Linda S Franck, PhD, RN, FRCPCH, FAAN, Karel O’Brien, MB BCh BAO, FRCP(C), MSc

Introduction:

Safe and high-quality neonatal care is best provided with the involvement of the infants’ parents/primary caregivers (1). This is supported by research showing the harm caused to infants, parents, family systems, healthcare professionals, and healthcare delivery systems when family- and community-centered neonatal care is not provided. Despite strong evidence, knowledge, and intention, most NICUs do not fully and consistently practice family-centered care, and care delivery remains predominantly provider and organization-centered. Now that there is strong evidence for a range of approaches for achieving family-centered care, the debate has shifted to be less about whether or not to provide family-centered care but rather how best to do so. Unfortunately, this shift has still not resulted in a noticeable improvement in the implementation of family-centered care. Instead, it may have distracted from the fundamental reforms needed to overhaul the neonatal care delivery model.

Changing clinical practice is hard (2). Sharing power and redistributing resources is even harder. Nevertheless, we are all called to do this hard work as part of our social contract as health professionals. For many decades, the Gravens conference has been a forum for healthcare professionals and family advocates to exchange knowledge, share innovative new practices, discuss ethical and social issues and recommit to advocacy and action to improve family and infant outcomes. At the 2023 Gravens conference, a session was devoted to discussing some of the main evidence-based programs that include families as partners. By the end of the panel discussion, it was clear that each program offered a unique focus while sharing some common features. What was striking was that the programs were not mutually exclusive and that in an ideal NICU, different approaches could be employed concurrently or as needed to support infants and families for the benefit of all. It was clear from the discussion that implementation of any program required similar actions: a demonstrated commitment to change the unit (and hospital) culture to support the family partnership in care delivery; resources for (re)training and maintaining staff skills; and resources/redesign of systems to address the socioeconomic barriers to full family engagement and participation in care.

Our thesis is that the Family Integrated Care (FICare) model (3) is the ideal starting point for NICU care delivery redesign, addressing some of the most fundamental structural changes in unit culture and practice that can enable the successful incorporation of other specific family-centered care practices and programs. In this article, we summarize the key features of FICare and suggest resources for successful implementation.

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References:

1. Franck LS, Axelin A, Van Veenendaal NR, Bacchini F. Im- proving neonatal intensive care unit quality and safety with family-centered care. Clin Perinatol. 2023;50(2):449-472. doi:10.1016/j.clp.2023.01.007
2. Rolnitsky A, Bell CM. Sustaining Improvement Initiatives: Challenges and Potential Tools. Clin Perinatol. 2023;50(2):307-320. doi:10.1016/j.clp.2023.01.001
3. Family Integrated Care. About FiCare [Internet]. [cited 2023 Jun 15]. Available from: https://familyintegratedcare.com/about/
4. Franck LS, Gay CL, Hoffmann TJ, et al. Neonatal outcomes from a quasi-experimental clinical trial of Family Integrated Care versus Family-Centered Care for preterm infants in U.S. NICUs. BMC Pediatr. 2022;22(1):674. Published 2022 November 22. doi:10.1186/s12887-022-03732-1
5. Franck LS, O’Brien K. The evolution of family-centered care: From supporting parent-delivered interventions to a model of family integrated care. Birth Defects Res. 2019;111(15):1044- 1059. doi:10.1002/bdr2.1521

Disclosure: The authors have no disclosures.