PFCC Methodology and Practice:Deliver Ideal Care Experiences and Outcomes…By DesignPamela K. Greenhouse, M.B.A.Executive D...
215th AnnualPatient Safety CongressA simple, replicable and sustainable six-step methodology todeliver ideal care experien...
315th AnnualPatient Safety Congress• UPMC is a $10 billion integrated global health systemheadquartered in Pittsburgh, PA•...
415th AnnualPatient Safety CongressHow Did PFCC Come About?• Total Joint Replacement• Magee Women’s Hospitalof UPMC• Excee...
515th AnnualPatient Safety CongressMany Different Care Experiences and Types ofHospitals - Big and Small, Tertiary to Rura...
615th AnnualPatient Safety CongressPFCC In Action At UPMC• PFCC is a grassroots effort to changethe culture...from over 64...
715th AnnualPatient Safety CongressKey #1 Key #2 Key #3Viewing all care asexperiences through theeyes of patients andfamil...
815th AnnualPatient Safety CongressPFCC Methodology and PracticeCare Giver Any person within a care settingwhose work tou...
915th AnnualPatient Safety CongressPLACE HOLDER – ER VIDEO
1015th AnnualPatient Safety CongressCurrent StateIdeal Experience1. Define Care Experience2. Guiding Council3. Current Sta...
1115th AnnualPatient Safety CongressLevel I Trauma Care ExperienceBegins:When EMS responds to patient who isneeding trans...
1215th AnnualPatient Safety CongressPFCC Methodology and PracticeCurrent StateIdeal Experience1. Define Care Experience2. ...
1315th AnnualPatient Safety CongressStep 2 Real World Example:Level I Trauma PFCC Guiding CouncilAdministrative Champion =...
1415th AnnualPatient Safety CongressPFCC Methodology and PracticeCurrent StateIdeal Experience1. Define Care Experience2. ...
1515th AnnualPatient Safety CongressWalk the walk of patients and families…Shadow patients and families throughout thesele...
1615th AnnualPatient Safety Congress• Health profession students, volunteers,summer interns, patientadvocates• New hires a...
1715th AnnualPatient Safety CongressShadowingObservationsEmpathyInsightsTim Brown: Change By DesignHarper Collins; 2009
1815th AnnualPatient Safety Congress• Shadowing continuously engages patients,families and care givers• Real-Time patient/...
1915th AnnualPatient Safety CongressCare Experience Flow MapDr.’s OfficeTransportHousekeepingHomeCall CenterLabReaches sch...
2015th AnnualPatient Safety CongressPLACE HOLDER –Champion talking about Shadowing
2115th AnnualPatient Safety Congress“Being a nurse for 25 years I thought Ihad a good understanding of what ourpatients an...
2215th AnnualPatient Safety CongressAnother Kind of Shadowing “Reality TV for CareGivers”
2315th AnnualPatient Safety Congress
2415th AnnualPatient Safety CongressReality TV for Care Givers01234567891011121301020304050607080Time/Visit(min)NumberofVi...
2515th AnnualPatient Safety Congress39%26%6%5%5%19%Nurse 39%Patient Care Technician 26%PT and OT 6%Patient Support Assista...
2615th AnnualPatient Safety Congress--Susan P. FergusonChief Nursing Officer,Baptist-Collierville“I can’t tell you how imp...
2715th AnnualPatient Safety CongressPFCC Methodology and PracticeCurrent StateIdeal Experience1. Define Care Experience2. ...
2815th AnnualPatient Safety CongressTouchpoints: Care Givers: Care Giver “TEAM List”EMSPortal/ED DepartmentTrauma BayCT/Ra...
2915th AnnualPatient Safety CongressThe PFCC Surgical Services Care ExperienceWorking Group
3015th AnnualPatient Safety CongressMedRecordsNursing MedicinePhysicalTherapyCare DeliveryFunctional Silos
3115th AnnualPatient Safety CongressPFCC Methodology and PracticeCurrent StateIdeal Experience1. Define Care Experience2. ...
3215th AnnualPatient Safety CongressStep 5: Write the Ideal StoryReal World Examples
3315th AnnualPatient Safety CongressPFCC Methodology and PracticeCurrent StateIdeal Experience1. Define Care Experience2. ...
3415th AnnualPatient Safety CongressPFCC Impact Project:Discharge Medication Shadowing revealed patients goinghome withou...
3515th AnnualPatient Safety CongressPFCC Impact Project:Web CamLaptop with Camera Capabilities UPMC Presbyterian Childre...
3615th AnnualPatient Safety CongressPFCC Impact Project:Bedside Nurse RoundingPatient ActivationShared Decision MakingPati...
