leadership project

swot analysis, assessment and smart goals

 Improving
Hand-off
Report

Student Names

Team Name and First/Last Names of Participants

Problem 
Report (timing and hand off errors):  The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes.  In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete.  Our task is to propose a change that will address these issues. 

Report (timing and hand off errors:  Unit managers observed that there was miscommunication between staff during shift report.  Often times leaving out important patient information as well as taking a significant amount of time to relay the information. Our goal it to offer a change that will address these issues. 
Now here is our SWOT analysis starting off with Derrick talking about the strengths.
Majka 
“Communication failures compromise patient treatment, care quality, and safety. It also leads to medical errors, the third leading cause of deaths in the United States” (Ghosh, et all., 2015)
“The varying parties and large amount of complex information included in patient handoff reports frequently contribute to informational gaps and omissions in the handoff report that can lead to sentinel events and patient hard” (Staggers & Blaz, 2013)
“Research has identifed handovers as a risky time in the care process, when information may be lost, distorted or misinterpreted (Borowitz et al 2008, Owen et al. 2009, Philibert 2009)
Report (timing and hand off errors):  The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes.  In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete.  Your task is to propose a change that will address these issues. 
Increase of errors during patient hand-off report leading to missed information and incomplete tasks 
Hand-off report time is taking a greater deal of time 
Our task is to implement the use of SBAR as the standard hand-off report between shifts in order to reduce errors and decrease the time spent giving report. 
2

SWOT

Strengths:
Multidepartment focus addressing handoff report problems(Robins et al., 2017)
Solutions shorten time taken in report while increasing quantity of pertinent information. (Stewart & Hand, 2017)
SBAR is supported by the Joint Commision (Stewart & Hand, 2017)
Proven error reduction due to use of SBAR tool. (Stewart & Hand, 2017)
SBAR is an evidence-based hand-off tool (Eberhardt, 2014)
Weakness
Use of the tool requires education to reduce user error (Stacey Eberhardt 2014)
Medical personnel have personal bias on giving report (Ghosh et al.,  2018)
Some staff are unreceptive to change (Robins & Dai, 2017).
Evaluating execution of report can be affected by observer bias (Robins & Dai, 2017)
Opportunities
SBAR is inexpensive as a tool and will earn its cost in education by the reduction of sentinel events (Stewart, 2017)
Improve patient handoff by implementing an evidence-based handoff tool in SBAR format  (Eberhardt, 2014)
For continued nursing education in standardizing hand-off report (Ghosh et al., 2018). Threats
Due to the variety of the change-of-shift reporting process, the findings of the study may not be applicable across similar settings (Ghosh et at., 2018).
Some staff are unreceptive to change (Robins et al., 2017).
Evaluating execution of report is subject to observer bias (Drach-Zahavy, 2014) 
Small sample sizes from 2 studies: only one randomized control study (Stewart, 2017)

Strengths:
Multidepartment focus on addressing problems with handoff report (Robins et al., 2017)
Solutions manage to shorten time taken to give report while increasing the amount of pertinent information given in that time frame. (Stewart & Hand, 2017)
SBAR is supported by the Joint Commision (Stewart & Hand, 2017)
Error reduction due to use of SBAR tool. (Stewart & Hand, 2017)
SBAR is an evidence-based hand-off tool (Eberhardt, 2014)
Weakness (Wendy) 
Use of the tool requires education for all staff to reduce user error (Stacey Eberhardt 2014)
Medical personnel have personal bias on how they want to give report (Ghosh et al.,  2018)
Healthcare worker disinterest in changing how they give report. (Robins et al., 2017).
Subjective approach to measuring a handover’s strategies might be subject to bias, as participants may behave differently in the presence of an observer.
Opportunities (ashley) 
SBAR is inexpensive as a tool and will earn its cost in education by providers by the reduction of sentinel events (each of which carries a high expense). (Stewart, 2017)
Improve patient handoff by implementing an evidence-based handoff tool in Situation Background Assessment Recommendation (SBAR) format  (Eberhardt, 2014)
For continued nursing education in standardizing hand-off report (Ghosh et al., 2018).
Threats (Alma)
Due to the variety of the change-of-shift reporting process, the findings of the study may not be applicable across similar settings (Ghosh et at., 2018).
The acuity of patient injury and medical history can increase the amount of time for patient hand-off (Robins, 2017).
Small sample sizes from 2 studies: only one randomized control study (Stewart, 2017) and sample size of 200 handovers in 5 wards in another study(Drach-Zahavy, 2014)
3

