1. PFCC Methodology and Practice:
Deliver Ideal Care Experiences and Outcomes…By Design
Pamela K. Greenhouse, M.B.A.
Executive Director
PFCC Innovation Center
May 8, 2013
(greenhousepk@upmc.edu)

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A simple, replicable and sustainable six-step methodology to
deliver ideal care experiences and improve clinical outcomes
while decreasing waste and cost.
Developed 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
The Patient and Family Centered Care Methodology
and Practice

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• UPMC is a $10 billion integrated global health system
headquartered 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 specialty
hospitals and 400 outpatient sites, employs more than 3,200
physicians, and an array of rehabilitation, retirement, and
long-term care facilities
UPMC: Who are We?

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How Did PFCC Come About?
• Total Joint Replacement
• Magee Women’s Hospital
of UPMC
• Exceeding the wants and
needs of patients and
families
Anthony M. DiGioia, M.D.

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Many Different Care Experiences and Types of
Hospitals - Big and Small, Tertiary to Rural
 Bariatric Surgery
 Total Hip and Knee Joint
Replacement
 Women’s Cancer Services
 Home Health Care
 Rehabilitation
 Emergency Services
 Surgical Services
 Transplant
 Adult Level I Trauma
 Urgent Care Centers

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PFCC In Action At UPMC
• PFCC is a grassroots effort to change
the culture...from over 64 different
Care Experience Working Groups
• >180 Project Teams Over 441
Completed Projects

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Key #1 Key #2 Key #3
Viewing all care as
experiences through the
eyes of patients and
families
Three Keys for the PFCC
Methodology and Practice
Engaging patients and
families as full partners in
co-designing care with us
Providing simple solutions
in a complex system in
order to break down silos
and barriers

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PFCC Methodology and Practice
Care Giver
 Any person within a care setting
whose work touches a patient’s or
family’s experience
Touchpoint
 Key moments and places in any
care setting where patient and
family care experiences are directly
or indirectly affected by any Care
Giver

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PLACE HOLDER – ER VIDEO

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Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Current State, View Care, Urgency
4. Working Group thru Touchpoints
5. Shared Vision for the Ideal
6. PFCC Projects and
…Improvement Teams
Six Steps
To Transform Care
PFCC Methodology and Practice

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Level I Trauma Care Experience
Begins:
When EMS responds to patient who is
needing transport to ED
Ends:
When patient is transported and
admitted to rehab facility
Example of Step 1

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PFCC Methodology and Practice
Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Current State, View Care, Urgency
4. Working Group thru Touchpoints
5. Shared Vision for the Ideal
6. PFCC Projects and
…Improvement Teams

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Step 2 Real World Example:
Level I Trauma PFCC Guiding Council
Administrative Champion =
 Clinical Director,
 Emergency and Trauma Services
Clinical Champions =
 MD and Trauma Nurse Coordinator
 Emergency and Trauma Services
PFCC Coordinator =
 Administrative Coordinator
 Emergency and Trauma Services

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Patient Safety Congress
PFCC Methodology and Practice
Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Current State, View Care, Urgency
4. Working Group thru Touchpoints
5. Shared Vision for the Ideal
6. PFCC Projects and
…Improvement Teams

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Walk the walk of patients and families…
Shadow patients and families throughout the
selected care experience, record observations
and insights
High impact and $ and effort
Step 3: Shadowing and Care Experience Flow
Mapping

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• Health profession students, volunteers,
summer interns, patient
advocates
• New hires and light duty staff
• PFCC Guiding Council
• The more “uninformed” the better
Who Can Shadow?… Anyone!

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Shadowing
Observations
Empathy
Insights
Tim Brown: Change By Design
Harper Collins; 2009

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• Shadowing continuously engages patients,
families and care givers
• Real-Time patient/family feedback
• Shadowing is the best way to get started
Shadowing is the First Step Toward Co-Design…

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Care Experience Flow Map
Dr.’s Office
Transport
Housekeeping
Home
Call Center
Lab
Reaches scheduler to
make an appointment
Call transferred to office
takes info and
receptionist makes
appointment
Front desk
receptionist checks
patient in
Physician assesses
patient and orders
tests
Escorted to
Ultrasound by
Transporter
Escorted to Inpatient
Unit by Transporter
Returned to Exam room
Physician updated pt.
Escorted to Exam
Room by Transporter
Moved to Room by
Clinical Manager; waits
40 minutes for room
Greeted by Unit Clerk
Touchpoints and Care Givers
Ultrasound
Technician performs
test; test takes 45
minutes
Phlebotomist draws
blood
Parking
Information
Desk
Parked car in wrong lot
per attendant
Dietary
Clinical Manager made
follow-up phone call
Cardiac Unit

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PLACE HOLDER –
Champion talking about Shadowing

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“Being a nurse for 25 years I thought I
had a good understanding of what our
patients and families wanted because I
live it and work it every day. But I found
out that there are some things that are
more important to the patients than I
thought they were. For example, I didn’t
realize how many people were having a
hard time just finding my unit. Or that
parking was such a big issue.”

