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

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

    • 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)
    • 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
    • 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?
    • 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.
    • 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
    • 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
    • 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
    • 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
    • 915th AnnualPatient Safety CongressPLACE HOLDER – ER VIDEO
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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!
    • 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/family feedback• Shadowing is the best way to get startedShadowing is the First Step Toward Co-Design…
    • 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
    • 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 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.”
    • 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)NumberofVisitsStaff TypeStaff Contacts/Time Analysis (22 patients)Avg Number of Visits Avg Time per Visit
    • 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
    • 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
    • 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
    • 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
    • 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. Guiding Council3. Current State, View Care, Urgency4. Working Group thru Touchpoints5. Shared Vision for the Ideal6. PFCC Projects and…Improvement Teams
    • 3215th AnnualPatient Safety CongressStep 5: Write the Ideal StoryReal World Examples
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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)
    • 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” 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
    • 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
    • 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
    • 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
    • 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
    • 4515th AnnualPatient Safety CongressPlace Holder: Lone Nut
    • 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
    • Thank you!