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Lessons Learned From Restricted Visitation

01/12/2022

By Dr. Tejal Gandhi, MD, Chief Safety and Transformation Officer, Press Ganey

In 2021, society had a renewed sense of optimism as vaccines became available to the public. 

Little did we know, a few short months later, we would face COVID-19’s ability to adapt with the Delta and Omicron variants. The unfortunate reality is that the pandemic may not subside any time soon and this is our “new normal.”  

With this in mind, the health care industry needs a fundamental reshaping of our physical and mental approach to patient safety, especially given that some safety outcomes have worsened during COVID. This reshaping gives more weight to the voice of the patient and encourages not only patient ownership, but also the family’s key role in the pursuit of zero harm. 

The U.S. National Action Plan To Advance Patient Safety highlights four foundational areas where organizations must focus to accelerate their progress in patient safety:

  • leadership and culture
  •  workforce safety
  •  learning systems
  • patient and family engagement

By engaging patients and families as active participants in their care and by prioritizing the patient voice in decision-making, policymaking and quality improvement, we can move the needle on patient safety. Pre-pandemic, there was an increasing focus on this kind of engagement, with shared decision making, expanded visitation hours and patient-family advisor councils.1 

However, at the start of the pandemic, the health care industry put policies into place to significantly curtail visitation with the sole intention of stopping the spread of infection. These decisions were not made lightly. 

 A quick solution to an immediate problem has also resulted in major unintended consequences: 

  • patients’ suffering due to not being able to see family and friends
  • increased feelings of isolation
  • health care worker stress due to being the sole person at the bedside in times of crisis
  •  removal of the crucial bedside safety net that visitors provide

How do we avoid these ramifications while needing to implement stringent measures to prevent infection? This question is explored in my article, “Don’t Go to the Hospital Alone: Ensuring Safe, Highly Reliable Patient Visitation,” from the January 2022 issue of The Joint Commission Journal on Quality and Patient Safety

Co-Design Visitation Strategies and Policies
The unintended consequences of lack of visitation illustrate the need to reemphasize patient and family engagement to achieve patient safety – and co-design visitation strategies and policies with patients and family members.

Health care leaders should also be making data-driven decisions when implementing and subsequently revisiting new policies. We need to measure infection rates and unintended consequences of policies like restricted visitation, in terms of:

  • safety outcomes
  • workforce well being
  • patient experience


Through tactics like surveys, focus groups and post-visit feedback, leaders can collect real-time patient and workforce feedback and act on it immediately. Additionally, aggregate data can show trends that influence outcomes, so leaders can make adjustments along the way. 

Since the beginning of COVID, health care executives have been challenged with the near impossible task of balancing competing factors of patient safety and comfort, staff well-being and survival. 

Given that COVID may be around a lot longer than anticipated, we can no longer rely on best practices that used to work pre- pandemic, or even at the beginning of it. As the virus mutates and evolves, so must our operations. 

The progress we’ve made to embed patient and family engagement cannot be another casualty of the pandemic. 

Dr. Tejal Gandhi, MD, MPH, CPPS, is the Chief Safety and Transformation Officer for Press Ganey, Boston. Dr. Gandhi is responsible for improving patient and workforce safety and developing innovative health care transformation strategies. She leads Press Ganey’s Zero Harm movement and helps health care organizations recognize inequity as a type of harm – for both patients and the workforce. Dr. Gandhi also leads the Press Ganey Equity Partnership, a collaborative initiative dedicated to addressing health care disparities and the impact of racial inequities on patients and caregivers.

Before joining Press Ganey, Dr. Gandhi served as Chief Clinical and Safety Officer at the Institute for Healthcare Improvement (IHI), where she led IHI programs focused on improving patient and workforce safety.


References:
1) National Steering Committee for Patient Safety. Safer Together: A National Action Plan to Advance Patient Safety. Boston, Massachusetts: Institute for Healthcare Improvement; 2020. (Available at www.ihi.org/SafetyActionPlan)