Patient and Family Centered Care, as a concept, is health care that is compassionate, includes patients and families as partners and collaborators, is provided with respect, and treats patients and families with dignity. It is care that revolves around the needs and desires of patients and families rather than around the organizations and systems in which it is provided.
How do we know what patients and families truly want and need? Is there an approach, an implementation mechanism, which will transform care delivery in any care setting from any current state to the ideal? The Patient and Family Centered Care Methodology and Practice does that and more.

The Patient and Family Centered Care Methodology and Practice (PFCC M/P)…

is a simple, replicable and sustainable 6-step methodology to deliver ideal care experiences and improve clinical outcomes while decreasing waste and cost. The PFCC M/P creates a sense of urgency to drive change by viewing all care experiences through the eyes of patients and families. PFCC Working Groups and Project Teams identify the gaps between current state and ideal care experiences — and close the gaps.

Since the start up of the PFCC Innovation Center in 2006, over 65 PFCC Working Groups have been launched at eight UPMC hospitals and in outpatient and pre- and post-acute care sites. It has been implemented in such diverse care experiences as trauma, outpatient mental health services, oncology, home health care, and total joint replacement. It has also been adopted by numerous health care organizations outside of UPMC — regionally, nationally, and internationally. The PFCC M/P is both a process improvement and performance improvement approach that stands on its own but can also build on process improvement approaches already in place such as TPS, Lean, etc. Developed specifically for health care, the PFCC M/P is based on the Design Sciences in which the goal is always to make things better for the end user — in health care the end users, of course, are patients and families. By understanding exactly what patients and families currently experience through real time, direct observation, we engage them in co-designing ideal care delivery. The PFCC M/P results in high performance care teams and culture change throughout the organization as more and more care givers at every level of the organization become involved.

Engage Patients and Families at Each Step

cirlcle_1 Step 1: Listen to your patients and families; select a care experience for improvement based on comments from reports, letters and surveys.
cirlcle_2 Step 2: Ask a patient or family member to be a Co-Champion on the Guiding Council.
cirlcle_3 Step 3: Understand and feel what your patients and families are truly experiencing: Shadowing, Patient’s Stories, Patient and Family Advisory Council, Discovery Interviews, Surveys and Shared Decision Making.
cirlcle_4 Step 4: Invite a patient or family member to join the Working Group or leave an empty chair at your working group meeting representing them.
cirlcle_5 Step 5: Seek the patient’s or family member’s input about what would have made their experiences better – ask them to imagine the perfect experience and tell you about it.
cirlcle_6 Step 6: Include the patient and family member on PFCC Project Teams.

How to Get Started

Achieving the PFCC Trifecta

When we hear the term “patient experience,” many of us think of the softer side of improving care delivery. We think about smiling more, listening with greater empathy, offering more ‘convenience’ services in the areas of parking, dining, and décor. All of these aspects of the care experience are important. Yet a care experience must always be defined through the eyes of patients and families and includes everything that leaves an impression on their journey toward wellness. Examples include clinical outcomes, interactions with and among care providers, transitions in care, the environment, safety, and costs. The PFCC M/P permits care providers to deliver memorable events and engage patients and families in an inherently personal way. Ideal care experiences lead to transformations that provide lasting benefits and are inspirational and substained over time. Indeed, the PFCC M/P achieves the PFCC Trifecta – improving experience, outcomes and cost!

With over 65 PFCC Working Groups at eight UPMC hospitals and in numerous outpatient sites, and many more successfully launched outside of UPMC, we have ample evidence that viewing care through the eyes of patients and families improves the experience of care, improves clinical outcomes, and decreases waste and cost. PFCC projects that close the gaps between the current and ideal states of the care experience can be big or small – all result in improvements that make a difference.

In an ever-increasing health care landscape of accountable care, our need to redesign care processes to deliver value by improving the experience of care, maximizing outcomes and minimizing cost requires a paradigm shift in how we deliver care day in and day out. The PFCC M/P is simple to learn and simple to implement – and it’s the perfect tool for achieving the PFCC Trifecta.

