Case Study: Implementing Family-Centered Rounds in a Community Hospital

Thesis Abstract

Family-centered rounds (FCR) have emerged as a key patient- and family-centered care practice aimed at improving communication, satisfaction, and safety in inpatient pediatrics and general medicine. This study investigates the implementation of FCR in a mid-sized urban community hospital, addressing the problem of inconsistent adoption, clinician resistance, and variability in family engagement that compromise care coordination and patient outcomes. The aim is to evaluate implementation processes, determinants of uptake, and preliminary effects on family satisfaction, care coordination, and perceived safety. Specific objectives are (1) to describe the stakeholder-driven implementation plan and its fidelity over a 12-month period; (2) to identify organizational, cultural, and individual determinants influencing adoption using the Consolidated Framework for Implementation Research (CFIR); (3) to assess changes in family satisfaction (using the Family-Cocused Care Scale) and perceived safety climate (using the Safety Attitudes Questionnaire) pre- and post-implementation; (4) to explore staff and family experiences with FCR through qualitative inquiry; and (5) to develop a model of sustained FCR integration for similar small-to-medium hospital settings. The study adopts a mixed-methods design, integrating a quasi-experimental pre-post component with sequential qualitative inquiry. The population comprises inpatients on general medicine and pediatric units, their families, and interdisciplinary staff (physicians, nurses, and case managers) at Riverbend Community Hospital, a 320-bed facility. A purposive sample of 180 patient-family dyads will be recruited for quantitative measures at baseline and 12 months post-implementation, with a stratified sampling approach ensuring representation across units. Qualitative strands will include 30 in-depth interviews with frontline staff and 20 focus groups with family participants, conducted at three phases pre-implementation, mid-implementation, and post-implementation. Data collection instruments include a standardized Family-Centered Care Satisfaction survey, the Safety Climate subscale, CFIR-based process-tracking logs, and semi-structured interview guides; all instruments will be piloted for reliability (Cronbach’s alpha ? .70) and validity. Quantitative analysis will employ descriptive statistics and repeated-measures ANOVA to detect changes in family satisfaction and safety climate over time, adjusting for covariates such as patient age, length of stay, and unit type. Regression analysis will examine predictors of implementation fidelity and positive outcomes, with a hierarchical linear model to account for clustering by unit. The qualitative data will be analyzed using thematic analysis, following a six-step framework (familiarization, coding, theme development, review, definition, and reporting), supported by NVivo 12. Triangulation will occur at the interpretation stage to integrate quantitative outcomes with experiential insights. The study will be anchored in the patient- and family-centered care theory and the CFIR to interpret determinants of implementation success and link them to observed outcomes, with a post-hoc refinement of a conceptual model for FCR sustainability. Key expected findings include (a) high-fidelity adoption of structured rounds, with improved completeness of family involvement and explicit inclusion of patient and family preferences in care planning; (b) statistically significant improvements in family satisfaction scores and perceived safety climate at 12 months compared with baseline; (c) identification of core facilitators (leadership support, unit-based champions, standardized rounding protocols, and accessible educational materials) and barriers (time constraints, staff turnover, and unclear role delineation) influencing implementation; and (d) rich qualitative insight into experiences of families and clinicians revealing shifts in communication norms and perceived empowered participation. The study anticipates a nuanced understanding of how context moderates FCR effectiveness, contributing to a parsimonious model of scalable implementation in community hospital settings. Contributions to knowledge include empirical evidence on the feasibility and impact of FCR in a non-academic hospital environment, elucidation of contextual determinants of uptake, and a validated mixed-methods framework for evaluating FCR programs. The main conclusion is that structured, team-driven, and family-inclusive rounds can enhance satisfaction and safety perceptions without compromising throughput when supported by targeted leadership, staff training, and clear workflow integration. Practical recommendations emphasize the development of unit-specific implementation playbooks, ongoing coaching for clinicians, integration of family advisors into governance structures, and periodic audit-and-feedback mechanisms. Suggestions for future research include multi-site replication, long-term patient outcomes tracking (readmission and adverse event rates), and economic evaluation of FCR implementation costs versus quality gains.