PFCC Methodology and Practice:

Deliver Ideal Care Experiences and Outcomes…By Design

Pamela K. Greenhouse, M.B.A. Executive Director PFCC Innovation Center May 8, 2013 (greenhousepk@upmc.edu)

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A simple, replicable and sustainable six-step methodology to deliver ideal care experiences and improve clinical outcomes while decreasing waste and cost.

Developed for health care, the PFCC M/P is based on the Design Sciences in which the goal is always to make things better for the end user

The Patient and Family Centered Care Methodology

and Practice

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• UPMC is a $10 billion integrated global health system headquartered in Pittsburgh, PA

• Named one of the nation’s Top 10 Hospitals on the U.S. News & World Report’s Honor Roll of America’s Best Hospitals

• Pennsylvania’s largest employer with 55,000 employee.

• Operates more than 20 academic, community, and specialty hospitals and 400 outpatient sites, employs more than 3,200 physicians, and an array of rehabilitation, retirement, and long-term care facilities

UPMC: Who are We?

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How Did PFCC Come About?

• Total Joint Replacement

• Magee Women’s Hospital of UPMC

• Exceeding the wants and needs of patients and families

Anthony M. DiGioia, M.D.

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Many Different Care Experiences and Types of

Hospitals - Big and Small, Tertiary to Rural

Bariatric Surgery

Total Hip and Knee Joint Replacement

Women’s Cancer Services

Home Health Care

Rehabilitation

Emergency Services

Surgical Services

Transplant

Adult Level I Trauma

Urgent Care Centers

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PFCC In Action At UPMC

• PFCC is a grassroots effort to change the culture...from over 64 different Care Experience Working Groups

• >180 Project Teams Over 441 Completed Projects

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Key #1

Key #2

Key #3

Viewing all care as experiences through the eyes of patients and families

Three Keys for the PFCC

Methodology and Practice

Engaging patients and families as full partners in co-designing care with us

Providing simple solutions in a complex system in order to break down silos and barriers

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PFCC Methodology and Practice

Care Giver

Any person within a care setting

whose work touches a patient’s or family’s experience

Touchpoint

Key moments and places in any

care setting where patient and family care experiences are directly or indirectly affected by any Care Giver

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PLACE HOLDER – ER VIDEO

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Current State

Ideal Experience

1. Define Care Experience

2. Guiding Council

3. Current State, View Care, Urgency

4. Working Group thru Touchpoints

5. Shared Vision for the Ideal

6. PFCC Projects and …Improvement Teams

Six Steps

To Transform Care

PFCC Methodology and Practice

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Level I Trauma Care Experience

Begins:

When EMS responds to patient who is needing transport to ED

Ends:

When patient is transported and admitted to rehab facility

Example of Step 1

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PFCC Methodology and Practice

Current State

Ideal Experience

1. Define Care Experience

2. Guiding Council

3. Current State, View Care, Urgency

4. Working Group thru Touchpoints

5. Shared Vision for the Ideal

6. PFCC Projects and …Improvement Teams

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Step 2 Real World Example:

Level I Trauma PFCC Guiding Council

Administrative Champion =

Clinical Director,

Emergency and Trauma Services

Clinical Champions =

MD and Trauma Nurse Coordinator

Emergency and Trauma Services

PFCC Coordinator =

Administrative Coordinator

Emergency and Trauma Services

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PFCC Methodology and Practice

Current State

Ideal Experience

1. Define Care Experience

2. Guiding Council

3. Current State, View Care, Urgency

4. Working Group thru Touchpoints

5. Shared Vision for the Ideal

6. PFCC Projects and …Improvement Teams

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Walk the walk of patients and families…

Shadow patients and families throughout the selected care experience, record observations and insights

High impact and $ and effort

Step 3: Shadowing and Care Experience Flow

Mapping

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• Health profession students, volunteers, summer interns, patient advocates

• New hires and light duty staff

• PFCC Guiding Council

• The more “uninformed” the better

Who Can Shadow?… Anyone!

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Shadowing

Observations

Empathy

Insights Tim Brown: Change By Design Harper Collins; 2009

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• Shadowing continuously engages patients, families and care givers

• Real-Time patient/family feedback

• Shadowing is the best way to get started

Shadowing is the First Step Toward Co-Design…

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Care Experience Flow Map

Dr.’s Office

Transport

Housekeeping

Home

Call Center

Lab

Reaches scheduler to make an appointment

Call transferred to office takes info and receptionist makes appointment

Front desk receptionist checks patient in

Physician assesses patient and orders tests

Escorted to Ultrasound by Transporter

Escorted to Inpatient Unit by Transporter

Returned to Exam room Physician updated pt.

Escorted to Exam Room by Transporter

Moved to Room by Clinical Manager; waits 40 minutes for room

Greeted by Unit Clerk

Touchpoints and Care Givers

Ultrasound

Technician performs test; test takes 45 minutes

Phlebotomist draws blood

Parking

Information Desk

Parked car in wrong lot per attendant

Dietary

Clinical Manager made follow-up phone call

Cardiac Unit

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PLACE HOLDER –

Champion talking about Shadowing

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“Being a nurse for 25 years I thought I

had a good understanding of what our

patients and families wanted because I

live it and work it every day. But I found

out that there are some things that are

more important to the patients than I

thought they were. For example, I didn’t

realize how many people were having a

hard time just finding my unit. Or that

parking was such a big issue.”

