How Can Hospitals Measure Family Experience with Communication?

What would it take to improve the family experience and provider communication? While there’s still no magic elixir to create the perfect provider relationship, scientists at the Regenstrief Institute say family experience improvement can start with measurement.

Healthcare has begun to really zoom in further on the family and caregiver experience of care. Very few patients fully go at it alone, and as patient engagement and satisfaction have become priorities, the family member has increasingly been recognized as an important member of the care team.

After all, study after study has confirmed the benefits of having an informed family member by the patient’s side. Providing health coaching to family members can improve patient activation, one November 2022 report said. Meanwhile, repeated studies have shown that better education and engagement for family caregivers during discharge can reduce the risk of hospital readmission.

That’s because family members often help patients manage their illnesses and recover once they return home. When a family member is engaged in and understands their loved one’s care plan, they can help the patient adhere to it and ideally achieve optimal outcomes.

But the family member is also important during the acute, inpatient stage of care, according to Alexia Torke, MD, MS, a Regenstrief Institute research scientist.

“Families are really important, and families become especially important when the patient can't speak for themselves,” like when the patient has dementia or is critically ill, Torke said in an interview. “Then the family becomes extremely important, both because they have to give information to the clinicians and then they have to work on making decisions.”

Put simply, there’s a lot riding on family engagement and communication. To that end, it is critical that healthcare organizations track the quality of family engagement and communication.

Torke led a team of researcher-clinicians from Regenstrief Institute and Indiana University School of Medicine in taking a big first step by developing the Family Inpatient Communication Survey, or FICS.

The FICS is a 30-item questionnaire that looks at how clinicians communicated with family members of patients who could not make decisions for themselves or were incapacitated due to serious illness. The team has also validated a five- and 10-item version of the FICS.

“We started out with a basic theory that there would be probably two elements of communication that are really important,” explained Torke, who is one of the FICS developers and a senior author of a study detailing the FICS. “This came from the field of communication, that there'd be an emotional and relational aspect of communication, and then there'd be an informational aspect of communication.”

After crafting questions that fit into those two information and relational buckets, the team weeded out questions that were not easy to understand and were redundant or duplicative. That led to the 30-item scale, Torke said, and eventually the five- and 10-item scales, which are prime for survey-heavy endeavors like medical research.

Information gleaned from the FICS should be effective for improving family engagement further down the line by helping to prompt quality improvement projects, but Torke added the FICS could also have good impacts on clinical outcomes.

Take, for instance, the emotional toll faced by family caregivers. Data has shown that family members of critically ill ICU patients face a high level of stress and that stress can have negative impacts on both the family member and the patient.

“We also know that it can be really distressing for a family member to be both the source of information and especially to have to make decisions,” according to Torke. “That’s all while they're coping with the serious or critical illness of somebody who's often in their family, often a loved one.”

Torke posited that the relational aspects of family communication could mediate some of that anxiety and depression. Conversely, improving communication of clinical information could help with clinical decision-making.

This is a novel approach to understanding the overall healthcare experience, Torke said. Sure enough, healthcare is ripe with different measures assessing the patient experience, but it is rare for these types of surveys to reach family members.

“The HCAHPS, for example, is a survey that's done in the hospital, but one thing that's interesting about that is that that is only sent to patients,” Torke pointed out. “But some hospitals might truly care about how the family feels about the communication experience. If people care about the quality of the communication with family, they might be interested in using something like the FICS to rate what it's like for the family member to communicate.”

Of course, the work doesn’t stop after surveying, Torke explained. Using the FICS to assess family engagement and communication experience is just the first step in improving provider communication skills. This will be especially important in those more relational survey questions, Torke explained, because they look at soft communication skills that some may think cannot be taught.

“We do think these things can be taught,” she asserted. “They probably aren't taught enough, but it is possible.”

By analyzing FICS data, healthcare organizations can determine what types of relational and empathy skills are more valuable to the hospital’s patient and family population.

“Those are the kinds of things that we find really matter,” Torke reported. “The person feels supported, they feel that they'll be listened to carefully, they feel like they can reach someone when they need it. It's those kinds of things that really show support, and it turns out that actually some of those behaviors can be taught.”

Some of Torke’s future research will look at how healthcare organizations can use SMS text messages to assess experience and communication in real-time, another step toward healthcare quality improvement. After all, a real-time patient and family experience rating can turn into a real-time course correction.

“Patients are so receptive to people caring about them,” Torke concluded. “They might have a really bad experience one day, but yes, that can be that can be addressed. You can repair relationships and patients and families are very willing to do that.”