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

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 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

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 Provides the Steps to Success

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

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 Provides the Steps to Success

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

1. Define Care Experience

2. Guiding Council

3. Shadow, Current State, Urgency

4. Working Group through Touchpoints

5. Shared Vision of the Ideal

6. PFCC Project Teams to Close the Gap

The PFCC Methodology Provides the Steps to Success

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

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 and Practice Provides the Steps to Success

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

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 and Practice Provides the Steps to Success

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?

The Value of ?

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%

%

of

Total

Discharges

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

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50

60

70

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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

Percentile Rank

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

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800

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1015202530354045505560

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

We are PFCC