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Another Kind of Shadowing “Reality TV for Care
Givers”

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Reality TV for Care Givers
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20
30
40
50
60
70
80
Time/Visit(min)
NumberofVisits
Staff Type
Staff Contacts/Time Analysis (22 patients)
Avg Number of Visits Avg Time per Visit

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39%
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 contacts
Hand washing - Top 5 Care Giver Groups That
Interact with Patients

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--Susan P. Ferguson
Chief Nursing Officer,
Baptist-Collierville
“I can’t tell you how impactful
Shadowing is; once people Shadow,
they talk about PFCC differently—
getting to view care through the eyes of
patients and families truly provides Care
Givers with a different perspective.”
Shadowing Changes Your Perspective

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Patient Safety Congress
PFCC Methodology and Practice
Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Current State, View Care, Urgency
4. Working Group thru Touchpoints
5. Shared Vision for the Ideal
6. PFCC Projects and
…Improvement Teams

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Touchpoints: Care Givers: Care Giver “TEAM List”
EMS
Portal/ED Department
Trauma Bay
CT/Radiology
Transport
ICU
Care Experience Flow Map and Working Group
Members
Paramedic
ED RNs
ED Physicians
CT Tech.
Transporter
ICU RN
Pat Smith
Chris Kelly
Sam Jones
Al Very
Sue Grade
Lou Simon
Deb Unger

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The PFCC Surgical Services Care Experience
Working Group

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Med
Records
Nursing Medicine
Physical
Therapy
Care Delivery
Functional Silos

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PFCC Methodology and Practice
Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Current State, View Care, Urgency
4. Working Group thru Touchpoints
5. Shared Vision for the Ideal
6. PFCC Projects and
…Improvement Teams

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Step 5: Write the Ideal Story
Real World Examples

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Patient Safety Congress
PFCC Methodology and Practice
Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Current State, View Care, Urgency
4. Working Group thru Touchpoints
5. Shared Vision for the Ideal
6. PFCC Projects and
…Improvement Teams

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PFCC Impact Project:
Discharge Medication
 Shadowing revealed patients going
home without medications
 Research showed sometimes three days
passed
 PFCC Project Team formed and
partnered with local pharmacy for
weekend and evening discharges
 Piloted results
 Hospital now increasing operational
hours of internal pharmacy to meet the
need

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PFCC Impact Project:
Web Cam
Laptop with Camera Capabilities
 UPMC Presbyterian
 Children’s Hospital
Facilitates teleconferencing between
adult & pediatric trauma patients
Collaborative effort between Children’s
Hospital & Presbyterian Trauma & Social
Work

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PFCC Impact Project:
Bedside Nurse Rounding
Patient Activation
Shared Decision Making
Patient Safety
Communication
Care Coordination
Accountability
• Increase of 9% in HCAHPS: Communication with Nurses
• Accelerate System-Wide Spread

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“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

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Patients:
 “Who is my doctor?”, “What is the plan (surgeon and consultants)?”
Nurses:
 “Which resident is covering this patient?”
Attendings:
 Resident continuity lacking
Residents:
 Workflow issues
Problems with the Current State
(Old System)

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BLACK TEAM GOLD TEAM BLUE
TEAM
TRAUMA “Primary” Care Teams

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PFCC Impact Project:
Restructured 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
0%
5%
10%
15%
20%
25%
30%
35%
%ofTotalDischarges
Trauma Discharge Comparison Aug/Sep 2009
August % of total D/C September MTD % of total D/C
The Trauma Restructure was associated with improvement in
time of discharge

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• 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 penetrating
assault and the worse the “assaultive dose”
• ALL trauma patients now screened
PFCC Impact Project: PTSD Screening

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PFCC Impact Project:
Medication Cards
To teach patient
about new meds
prescribed in Hospital
Card triggers teaching & cross-
interaction check
Nurses and Pharmacy
are collaborating
Improve Safety, Satisfaction, Reduce Re-Admission Rates

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• Real Time Patient and Family Advisory Council
• Transition from ICU
• Seamless Hospital & Rehab Discharge Instructions
• Resident Orientation
Sample of Current PFCC Projects

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"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
A Physician Becomes a Patient

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Place Holder: Lone Nut

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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
 Atrius/Vanguard/Harvard, Boston
 WellSpan Health, Pennsylvania
 Rochester General Hospital, New York
 UNC Healthcare, North Carolina
 Aneurin Bevin Health, Wales
www.pfcc.org

47. Thank you!