PFCC Presentation to Masspro: Engaging Patients and Families in Redesigning Care

Pamela K. Greenhouse, M.B.A.
Executive Director
PFCC Innovation Center
(greenhousepk@upmc.edu)
Engaging Patients and Families
in Redesigning Care Delivery:
Go Shadow

What is UPMC and How Did
PFCC Come About?
• UPMC is a $10 billion global health
enterprise; 55,000 employees; 20
hospitals; 400 clinical locations;
passion for innovation
• PFCC is a grass roots effort; spread
through word of mouth; bottom-up
initiative; now looking at top-down –
meets-bottom-up

Why Do We Need to Change?
Just ask patients and
families – we are not
delivering even the
basics well

Is Patient Experience Important?
84% of those completing the 2012 HealthLeaders
Media Patient Experience Survey placed patient
experience among their top three priorities.
Yet, 85% said they have not made specific
investments in time or resources for improving
the patient experience in the past year.
The biggest stumbling blocks to creating a
patient experience strategy are “higher priorities”

There are successful examples…but
most can’t explicitly explain how
they got there… “no methodology”
Are solutions transferrable?
Everyone’s “current state” is different
There are success stories…
but how can we all get there?

We need a new
Operating System
for the delivery of care…

Three Keys to Success for the
New Operating System

Key #1
View All Care as an
Experience
and Through the Eyes of
Patients and Families

Key #2: Engagement
Complaining
Consulting and Advising
Giving Information
Listening and Responding

Key #3:
Simple Approach to Overcoming Hurdles
• Simple
• Replicable
• Sustainable

The PFCC Methodology
• Singular goal to provide exceptional care
experiences for patients and their
families
• Which also delivers better outcomes and
decreases waste and cost (PFCC Trifecta)
• Re-focus existing resources…does not
require new ones
• Engage patients, families, and care givers
to identify opportunities implement
solutions

Common Misconceptions
about PFCC
• Another clinical pathway
• Takes too much time
• Expensive
• Too big an initiative
• PI “flavor of the week”(i.e. TPS,
Lean, CMI, Six Sigma, CQI…)
• Requires renovation or building a
“new” hospital

What is a Care Giver?
ANYone in the health
care environment who
affects the patients’
and families’
experience at any
point in their health
care journey
Doctors, nurses,
therapists,
technicians,
housekeepers,
parking attendants,
appointment
schedulers AND
those behind the
scenes – finance
reps, medical records
clerks…

Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Shadow, Current State, Urgency
4. Working Group thru Touchpoints
5. Shared Vision of the Ideal
6. PFCC Project Teams
to Close the Gap
The PFCC Methodology :
Six Steps to Ideal Care

Current State
Ideal Experience
1. Define Care
Experience
2. Guiding Council
to Close the Gap
Provides the Steps to Success

Step 1
Define the Care Experience:
Example: Total Joint
Begins:
The initial phone call
for an appointment
Ends:
When the patient
returns to the MD
office for 1 month
follow-up visit

Current State
Ideal Experience
2. Guiding Council
to Close the Gap

Administrative Champion
Clinical Champion
PFCC Coordinator
Responsibilities:
• Go Shadow
• Develop the Care Experience Flow Map
• Expand into the PFCC Working Group
• Guide PFCC Working Group
Step 2
Establish a PFCC Care
Experience Guiding Council

Example of Step 2:
Diabetic Care Experience Guiding Council
Administrative Champion =
Vice President, Ambulatory
Services
Clinical Champion =
Program Director, Center for
Diabetes and Endocrinology
PFCC Coordinator =
Practice Manager, Center for
Diabetes and Endocrinology

Current State
Ideal Experience
2. Guiding Council
3. Shadow, Current State,
Urgency
to Close the Gap

What is Shadowing?
Shadowing is repeated
real time
observation of patients
and families as they
move through each step
of their health care
journey

Understand the Current
State
• Walk the walk of patients and
families…
• Shadow patients and families through
the selected care experience, record
subjective and objective observations
and insights
• High impact for the $’s and effort
Step 3

It’s Easy
“We watch what people do (and do not do) and
listen to what they say (and do not say). The
easiest thing about the search for insight – in
contrast to the search for hard data – is that it’s
everywhere and it’s free.”
“This enlightened perception reveals the
experience, not just the process.”
Tim Brown, Change by Design

Who Can Shadow?…Anyone!
Guiding Council and care givers
New hires and light duty staff
Health profession students, volunteers,
summer interns, patient advocates
All of the resources
already exist within our organizations!

