1. What does parental involvement in in-patient safety mean to you?

Allow parents to parent

In the community parents assume responsibility for their child’s care needs. Should this automatically be taken away on admission to hospital?Particularly if the child or young person (CYP) has a complex chronic or rare condition which parents and CYP have unique expertise with. Parents could be given the same responsibilities as at home, giving medications, escalating care when concerned. For some, parental involvement in in-patient safety simply means parental presence. Admit them with the child – treat as a family unit –recognition that the child does not come alone.

Purposefully foster relationships

Recognise parents' expertise and value their contribution and role.Listen to parents. Believe that their concerns are real and important. Seek their contribution – make sure they know their input is wanted and valuable. Make them feel part of the care team. Encourage open dialogue, rather than ‘telling’ them things – learn together. Take time to build partnerships.Listen to parents alongside rather than instead of children.

Involvement should be to the extent that parents feel able and willing

Different parents will have different professional expertise (e.g. some are healthcare professionals (HCP)), health experiences and preferences about how much they may feel able or willing to participate. Handing all of the responsibility over to HCPs may be what some parents prefer when their child is unwell. It’s important to realise that parents may also have health needs of their own.

Empathetic healthcare professionals with emotional intelligence who truly appreciate the importance of parental experience/ contribution/ concerns

For many parental involvement in safety requires HCPs who are open that involvement and happy to ‘power share’ where appropriate.

2. What examples of good practice have you seen involving parents ofchildren admitted to hospital and how has this impacted on safety?

Encouraging parents to share concerns

•White boards
•Parents writing in medical notes
•Parent escalation tools
•Diaries on neonatal unit incubators

Participation 

•Ward rounds
•Huddles
•Multi-disciplinary team discussions and meetings

3. What barriers prevent us from involving parents more than we do?

Staff barriers

•Attitude
•Fear of change
•Fear of being unable to help/ answer 

Parents questions

•Not listening to feedback
•Concerns about child protection always at the back of mind in paediatrics
•Seeing parents as a nuisance

Organisational barriers

•Excluding parents from processes
•Defensive culture
•Failure to learn from mistakes
•Arbitrary/ meaningless targets
•Tick-box exercises

Parent barriers

•Education
•Disability
•Feeling like a nuisance

4. How can we make best practice the norm and what would an ideal future look like?

Education

Formal training in communication for professionals was supported with requirements to reflect on, refresh, and evaluate these skills over time to ensure our standards don’t drop over time. Is there perhaps a role for CYPs and parents to do Team Assessments of Behaviour (TABs) for doctors? A method of providing formal feedback on professionals’ communication skills and behaviour was felt to be important.

Transparency 

The importance of acknowledging the limits of our medical knowledge was reiterated: being frank about what we do and do not know. In-keeping with this,duty of candour arose as a key theme. Many highlighted the importance of professionals admitting when they are wrong and have made mistakes, and subsequently apologising for those mistakes. Honest discussions such as these were felt to be important to foster partnerships.

Meaningful collaboration.

Integration of parent representatives into the hospital team was suggested. Even having parents employed to represent the parent view during multidisciplinary team discussions was suggested.