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Another Kind of Shadowing “Reality TV for Care

Givers”

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Reality TV for Care Givers

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Tim

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Vis

its

Staff Type

Staff Contacts/Time Analysis (22 patients)

Avg Number of Visits Avg Time per Visit

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39%

26%

6%

5%

5%

19% Nurse 39%

Patient Care Technician 26%

PT and OT 6%

Patient Support Assistant 5%

PT Technician 5%

Others 19%

28 Staff Types Top 5 Care Givers # of contacts = 4034 # of contacts = 3221

(23 Staff Types)

Account for 81% of contacts

Hand washing - Top 5 Care Giver Groups That

Interact with Patients

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--Susan P. Ferguson Chief Nursing Officer,

Baptist-Collierville

“I can’t tell you how impactful Shadowing is; once people Shadow, they talk about PFCC differently—getting to view care through the eyes of patients and families truly provides Care Givers with a different perspective.”

Shadowing Changes Your Perspective

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PFCC Methodology and Practice

Current State

Ideal Experience

1. Define Care Experience

2. Guiding Council

3. Current State, View Care, Urgency

4. Working Group thru Touchpoints

5. Shared Vision for the Ideal

6. PFCC Projects and …Improvement Teams

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Touchpoints:

Care Givers:

Care Giver “TEAM List”

EMS

Portal/ED Department

Trauma Bay

CT/Radiology

Transport

ICU

Care Experience Flow Map and Working Group

Members

Paramedic

ED RNs

ED Physicians

CT Tech.

Transporter

ICU RN

Pat Smith

Chris Kelly

Sam Jones

Al Very

Sue Grade

Lou Simon

Deb Unger

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The PFCC Surgical Services Care Experience

Working Group

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Med Records

Nursing Medicine Physical Therapy

Care Delivery

Functional Silos

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PFCC Methodology and Practice

Current State

Ideal Experience

1. Define Care Experience

2. Guiding Council

3. Current State, View Care, Urgency

4. Working Group thru Touchpoints

5. Shared Vision for the Ideal

6. PFCC Projects and …Improvement Teams

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Step 5: Write the Ideal Story

Real World Examples

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PFCC Methodology and Practice

Current State

Ideal Experience

1. Define Care Experience

2. Guiding Council

3. Current State, View Care, Urgency

4. Working Group thru Touchpoints

5. Shared Vision for the Ideal

6. PFCC Projects and …Improvement Teams

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PFCC Impact Project:

Discharge Medication

Shadowing revealed patients going home without medications

Research showed sometimes three days passed

PFCC Project Team formed and partnered with local pharmacy for weekend and evening discharges

Piloted results

Hospital now increasing operational hours of internal pharmacy to meet the need

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PFCC Impact Project:

Web Cam

Laptop with Camera Capabilities

UPMC Presbyterian

Children’s Hospital

Facilitates teleconferencing between adult & pediatric trauma patients

Collaborative effort between Children’s Hospital & Presbyterian Trauma & Social Work

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PFCC Impact Project:

Bedside Nurse Rounding

Patient Activation

Shared Decision Making

Patient Safety

Communication

Care Coordination

Accountability

• Increase of 9% in HCAHPS: Communication with Nurses • Accelerate System-Wide Spread

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“Patients complained that they didn’t know who their doctors were, and they didn’t know the plan of care because it changed depending on which doctors they saw.”

Patient and MD Partnerships

--Dr. Louis Alarcon, MD PFCC Champion Trauma Working Group

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Patients:

“Who is my doctor?”, “What is the plan (surgeon and consultants)?”

Nurses:

“Which resident is covering this patient?”

Attendings:

Resident continuity lacking

Residents:

Workflow issues

Problems with the Current State

(Old System)

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BLACK TEAM

GOLD TEAM

BLUE TEAM

TRAUMA “Primary” Care Teams

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PFCC Impact Project:

Restructured Level I Trauma Teams

Created Three “Primary Care” Trauma Teams

Results showed:

Improved continuity of care

Improved communication

Improved patient & family satisfaction

Improved resident work hour compliance

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5%

10%

15%

20%

25%

30%

35%

% o

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isch

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Trauma Discharge Comparison Aug/Sep 2009

August % of total D/C September MTD % of total D/C

The Trauma Restructure was associated with improvement in time of discharge

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• Overall 25% of trauma pts tested positive (Score >35)

• Highest incidences (43%) in patients who sustained assault

• Risk factors: <55 yo, female, MVA, blunt or penetrating assault and the worse the “assaultive dose”

• ALL trauma patients now screened

PFCC Impact Project: PTSD Screening

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PFCC Impact Project:

Medication Cards

To teach patient about new meds prescribed in Hospital

Card triggers teaching & cross-interaction check

Nurses and Pharmacy are collaborating

Improve Safety, Satisfaction, Reduce Re-Admission Rates

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• Real Time Patient and Family Advisory Council

• Transition from ICU

• Seamless Hospital & Rehab Discharge Instructions

• Resident Orientation

Sample of Current PFCC Projects

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"So now, on the other side of the fence, I have also been able to think about being a patient, and one whose life is threatened. I have come to regret how much better a doctor I might have been, had I been at the receiving end of medical care earlier in my career. In the past eighteen months I have learnt as many lessons from sometimes unwittingly insensitive doctors and nurses as from many others whose patience, encouragement and quiet humor have sustained me through dark times."

-Elizabeth Bryan

Singing the Life

A Physician Becomes a Patient

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Place Holder: Lone Nut

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The PFCC Community of Practice is Growing

Baptist Memorial, Collierville - Tennessee

Nemours, A Children’s Health System, Delaware & Orlando

National Health Service, UK

Korean Health System, Korea

Atrius/Vanguard/Harvard, Boston

WellSpan Health, Pennsylvania

Rochester General Hospital, New York

UNC Healthcare, North Carolina

Aneurin Bevin Health, Wales

www.pfcc.org

Thank you!