Barriers and enablers of patient and family centred care in an Australian acute care hospital: Perspectives of health managers

Abstract

The aim of this study was to identify and explore organisational barriers to, and enablers of, patient and family centred care within an Australian acute care hospital from the perspective of that hospital's management staff. A qualitative study, incorporating purposive sampling and semi-structured interviews was undertaken in a 215-bed metropolitan acute care public hospital in Sydney, Australia. Fifteen health managers from a broad range of professional groups, including Medicine, Nursing, Allied Health and non-clinical services were interviewed. Interview data were recorded, transcribed, and analysed for key themes using the Framework Approach. The key barriers to patient and family centred care were: i) staffing constraints and reduced levels of staff experience, ii) high staff workloads and time pressures, iii) physical resource and environment constraints and iv) unsupportive staff attitudes. The key enablers of patient and family centred care were: i) leadership focus on patient and family centred care, ii) staff satisfaction and positive staff relations, iii) formal structures and processes to support patient and family centred care, iv) staff cultural diversity and v) health professional values and role expectations. This study provides an understanding of the factors that restrict and enhance patient and family centred care specific to an Australian acute care hospital setting. Implementation of strategies targeted at these factors may help the study site, and potentially other hospitals in similar settings, to improve patient and family centred care. In turn, this may lead to improved outcomes for patients, families, staff and healthcare organisations.

Facilitators and barriers of patient-centered care at the organizational-level: a study of three district hospitals in the central region of Ghana

“…Work environment has several dimensions including social support, suitable working conditions, job characteristics, staff training and development and communication [22–24]. These form essential component of staff motivation and has implications for health professionals’ performance and quality patient experience of care [17, 25, 26].…”

“…Even though Shaller’s work did not consider barriers to PCC, literature has detailed resource constraints, resistance to change, low employee value, unsupportive policies, and poor staff commitment and interest as organizational-level factors inimical to PCC [14, 17, 23, 26]. For instance, human, time and financial resource constraints have been mentioned as challenges to the delivery of PCC, particularly, limited staff capacity, insufficient staff, limited time to set the stage for PCC, limited office space and lack of equipment [17, 18].…”

Family centered care and practice in the neonatal intensive care unit

“…Introduce the family member into care even if the child is in severe clinical condition; weekly meetings between family and health team; Kangaroo method and encouragement of lifelong education for skills are strategies to make the care of the newborn and his/her family safer and more humanized (6,19) .…”

“…Despite the benefits of family centered care, some limitations are still part of this process, such as restrictions on human resources and lack of clarity in the implementation of family centered care, as well as reduced levels of experience on the subject, work overload, and physical and environmental resources (19)(20) .…”

Perceived work environment and patient-centered behavior: A study of selected district hospitals in the central region of Ghana

“…For instance, Sheller [ 2 ], stresses the importance of nurturing an environment that values and treats professionals in the same manner organizational leaders expect employees to care for patients and families to the success of PCC. Lloyd, Elkins, and Innes [ 5 ] have also specified staff workload, positive staff relationships, and support as factors that affect centered care.…”