3715th AnnualPatient Safety Congress“Patients complained thatthey didn’t know who theirdoctors were, and they didn’tknow t...
3815th AnnualPatient Safety CongressPatients: “Who is my doctor?”, “What is the plan (surgeon and consultants)?”Nurses: ...
3915th AnnualPatient Safety CongressBLACK TEAM GOLD TEAM BLUETEAMTRAUMA “Primary” Care Teams
4015th AnnualPatient Safety CongressPFCC Impact Project:Restructured Level I Trauma TeamsCreated Three “Primary Care” Trau...
4115th AnnualPatient Safety Congress• Overall 25% of trauma pts tested positive (Score >35)• Highest incidences (43%) in p...
4215th AnnualPatient Safety CongressPFCC Impact Project:Medication CardsTo teach patientabout new medsprescribed in Hospit...
4315th AnnualPatient Safety Congress• Real Time Patient and Family Advisory Council• Transition from ICU• Seamless Hospita...
4415th AnnualPatient Safety Congress"So now, on the other side of the fence, I have also been able to think about being ap...
4515th AnnualPatient Safety CongressPlace Holder: Lone Nut
4615th AnnualPatient Safety CongressThe PFCC Community of Practice is Growing Baptist Memorial, Collierville - Tennessee...
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PFCC Methodology and Practice: Deliver Ideal Care Experiences and Outcomes…By Design

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PFCC Methodology and Practice: Deliver Ideal Care Experiences and Outcomes…By Design

  1. 1. PFCC Methodology and Practice:Deliver Ideal Care Experiences and Outcomes…By DesignPamela K. Greenhouse, M.B.A.Executive DirectorPFCC Innovation CenterMay 8, 2013(greenhousepk@upmc.edu)
  2. 2. 215th AnnualPatient Safety CongressA simple, replicable and sustainable six-step methodology todeliver ideal care experiences and improve clinical outcomeswhile decreasing waste and cost.Developed for health care, the PFCC M/P is based on the DesignSciences in which the goal is always to make things better forthe end userThe Patient and Family Centered Care Methodologyand Practice
  3. 3. 315th AnnualPatient Safety Congress• UPMC is a $10 billion integrated global health systemheadquartered 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 specialtyhospitals and 400 outpatient sites, employs more than 3,200physicians, and an array of rehabilitation, retirement, andlong-term care facilitiesUPMC: Who are We?
  4. 4. 415th AnnualPatient Safety CongressHow Did PFCC Come About?• Total Joint Replacement• Magee Women’s Hospitalof UPMC• Exceeding the wants andneeds of patients andfamiliesAnthony M. DiGioia, M.D.
  5. 5. 515th AnnualPatient Safety CongressMany Different Care Experiences and Types ofHospitals - Big and Small, Tertiary to Rural Bariatric Surgery Total Hip and Knee JointReplacement Women’s Cancer Services Home Health Care Rehabilitation Emergency Services Surgical Services Transplant Adult Level I Trauma Urgent Care Centers
  6. 6. 615th AnnualPatient Safety CongressPFCC In Action At UPMC• PFCC is a grassroots effort to changethe culture...from over 64 differentCare Experience Working Groups• >180 Project Teams Over 441Completed Projects
  7. 7. 715th AnnualPatient Safety CongressKey #1 Key #2 Key #3Viewing all care asexperiences through theeyes of patients andfamiliesThree Keys for the PFCCMethodology and PracticeEngaging patients andfamilies as full partners inco-designing care with usProviding simple solutionsin a complex system inorder to break down silosand barriers
  8. 8. 815th AnnualPatient Safety CongressPFCC Methodology and PracticeCare Giver Any person within a care settingwhose work touches a patient’s orfamily’s experienceTouchpoint Key moments and places in anycare setting where patient andfamily care experiences are directlyor indirectly affected by any CareGiver
  9. 9. 915th AnnualPatient Safety CongressPLACE HOLDER – ER VIDEO
  10. 10. 1015th AnnualPatient Safety CongressCurrent StateIdeal Experience1. Define Care Experience2. Guiding Council3. Current State, View Care, Urgency4. Working Group thru Touchpoints5. Shared Vision for the Ideal6. PFCC Projects and…Improvement TeamsSix StepsTo Transform CarePFCC Methodology and Practice
  11. 11. 1115th AnnualPatient Safety CongressLevel I Trauma Care ExperienceBegins:When EMS responds to patient who isneeding transport to EDEnds:When patient is transported andadmitted to rehab facilityExample of Step 1
  12. 12. 1215th AnnualPatient Safety CongressPFCC Methodology and PracticeCurrent StateIdeal Experience1. Define Care Experience2. Guiding Council3. Current State, View Care, Urgency4. Working Group thru Touchpoints5. Shared Vision for the Ideal6. PFCC Projects and…Improvement Teams
  13. 13. 1315th AnnualPatient Safety CongressStep 2 Real World Example:Level I Trauma PFCC Guiding CouncilAdministrative Champion = Clinical Director, Emergency and Trauma ServicesClinical Champions = MD and Trauma Nurse Coordinator Emergency and Trauma ServicesPFCC Coordinator = Administrative Coordinator Emergency and Trauma Services
  14. 14. 1415th AnnualPatient Safety CongressPFCC Methodology and PracticeCurrent StateIdeal Experience1. Define Care Experience2. Guiding Council3. Current State, View Care, Urgency4. Working Group thru Touchpoints5. Shared Vision for the Ideal6. PFCC Projects and…Improvement Teams
  15. 15. 1515th AnnualPatient Safety CongressWalk the walk of patients and families…Shadow patients and families throughout theselected care experience, record observationsand insightsHigh impact and $ and effortStep 3: Shadowing and Care Experience FlowMapping
  16. 16. 1615th AnnualPatient Safety Congress• Health profession students, volunteers,summer interns, patientadvocates• New hires and light duty staff• PFCC Guiding Council• The more “uninformed” the betterWho Can Shadow?… Anyone!
