Child and Family- Centered care conquering Serbian children's hospitals

Child and Family- Centered care conquering Serbian children's hospitals

Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
$10,000 - $50,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Partnerstvo za zdravlje develops innovative solutions to enhance the quality of Serbian health services in the following areas:HIV prevention, child rights.

About Project

Problem: What problem is this project trying to address?

During hospitalizations and medical procedures, children’s rights (UNCRC) are violated frequently in many countries (right to remain with parents, play, learn, be involved and heard in decisions regarding their own health). Medical procedures/interventions for diagnosis, treatment and care are often the cause of significant pain, resulting in trauma and life-long changes in pain responding. Baseline data collected in Serbia (2010) indicated a pervasive lack of pharmacological and cognitive pain control, poor staff-family communications, low involvement of child and family in treatment and care decisions, low access to recreational and medical play and learning, lack of staff trained in children’s developmental needs and pain assessment in children, and poor understanding of child rights.

Solution: What is the proposed solution? Please be specific!

The project “Hospital – a friend to children and families”, approved by the Serbian Ministry of Health, introduces the child- and family-centered care (CFCC) approach (UK, North America, Australia) to pediatric hospital staff. The approach humanizes the hospital environment by respecting child rights and contributing to faster recovery of pediatric patients; it also increases the satisfaction of involved hospital staff and families with the quality of care. The approach teaches staff about children’s development and their understanding of medical interventions. It provides them with practical skills in helping children and families prepare for and cope with health care procedures, reduce pain and discomfort, integrate play and learning in the hospital, provide patient-and family-centered care by transparently sharing information and involving families and patients in care decisions. Primary targets are nursing staff and hospital teachers who send most time in hands-on patient-care.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Before training, medical staff was not aware of children’s rights. Also, nurses believed that sharing information about medical procedures would increase children’s fears; procedures should be done quickly, if necessary by restraining the child; parents were allowed to care for children, but were not included and prepared for procedures, nor adequately informed; play was not considered important. Also, the privacy of older children was routinely violated. For example, placing an IV was usually accompanied by fear and crying, and nurses restraining the child, with worried parents standing in front of the intervention room. Often nurses couldn’t place an IV at the first attempt, because children were frightened and moved their hands. After the training, staff started to use distraction and calming techniques, such as blowing bubbles and breathing to make medical less stressful and painful. One staff described how she had placed an IV for a boy: Before starting, the nurse explained why she had to place an IV, then described the steps and showed him how to use breathing so the process would be easier. The boy started to breathe, the nurse was breathing with him, and the boy concentrated so hard on his breathing that he didn’t feel anything. The nurse successfully placed the IV, and when the boy asked the nurse when she would start, she showed him that the IV was already in his hand. With similar success, parents were instructed by nurses to help their children through medical procedures with increased feelings of competence, empowerment, and control for children and parents.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Unfortunately for Serbian children, there are no competitors. Several NGOs are working on children’s rights and there are groups of parents of children with cancer. UNICEF has introduced the baby-friendly hospital initiative. It focuses on delivery and support of breastfeeding practices and does not extend to older children. Our NGO has specifically developed this approach for this region that lacks staff assigned to help families and young patients deal with hospitalization. We are developing our own network of nurses and hospital staff committed to improving the quality of pediatric care and hope to increase networking with professional organizations (European Pediatric Nursing Council) in Serbia. The Council of Europe in 2011 released policy guidance on child-centered approaches.

Founding Story

The Director of a Swiss NGO was visiting a pediatric hospital in Macedonia where her NGO had supported capacity building activities for years. The staff took her around. She saw children lying bored and lonely in their beds in rooms without toys. For uncomfortable/painful procedures, children were restrained by several adults. Procedures that could not be completed because children did not “cooperative,” were also hard on the staff (i.e., causing pain). The staff also showed her a locked room full with donated toys. As a child psychologist exposed to U.S. hospitals, she knew that treatment is less traumatizing when children are prepared/treated in line with their developmental level. After consulting with health professionals in the region, she contacted several pediatric departments in Central Europe and the U.S. and developed a training approach for pediatric staff with the Director of the Johns Hopkins Hospital Child Life Department, her Serbian NGO partner, and the Serbia MOH.
About You
Partnerstvo za zdravlje
About You
First Name


Last Name


About Your Organization
Organization Name

Partnerstvo za zdravlje

Organization Country
Country where this project is creating social impact
How long has your organization been operating?

More than 5 years

The information you provide here will be used to fill in any parts of your profile that have been left blank, such as interests, organization information, and website. No contact information will be made public. Please uncheck here if you do not want this to happen..

How long have you been in operation?

Operating for 1‐5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two


Social Impact
Please describe the goal of your initiative; outline what you are trying to achieve

Our goal is to make the hospital experience less stressful, traumatic or painful for children and families and improve the quality of care by equipping pediatric staff with knowledge about children’s development, needs and rights and helping them to apply Child and Family centered health care principles in every day practice. We are educating health care providers on children’s rights, to know to recognize the stress and anxiety at children and their parents caused by hospitalization, to reduce stress, how to prepare children for medical procedures, how to lead appropriate communication with children and parents, how to asses and manage pain (no pharmacologically). It means enabling play and learning in hospitals, providing medical play as a way to prepare children for procedures.

