country.

The approach has very much mainstreamed into adult care, as well as the care of children, looking at a model of partnership, engagement, transparency and inclusion in decision making to ensure safety and productive health outcomes.

FH:  What makes a successful patient/family-centered care model?


"It doesn't mean 'focusing' on patients or families; it means partnering with patients and families."

ML: First, define what it is and then what makes it successful.

In the most comprehensive way, patient- and family-centered care is an approach to partnership. It doesn't mean "focusing" on patients or families; it means partnering with patients and families, which is quite different.

True patient- and family-centered care is a partnership where we, as healthcare professionals, recognize that the people who can best speak to what works for patients and families are indeed patients and families. And so that requires having systems in place to regularly hear from patients and their family members.

Some of them are qualitative and some are quantitative. In most settings across the country, there are quantitative ways, whether that's surveys and focus groups to get feedback. But quantitatively, just getting feedback from surveys is not enough. If you look at a survey finding and see room for improvement, the qualitative piece is what really helps you know how to improve.


"It's not hotel amenities. It's not china plates for meals. While those things are very nice, a true patient/family-centered care model is really at the core of the heart of care."

In terms of what makes a successful model, is understanding the core principles of partnership, of dignity and respect of information sharing, and transparency.

So it's not hotel amenities. It's not china plates for meals. While those things are very nice, a true patient/family-centered care model is really at the core of the heart of care and coordination and decision making about care.

FH: What are some qualitative ways to hear from patients and families?

ML: There are many ways to give voice, if you will, and stories and texture to that static, sterile numerical survey feedback data.

Qualitative ways would include things like having a patient or family advisory council that is very robust in an organization partnering on every strategic issue. If your strategic objective is constructing a new building, that's on the agenda with your family and family advisory council to get their feedback and input. If one of your strategic objectives is to ever-improving the safety of patients, maybe with central-lines, you would have that on the agenda so patients and families would give direct feedback about those things.

Another way is focus groups with families over very defined topics to get deep input. It's qualitative, it's not statistically significant, but it gives voice and insight needed to make improvements.

A third way is having family faculty, where actual patients and family members are recruited to teach hospital staff--at every new employee orientation, new orientation for residents and fellows. It's a truly educational approach where families are the educators.


"Hold senior executive roundtables,   where you invite four or five family members each session to come and tell their story."

Other ways are to hold senior executive roundtables, where you invite four or five family members each session to come and tell their story about themselves as a patient or about their family member, what went well in their healthcare experience, what was a barrier to an effective experience, and just giving executives face-time, real-time in a room with patients and families learning about how their health system works.

Another way that is widely practiced is doing family-centered rounds. That would be medical leaders, nursing leaders, senior executives rounding and talking directly to patients and families who are receiving care in the organization--whether it's outpatient or inpatient--to find out what's working, what's challenging to them, what are the things if they were in charge of the hospital they would change.

It's all qualitative, but if you do you see patterns and themes, that helps you understand your quantitative data.

FH: How will the industry benefit from more organizations implementing the model?

ML: The most significant benefit will be a safer healthcare delivery system. We know hundreds of thousands of people are unintentionally harmed or killed each year in America as a result of our healthcare system. True partnering and modeling of family-centered care, just like the IOM began describing in its first work on safety, "To Err is Human," is a very important part of the answer to our safety dilemma in healthcare.

FH:  What are some challenges to implementing the model, and how can hospitals overcome them?

ML: Some of the challenges to implementing a robust patient- and family-centered care model are that, oftentimes, people get confused about what the definition is and think it's being nice, for example, so they put in systems that are meant to mirror hotel-type services. And those are certainly all good, and we all would want to be treated very well from an amenities perspective if we were hospitalized, yet that won't achieve more positive healthcare outcomes or safety.


"People get confused about what the definition is and think it's being nice ... so they put in systems that are meant to mirror hotel-type services."

And so one challenge is truly understanding what the model is, and then implementing strategies that families and patients help to design to advance care. In some organizations that aren't experienced or fully comfortable in working transparently with families, there's reluctance and hesitation to fully engage families in planning and leading programs, services and designs for the future.

Sometimes, people who haven't had that experience believe that families will take over, and so there's worry that it will not be productive. Yet, I've never experienced that in all the travel and conversations with people across that country once they've fully embraced that.

It takes time and effort to develop a robust patient- and family-centered care model. It really is about true partnership, lots of communication, open dialogue, having families on every important committee in the organization.

FH:  How can hospitals use the patient/family-centered care model to boost patient satisfaction scores?

ML: If you look on any patient satisfaction score tool, there are always things about communication and being prepared for discharge, understanding the treatment options or effective pain management--the whole range of things we all know as those core indicators.

Let's say an organization is struggling with pain management, you would use your patient-family advisory council and take those scores and say, "From a patient perspective, when you're thinking pain management, what does it look like to you?" So get people to describe what it looks like, what it doesn't look like, and then develop new approaches and new education materials.

The educational materials would be around improving outcomes, (you might say satisfaction scores, but it's really about outcomes), for example, about pain management that patients can review and give you feedback. You would take the educational materials to the families or the patients and say, "Does what we've written here convey what you said was important that patients need to understand?" And you would let patients wordsmith that before you finalized it and used those materials to help educate families around pain.

FH:  What advice would you give to other hospitals looking to make a patient/family-centered approach part their organization's culture?

ML: Almost every health system in America has patient safety and quality at the top of their agenda--or needs to. I would absolutely recommend to link a patient- and family-centered approach to that agenda so that it's not separate, just to be nice or to improve satisfaction scores. It really is linked to the safety-quality agenda.

In terms of how to do this: Start recruiting patients and families to teach you about their experiences. Begin by having very robust patient and family advisory councils that do real work that is aligned with the organization's strategic plan.

Also, have families and patients address staff in education and leadership forums so the leaders of the organization begin getting comfortable hearing directly from patients and their families.

If you haven't begun, just start where you're able to. Start with whatever makes sense in your organizational culture.