Assessment 
Inefficient communication during hand off report is a challenge to patient care. (Ghosh, et al., 2018)​
Communication error given during report increases risk of poor patient outcomes. (Stewart, 2017)
​
Hand off communication between medical personnel leads to an increase in medication errors, incomplete tasks, disorder, and eventually poor patient outcomes (Robins et al., 2015)​
According to The Joint Commission, communication errors have been among the top three leading root causes of reported sentinel events every year since 2004. (Stewart, 2017)

The information we had gathered from our assessment on giving report overall was – 
1. Poor communication leads to poor patient outcome 
2. The Joint Commission has stated communication errors has been the top 3 leading root causes of unanticipated major events in the healthcare setting that results in death or serious physical or psychological injury to a client which require immediate investigation by the health care facility since 2004
3. And now we will be talking about our Diagnosis.

Goal should comes from assessments (SMART (MEASURABLE))
Assessment will be bullet points of why is this a problem 
Specific, measurable, attainable, realistic, timely
All RNs and assistive personnel will attend 1 or more in-services on the use of SBAR handoff report within three weeks.
During the same three week period, charge nurses and nursing management will include SBAR teaching in pre-shift meetings, encouraging staff to begin to practice using the SBAR template during report. 
Following the three week introduction of SBAR to the staff, SBAR will be implemented on the unit for a trial period of 1 month with the goal of receiving ideas of how we can improve it from the staff at the end of the 1 month period. 
At the end of the one month period, staff nurses and assistive personnel will be invited to discuss their experiences with SBAR, as well as any ideas they have to improve it, during pre-shift meetings, down-time during their shift, or via email with the nurse manager.
15 days into the trial month, as well as at the end of the trial month, the nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit.
At the end of the 1 month trial period, metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year.
During the second month, a new SBAR form that includes select suggestions from staff will be used by those staff members while other staff members continue to use the known SBAR report. Communication errors, sentinal events, falls, nosocomial infections, et al will be compared between the two systems. 
Majka 
4

Diagnosis
Lack of standardization in report
Communication Barriers (Stewart & Hand, 2017) 
Communication practices learned by various career stages of nurses (promise, momentum, harvest) 
Different individual communication styles
Gaps in knowledge regarding lack of standardized reporting

A lack of standardization in report increases risk of error and poor patient outcomes
5

S.M.A.R.T. Goal
Use an evidence-based standardized hand-off report tool to reduce report times to less than 45 minutes while reducing report-based errors by 20% within 6-month period. 

Precontempemplation: Nurse manager goes to charge nurses, harvest nurses, and harvest support staff with the SBAR template and asks them to sit with it for one week. He or she will ask for feedback from these individuals about implementing it on the unit. 
Contemplation: Harvest nurses and support staff, and charge nurses spend a week with the SBAR template and consider its strengths, weaknesses, and or simply form an opinion around it.  
Preparation: nurse manager introduces in-services on SBAR and charge nurses begin introducing the template during pre-shift meetings. 
Action: Nurses and support staff begin using the template during all hand-off reports for a one month period. Nurse manager seeks input from harvest staff on ways to improve the system and attempts to include their input on a trial period, thereby extending the practice of the original SBAR for another month with most staff, and offering a personalization to those interested in improving the system. 
Maintenance: Nurse manager compares statistics from the same time period one year ago, to the same length of time prior to using the SBAR report, and the data from the SBAR report compared with the modified SBAR report and presents the data to the staff at a staff meeting. At the meeting the nurse manager encourages public input and opinions on the SBAR report. If there is resistance, the manager asks that SBAR be continued in practice for a 3 month period in which he or she will personally receive report from individuals on their patients – helping those nurses who need it with ways to be more succinct. At this point, the report will have been used in practice for 5 months and will have become habit for many of the staff. 
Alma 
6

