Over the past 3 years, six hospitals have been selected to participate in the CCFAP. These hospitals represent a wide range of model types, as follows: community teaching hospital (Evanston Northwestern Healthcare, two sites); governmental institution for veterans of US military service and statewide service center (Oklahoma City Veterans Affairs Medical Center); inner-city hospital (Ben Taub General Hospital); academic medical center (University of South Alabama Medical Center); and rural/small community hospital (Pardee Hospital of Hendersonville, NC). The geographic, institutional, and patient diversity of these hospitals provides multiple opportunities not only for research and evaluation of the effectiveness of the CCFAP within different models, but also an occasion for presenting the CCFAP over a wide area of the country to medical communities with different interests and needs.
The first task of the project coordinator is to make certain that all divisions of the host hospital are thoroughly familiar with the goals and objectives of the CCFAP. The cooperation of all divisions is essential if the program is to be successful. This information is communicated in meetings, newsletters, and one-on-one meetings with division leaders. Within any hospital, there are many conflicting priorities vying for resources, and the CCFAP project coordinator needs to continually reinforce the importance of the program in enhancing patient care. Each of the CCFAP sites has developed branding slogans, which express a commitment to the concept of serving families. These slogans are prominently displayed in the waiting room and around the entrance to the ICU. To foster the concept of being family-friendly, the CCFAP logo is displayed on whatever the site produces, be it folders, brochures, or tote bags.
The CCFAP sets out to create a change in the culture of an ICU; its primary aim is to create a site that is committed to bringing satisfaction to the families of ICU patients. To achieve such a goal, there must be intensive examination of the activities involved and a careful scrutiny of their success. All parameters of the CCFAP program are consistently examined. The evaluation process begins even before the strategic plan is complete. The project coordinator develops a family needs-assessment plan to determine from families their greatest perceived needs. The CHEST Foundation provides assistance to the project coordinator, supplying an evaluation consultant to help with the development and administration of the survey, as well as the analysis and interpretation of the results. Surveys are distributed both to families and to staff, and provide the project coordinator and the core planning group with data about the following issues:
• Relationship between ICU staff and family members;
• Resources needed to implement the CCFAP;
• Techniques and skills needed to improve services provided by the ICU;
• Techniques and skills needed to improve information provided by ICU; and
• Competencies needed to improve the treatment of families by the ICU.
The project coordinator, along with the core project team, develops a strategic plan for staffing that aims at clarifying the role that each position will have in achieving the goals and objectives of the CCFAP. Prior to determining the design of the CCFAP at a given site, the project coordinator works closely with the project director to decide how to structure the role that each person will play in establishing that design. A few staff will have final decision-making authority; others will be actively involved in developing design details; some will be given an opportunity to review plans and provide input; others will be kept continually informed about decisions and progress but will have no direct role in providing information.
While all participants in the CCFAP have important roles within the hospital, it is the project coordinator who has the responsibility of determining roles within the CCFAP. The core planning group is utilized by the project coordinator to communicate both the strategic plan and the role that each individual will play within it. The impact that each role has on the total program is discussed, and the interrelationship of the various roles is explored in depth. When gaps are discovered, the project coordinator uses the core planning group to assist in determining how those gaps are to be filled. Out of these discussions and decisions emerges a sense of accountability in which each individual is aware not only of a particular, individual role, but also of the importance of coordination with others. The project coordinator ensures that the strategic plan for the CCFAP is carried out, that there are no gaps in service to families, and that patients and their families are satisfied with their treatment within the ICU.
Encouraged by support from the hospital administration, project coordinators assume responsibility for bringing together departmental personnel who support the concept of the CCFAP and are critical to its success. These core project team members, under the leadership of the project coordinator, are the primary stakeholders, with responsibility for determining what important steps need to be taken for the well-being of the families of ICU patients. In each CCFAP hospital, the core planning group supports the project coordinator in developing those attitudes and actions that form the basis of the CCFAP model of care. From the beginning, this core group has been the essential component in engendering cooperation and support, and in fostering enthusiasm for the CCFAP, not only within the ICU, but also in those departments with only an indirect relationship to the CCFAP. Leading the core planning team and serving as the CCFAP champion remains the key role of the project coordinator. The positive attitude conveyed by the project coordinator has been instrumental in fostering early adoption of the CCFAP program goals by the core planning team. Simultaneously, project coordinators seek to distance themselves from any authoritarian position. The CCFAP is not to be viewed as the coordinator’s program, but as a key program to which the hospital has made a commitment. The core planning team fosters this feeling of unity as it develops a strategic plan and continues to watch over every aspect of its implementation.
A review of the formation and development of the Critical Care Family Assistance Program (CCFAP) traces its origins to a series of goals and objectives that are based on findings from several decades of research about family satisfaction. These goals and objectives that were developed by The CHEST Foundation culminate in a mandate “to respond to the unmet needs of families of critically ill patients in hospital ICUs through the provision of educational and family support resources” (The CHEST Foundation; unpublished data; 2002).
In 2002, the task of the two pilot hospitals, Evanston Northwestern Healthcare, Evanston, IL, and the Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK, was to transform these goals and objectives into reality. In 2003, the program was expanded at Evanston Northwestern Hospital to include a second hospital in Highland Park, IL, and Ben Taub General Hospital in Houston, TX, received funding to replicate the CCFAP. While each of these hospitals has approached this task uniquely, seeking to fulfill the goals and objectives of the program within the special model of care provided by geographically and institutionally diverse hospitals, there has been a general sharing of information, and each has sought to profit from the insights received from other pilot institutions.