My final stop was in Calgary, at the Alberta Children’s Hospital. The hospital was built ten years ago but you would think it was newer to walk around it as it looks enviably good, particularly as viewed by someone like myself coming from a 1970’s build!
The whole hospital was built with family centred care at the core and it has some great features, like a greenhouse where the kids in the neuro rehab program and the children in the eating disorder program (amongst others) can help in growing plants and caring for the garden. It has a lovely centre where the canteen is and space for events and every week they have a film night where the children who are well enough can come down and watch a film and eat popcorn. It was the Calgary Stampede when I was there and they had music, fun fair stalls and cowboy hats for all! All of this is volunteer led and there is a waiting list to become a volunteer. My favourite feature by a mile though, was the special pet room on the outside of the building which had an internal and external door so the longer term inpatients could be taken in from the inside and their family pet could be brought in from the outside so they could have quality time with their pets without any infection control concerns! I wish every children’s hospital could have this, sometimes the biggest upset for the kids is not being able to see their pets!
Family centred care is embedded not just in the design of the building but in the practice on the PICU. It is a med-surg PICU with large single rooms that have easy chairs and a bed for the parents. Each room has these lovely boards (see below), which are very popular and allow the staff to learn more about child and their family and allow the family to be able to see the plan and ask questions even if they can’t be there for ward round.
I spent a lot of time here talking to the nursing staff and was very impressed with their commitment to ensuring parents can be present by the bedside at all times, including during invasive procedures. When I told them about the work they are doing in Boston in facilitating parental presence, they all told me that it has always just been standard practice for them, to the point that they have had parents sat on easy chairs just outside their child’s room during ECMO cannulation! There is a fantastic social worker on the unit who normally stays with the family and there is always a social worker on site overnight if needed.
The social worker says the benefit of her position is that she has the luxury of time to sit and talk to families and find out how best to support them. She does a lot of family support and support in death and dying. One of the big things she does with the families is illness adjustment, helping the families understand what has happened and work towards coming to terms with it. She touches base with the families everyday and says she often has to help them grieve the loss of their healthy child, even if their child has not died, it often still means the expectations they had for their child have to change.
There is also a great staff support system in place, the Clinical Incident Stress Management team. They carry a pager and come and support staff when there has been a death, particularly a sudden one. They do a group debrief after the incident and can then arrange individual debriefs where needed and identity how the staff will need supporting. The aim is to keep the staff emotionally healthy and I heard some very positive feedback from the nurses about this service.
Hospital wide, there is a very strong PFCC structure. This includes a PFCC network of patients and families with some staff who take part in surveys and sit on committees. There is a Family Advisory Council which is chaired by parents and includes a very diverse mix of families and a Child and Youth Advisory Council which meets 8 Saturday’s a year and is involved in lots of activities and provides a youth voice, for example in how to make health promotion campaigns age appropriate. There is also a PFCC steering group which provides a more strategic view on the PFCC objectives and how to increase engagement. When talking to the PFCC coordinators, I asked what the PCCU specific goals were and they spoke about how difficult families can find the transition from PCCU to the wards and that they were looking to pull in family advisors to examine how to improve this. I will be really interested to hear the results of this as this is something we have identified as a source of family stress in Nottingham.
I was also lucky enough to see some of the other features of this wonderful hospital. The picture above is from the new and beautiful SIM lab where I watched a session with some medical students. They also do end of life sims and also training sims with the families of children with epilepsy to help them feel confident in treating their child’s seizures.
On site there is also a beautiful hospice which I took a tour round and is a fantastic facitility to have so close to the hospital. There is also a child abuse centre where all the staff who work on child abuse cases including social workers and police are in the same office and there is a child friendly area for medical exams and interviews. This is a great format that means that if a child abuse case comes into the hospital, a team can be present on the ward within half an hour and the information can be shared between the relevant parties quickly and confidentially and reduces the risk of miscommunication as everyone is working together in the same place. I would love to see this in the UK!
My week in Calgary was fantastic and it was amazing to visit somewhere with PFCC built into the foundations of the hospital and taken as standard practice throughout! The Calgary Stampede spirit was all around as well, with at least half the hospital staff in cowboy boots and I got to go to a Stampede Staff Appreciation pancake breakfast which included, of course, maple syrup and line dancing!