What can we do to foster more family member involvement?

One of the most common comments I get when presenting anything on family-centered care (FCC) is: “I really love the idea of including family in my appointments, but how do I fit it all in?” And with so many clinical tasks to get through, this is not an unreasonable question!

Although I never like to focus on the negatives, I also recognise that before we try a new idea or implement a new process, we must first identify what is preventing us from doing something, and once this is out of the way, we can start brainstorming approaches to overcome these barriers and focus on the facilitators …

So what are the common barriers to FCC?

It will come as no surprise that time is the most commonly identified barrier to FCC, therefore it would be remiss of me to ignore this very real barrier to implementing FCC. There are a plethora of potential solutions to this, which all center around making time for FCC by saving time on other clinical tasks. For example, some clinicians have reported success in sending out case history questionnaires for the patient to complete before the appointment, while others reduce the amount of time they spend explaining the audiogram. At the end of the day however, it’s not about having extra time to implement FCC, but rather prioritising our time so that we can build relationships with our patients and their family.

Another critical barrier to implementing FCC is getting the family member there in the first place! History tells us that most patients will attend appointments on their own, and for those who do make their way to the appointment with a family member, the family may be inclined to do a “drop and run”, choosing to spend the appointment time completing other errands or simply having some “respite” time in the waiting room with a book or magazine! Clinicians have overcome these barriers in a number of ways, including:

• Setting up an expectation before the appointment that family members are important too and should come along.
• Making phone calls or sending emails to family members during or after the appointment to give them an update or ask them any relevant questions. A strategy we have termed “asynchronous FCC”!
• Explicitly inviting family into the appointment by welcoming both the patient and their family in the waiting room and asking them both to “come this way”.
• If any resistance is felt from the family member, clinicians have reported “bribing them with coffee” or telling them to “come in anyway and bring your book”

Other clinical processes which can serve as barriers to FCC include patient health records and outcome measures which tend to exclude family members from the clinical encounter, with most systems only requiring clinicians to keep records on the patient with hearing loss. This is a barrier to recognizing the important role of family and the importance of measuring their outcomes. Some clinics have overcome this barrier by developing a template for their clinical notes to ensure the names of family members, their goals, and outcomes are recorded on file.

Finally, the family members themselves can also be perceived as a barrier to FCC. Clinicians have sometimes reported concerns about “overbearing” family members causing conflict in the appointment, and therefore causing more harm than good! Linked to this have been concerns that patients may sense a of loss of control if their family becomes involved, especially if the family has a negative attitude or they feel “ganged up on” by the audiologist and family member. Common strategies to overcoming these barriers include setting clear expectations at the beginning of the appointment regarding each person’s contribution. The Phonak Recommendations to Implementing FCC provides some specific advice for managing this part of the appointment: “Start the appointment by letting the patient and the family member know that input will be sought from both of them – patient first and then the family member.” So you could say: “We are going to do a lot today. For the next 10 minutes, I want to find out about your hearing and communication (directed to the patient) and then I want to find out about this from your perspective (directed to the significant other).”

What are the facilitators to FCC?

In addition to the above strategies, one of the most important facilitators to FCC is getting the whole team on board. This includes not only the clinical staff, but also management, clinical trainers, and front-of-house staff. In other words, a clinician is only as family-centered as the practice in which they work, so working with all they key players to identify what role they can play in the roll-out of FCC is essential. For example:

• Display posters throughout the clinic emphasizing the importance of family members.
• Ask front-of-house staff to invite family members along when making appointments, making note of the family member’s name.
• Reinforce family member attendance on written appointment letters or text message.
• Set up the clinical room to make family feel welcome. In other words, don’t delegate them to a chair at the back of the room!
• Make the family member feel welcome by thanking them for coming and reinforcing the important role they will play in achieving a successful outcome.

Finally, one of the fundamental principles of FCC is treating the entire family as the “unit of attention”. This means that a key facilitator of FCC is acknowledging family members as the “client”, not just the patient with the hearing loss. Ask family how the hearing loss is affecting them, and involve them every step of the way!

 

We invite you to visit the Phonak Family-Centered Care page on phonakpro.com for FCC tools and resources.

And click here to learn about our FCC eLearning course.