Clinical Orthopaedics and Related Research®

, Volume 470, Issue 4, pp 1038–1045 | Cite as

Care Experience-based Methodologies: Performance Improvement Roadmap to Value-driven Health Care

  • Anthony M. DiGioiaIII
  • Pamela K. Greenhouse
Symposium: Value Based Healthcare



The literature contains proposals for creating value by creating exceptional patient experiences rather than simply improving services. However, few articles describe replicable applications focused on the patient experience.


We (1) describe the refinement and exportation of an approach that focuses on the patient and family experience; and (2) report changes in patient satisfaction, infection rates, length of stay, mortality rates, clinical indicators, staff turnover, and cost.


The Patient and Family-Centered Care Methodology and Practice (PFCC M/P) is a six-step process: (1) selecting a care experience needing improvement; (2) establishing a guiding council; (3) evaluating the current state; (4) developing a permanent working group; (5) creating a shared vision of the ideal experience; and (6) identifying improvement projects to address the gap between the current and ideal experience. We assessed patient satisfaction, changes in clinical indicators, staff turnover, and cost in three clinical programs.


In TJA, patient satisfaction is at the 99th percentile; length of stay, infection rates, and mortality rates are substantially better than the national average. In trauma, patient satisfaction increased, time in cervical collars decreased, staff turnover decreased, and the incidence of lost patient belongings was eliminated. In orthopaedic spine, patient satisfaction is higher than the national average, average time for transfer to bed decreased (%), length of stay decreased, and average discharge time decreased. Each of these would have a positive impact on cost.


PFCC M/P offers a road map for redefining value as what is important to patients and families.


Project Team Care Experience Staff Turnover Family Experience Cervical Collar 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Holly Lorenz, David Bertoty, Dee Nicholas, and Mary Beth Pais as well as the entire PFCC Level I Trauma and Surgical Care Experience Working Groups and the Orthopaedic Spine Project Improvement Team at UPMC Presbyterian, all of whom played key roles in the refinement and exportation of the PFCC M/P. Also, special thanks to Patricia Embree and the staff of the Innovation Center of UPMC for their help in guiding these teams.


  1. 1.
    Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care. 2006;15:307–310.PubMedCrossRefGoogle Scholar
  2. 2.
    Brown T. Change by Design. New York: HarperCollins Publishers, Inc; 2009.Google Scholar
  3. 3.
    Christensen C. The Innovator’s Dilemma: The Revolutionary Book That Will Change the Way You Do Business. New York: HarperCollins Publishers, Inc; 2003.Google Scholar
  4. 4.
    DiGioia A, Greenhouse PK. Patient and family shadowing: creating urgency for change. J Nurs Adm. 2011;41:23–28.PubMedCrossRefGoogle Scholar
  5. 5.
    DiGioia A, Greenhouse PK, Levison MS. Patient and family centered collaborative care: an orthopaedic model. Clin Orthop Relat Res. 2007;463:13–19.PubMedGoogle Scholar
  6. 6.
    DiGioia A, Lorenz H, Greenhouse PK, Bertoty D, Rocks S. A patient centered model to improve metrics without cost increase: viewing all care through the eyes of patients and families. J Nurs Adm. 2010;40:540–546.PubMedCrossRefGoogle Scholar
  7. 7.
    Herzlinger R. Who Killed Health Care? America’s $2 Trillion Medical Problem—and the Consumer-driven Cure. New York: McGraw Hill; 2007.Google Scholar
  8. 8.
    Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 1999.Google Scholar
  9. 9.
    Institute of Medicine. Crossing the Quality Chasm: A New Health System for the Twenty-first Century. Washington, DC: National Academies Press; 2001.Google Scholar
  10. 10.
    Jones CB, Gates M. The cost and benefits of nurse turnover: a business case for nurse retention. Online Journal of Issues in Nursing. Available at: Accessed July 23, 2011.
  11. 11.
    McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635–2645.PubMedCrossRefGoogle Scholar
  12. 12.
    Meyer H. At UPMC, improving care processes to serve patients better and cut costs. Health Aff. 2011;30:400–403.CrossRefGoogle Scholar
  13. 13.
    Pine JB. Staging the Healthcare Experience. Available at: Accessed August 19, 2010.
  14. 14.
    Pine JB, Gilmore JH. The Experience Economy: Work is Theatre & Every Business a Stage. Boston: Harvard Business School Press; 1999.Google Scholar
  15. 15.
    Porter ME, Teisberg EO. Redefining Health Care: Creating Value-based Competition on Results. Boston: Harvard Business School Press; 2006.Google Scholar
  16. 16.
    Simon HA. The Sciences of the Artificial. Boston: Massachusetts Institute of Technology Press Books; 1996.Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  1. 1.Renaissance Orthopaedics PC and Innovation Center and The Orthopaedic ProgramMagee-Women’s Hospital of the University of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Pamela Greenhouse AssociatesPittsburghUSA

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