References
Drach-Zahavy A ; Hadid N. Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift. J Adv Nurs. 2015; 71: 1135-1145
Ghosh, K., Curl, E., Goodwin, M., Morrell, P., & Guidroz, P. (2018). An Exploratory Study on how to Improve Bedside Change-of-Shift Process: Evidence from One Hospital Using Technology to Support Verbal Reporting. HICSS.
Marquis, B.L., & Huston, C.  (2011). Leadership roles and management functions in nursing: Theory and application (9th ed).  Lippincott, Williams, Wilkins.  ISBN: 978-1-4963-4979-8
Robins, H., & Dai, F. (2015). Handoffs in the Postoperative Anesthesia Care Unit: Use of a Checklist for Transfer of Care. AANA journal, 83 4, 264-8.
Stewart, Kathryn R., “SBAR, communication, and patient safety: an integrated literature review” (2016). Honors Theses. https://scholar.utc.edu/honors-theses/66

© 2018 Global Journal on Quality and Safety in Healthcare | Published by Wolters Kluwer ‑ Medknow 33

Abstract

Original Article

IntroductIon
Why do we need family involvement in patient care?
Patient‑centered care is one of the six domains of quality
identified in the Institute of Medicine Report “Crossing the
Quality Chasm.”[1] Involving the family in patient’s care is
critical as it has multiple benefits for the patients themselves,
staff, and the organization [Table 1].

Family members (FMs) play important roles in the care of
patients including contribution to decision‑making, assisting
the health‑care team in providing care, improving patient
safety and quality of care, assisting in home care, and
addressing expectations of patient’s family and society at
large.[2,3]

Societies vary in the structure and hierarchy of the family
unit, and therefore, the size of extended families and the roles
of different members among cultures. There are many factors
affecting family dynamics including religion, educational,
cultural, and legal variables, in addition to the prevailing
health‑care culture in relation to the family’s involvement

in a patient’s care. Middle Eastern and other developing
countries share many issues related to family dynamics
including large extended families that are heavily involved
in patient care and committed to the personal care of their
loved ones.[4‑6]

From our experience, extended families with diverse members
background and educational levels represent a challenge to the
health‑care providers in terms of communication and family
involvement and may lead to conflicts and dissatisfaction of
staff and family.[7‑9]

Despite the call by different international bodies to increase
patient involvement, there is no agreement to what is this
involvement means and how it should take place.[3,10‑12]

Background: Family involvement is a critical component of patient‑centered care that impacts the quality of care and patient outcome. Our aim
was to develop a patient‑ and family‑based communication model suitable for societies with extended families. Methods: A multidisciplinary
team was formed to conduct a situational analysis and review the patterns of family involvement in our patient population. Patient complaints
were reviewed also to identify gaps in communication with families. The team proposed a model to facilitate the involvement of the family
in the patient’s care through the improvement of communication. Results: A communication model was developed keeping the patient in the
center of communication but involving the family through identifying the most responsible family member. To assure structured measurable
contact, mandatory points of communication were defined. The model streamlines communication with the family but maintaining the patients’
rights and autonomy. Conclusion: Our proposed model of communication takes into account the importance of communication with the family
in a structured way. The team believes that it is going to be accepted by patients who will be explored in the pilot implementation stage as
the next future step.

Keywords: Communication model, family‑oriented care, involving the family in patient care

Address for correspondence: Dr. Abdul Rahman Jazieh,
Department of Oncology, National Guard Health Affairs, King Abdulaziz

Medical City, King Saud Bin Abdulaziz University for Health Sciences,
Mail Code 1777 P. O. Box. 22490, Riyadh 11426, KSA.

E‑mail: jaziehoncology@gmail.com

Access this article online

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Website:
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DOI:
10.4103/JQSH.JQSH_3_18

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remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
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For reprints contact: reprints@medknow.com

How to cite this article: Jazieh AR, Volker S, Taher S. Involving the family
in patient care: A culturally tailored communication model. Glob J Qual Saf
Healthc 2018;1:33‑7.

