Case Study: Implementing Family-Centered Rounds in an Urban Hospital

Thesis Abstract

This study investigates the implementation of family-centered rounds (FCR) within an urban hospital setting to address persistent gaps in family engagement, communication, and patient satisfaction that accompany traditional rounding practices. The context is a tertiary-care 450-bed urban hospital serving a diverse patient population with high acuity pediatric and neonatal units, where inconsistent incorporation of family input has been linked to suboptimal care coordination and perceived care dissatisfaction. The aim is to evaluate the process, outcomes, and sustainability of FCR in promoting family engagement, reducing conflict during rounds, and improving patient- and family-reported experience measures. Specific objectives include (1) assessing changes in family satisfaction with rounds using a pre-post design, (2) evaluating the fidelity of FCR implementation across departments (pediatrics, neonatal, and medicine), (3) identifying barriers and facilitators to adoption from perspectives of frontline staff and families, (4) examining the impact of FCR on clinical communication quality, care plan clarity, and discharge preparedness, and (5) exploring associations between FCR adherence and measurable outcomes such as length of stay, readmission rates, and medication reconciliation concordance. A mixed-methods design underpins the study, integrating quantitative and qualitative strands to provide a comprehensive assessment. The population comprises nurses, physicians, allied health professionals, and family caregivers engaged in rounds on pediatric and neonatal units. A purposive sampling strategy selects 120 families and 60 clinicians across three units for the quantitative component, with an embedded qualitative cohort of 25 family participants and 20 clinicians for in-depth interviews. Data collection instruments include the Family-Centered Rounds Fidelity Scale, the Family Satisfaction with Care Rounds (FSCR) questionnaire, a clinician-rated Communication Quality Instrument, and medical record abstractions for care plan clarity and discharge readiness. Instrument validity and reliability are established through content validation by a panel of pediatric care experts and a pilot study (n=20 families) with Cronbach’s alpha exceeding 0.80 for key scales. Data collection occurs in two phases a 6-month baseline pre-implementation period, followed by a 9-month post-implementation period, enabling interrupted time-series analysis. Quantitative data will be analyzed using descriptive statistics, paired t-tests or Wilcoxon signed-rank tests for pre-post comparisons, and multilevel mixed-effects regression to account for clustering by unit and repeated measures. ANOVA will examine differences in fidelity and outcomes across units, while logistic regression will assess associations between FCR adherence and binary outcomes such as discharge readiness achieved within 24 hours. The qualitative component employs thematic analysis of semi-structured interviews and focus groups, guided by theDonabedian framework and the theory of patient- and family-centered care, to elucidate contextual determinants of implementation—barriers, facilitators, and adaptive strategies. Triangulation will integrate quantitative findings with qualitative insights to derive a comprehensive understanding of the FCR rollout. Anticipated findings include a statistically significant improvement in FSCR scores and caregiver-reported satisfaction (p<0.05), increased perceived clarity of care plans, and higher rates of discharge readiness documentation within 24 hours post-FCR. Fidelity analyses are expected to reveal substantial variability across units, with pediatrics showing greater adherence due to targeted training and leadership engagement. It is anticipated that higher fidelity correlates with improved communication quality and reduced rounds-related conflict, while minimal changes are expected in objective clinical outcomes such as length of stay, given complex patient trajectories, though modest reductions in readmission rates may emerge. The study contributes to knowledge by providing robust, context-specific evidence on the feasibility, effectiveness, and sustainability of family-centered rounds in an urban hospital setting, clarifying the relationship between organizational culture, staff engagement, and family participation. It extends existing literature on patient- and family-centered care by operationalizing FCR fidelity, linking process measures to experiential outcomes, and offering a practical implementation framework for hospitals seeking to align rounding practices with family needs. Based on findings, recommendations include tiered staff training programs, continuous feedback mechanisms from families, integration of FCR into electronic health records prompts, and leadership-driven change management to ensure enduring adoption across departments. The study concludes that systematic implementation of FCR, accompanied by rigorous fidelity monitoring and targeted support for units with lower uptake, yields meaningful improvements in family experience and communication quality, with potential downstream benefits for care coordination and patient safety.