Abstract
Background
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.
Questions/purposes
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.
Methods
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.
Results
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.
Conclusions
PFCC M/P offers a road map for redefining value as what is important to patients and families.
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Acknowledgments
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.
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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
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Appendix 1. Glossary of terms
Appendix 1. Glossary of terms
Caregiver = Defined broadly as any person within the healthcare setting whose work touches a patient’s or family’s care experience, including the doctors, nurses, therapists, technicians, dietitians, appointment schedulers, parking attendants, janitors, and even hospital leaders, purchase and supply chain employees, and financial representatives who the patient and family might never see.
Guiding Council = A small group of committed healthcare professionals, including administrators, to: (1) serve as champions to guide and expand the use of the PFCC M/P; and (2) to perform the essential function of communicating with all levels of the organization.
PFCC Toolbox = Tools to help gather accurate information about patient and family experiences. The PFCC Toolbox includes Shadowing, Care Flow Mapping, storytelling, advisory councils, surveys (phone and paper), digital recording systems, and real-time location systems.
Shadowing = Following patients and families through every step of a defined care experience pathway to observe and record the care experience through their eyes.
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DiGioia, A.M., Greenhouse, P.K. Care Experience-based Methodologies: Performance Improvement Roadmap to Value-driven Health Care. Clin Orthop Relat Res 470, 1038–1045 (2012). https://doi.org/10.1007/s11999-011-2051-3
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DOI: https://doi.org/10.1007/s11999-011-2051-3