Involving the Family in Patient Care: A Culturally Tailored
Communication Model

Abdul Rahman Jazieh, Susan Volker, Saadi Taher

Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences,
Ministry of National Guard Health Affairs, Riyadh, Saudi Arabi

a

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Jazieh, et al.: Involving the family in patient care – A culturally tailored communication model

34 34 Global Journal on Quality and Safety in Healthcare ¦ Volume 1 ¦ Issue 2 ¦ October‑December 2018

In this manuscript, we propose a communication model to
overcome these challenges in societies with extended family.

Methods
A multidisciplinary team was formed to address the family
involvement in patient care at our hospital and propose an
approach to involve the family systematically in the care
plan. The team included members from the Intensive Care
Unit (ICU), medical and surgical specialties, social services,
religious affairs, patient services, and patient’s relation.

A situational analysis using strength, weakness, opportunities,
and threats tool was done. Furthermore, the team reviewed
various family and patient’s complaints and staff concerns.
A review of the communication process revealed the need
for streamlining the flow of information and improve the
communication in standard fashion.

Current communication scheme
The team developed the current communication practice model
which represents the real‑life situations highlights the anarchy
of communications with patients and families [Figure 1].
Health‑care providers (HCPs) may have to talk to multiple FMs
repeatedly delivering same information. This current practice
may lead to frustration and wasted time and may result in
conflict between the HCP and demanding FMs or among FMs
themselves. The HCP may talk to FMs without the patient’s
knowledge or approval, and sometimes different HCP teams
may talk to different FMs resulting in confusion and conflicts.

This situation highlights the need for a new communication
model that streamlines the flow of information between the
HCP and patients and their families.

The spectrum of family involvement
We serve patients of all ages with primary care to tertiary
advanced care. Patients may have large number of siblings
or children and first‑ and second‑degree relatives involved
in their care. Family involvement in decision‑making spans
over a wide spectrum. Table 2 provides the type of family
involvement, the reasons and dynamics, in addition to giving
real‑life examples to illustrate the issue. From the team
daily observation of family dynamics, it was clear that the
involvement ranges from total voluntary withdrawal of the
family to fully taking charge of decision‑making without the
approval of the patient.

results
The evaluation of the situation revealed the strong need to
propose a standardized communication model to help in
improving the interactions between HCPs, the patient, and
FMs.

Components of the proposed communication model
The two major components of the communication model are
identifying the most responsible FM (MRFM) and establishing
points of communication [Figure 2].

Identifying the most responsible family member
According to our model, the unit of care includes the
health‑care teams, the patient, and the family. To streamline
communication with the family, a single individual FM should
be identified who will be the MRFM with the following
characteristics:

• The MRFM may be different from the next of kin and
should be appointed by the patient and be willing to
provide continuity of care.

• The MRFM should be clearly identified to all members
of the professional health‑care team as well as the FMs.

• Accurate and up‑to‑date contact information for the
MRFM must be readily available.

• The MRFM should be the first line of contact with
the family, if communication is required. His/her
responsibilities will be to communicate with other FMs.

• This does not replace the utilization of family conferences
with other FMs, as needed.

• If a patient is not able to identify MRFM due to mental
status changes or any other reason, next of kin according
to local laws will be designated by HCPs to serve as
MRFM.

The proposed communication model brings the family into
the care unit in a structured way keeping the patients in the
center of communication and introduces the MRFM as the
second person in that patient‑family team to have a direct line
of communication. The sitter may be different than MRFM or
the same person and may not be a FM at all. The model does
not eliminate the communication with the rest of the family
but it limits that to certain situations such as a request for a
family conference.Figure 1: Current communication model. FM = Family member

Table 1: Reasons to involve family in patient care
Providing relevant additional or different information
Contributing to decision‑making
Assisting in providing care in the hospital
Improving quality and safety of care[17‑22]

Providing care at home or outside the hospital
Patient, family, and societal expectation

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Jazieh, et al.: Involving the family in patient care – A culturally tailored communication model

