Effective Communication of Restricted Inpatient Visitation Policies during COVID-19

Health Systems Fall Short

November 1, 2021

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In March 2020, I (JLH) stood in a hospital room with a long-married couple. I took a final picture of them embracing, their faces turned towards the cell phone camera I held, and then I separated them. I sent the patient’s spouse home due to a newly enacted hospital policy that banned family members’ presence at the bedside. The patient never returned home.

Similar separations occurred nationwide as federally guided restrictions on inpatient visitation attempted to contain the rapidly spreading virus causing COVID-19. These restrictions posed an immediate threat to decades of progress in the provision of family-centered inpatient care. As we now know, they also had unintended consequences: they delayed medical decision-making and worsened clinical outcomes, such as delirium.

How health systems communicated these changing policies during a crisis shaped public perceptions about the restrictions and affected relationships with the community more broadly. In a recent study, we analyzed communication patterns early in the pandemic across 363 inpatient facilities in Pennsylvania, and assessed their impact on patients’ willingness to seek care. Here we highlight communication strategies that improve public receptiveness of restrictive visitation policies by emphasizing community protection, ownership over the facility’s policy, and promoting family-centered care.

We started by analyzing inpatient visitation policy statements published on facilities’ websites, as captured between April 30 and May 20, 2020. Most (95.2%) of these policies prohibited family presence in the hospital. The average reading level for these policies required a college-level education and only four facilities offered the policy in a language other than English. Facilities justified the restricted visitation policies based on community protection (56.7%), authorities’ guidance or regulations (32.7%), or scientific rationale (22.1%). A minority (36.5%) addressed how restrictive visitation might impair family-centered care. Facilities tended to use the passive voice when communicating the restrictions, thereby deflecting attention from their own role in implementing the policy.

Drawing on these findings, we then tested the impact of communication choices on the general public’s perception of health systems. In October 2020, 1,321 U.S. adults from online research panels completed a survey in which we presented composite policies that varied in their justification for restricted visitation, the degree to which the facility expressed ownership of the policy, and the inclusion of family-centered care support plans. We found that individuals were more willing to recommend the facility if it justified the restrictive policy based on community protection or scientific rationale rather than on a governing authority, when the facility expressed a higher degree of ownership over the policy decision, and most strongly, when it included family-centered care support plans. The goals of family-centered care are to respect family members as care partners, foster collaborations between family members and the health care team, and maintain family integrity. Our participants valued the inclusion of these elements and recognition of family members’ distress when health systems communicated visitation restrictions.

Our findings confirm the importance of communication choices during periods of crisis. Health systems’ communication of restricted visitation policies did not reflect best practices in crisis communication and may fail to represent health systems’ commitment to their communities’ health and their motives for establishing restrictive visitation policies. To improve public perception, health systems and facilities should:

Convey ownership over their policy decisions
Explain how the policy directly benefits the community
Include resources supporting family-centered care
Use language accessible to those with lower reading levels
Provide policies in languages other than English as locally relevant
Provide clear explanations for novel policies
Incorporate statements of empathy and compassion

Because these specific elements of visitation policy statements that improve public perception are unrelated to the visitation rules themselves, health systems can rapidly implement our findings as they adapt to changing course of the pandemic. These communication strategies can build trust between organizations and the people they serve, promoting a sense of partnership and mitigating the harms of restrictive visitation policies.

The study, Content and Communication of Inpatient Family Visitation Policies During the COVID-19 Pandemic: Sequential Mixed Methods Study, was supported by an LDI COVID-19 Rapid Response Grant and was published in the Journal of Medical Internet Research in September 2021. Authors include Joanna Hart, Amy Summer, Kuldeep N. Yadav, Summer Peace, David Hong, Michael Konu, and Justin T. Clapp.