Shadowing Provides that
Moment!
Shadowing
Empathy
Insights

Re-Shadow Periodically Over Time!
1.Current states change
2. Need to assess whether previous
projects are still in place and relevant
3. Need to assess whether previous
projects achieved what was intended
4.Creates sustainability!

Care Experience Flow Maps
• Inefficiencies in processes
• Transitions in care issues
• Communication gaps
• Bottlenecks and redundancies
• Care delivery silos
• Opportunities to improve experiences
and clinical outcomes while decreasing
cost
What they will reveal…

Ambulatory Surgery Care Experience Flow Map
Pre - PFCC
Touchpoints Caregivers

Ambulatory Surgery Care Experience Flow Map
Post - PFCC

If Any Doubts…Go Shadow
• Engages patients and families as
full partners in care delivery
redesign
• Creates empathy and urgency to
drive change
• Establishes true current state
Engage Patients and Families
in Re-Designing Ideal Care

A Physician Becomes a Patient
"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

Aim for the Heart
and Backfill with the Data

Current State
Ideal Experience
2. Guiding Council
4. Working Group through
Touchpoints
to Close the Gap

Touchpoints:
• Call Center
• Dr.’s Office
• Exam Room
• Radiology
• Transport
• Inpatient
Unit/Room
Care Givers:
• Scheduler
• Receptionist
• CRNP
• Technician
• Transporter
• Unit Director
• Nurse
Example of Step 4: Women’s Cancer
Care Crosswalk to Member List
WG Member
• Pat Smith
• Chris Kelly
• Sam Jones
• Al Very
• Sue Grade
• Lou Simon
• Deb Unger

• Establish your WG Members
from your Touchpoints
• Cut a wide swath across the
silos of care delivery
• Working Groups are forever and
make the PFCC M/P sustainable
Expand the Guiding Council into
your PFCC Working Group
Step 4

Med
Records
Nursing Medicine
Physical
Therapy
Care Delivery
Functional Silos

Home
Health
Acute
Hospital
Follow the Patient and Family
Continuum of Care Silos
Home
Physician
Office
Acute
Hospital
Health
Insurance
Pharmacy
Home
Health
Outpt.
Therapy
Rehab or
SNF
Care Delivery

Current State
Ideal Experience
2. Guiding Council
5. Shared Vision of the
Ideal
to Close the Gap
The PFCC Methodology and Practice

Step 5 Write the Story of the Ideal
Patient and Family Experience
• Imagine what ideal care would
look like in the perfect care
experience and perfect world
• All stories must be written as if
you were the patient or family
member
• No constraints!

Current State
Ideal Experience
2. Guiding Council
6. PFCC Project
Teams to Close the
Gap
The PFCC Methodology and Practice

Step 6 Identify your PFCC Projects and
form Project Improvement Teams
• Potential projects are identified by
comparing current state to the
ideal
• Based on patient and family
experiences and prioritized by their
needs

Continuous Performance Improvement
and Sustainability
Rapid
Rehab
Identify
“At Risk
Patients”
One-Stop
Shop Pre-
Op Testing
Patient and
Coach
Education
Sessions

Why Should Physicians Participate?