Outcomes

The PFCC Methodology and Practice can put you on a path toward improved outcomes including decreased length of stay, decreased readmission, improved patient reported outcomes and satisfaction, reductions in fall rates and hospital acquired infections, and improved coordination of care.

Below are a few examples of PFCC Projects improving clinical outcomes:

Blood Conservation in Total Hip and Knee Joint Replacement (TJR) Care Experience

  1. 0.9 % reduction in length of stay for non-transfused vs. transfused patients.
  2. Decrease transfusion rates = fewer infections/complications.

 

Reducing Readmissions after Bariatric Surgery

  1. Reduced readmissions in this patient population from an average of 9.5/months to 1/month in the initial 22 patients intervention group.
  2. Fewer readmissions = fewer infections.

 

Post-Traumatic Stress Disorder Screening (PTSD)

  1. Study revealed 25% of all patients seen in outpatient trauma clinic screened positive for PTSD.
  2. 100% of patients seen in outpatient trauma clinic now screened for PTSD.
  3. With improved identification of PTSD, more patients receive the benefit of assessment and treatment, when indicated.

 

Improve Patient Belongings Process

  1. Indirectly required staff to focus on patient/family “flow” through the system.

Experience

Leave an impression on patient and families’ journey to wellness by improving their experience through managing their expectations, shared decision making, increasing patient safety, increasing patient and family engagement, improving communications between patients, families, and care givers.

Here are examples of how PFCC Projects have provided better experiences for patients and families:

Blood Conservation in Total Hip and Knee Joint Replacement (TJR) Care Experience

  1. Reducing venipuncture and finger stick samples improves patient and staff satisfaction.
  2. Decreased transfusion rates from 14% to 2% for Total Knee Replacement and from  9% to 1%  for Total Hip Replacement.
  3. Eliminated Type and Screen and Type and Cross lab draws in all patients undergoing TJR.



Reducing Readmissions after Bariatric Surgery

  1. Fewer symptoms of dehydration (eg, nausea & pain).
  2. Reducing readmissions minimizes disruption toward wellness.
  3. Focus on wellness.



Post-Traumatic Stress Disorder Screening

  1. Increased mental health screening and treatment correlates with improved experience of care.



Improve Patient Belongings Process

  1. Lost belongings between the ER, OR, and inpatient unit has a negative impact on patient satisfaction with the experience of care.

Costs

The PFCC M/P can help to reduce costs by decreasing office appointments and/or cancellations, reducing readmission rates, increasing reimbursement rates, and decreasing adverse events.

Here are examples of how PFCC Projects have demonstrated reduced costs:

Blood Conservation in Total Hip and Knee Joint Replacement (TJR) Care Experience

  1. Reduction in transfusion rate from all patients undergoing primary TJR annualized savings of over $148,000 in transfusion related cost.
  2. Patients not transfused vs. transfused had a decrease length of stay of 0.9 days.
  3. Eliminating Type and Cross saved $339.25 per patient = $349,000 in 2012.
  4. Eliminating routine Type and Screen in all primary TJR reaped an annual savings of $210,000.



Reducing Readmissions after Bariatric Surgery

  1. Reduced readmissions in this patient population from an average of 9.5/months to 1/month in the initial 22 patients intervention group.
  2. Cost reductions for reducing readmissions are significant and include not only reimbursement but the ability for the patient and family to return to pre-surgical levels of activity and work sooner.



Post-Traumatic Stress Disorder Screening

  1. Improved screening, assessment, and treatment of PTSD correlates with lower cost of care/higher return-to-work rate.



Improve Patient Belongings Process

  1. Unmarked patient belonging bags reduced from 15-25/week to 0.
  2. Spent small amount on new patient belongings bags and now save thousands of dollars annually through elimination of lost belongings which must be reimbursed.
  3. We would save even more if this process spreads hospital-wide and system-wide.

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