  17. 17. 1715th AnnualPatient Safety CongressShadowingObservationsEmpathyInsightsTim Brown: Change By DesignHarper Collins; 2009
  18. 18. 1815th AnnualPatient Safety Congress• Shadowing continuously engages patients,families and care givers• Real-Time patient/family feedback• Shadowing is the best way to get startedShadowing is the First Step Toward Co-Design…
  19. 19. 1915th AnnualPatient Safety CongressCare Experience Flow MapDr.’s OfficeTransportHousekeepingHomeCall CenterLabReaches scheduler tomake an appointmentCall transferred to officetakes info andreceptionist makesappointmentFront deskreceptionist checkspatient inPhysician assessespatient and orderstestsEscorted toUltrasound byTransporterEscorted to InpatientUnit by TransporterReturned to Exam roomPhysician updated pt.Escorted to ExamRoom by TransporterMoved to Room byClinical Manager; waits40 minutes for roomGreeted by Unit ClerkTouchpoints and Care GiversUltrasoundTechnician performstest; test takes 45minutesPhlebotomist drawsbloodParkingInformationDeskParked car in wrong lotper attendantDietaryClinical Manager madefollow-up phone callCardiac Unit
  20. 20. 2015th AnnualPatient Safety CongressPLACE HOLDER –Champion talking about Shadowing
  21. 21. 2115th AnnualPatient Safety Congress“Being a nurse for 25 years I thought Ihad a good understanding of what ourpatients and families wanted because Ilive it and work it every day. But I foundout that there are some things that aremore important to the patients than Ithought they were. For example, I didn’trealize how many people were having ahard time just finding my unit. Or thatparking was such a big issue.”
  22. 22. 2215th AnnualPatient Safety CongressAnother Kind of Shadowing “Reality TV for CareGivers”
  23. 23. 2315th AnnualPatient Safety Congress
  24. 24. 2415th AnnualPatient Safety CongressReality TV for Care Givers01234567891011121301020304050607080Time/Visit(min)NumberofVisitsStaff TypeStaff Contacts/Time Analysis (22 patients)Avg Number of Visits Avg Time per Visit
  25. 25. 2515th AnnualPatient Safety Congress39%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 contactsHand washing - Top 5 Care Giver Groups ThatInteract with Patients
  26. 26. 2615th AnnualPatient Safety Congress--Susan P. FergusonChief Nursing Officer,Baptist-Collierville“I can’t tell you how impactfulShadowing is; once people Shadow,they talk about PFCC differently—getting to view care through the eyes ofpatients and families truly provides CareGivers with a different perspective.”Shadowing Changes Your Perspective
  27. 27. 2715th AnnualPatient Safety CongressPFCC Methodology and PracticeCurrent StateIdeal Experience1. Define Care Experience2. Guiding Council3. Current State, View Care, Urgency4. Working Group thru Touchpoints5. Shared Vision for the Ideal6. PFCC Projects and…Improvement Teams
  28. 28. 2815th AnnualPatient Safety CongressTouchpoints: Care Givers: Care Giver “TEAM List”EMSPortal/ED DepartmentTrauma BayCT/RadiologyTransportICUCare Experience Flow Map and Working GroupMembersParamedicED RNsED PhysiciansCT Tech.TransporterICU RNPat SmithChris KellySam JonesAl VerySue GradeLou SimonDeb Unger
  29. 29. 2915th AnnualPatient Safety CongressThe PFCC Surgical Services Care ExperienceWorking Group
  30. 30. 3015th AnnualPatient Safety CongressMedRecordsNursing MedicinePhysicalTherapyCare DeliveryFunctional Silos
  31. 31. 3115th AnnualPatient Safety CongressPFCC Methodology and PracticeCurrent StateIdeal Experience1. Define Care Experience2. Guiding Council3. Current State, View Care, Urgency4. Working Group thru Touchpoints5. Shared Vision for the Ideal6. PFCC Projects and…Improvement Teams
  32. 32. 3215th AnnualPatient Safety CongressStep 5: Write the Ideal StoryReal World Examples
  33. 33. 3315th AnnualPatient Safety CongressPFCC Methodology and PracticeCurrent StateIdeal Experience1. Define Care Experience2. Guiding Council3. Current State, View Care, Urgency4. Working Group thru Touchpoints5. Shared Vision for the Ideal6. PFCC Projects and…Improvement Teams
