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A Roadmap for Hospitals Introduction Checklist of Recommended Issues to Address Each chapter of the Roadmap for Hospitals opens with a checklist of several recommended issues to address. The issues reflect recommendations from an expert advisory panel, and many of the practices and resources were collected during the development of the new patient-centered communication standards for hospitals. The complete checklist of all recommended issues included throughout this monograph can be found in Table 2, pages 5 and 6, and also appears as Appendix A on page 47. Joint Commission Requirements The Joint Commission views effective communication, cultural competence, and patient- and family-centered care as important components of safe, quality care. Relevant Joint Commission standards and elements of performance that support the recommendations included in the Roadmap for Hospitals are presented in both Appendices B and C beginning on pages 49 and 57, respectively. Additional guidance on compliance and implementation of the new patient-centered communication standards is also provided. Laws and Regulations There are a number of federal, state, and local laws that support the issues of effective communication, cultural competence, and patient- and family-centered care. Appendix D on page 65 presents the legal support for the recommendations and practice examples addressed in this Roadmap for Hospitals. Resource Guide The Roadmap for Hospitals contains a list of additional resources that may be helpful as hospitals begin to implement the recommendations or continue in their efforts to address effective communication, cultural competence, and patient- and familycentered care. Links to supplemental information, model policies, and educational tools are provided to offer guidance and best practices from the field. Hospitals can build on these examples for new services or programs, modify the sample policies and tools to meet the needs of their patient populations, or contact other organizations and experts for further assistance. A compilation of these resources is provided in Appendix E on page 77. Suggested Ways to Use the Roadmap for Hospitals Every organization’s journey to improve communication, cultural competence, and patient- and family-centered care will be unique. We have organized the Roadmap for Hospitals in such a way as to provide a comprehensive look at many of the systems and processes necessary to support effective communication, cultural competence, and patient- and family-centered care. Given each organization’s unique needs, it will be vital that this monograph is used as a complement to existing efforts to monitor and improve quality and safety. To help hospitals embed quality and safety into all activities of the organization, some ideas for practical use of this monograph appear in the following sections. To Improve Performance The Joint Commission recommends taking a comprehensive approach to each of the issues explored in the monograph. Hospitals should designate a dedicated group of individuals to review the monograph in its entirety. Ideally, individuals from a variety of disciplines across the organization will come together to discuss implications for the practices outlined in this monograph. Then, it may be useful to identify how the processes in the Roadmap for Hospitals are reflected in the hospital’s current processes and pinpoint any gaps that may exist. The checklist in Table 2, pages 5 and 6, can be used as a quick reference to help catalogue your hospital’s efforts to improve in the areas of effective communication, cultural competence, and patient- and family-centered care. To Train Staff Hospitals may choose to distribute reading assignments from the Roadmap for Hospitals to key staff. For example, it may be important to have all quality, patient safety, and risk management staff read the content of the monograph so that they can incorporate relevant practices into their existing processes. Clinical staff may benefit from reading the core chapters to gain an understanding of how various patientfocused issues can be addressed throughout the continuum of care. This monograph could also be used as part of a comprehensive staff and medical staff orientation program. To Help Inform Policy Some hospitals may want to use the Roadmap for Hospitals to evaluate policy and procedures. While the intent is not to focus on policy, well-crafted policy can support care practice that is effective and responsive to patient and clinician needs. Some of the areas that may be informed by the Roadmap for Hospitals include the patient satisfaction policy, visitation policy, interpreter service/language access policy, patient rights policy, complaint and grievance procedures, and so forth. 4
A Roadmap for Hospitals Introduction Table 2. Checklist to Improve Effective Communication, Cultural Competence, and Patient- and Family-Centered Care Across the Care Continuum Admission ❑ Informpatientsoftheirrights. ❑ ❑ ❑ ❑ ❑ ❑ ❑ Identifythepatient’spreferredlanguagefordiscussing healthcare. Identifywhetherthepatienthasasensoryor communicationneed. Determinewhetherthepatientneedsassistance completingadmissionforms. Collectpatientraceandethnicitydatainthemedical record. Identifyifthepatientusesanyassistivedevices. Askthepatientifthereareanyadditionalneedsthat mayaffecthisorhercare. Communicateinformationaboutuniquepatientneedsto thecareteam. Assessment ❑ Identifyandaddresspatientcommunicationneeds duringassessment. ❑ Beginthepatient–providerrelationshipwithan introduction. ❑ Supportthepatient’sabilitytounderstandandacton healthinformation. ❑ Identifyandaddresspatientmobilityneedsduring assessment. ❑ Identifypatientcultural,religious,orspiritualbeliefsor practicesthatinfluencecare. ❑ Identifypatientdietaryneedsorrestrictionsthataffect care. ❑ Askthepatienttoidentifyasupportperson. ❑ Communicateinformationaboutuniquepatientneedsto thecareteam. Treatment ❑ Addresspatientcommunicationneedsduringtreatment. ❑ Monitorchangesinthepatient’scommunicationstatus. ❑ Involvepatientsandfamiliesinthecareprocess. ❑ Tailortheinformedconsentprocesstomeetpatient needs. ❑ Providepatienteducationthatmeetspatientneeds. ❑ Addresspatientmobilityneedsduringtreatment. ❑ Accommodatepatientcultural,religious,orspiritual beliefsandpractices. ❑ Monitorchangesindietaryneedsorrestrictionsthat mayimpactthepatient’scare. ❑ ❑ Askthepatienttochooseasupportpersonifoneisnot alreadyidentified. Communicateinformationaboutuniquepatientneedsto thecareteam. End-of-Life Care ❑ Addresspatientcommunicationneedsduringend-of-life care. ❑ Monitorchangesinthepatient’scommunicationstatus duringend-of-lifecare. ❑ Involvethepatient’ssurrogatedecision-makerand familyinend-of-lifecare. ❑ Addresspatientmobilityneedsduringend-of-lifecare. ❑ Identifypatientcultural,religious,orspiritualbeliefsand practicesattheendoflife. ❑ Makesurethepatienthasaccesstohisorherchosen supportperson. Discharge and Transfer ❑ Addresspatientcommunicationneedsduringdischarge andtransfer. ❑ Engagepatientsandfamiliesindischargeandtransfer planningandinstruction. ❑ Providedischargeinstructionthatmeetspatientneeds ❑ Identifyfollow-upprovidersthatcanmeetuniquepatient needs. Organization Readiness Leadership ❑ Demonstrateleadershipcommitmenttoeffective. communication,culturalcompetence,andpatient-and family-centeredcare. ❑ Integrateuniquepatientneedsintoneworexisting hospitalpolicies. Data Collection and Use ❑ Conductabaselineassessmentofthehospital’sefforts tomeetuniquepatientneeds. ❑ Useavailablepopulation-leveldemographicdatatohelp determinetheneedsofthesurroundingcommunity. ❑ Developasystemtocollectpatient-levelraceand ethnicityinformation. (continued on page 6) 5
Page 1 and 2: Advancing Effective Communication,
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