EXECUTIVE SUMMARY

By developing and implementing a method for seeing the healthcare experience from the standpoint of patients and family members, the University of Pittsburgh Medical Center has improved care delivery, lowered costs, and improved patient satisfaction.

  • Cross-functional, multidisciplinary teams use a six-step patient and family-centered care methodology to identify gaps and develop changes that will improve the patient experience and clinical outcomes.
  • Committee members shadow patients and family members to get firsthand knowledge about what they are going through and what goes wrong and what goes right.
  • The teams proposed minor and major changes, but none involve adding more staff and few involve more expenditures.

The University of Pittsburgh Medical Center has improved care delivery, increased patient satisfaction, and lowered cost of care by developing and implementing a six-step approach to understanding the healthcare experience from patients’ and family members’ viewpoints.

“Healthcare providers should view all care as an experience through the eyes of patients and families,” says Pamela Greenhouse, MBA, executive director of the Patient and Family Centered Care Innovation Center at the 21-hospital healthcare system.

“In 2006, Anthony DiGioia, MD, a practicing orthopedic surgeon, developed the Patient and Family-Centered Care [PFCC] methodology to improve the experience of care and implemented it with patients undergoing hip and knee replacement surgery,” Greenhouse says. When the pilot project was successful in improving clinical outcomes and decreasing costs as well as improving the patient experience, the program was expanded to other parts of the hospital.

“We proposed implementing the program in a more complex care setting and tried it in the trauma service at our flagship hospital. They have made many changes as a result of the program and continue to do so,” Greenhouse says.

Today, UPMC has more than 70 cross-functional, multidisciplinary working groups at eight UPMC hospitals, outpatient sites, pre-acute, and post-acute facilities. In addition, the PFCC methodology is now being used in hundreds of care settings around the world, Greenhouse says.

The teams are using the six-step PFCC methodology to identify gaps and develop changes that will improve the patient experience and clinical outcomes while decreasing costs, Greenhouse says. The teams include clinicians and non-medical staff — anyone who touches the experiences of patients and families, including administrators, parking staff, billers, and schedulers.

None of the teams at UPMC have suggested solutions that involve adding more staff, Greenhouse reports. “The vast majority of initiatives don’t cost anything other than the time staff members spend each week implementing them,” she adds.

The only way to improve the experience of patients and their family members is to listen to them and find out what they are feeling, Greenhouse says. She suggests talking to patients and family members about their experiences, reviewing patient letters and surveys, and inviting patients and family members to participate in your improvement initiatives.

Shadowing patients and their family members to find out their experiences is a key to improving the experience of patients and their families, Greenhouse says.

When they shadow patients, the staff members have an opportunity to see firsthand what goes right and what goes wrong for patients and identify areas where processes can be improved, she adds.

“Shadowing gives us a picture of what is happening and identifies areas for improvement. If someone shadows one time, they will see actionable opportunities. If they shadow several times, they will see even more,” she says.

Since it would be next to impossible for one person to stay with a family through the entire hospital experience, break the entire episode of care into small increments and have staff members take turns shadowing.

The PFCC initiatives should go far beyond just improving amenities like parking and meals, Greenhouse says. For instance, when clinicians from the trauma service shadowed patients and caregivers, they learned how difficult it is for people to know who is in charge, who is directing the plan of care, and to whom they should address questions.

“Trauma patients may be seen by orthopedic surgeons, neurosurgeons, hospitalists, nurse care managers, and others. A lot of time, patients and family members may get different, conflicting information from different care providers. The neurosurgery team may say the patient needs a procedure, but the orthopedic surgeon says something different. It’s very confusing and causes a lot of anxiety and frustration,” she says.

Among the initiatives the trauma service working group recommended was dividing the trauma staff into three teams which follow patients throughout their stay. Each team includes an ED nurse, a hospitalist, and six or seven other members from a variety of disciplines.

“The same team follows the trauma patient from the emergency department into the operating room, the intensive care unit, and the inpatient unit and are with the patient throughout the entire stay. This arrangement gives patients and family members someone specific to meet with and has helped the care team as well because they know who to contact with questions,” Greenhouse says.

The trauma service team also developed a real-time patient and family advisory council that invites patients who currently are in the hospital and their family members to meet with the leadership team and discuss what is going right and what isn’t. “This ratchets up the pressure on the trauma team, but it gives them the opportunity to fix the problem while the patient is still in the hospital and take steps to prevent it from happening to someone else,” she says.

Since the trauma service implemented the initiatives, length of stay and 30-day readmissions have decreased and patient satisfaction has increased.

When the bariatric department’s working group found a significant number of readmissions of weight loss surgery patients, a chart review revealed that a large number of patients were being readmitted due to dehydration. The team worked with patients and family members to revamp the educational process and determine when is the best time to introduce educational materials. Patients told them it would be helpful to provide a measured liter bottle that showed exactly how much they needed to drink that day. When the changes were instituted, readmissions due to dehydration dropped to zero.

“The team came up with these changes by listening to patients and family members. Looking at care through the eyes of the patient and family helps us improve the patient experience, and at the same time improve clinical outcomes and lower costs,” she says.

At the women’s hospital, where the patient population ranges from new mothers to patients who have had breast cancer surgery to women at the end of life, case management department representatives were part of a team that came up with a way to alert the staff as to which patients are receiving palliative care. The solution is to post a photograph of a white rose on the doors of patients at the end of life.

“Patients’ reasons for being in the hospital take in the full cycle of life, but we didn’t have a way to make staff aware at the very sensitive time when patients are nearing the end of life. The rose on the door alerts dietary, maintenance, and other staff members who might not know the patients’ situations,” she says.

Shadowing helps the entire care team see what’s happening during each step of the healthcare experience from the patient’s and family’s point of view and develop solutions, Greenhouse says.