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

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2013 Keynote Presentation by PFCC's Pam Greenhouse to Masspro: Engaging Patients and Families in Redesigning Care

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

  1. 1. Pamela K. Greenhouse, M.B.A. Executive Director PFCC Innovation Center (greenhousepk@upmc.edu) Engaging Patients and Families in Redesigning Care Delivery: Go Shadow
  2. 2. 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
  3. 3. Why Do We Need to Change? Just ask patients and families – we are not delivering even the basics well
  4. 4. 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”
  5. 5. 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?
  6. 6. We need a new Operating System for the delivery of care…
  7. 7. Three Keys to Success for the New Operating System
  8. 8. Key #1 View All Care as an Experience and Through the Eyes of Patients and Families
  9. 9. Key #2: Engagement Complaining Consulting and Advising Giving Information Listening and Responding
  10. 10. Key #3: Simple Approach to Overcoming Hurdles • Simple • Replicable • Sustainable
  11. 11. 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
  12. 12. 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
  13. 13. 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…
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. What is Shadowing? Shadowing is repeated real time observation of patients and families as they move through each step of their health care journey
  22. 22. 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
  23. 23. 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
  24. 24. 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!
  25. 25. Shadowing Provides that Moment! Shadowing Empathy Insights
  26. 26. 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!
  27. 27. 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…
  28. 28. Ambulatory Surgery Care Experience Flow Map Pre - PFCC Touchpoints Caregivers
  29. 29. Ambulatory Surgery Care Experience Flow Map Post - PFCC
  30. 30. 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
  31. 31. 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
  32. 32. Aim for the Heart and Backfill with the Data
  33. 33. 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
  34. 34. 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
  35. 35. • 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
  36. 36. Med Records Nursing Medicine Physical Therapy Care Delivery Functional Silos
  37. 37. 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
  38. 38. 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
  39. 39. 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!
  40. 40. 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
  41. 41. 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
  42. 42. Continuous Performance Improvement and Sustainability Rapid Rehab Identify “At Risk Patients” One-Stop Shop Pre- Op Testing Patient and Coach Education Sessions
  43. 43. Why Should Physicians Participate?
  44. 44. The Value of ?
  45. 45. PFCC in Action: A Sample of PFCC Success Stories
  46. 46. 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
  47. 47. “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
  48. 48. 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
  49. 49. 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
  50. 50. 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
  51. 51. 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.
  52. 52. 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
  53. 53. 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
  54. 54. 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
  55. 55. Organizational Effort to Adopt, Accelerate, Spread
  56. 56. 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
  57. 57. PFCC Engages Patients at Each Step
  58. 58. 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.
  59. 59. 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
  60. 60. 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
  61. 61. We are PFCC

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