  34. 34. 3415th AnnualPatient Safety CongressPFCC Impact Project:Discharge Medication Shadowing revealed patients goinghome without medications Research showed sometimes three dayspassed PFCC Project Team formed andpartnered with local pharmacy forweekend and evening discharges Piloted results Hospital now increasing operationalhours of internal pharmacy to meet theneed
  35. 35. 3515th AnnualPatient Safety CongressPFCC Impact Project:Web CamLaptop with Camera Capabilities UPMC Presbyterian Children’s HospitalFacilitates teleconferencing betweenadult & pediatric trauma patientsCollaborative effort between Children’sHospital & Presbyterian Trauma & SocialWork
  36. 36. 3615th AnnualPatient Safety CongressPFCC Impact Project:Bedside Nurse RoundingPatient ActivationShared Decision MakingPatient SafetyCommunicationCare CoordinationAccountability• Increase of 9% in HCAHPS: Communication with Nurses• Accelerate System-Wide Spread
  37. 37. 3715th AnnualPatient Safety Congress“Patients complained thatthey didn’t know who theirdoctors were, and they didn’tknow the plan of carebecause it changeddepending on which doctorsthey saw.”Patient and MD Partnerships--Dr. Louis Alarcon, MDPFCC Champion Trauma Working Group
  38. 38. 3815th AnnualPatient Safety CongressPatients: “Who is my doctor?”, “What is the plan (surgeon and consultants)?”Nurses: “Which resident is covering this patient?”Attendings: Resident continuity lackingResidents: Workflow issuesProblems with the Current State(Old System)
  39. 39. 3915th AnnualPatient Safety CongressBLACK TEAM GOLD TEAM BLUETEAMTRAUMA “Primary” Care Teams
  40. 40. 4015th AnnualPatient Safety CongressPFCC Impact Project:Restructured Level I Trauma TeamsCreated Three “Primary Care” TraumaTeamsResults showed: Improved continuity of care Improved communication Improved patient & family satisfaction Improved resident work hour compliance0%5%10%15%20%25%30%35%%ofTotalDischargesTrauma Discharge Comparison Aug/Sep 2009August % of total D/C September MTD % of total D/CThe Trauma Restructure was associated with improvement intime of discharge
  41. 41. 4115th AnnualPatient Safety Congress• 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 penetratingassault and the worse the “assaultive dose”• ALL trauma patients now screenedPFCC Impact Project: PTSD Screening
  42. 42. 4215th AnnualPatient Safety CongressPFCC Impact Project:Medication CardsTo teach patientabout new medsprescribed in HospitalCard triggers teaching & cross-interaction checkNurses and Pharmacyare collaboratingImprove Safety, Satisfaction, Reduce Re-Admission Rates
  43. 43. 4315th AnnualPatient Safety Congress• Real Time Patient and Family Advisory Council• Transition from ICU• Seamless Hospital & Rehab Discharge Instructions• Resident OrientationSample of Current PFCC Projects
  44. 44. 4415th AnnualPatient Safety Congress"So now, on the other side of the fence, I have also been able to think about being apatient, and one whose life is threatened. I have come to regret how much better adoctor I might have been, had I been at the receiving end of medical care earlier in mycareer. In the past eighteen months I have learnt as many lessons from sometimesunwittingly insensitive doctors and nurses as from many otherswhose patience, encouragement and quiet humor have sustained me throughdark times."-Elizabeth BryanSinging the LifeA Physician Becomes a Patient
  45. 45. 4515th AnnualPatient Safety CongressPlace Holder: Lone Nut
  46. 46. 4615th AnnualPatient Safety CongressThe PFCC Community of Practice is Growing Baptist Memorial, Collierville - Tennessee Nemours, A Children’s HealthSystem, 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, Waleswww.pfcc.org
  47. 47. Thank you!
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