Two years ago, Colin’s first son was born at a hospital in a mid-size city in southern Ontario.
After a long, difficult labour, his wife and baby were moved to a semi-private room at 5:30am. But Colin was not allowed to join them.
“The nurses said I’d have to leave, and come back later in the morning,” he explains. When he protested, Colin was told that even though no one else was in the semi-private room, the hospital visiting hour policy prevented any visitor – even a brand new father – from staying overnight. Colin spent the rest of the night in the hospital lobby, hoping that his wife was coping with the pain and wishing he was able to see his newborn son.
Colin’s experience is far from unique, but may soon be a thing of the past, as many Canadian hospitals are beginning to do away with traditional, restricted visiting hours in favour of more flexible, patient and family-friendly policies.
Eliminating restrictive visiting policies
Kingston General Hospital (KGH) is one of the hospitals that has made the switch. Beginning in 2010, KGH adopted an unrestricted visiting policy, providing families and friends the opportunity to visit 24 hours a day, 7 days a week. “The idea came from the patients and families,” noted Leslee Thompson, the CEO of KGH. “They talked about the importance of people special to the patient in the healing process.”
Given the focus on improving the patient experience within the Canadian health-care system, advocates suggest that unrestricted hospital visiting policies represent a relatively straightforward step towards achieving this goal.
In the United States, the Institute for Patient and Family-Centred Care (IPFCC) has advocated for unrestricted visiting policies for a number of years, with notable success. Although a 2008 survey of 606 American hospitals indicated that more than 75% had restrictive visiting policies, a survey conducted in 2014 by the American Hospital Association found that only 42% had restricted access to patients.
However, these same dramatic shifts have not been reproduced in Canada. A survey of posted visiting hour policies in 128 Ontario hospitals by HealthyDebate revealed that almost 90% maintain restricted visiting hours for patients and families.
In response to the slow uptake in Canadian hospitals, the IPFCC has partnered with the Canadian Foundation for Healthcare Improvement (CFHI) on the “Better Together: Partnering with Families” campaign. This initiative aims to encourage hospitals to eliminate restrictive visiting policies and provides a toolkit on developing the change.
Not just a visitor
More than simply expanding the length of visiting hours, advocates of unrestricted visiting policies note that there is a need to redefine the family’s role during a patient’s stay in hospital. Specifically, it is important that the families be regarded not as “visitors,” but instead embraced as true partners in the care of the patient.
“One of the most important insights was from the families who said that ‘You talk about us as if we’re visitors, but I’m the husband, I’m the daughter, I’m the wife – I’m not a visitor,’” recalls Thompson.
This was the idea behind the approach taken at South Health Campus (SHC), a hospital in Calgary that was identified by the IPFCC as one of the 12 hospitals in North America with the best practices in patient experience. Under their modified form of unrestricted visiting, patients can identify individuals who they view as “family” or their “primary support.” While there are still visiting hours for others, primary support individuals are encouraged to be involved in all of the patient’s health encounters and are welcome to stay overnight if the patient wishes.
The goal is to “welcome families as partners because they’re the constant in the patient’s life,” notes Joanne Ganton, the manager of patient and family-centered care at SHC.
Benefits for patients, families & health care providers
For many, the benefits of unrestricted visiting policies are evident – patients and their families want to know that when they want to be together, they can be.
Advocates of the change cite a number of studies that suggest unrestricted or flexible visiting has positive impacts on both the patient’s and family’s health. These include decreased anxiety, confusion and agitation for the patient, and increased satisfaction with the care provided. In particular, families were found to feel better informed about the patient’s condition, owing to improved communication with the health care team.
Families can also play a critical role in ensuring patient safety. “There’s a lot of research that shows that patients are safer if their family members are by their side. It’s another set of eyes and ears that can ask questions, spot medication errors, prevent falls and potentially prevent unnecessary tests,” says Ganton. Often this simply comes down to the fact that families will always know more about the patient than the health-care provider can gather in the limited time frame of a hospital stay.
However, the benefits also extend to the health-care providers themselves, in particular the nurses who often must act as the gatekeepers in upholding a hospital’s visiting policy. The reality is that even in hospitals with restricted visiting, many nurses are flexible about the visiting policy when they feel it is justified (for example, when the patient is in a serious condition). However, this comes with its own set of complications, as the variability among nurses can result in tension between families and nurses who are stricter with the visiting hour rules.
As such, Ganton says the unrestricted visiting at SHC can actually facilitate the jobs of nurses as they “don’t feel like the police anymore and get to focus on being nurses.”
Changing the status quo
Given these apparent benefits, what are the challenges that hospitals face in attempting to bring unrestricted visiting policies to their facilities?
The majority of those opposing the switch to unrestricted visiting policies are health professionals who believe that removing the restrictions will create chaos. For example, they worry that the number of people who visit will rise sharply, that units will be too noisy, or that there will be infection control challenges. However, as mentioned, in reality most health professionals do not currently enforce posted visiting hour restrictions anyway.
This has been the case at The Ottawa Hospital (TOH), where there has been much debate about how and when to implement more flexible visiting hours. For the most part, patients’ families, friends, and caregivers already visit when they want and need to, and this will not change with an open visiting policy. What would change is that there would be guidelines about how to handle challenging situations and how to ensure staff and patients have the information and tools they need to communicate with one another.
For patients, the primary concern is that by having visitors come by at any time of the day or night, there is a risk that they may not get enough rest. This is of particular concern in older hospitals with a larger number of ward rooms, accommodating anywhere from two to six patients at a time. In these scenarios, a patient may be prevented from properly resting by another patient’s visitors, who can inadvertently cause a disruption despite their best intentions. However, as Thompson explains, in her experience, patients and families generally respect the environment and for most situations “common sense prevails.”
Finally, one of the most commonly cited concerns about unrestricted visiting is the potential increase in hospital traffic throughout the night. Security is an issue at every hospital. However, depending on the circumstances and location of each facility, different measures to ensure staff safety and protect against theft are required.
This is an important consideration when opening up visiting overnight as monitoring and controlling the environment with minimal staff can be difficult. Nevertheless at KGH, Thompson noted that the changes in security simply included altering hospital entrance protocols at night and installing additional surveillance cameras, the costs of which were “very minor”.
Future of visiting hours
It remains to be seen if the same dramatic shift that appears to have occurred in the United States will translate north of the border. However Thompson is optimistic. “We absolutely believe that this is something that other [hospitals] can choose to do,” she says.
In the end, while the introduction of unrestricted visiting policies poses novel challenges and requires a degree of culture change among health-care providers, the emphasis on developing a patient and family-centered health care system requires that the issue be explored further. According to Ganton, “how it will look in all hospitals will be somewhat different…it’s just a matter of [taking] the principles and goals of what you’re trying to achieve with the family presence philosophy and [making] it work for each environment.”