PFCC in Action:
A Sample of PFCC Success Stories

As Simple as…
Universal Cell
Phone Charger in
ICU Family Lounges
As Big as…
Restructure of Level I Trauma Teams
Created Three “Primary Care” Teams
Black Gold Blue

“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

Problems with the Current State
(Old System)
• Patients: “who is my doctor?”, “what is
the plan (trauma and consultants)?”
• Nurses: “which resident is covering this
patient?”
• Attendings: “discovery rounds”, resident
continuity lacking
• Residents: workflow issues, work-hour
violations
• Unpredictable and inconsistent rounding

0%
5%
10%
15%
20%
25%
30%
35%
%
o
f
T
o
t
a
l
D
i
s
c
h
a
r
g
e
s
Time of Discharge
Trauma Discharge Comparison
Aug/Sep 2009
August %
of total D/C
September
MTD % of
total D/C
Restructure of 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
The Trauma Restructure was associated with
improvement in time of discharge

PFCC Impact Project:
Level 1 Trauma Services WebCam
• Laptop with Camera
Capabilities
• Facilitates teleconferencing
between adult & pediatric
trauma victims
• Collaborative effort between
Children’s Hospital &
Presbyterian Trauma &
Social Work

Outpatient Behavioral Health
Admission Experience
PFCC Project Team Accomplishments
Transportation
• Creation of community transportation resource document and resources
paid for by insurance products.
Environment of Care
• Implemented directional signage.
• Organized print material for easy access and readability
• Consolidated programmatic required postings into a single posting
Caregiver
Communication
• Created wallet cards with pertinent information, phone numbers and
resources
• Revised prompts for newly installed phone tree, solicited client feedback
after a two week period and revised.
• Created resource and educational information played in the waiting area.
• Created customer service standards applying recovery principles to be
used in new hire orientation and performance reviews.
Front Door (Access)
• Reduced admission process from 3 appointments to one.
• Revised collection of information so information is gathered by phone prior
to appointment.
• Shifted initial plan of care to first visit vs. 3rd visit.
• Assessed and intervened using motivational and engagement techniques
at call for service to address first appointment utilization. Standby schedule
implemented.

Condensed Appointments
Savings $11,648/patient
Condensed 3 Appointments to 1
Condensed Phone Tree
Improved Transit System to and
from Appointment
Behavioral Health
Rapid Admission Process
Rapid Implementation of
Plan of Care
Improved
Outcomes
Better
Experiences
Decrease
Costs

Problem: Lack of resources for women under age 45
Solution: A program that provides knowledge and
encouragement throughout the entire cycle of care
Women’s Cancer Care Experience
Working Group
Impact Project: Empowering You
Program includes:
• Education
• Patient Navigators
• Genetic Counseling and Testing
• Fertility and Reproductive Options
• Holistic Care
• Breast Reconstruction
• Survivorship Program and
Personal Mentors

HCAHPS – Noiselessness
Working Group
Impact Project: Putting the Hospital to Sleep
Source of Noise
• Equipment
• Voices
• Hallway
• Nurses Station
What Did We Do?
• Quiet the Equipment
• Lights Out
• Goodnight Message
with Chimes
20
30
40
50
60
70
80
10/1/09-
12/31/09
1/1/10-
3/31/10
4/1/10-
6/30/10
7/1/10-
9/30/10
10/1/10-
12/31/10
PercentileRank
HCAHPS Quarterly Trend

Organizational Effort to
Adopt, Accelerate, Spread

Alignment: PFCC
Brings Everyone Together
• PFCC encompasses all levels of
your organization
• From the C-Suite to
the front line
• Everyone is championing the
singular focus and cause: taking
care of our patients and families

PFCC Engages Patients at Each Step

0
200
400
600
800
1000
1200
1400
0
5
10
15
20
25
30
35
40
45
50
55
60
2006 2007 2008 2009 2010 2011 2012
PFCC Working Group Membership
# Total Working Groups # of Total Working Group Members
PFCC is Making a Difference
PFCC is a grassroots effort to change the
culture... with over 60 different PFCC Working
Groups in 2012. More than 180 Project Teams
Over 500 Completed Projects.

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
• WellSpan Health, Pennsylvania
• North Shore Medical Center, NY/New Jersey
• UNC Healthcare, North Carolina
• Aneurin Bevin Health, Wales

The PFCC Operating System
Adopt Accelerate Spread
The PFCC Methodology can get us
heading in the right direction to
succeed in an era of health care
reform ….no need to wait – start by
Shadowing

PFCC Presentation to Masspro: Engaging Patients and Families in Redesigning Care

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