Taking the Lead: Changing the Experience of Family ICU Syndrome by Changing the Organization of Care

Abstract

Open and patient-tailored guidelines have been recommended as the preferred family visitation model in critical care settings, but many intensive care units continue to restrict visitation. One of the major developments in modern management theory and research has been its continued focus on better understanding how to introduce and manage organizational change. Leading and managing a change effort within an ICU is not easy and not well suited to the simplistic and over-reductionist models that tend to dominate the popular business literature. Further, while the practice of medicine may be viewed as a business, a fundamental error is made if the differences between providing care and treatment for a person in medical need are ever truly confused or conflated with the purpose, processes, and ethics of producing good or service in a purely economic marketplace. A current example where this confusion is present is in the widespread use of the Plan-Do-Study-Act model of continuous quality improvement (CQI) to change the way in which healthcare services are produced. While useful in some situations, the CQI model was developed foundationally to standardize the structure and processes for producing automobiles and other industrial products – not provide medical care to those in need and suffering. An alternative to overly-simplistic and industrial models of change is presented through the exposition of four key elements of a person-focused approach to ICU care that treats patients as real people, respects and engages with the diversity of families, and releases physicians and other caregivers from the constraints of existing medical bureaucracies.