Global Journal on Quality and Safety in Healthcare ¦ Volume 1 ¦ Issue 2 ¦ October‑December 2018 35

Determining mandatory points of communication with family
To align expectations of all involved and be able to measure
interaction, mandatory communication points are required.
Our model proposes the following points:

• At the time of admission at the hospital
• During the discharge planning process and at the time of

discharge
• Before any procedure (consent) and update after the

procedure
• Any significant change in the patient or FM with the

patient’s condition, especially life‑threatening conditions
• Decision related to “No Code” or withdrawal of support
• On request of the patient or FM with the patient’s approval

The following is a case study illustrating the utilization of our
proposed model in complex family scenario.

Deciding with families: A case study
A 56‑year‑old woman was diagnosed with advanced cancer and
received all available chemotherapy over many years. There

was no other effective cancer therapy available at the time. She
was admitted to the hospital for progressive dyspnea and chest
pain. The reason for admission was symptom management
and transition to a palliative care service for end‑of‑life care.

Family conflict about decision‑making
Her husband refused referral to palliative care and demanded
that the oncology service remains the primary service. Two
brothers of the patient disagreed with the husband’s decisions
and wanted to direct the care plan and they were supported by
the patient’s two adult children. They did not want the husband
to make decisions on the patient’s behalf. These differing
opinions resulted in a full‑fledged family conflict.

Few questions arose from this conflict including:

• Who should be involved in the decision‑making?
• Who has the final say in these decisions?
• What about the involvement of other FMs?

Decisions had to be made regarding discontinuing further
cancer therapies, making the patient “No Code” (do not

Figure 2: Proposed communication model between the patient, their family members, and staff. Solid lines represent direct communication is required,
dashed line depicts communication is done on as needed basis. MRP = Most responsible physician

Table 2: Spectrum of family involvement in decision‑making

Not involved at all Participatory Fully making the decision

Reason for
involvement

Patient or family

choice

HCP choice Patient and HCP
choice

With patient’s approval Without patient’s approval

Dynamics of
involvement

Patient refuses,
FM refuses, or FM
does not show up

Oversight by
HCP or by
choice of HCP

Both patient
and HCP invite
and accept FM
participation

Patient delegates
decision‑making to a
particular FM

Making decisions
without the
patient’s
knowledge

Making decision
against the
patient’s wishes

Real‑life
examples

A son dropped off
his sick mother,
left, and could not
be reached
A patient asked the
family to leave the
room to discuss
his condition

HCP visits
the patient,
examines and
talk to him,
but they do not
acknowledge
other individual
in the room
HCP asked a
FM to wait
outside the
room so that he
can talk to the
patient privately

Issues discussed
openly with patients
and FMs who
provide advice and
opinions to the
patient and HCP, but
do not impose the
decision or take over
the patient’s role

One of the patients
asked HCP to examine
her, allow her to leave
the room, and then
discuss the case with her
brother

FMs try to make
decisions on
behalf of the
patient without his
knowledge of the
choices or even
his disease, citing
fear of his mental
well‑being and
general health

FMs may try to
make a decision
against the will
of the patient

From left to right: increasing roles of FMs in decision making. HCP: healthcare provider; FM, family member.

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Jazieh, et al.: Involving the family in patient care – A culturally tailored communication model

36 36 Global Journal on Quality and Safety in Healthcare ¦ Volume 1 ¦ Issue 2 ¦ October‑December 2018

resuscitate) and arranging a transfer to palliative care. Figure 3a
depicts the current family communication process.

Applying the communication model
We asked the patient about who should be the final decision‑maker
in terms of her health‑care issues. Her answer was: “My
Husband should make all decisions about my health.” The
second question was if other FM should be informed about her
condition? Her answer was: “Yes, but not to make decisions.”

From the discussion with the patient, we drew a new
communication model [Figure 3b] making the husband the
main decision‑maker (on behalf of the patient per her request).
He was also the sitter. The two brothers and daughters remained
in the family unit to be informed but not to make decisions.
The oncology team remained the primary care team and was
consulted in terms of the palliative care as per the husband’s
request.

