Implementing family-centered care in a whole-of-clinic manner

Evidence from research and clinical practice has shown that effective implementation of a family-centered care approach can lead to better client outcomes, such as improved hearing aid uptake and improved client satisfaction with hearing care services. However, implementing family-centered care may mean some behaviors in the clinic have to change. For clinicians to have positive interactions with clients and their family members, it is vital that family members are invited in to the clinic and the consultation room. This statement seems self-explanatory but a recent study showed that sometimes simply asking a family member to attend an appointment is not that easy.

Gaining insight into how FCC is practiced

Here at the School of Health and Rehabilitation Sciences at The University of Queensland, Brisbane, Australia we have conducted a range of studies investigating the benefits of social support in hearing aid uptake and outcomes, and the implementation of family-centered care in audiology. One ongoing study being conducted with a group of hearing aid clinics is investigating how family-centered care practices are a part (or not) in the interactions that staff have with their clients, and how these interactions can be optimized. To gain a holistic insight into how family-centered care is practiced currently, baseline data was collected in four different ways:

• Interviews with various staff members, including management, clinical trainers, front-of-house staff and clinicians.
• Questionnaires and demographic data from clients, and their family members.
• Video-recordings of audiology appointments.
• Audio-recordings of appointment-booking telephone calls

The results from this baseline phase showed that while management were strongly committed to a family-centered care approach, in practice there were a number of potential improvements to address. For example, of the audiology appointments observed only 30% included a family member. Furthermore, during the interviews, many of the client-facing staff such as front-of-house staff described feeling discomfort when asking a client to bring a person close to them to their audiology appointments. Some reasons given included feeling a sense of overstepping a boundary, questioning a client’s independence or concern that a client would take offence. Some staff also felt that, in the case of initial telephone calls, there was so much information to impart, that asking for a family member to attend was burdensome.

The results also indicated that staff were uncertain how to best phrase the question asking for a family member to attend, how to explain to the client why this was important, and how to overcome possible objections. Lastly, the results showed there were inconsistencies in the formal training that staff had received about the concepts and benefits of family-centered care. The audio-recordings of telephone calls also highlighted that either family member attendance was not addressed during the phone call, or if it was, the reasons given to clients for bringing a family member were confusing or unclear.

Optimizing FCC by training staff

From these observations and data, the first way to optimize family-centered care in these clinics was to ensure that clients’ family members were invited and encouraged to attend. To do this, we developed and delivered a staff training session for front-of-house staff and clinicians which:

• Explained the benefits of family-centered care,
• Highlighted the importance of explaining the reason for asking for family member attendance before the question is asked.
• Role-played new ways of wording the question, and
• Provided possible responses if clients had further questions or objections

The next necessary steps

Our study will continue to measure if implementing these changes will result in an increase in family member attendance at appointments. We will also continue to gather perspectives from clients and family members, take audio-recordings of telephone calls and video-record audiology appointments. It was important for us to identify that the ‘simple’ step of asking for family member attendance may not be so simple and may in fact create discomfort for some audiology clinic staff. This should be addressed if the clinic is to truly embrace family-centered care in a whole-of-clinic manner.

If you’d like to see if your clinic is truly family-centered, why not take the 10-step family-centered care audit which can be found in the Hearing Review.