Imagine trying to do a critical, life-in-the-balance job under extreme time pressure while hundreds of random strangers wander around your workplace asking too many questions and getting underfoot. It would be disconcerting to say the least. That is a worst-case perspective of having visitors in a healthcare facility.
On the other hand, the presence of friends and family in a hospital can also be life sustaining, as these visitors provide information that can help healthcare providers understand patient ailments and they deliver support that gives patients comfort and a greater will to recover. That presents a more positive interpretation of the practice and a reason that hospital visitation exists. The key to achieving the rosier situation is managing visitation as well as you do other technical, operational, and interpersonal processes in the facility.
Who are the visitors in a hospital?
When we look at managing any general process we consider who the doers are, what they are doing, and when, where, why, and how they are acting. Then we create policies, procedures and metrics to ensure success. That’s true for hospital visits as well.
Who are the visitors we need to plan for?
Patient family and friends – Having a “person” for the patient is not only comforting to the patient, but can also be a benefit for hospital staff. The visitor can help with minor needs and wants, from pillow fluffing to providing assistance getting to the bathroom and can offer distractions to help the patient defocus from discomfort. On the negative side, if visitors overstep by getting in the way of staff, bringing in contraband, or even becoming hostile, problems can arise.
Contract employees and volunteers – While not family guests, these regular visitors to the site are not full-time employees of the hospital. This might include contract food service or cleaning crews, lactation consultants, social workers, clergy members, candy stripers, and other volunteers.
Vendors – Numerous vendors may come into a unit for supplies restocking, delivering flowers, or providing other frequent services.
Healthcare observers – To a patient, anyone in a uniform even closely resembling scrubs is a doctor or a nurse, potentially there to help the patient with his or her immediate needs. However, numerous uniformed folks might pop into a patient’s room, including medical students, rotating residents, international medical visitors, researchers, and hospital administrators.
How do you establish optimum visitation management?
As with so many other healthcare facility management processes, improvement starts with forming a team. This one will include hospital staff from security, nursing, and purchasing or materials management. To get a varied perspective of needs, you might also choose to include representatives from vendors or patient families.
As a first step, the team will establish an overall vision for healthcare visitation, likely with the overriding objective of assuring patient safety and security. From there, specific issues and situations are identified and appropriate policies and procedures can be established. Communications and training must follow to ensure all staff and visitors understand the relevant requirements.
What components of hospital visits need policies?
Given that the patient’s health and safety is foremost in the hospital, visitation must ensure no adverse effect to the patient.
Specific issues for patient safety and security may include policies around:
- hand washing or use of hand sanitizer
- requirement for facial masks, when appropriate
- disallowed visitation for certain infectious conditions
- allowance (or not) of outside food or drink
- quiet hours
General visitor issues and questions such as these are often included in visitor policies and planning:
- specific hours of visitation, including any allowance for overnight stay
- visitor parking locations and fees
- visitor age limit
- limits to number of visitors
- entry point(s) for visitors
- identification needed for visitor admission
- sign-in and sign-out requirements
- badging while in the facility
- restricted visitation areas
- smoking (generally only in designated areas)
- photography rules (e.g. only within patient room with patient’s permission)
- disallowed items (e.g. backpacks, suitcases)
- firearms and other weapons (generally not allowed onsite)
- service animal and pet visitation policies
- waiting room locations and services (e.g. vending machines and Wi-Fi access)
- cafeteria access
- communication of evacuation procedures
- directions to specific areas of the hospital
- visitor accompaniment, if required
Specific policies about these issues need to be communicated to visitors. Regular visitors, such as contract employees, vendors, and volunteers, will have an initial orientation and training with updates for hospital policy changes.
Family and friends should be able to find guidance online and at onsite postings at a central reception area. Staff who man the central area as well as other visitor-facing team members will have training to present a helpful and cheerful face to the visitor.
Much of the policy information can be included in a visual management board. Many hospitals use floor striping and signage to indicate paths from the entry point to specific wards. Some hospitals provide “good visitor” advice for interacting with patients.
What kinds of visitor issues can arise?
Well-meaning visitors may bring outside food, drink or drugs that are in conflict with the patient’s treatment plan. They may enable an unauthorized discharge when the patient is not yet advised to leave medical care. They may insist on being present during an exam or treatment, getting in the way or interfering with patient care.
The expression “killing with kindness” might be a good fit for overzealous family members who shower a patient with attention when she just needs to rest and recover. While visitor allowance is by patient choice, medical staff may need to step in to limit overexposure.
Certain areas of the hospital are off-limits to visitors or may require additional clearance. For example, many maternity wards often have a secondary visitor reception spot for sign-in. Visitation in ICUs may not be allowed or may be very limited.
Privacy and security are important issues. In today’s world, patient privacy can easily be infringed upon with a simple unauthorized post to Facebook, Twitter, Instagram or other social media. With a large number of people coming and going, security becomes difficult to manage. The idea of “see something, say something” can apply here for any staff member, patient or visitor who feels uncomfortable about the behavior of any other individual onsite.
While the majority of hospital visits will go quite smoothly and provide benefit for the patient, staff members must have procedures and training for dealing with conflict. In most cases, a firm word from a staff member or supervisor to a visitor will be enough to correct the situation. In other cases, the security team may need to be called in. How to recognize the need for escalation and trigger the call for security should be part of staff training.
These and other issues can be identified and addressed with potential problem assessment and updates to a living visitor policy document. Optimizing the visitor management process is one piece of achieving operational excellence in a healthcare facility. Contact EON for help getting started, and see a demo of the platform.