Family-Centered Care (FCC) is a collaborative approach that shifts healthcare from a provider-centric model to one where the patient and their family are integral members of the care team. FCC aims to ensure that healthcare planning, delivery, and evaluation are responsive to the patient’s unique preferences, values, and circumstances. The family, as defined by the patient, becomes an essential ally in improving the quality and safety of the care experience.
The Guiding Principles of Care
The philosophy of Family-Centered Care is built upon four foundational concepts.
Dignity and Respect
This principle requires healthcare practitioners to actively listen to and honor the perspectives and choices of the patient and family. The patient’s cultural background, values, and beliefs are incorporated directly into the care planning process.
Information Sharing
This mandates that all information provided to the family must be timely, complete, and unbiased. Healthcare professionals must communicate complex medical information clearly, ensuring the family has the knowledge necessary to participate effectively in decision-making.
Participation
Patients and families are actively encouraged and supported to be involved in their care and decision-making at the level they choose. This is an empowered role where families contribute their unique knowledge of the patient.
Collaboration
This concept extends the partnership beyond the bedside to the organizational level. Collaboration involves patients, families, and healthcare leaders working together on developing and evaluating policies, programs, and the design of healthcare facilities. Including consumer perspectives ensures the entire system supports family involvement in care delivery.
Changes to the Healthcare Environment
A facility adopting Family-Centered Care implements operational shifts to support family participation.
Unrestricted Family Presence
One noticeable change is the move toward open, flexible, and unrestricted family presence, often called 24/7 visitation. This policy eliminates traditional visiting hours, recognizing that a support person is a necessary partner in the patient’s recovery and emotional well-being.
Family-Centered Rounds (FCR)
The family’s role is made tangible through Family-Centered Rounds (FCR), where the interdisciplinary care team meets at the patient’s bedside. The family is an active participant, hearing the medical assessment, discussing the daily plan, and asking questions directly to the clinical staff. This ensures the family can provide immediate input, often generating new information about the patient.
Patient Navigators
Many facilities integrate patient navigators or advocates into the care team to help families navigate the complex medical system. These specialized staff members serve as a central point of contact, helping families overcome logistical barriers like scheduling appointments or finding community resources. They also provide education and emotional support, especially for families dealing with complex diagnoses.
Adapted Physical Environment
The physical environment is often adapted to support constant family presence by providing dedicated spaces. This includes comfortable waiting lounges, resource centers, and sometimes sleep areas near the patient’s room. These environmental supports ensure the family unit remains involved in day-to-day care routines.
The Process of Shared Decision Making
The process of shared decision making (SDM) involves the patient and family working directly with the clinical team to select a treatment plan. The clinical team presents all medically reasonable options, detailing the evidence, risks, and expected benefits of each choice. The family contributes their knowledge of the patient’s values, lifestyle, and preferences, which customizes the care plan.
The final care plan balances clinical evidence with the patient’s personal priorities. This customization leads to a plan the patient and family are more likely to adhere to. The shared plan includes negotiated actions and defined roles, establishing mutual accountability for follow-through on the agreed-upon steps.
Surrogate Decision-Making
When a patient lacks the capacity to make choices, such as due to severe injury or cognitive impairment, the process shifts to a surrogate decision-maker. The surrogate, often a designated health care agent or family member, is guided by two ethical standards to respect the patient’s autonomy.
The first standard is “substituted judgment,” where the surrogate attempts to make the decision the patient would have made based on their known wishes or values. If the patient’s preferences are unknown, the surrogate follows the “best interest” standard. This requires choosing the option that provides the most benefit and the least burden to the patient, ensuring the patient’s well-being remains central to the care plan.