May 12, 2006

Family approach to care also crucial for adults: Smith

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Terrell Smith, M.S.N., R.N.

Family approach to care also crucial for adults: Smith

Terrell Smith, R.N., M.S.N., has always been known as a champion for children and families at the Monroe Carell Jr. Children's Hospital at Vanderbilt. Now she can add adults to the list.

Last year, Smith was named to a new position — director of Patient/Family Centered Care for Vanderbilt University Hospital and Clinics — only months after her own mother had been hospitalized for seven weeks at Vanderbilt.

She quickly realized that the need for family involvement in the health care experience was the same for all patients, no matter their age.

“Although there were wonderful doctors and nurses on the adult side, I recognized that some of the changes that had been made at the Children's Hospital were not implemented on the adult side,” Smith said.

“So we started thinking — how do we partner with patients and families to improve our quality of care and the safety of the patient? How do we get ideas to improve our system?”

Smith admits that children's hospitals around the country are at least 12 years ahead of the adult centers.

The concept of patient- and family-centered care spread to adult hospitals when the Institute of Medicine published “Crossing the Quality Chasm.” It recommends establishing a partnership among practitioners, patients and their families to ensure that decisions respect patients' wants, needs and preferences, and that education and support are provided so patients can make decisions and participate in their own care.

Smith believes that the patient and family advisory council is the right venue for raising awareness of the need for patient- and family-centered care at Vanderbilt's adult hospital.

The creation of an advisory council made up of patients and/or their family members is one of the first initiatives Smith will oversee. Among the possible duties of the 15-member volunteer council: offering suggestions to leadership about the planning and design of new programs and facilities; evaluating existing services; assisting with the orientation of new staff members; and providing input on teaching materials.

“In order to decide what is best for patients and families, we need their perspective,” Smith said. “We are looking for people who can see beyond their own personal experiences and translate it into something that can improve how we deliver care and how we interact with families.

“There are a lot of things going on at the hospital and many folks are tuning in, but there is still so much we can do to improve.”

Smith envisions a council where the participants are collaborating on patient safety initiatives, serving on the hospital patient safety committee, reviewing patient education materials for clarity and advising hospital administrators on how to improve patient/family support.

Plans call for recruitment and orientation of the council to be completed by this summer. A brochure will also be available for those interested in learning more about patient- and family-centered care, an outgrowth of the elevate program that highlights the medical center's effort to improve services and operational performance.

“This group will serve as our eyes and ears,” Smith said. “We will make rounds with members of the council so that we can see the hospital from their perspective. We may not see the torn wall paper or worn carpet or whether our waiting rooms are comfortable and our visiting hours are meeting families' wishes and needs. But they do.”

As important as comfort and environmental needs are, the one thing patients and families most want is communication with their health care team, Smith said.

“This has been demonstrated again and again through patient satisfaction comments and focus groups,” she said. “The council can also help us with strategies on communication and collaboration with the health care team.”

Smith welcomes suggestions for potential advisory council members. If you have a candidate please email her at

“There is such a need for consumer input,” Smith said. “We have to change the culture at our hospitals and one way to do that is through the patient and family advisory council.”