The patient expired peacefully with husband and other FMs
at the bedside.

dIscussIon
Communication with multiple members of the patient’s family
presented a challenge to our health‑care delivery resulting

in repeated friction between staff and FMs and among FMs
themselves. In addition, family involvement may encroach
in many occasions on the patient’s own rights and autonomy.
Therefore, our model was developed based on our knowledge
of the culture and family dynamics.

Although the model was developed based on experience in one
setting, the model is applicable to any society as the guiding
principles about family involvement, and patient’s right and
autonomy are the main consideration in this model. The model
can be adapted to an individual patient which is very essential
step in personalizing care.

As we advanced our knowledge in precision medicine and
we know how to select the best treatment for the patient,
communication with patient and family should be also
personalized. This model will enable a health‑care professional
to do so. Developing a communication model will help in
many ways including improving patient care the satisfaction
of patients, their family, and the staff. Assuring proper and
structured family involvement which will help to improve the
patient’s care as FMs can provide information that the patient
may not know, notice, or remember. They will help take care
of the patients in the hospital and at home. The improvement
of quality of care and patient’s safety is also expected outcome

Figure 3: (a) Case study: Schematic illustration of patient care unit. (b) The anatomy of the family‑oriented care communication model. MRP: most
reponsible physician. Solid lines represent direct communication is required, dashed line depicts communication is done on as needed basis

Husband

The Patient

Daughter 1

Daughter 2

Brother 1

Brother 2

Palliative Care
and OthersMRP/Team

2 Brothers &
2 Daughters

Most Responsible Family Member
(Husband)

Patient Oncology Team
& Care Team

Palliative Care
And Others

Unit of Care
Husband was the sitter

and main decision
maker per patient’s

choice

Providers
MRP team maintained
primary responsibilities

and other teams
were consultative

only
b

a
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Jazieh, et al.: Involving the family in patient care – A culturally tailored communication model

Global Journal on Quality and Safety in Healthcare ¦ Volume 1 ¦ Issue 2 ¦ October‑December 2018 37

in family‑centered care model. Supporting patients in his care
and decision‑making will help reduce the pressure from the
patients.

D a m a g i n g c o n f l i c t s c o u l d h a p p e n a s a r e s u l t o f
miscommunication, especially if there was an abrupt change
in the patient’s condition.[13,14]

While others developed communication models, these models
were specific for certain setting, not generalized and tackle one
aspect of communication.

For example, Workman proposed communication model for
end‑of‑life care.[15] This model focuses only on end‑of‑life
care and the points of communication which related only to
the treatment decision. The model does not describe how the
family should be involved like we did in our model.

Other investigators reported structured family involvement
in certain settings such as cardiopulmonary resuscitation or
ICU rounds, but these are special situations that do not cover
the whole spectrum of the patient journey with the disease.[16]

With the application of this model, it is anticipated that HCP
will have less conflicts, will save time and energy resulting
from talking to many FMs and confusion about whom to talk
from the family. Our model is adaptable to any individual
patient or setting and it maintains the focus on the patient and
brings the family in a proactive structured way.

conclusIon
In summary, involving the family in patient care is more
challenging in societies with large families. Applying the
proposed communication model should facilitate this involvement
and enable the family to participate in the patient’s care without
negating the patient’s autonomy and rights. We plan to pilot test
the model in our hospital in escalating fashion to determine the
best approach to utilize this model and adjust accordingly.

Financial support and sponsorship
The authors disclosed no funding related to this article.

Conflicts of interest
The authors disclosed no conflicts of interest related to this
article.