What has been the impact of your solution to date?

The concepts of child and family-centered care was the first time introduced in Serbia in 2009 by the Suisse NGO Partnerships in Health and the Child Life Department of the Johns Hopkins Child Life Department together with the Serbian NGO Partnerstvo za zdravlje. The Ministry of Health of Serbia reviewed and approved “A Child- Centered Health Care Trainer Manual” (Schwethelm, Capello, Brylske, & Munn, 2010), the project and the approach. A Baseline survey was completed with 22 Serbian hospitals. A 5-day trainer course with 6 Serbian and 2 Macedonian hospital teams was conducted in May 2010. 100 staff and 60 last year nursing students have been trained in seven modules and received monitoring. Training at one of the two main pediatric centers in Belgrade begins in January 2012. Based on parent input, family information materials are being developed. The trainings have been received with enthusiasm, since they are gradually improving quality of care and provider/parent satisfaction.

What is your projected impact over the next five years?

Hospital management will institutionalize child-centered services through policies. Pediatric staff, including doctors, in ½ of Serbian hospitals will integrate child-centered principles into daily practice. New information materials will prepare children/parents for hospitalization and common medical procedures, and parents and patients will be involved as feasible in the planning of care. As a result, providers, parents, and patients will be more satisfied with the care. Nursing schools will include the course content into the nursing curriculum. Increasingly, child/family centered becomes the standard approach, with increased family satisfaction. Transfer to neighboring countries is occurring. A network of child-centered practitioners and facilities shares materials and best practices.

What barriers might hinder the success of your project? How do you plan to overcome them?

Potential barriers are lack of awareness, interest, and motivation of health care providers to participate in trainings and change their attitudes and interactions with children and families during hospitalization. However, the approach can be self-motivating as it makes treating children easier and less distressing. Other benefits include reduced length of hospitalization due to fewer complications and faster recovery, less use of pain medications, and increased satisfaction of pediatric patients, families, and hospital staff. It helps Serbia to be more in-line with quality of care approaches in Western Europe and guidance outlined by the Council of Europe . Also good media promotion can empower parents to request treatment in hospital be in line with child and family-centered care.

Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact

Expand to include the two biggest pediatric hospitals and develop parent information materials

Identify three major tasks you will have to complete to reach your six-month milestone
Task 1

Obtain approvals and train at the two referral hospitals, focusing primarily on nursing staff, but inviting also doctors

Task 2

Using parent input, produce and widely disseminate parent/child-friendly materials on hospitalization/common procedures

Task 3

Monitor trained staff, discuss obstacles to implementation of new skills and promote problem-solving and networking

Now think bigger! Identify your 12-month impact milestone

Increase public/professional awareness & participation of Serbian hospitals/nursing schools/ professional associations

Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1

Engage 1-2 hospitals not involved in the original trainer course and train and monitor staff

Task 2

Increase interest with the Association of Nursing Schools and, upon invitation, provide pre-service training to nursing students

Task 3

Reaching out to Ministries of Health of Balkan countries and present approach and teaching materials also to professional assoc

Tell us about your partnerships

The Ministry of Health of Serbia recognized the need for such initiative in Serbia and became our partner. The Child and Family-centered health care initiative in Serbia was technically supported by specialists from the Johns Hopkins Hospital Child Life Department in Baltimore (USA), Patrice Brylske and Erin Munn, Dr Bettina Schwethelm from Fondation PH Suisse – Partnerships in Health, Switzerland. Two Swiss foundation and a Swiss City supported the development, baseline, and start-up of our activities. Serbian hospitals participate by choice, provide training space, and free their staff.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

We are planning to expand our initiative to other Balkan countries since this region still doesn’t use this approach as a standard for providing quality care to children. We recently established contact with Ministry of Health of Montenegro and the country UNICEF office to explore a partnership in implementation of child and family–centered care in MNE.
We are also exploring partnering with the Association of Pediatric Nurses, Slovenia to introduce this approach in the country .

What type of operating environment and internal organizational factors make your innovation successful?

Health Care institutions in Serbia are still governmental, so the support, collaboration and assistance of Ministry of Health of Serbia was very much needed to enter the hospitals and promote the whole project and to recruit the health care staff for trainings and education. Project implementing team is consisted of training teams in each hospital, Partnerstvo za zdravlje staff and international advisors(the manual authors), specialized in child development, child rights and child and family centered care provide additional source of information and support in project implementation in Serbia.

Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list

Needs. 1. Collaboration with international professional associations (e.g., Child Life Council, Health Promoting Hospital network, Pediatrics Nursing Associations of Europe (PNAE) help to improve local acceptance. 2. Regional professional network of child-friendly practicioners to increase motivation 3. Collaboration and strengthening of parents-of-sick children associations