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Student Name: Therese Prisca Nkou

EBP Journal Article in APA Format:

Jazieh, A. R., Volker, S., & Taher, S. (2018). Involving the family in patient care: A culturally tailored communication model. Global Journal on Quality and Safety in Healthcare, 1(2), 33-37.

https://doi.org/10.4103/JQSH.JQSH_3_18

.2 points

.4 points

.4 points

Is this an Evidence Based Article? Name of Journal and Year article was written?	Yes Name of Journal: Global Journal on Quality and Safety in Healthcare. Year: 2018		.2 points
State the problem What was the goal of the project in the article? Does this project correlate with your problem? State how? What are you trying to achieve? Does this article support this goal?	Problem: Lack of patient satisfaction in the medical surgical unit is on the rise and one of the main reasons is poor communication between health workers and the patients and their families. Poor communication can result from language barrier, insufficient knowledge, and multitasking among healthcare workers among other reasons. Goal: The goal of this project was to achieve patient-family-centered care where the family is fully involved in the care plan by determining the order in which the family members contribute directly to the patient’s well-being. When the patient and their family feel and engage with their role in healthcare patient’s quality of life and satisfaction is increased. The goal of the project is to achieve high patient satisfaction by providing a communication environment that includes the patients and their families. To achieve this goal the group was to propose a move toward a patient-family-centered care environment to tackle the problem of poor communication which is one of the main reasons for the lack of patient satisfaction. This goal correlates with the chosen journal article’s aim since the article is aimed at family involvement in patient care using a culturally tailored communication model. The article’s suggestive communication mode can be applied to the medical surgical unit and improve communication among healthcare workers, patients, and their families.
Strengths (Internal) What’s was good about your article?	Staff input: Staff input was very effective in making the study successful as it involved members from the intensive care units (ICU), medical and surgical specialists, religious affairs, social services, patients, and their families. All these members formed a multidisciplinary team that was to evaluate the communication gaps that exist and see how the model could be incorporated as per each patient’s needs. Method of evaluation: The multidisciplinary team conducted a situational analysis using strengths, weaknesses, opportunities, and threats to determine how effectively or ineffectively families have been involved in patient care. In addition, they reviewed patients’ and family’s complaints and the concerns of the staff. Strategy to implement the communication model: Depending on the complaints they reviewed, the team decided to form a protocol to improve communication in a standard form. This means that they considered the most responsible and close family member to be the one to directly communicate with the staff instead of every family member. The rest of the family was also to be made aware of which communication has been passed by the patient, the chosen family member, and the hospital staff. Cost: The project was cost-effective as the communication model was proposed and implemented at the hospital and did not use any outside sources or resources to make it a success. The implementation of the communication model was done on a patient in the palliative care unit, and not directly to our group area which is the medical-surgical unit.	.4 points
Weakness (Internal)- issues	Size: The model was implemented on one unit of the hospital, which makes it difficult to determine whether it can be used effectively on other hospital units. The selected communication model would be hard to apply in large families where they have a different opinion on who should be in charge to make the decisions in the care plan. When there are disagreements between family members the patient can feel pressured when making decisions and they need assistance from the family. Lack of knowledge: It was difficult to know which family member understands the patient’s condition, and how close they are to the patient to be trusted with making decisions unless the patient points out. Time: The model is more time-consuming as communications have to follow a structured form which can result in communication delays. It is a process to pick which member to communicate to directly and when to engage the others.			.4 points
Opportunities (External)	Patient and family education: The researchers did not highlight patient education which is a key thing that makes communication effective when planning care as everyone is given information about the underlying condition. Patient satisfaction: The researchers did not make it clear as to whether or not the structured communication model had any significant relation to increased patient satisfaction, even though it did highlight that the mode provided easier communication flow involving families in patient care. Stakeholders: The researchers need to include outside sources to share views and opinions on their new model to know how they can make it better and effective or if it can be applied in other clinical settings like nursing homes and outpatient centers. Baseline data: Even though the researchers did not give a correlation between the mode and patient satisfaction, they suggested that the model is flexible to be used in other hospital units which involve patient autonomy and family involvement as the main ideas.
Threats -(External)	Limitations: The researchers developed the model on their understanding of culture and family dynamics which varies with people of different descent. This means that to some families the mode might not work. Even though the researchers suggest further experimentation of the model, from their side it is not clear as to whether or not it can be implemented successfully in other hospital units. Time and resources: The researcher’s next step is to do a pilot implementation of the model on patients that will accept to be part of the study with no specifications of the resources required for the pilot study or the time they need to prepare.

Total Points = 2 points