Pamela K. Greenhouse

A patient-centered model to improve metrics without cost increase: viewing all care through the eyes of patients and families.

The need for patient-centeredness in care delivery has been articulated for decades, yet meaningful progress toward patient-centered healthcare has been hobbled by the lack of a replicable patient-centered care model and method. The authors describe the patient- and family-centered care method, built around viewing every care experience through the eyes of the patient and family, and its outcomes proving the approach is replicable and sustainable while improving outcomes without additional cost. A follow-up article on patient and family shadowing will be published in the January 2011 issue.

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

BackgroundThe 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/purposesWe (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.MethodsThe 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.ResultsIn 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.ConclusionsPFCC M/P offers a road map for redefining value as what is important to patients and families.

Integrating patient- and family-centered care with health policy: four proposed policy approaches.

Achieving patient-centeredness in health care delivery has been difficult, in large part due to the lack of a replicable methodology. We describe the Patient- and Family-Centered Care Methodology and Practice (PFCC M/P), designed specifically for health care, to establish and sustain patient-centeredness in any care setting. The PFCC M/P meets the needs of all stakeholders—patients, families, providers, payers, and government—in improving the patient experience, patient safety, and clinical outcomes while decreasing waste and cost. We also propose options for aligning the PFCC M/P with policy as a means of bringing about widespread transformation in health care delivery.

Transforming care at the bedside: Patient-controlled liberalized diet

A 2003 partnership between the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation created an initiative to redesign medical-surgical inpatient care – Transforming Care at the Bedside (TCAB). TCAB is intended to transform the elements that affect care on medical/surgical units by rapidly creating, testing, and measuring new ideas. TCAB began as a pilot with three hospitals nationwide, including the University of Pittsburgh Medical Center (UPMC) Shadyside in Pittsburgh, Pennsylvania. UPMC Shadyside initiated its TCAB efforts with an interdisciplinary initiative, involving registered nurses (RNs), nursing assistants, registered dietitians (RDs), and medical doctors (MDs), to transform nutritional services for medical-surgical inpatients. The Patient Controlled Liberalized Diet Program, piloted in late 2003 and rolled-out house-wide in August, 2004, puts the patient in control. The goal is to improve nutritional status and satisfaction among inpatients by empowering them to make menu selections and providing individualized nutrition education. Positive quantitative and qualitative outcomes have resulted, leading to plans for system-wide (19-hospital) spread and further programmatic evolution.

Community Hospital Successfully Implements erecord and Cpoe

Despite media attention on converting the nations paper-based medical record systems to electronic systems, few hospitals, and even fewer community hospitals, have done so. University of Pittsburgh Medical Center St. Margaret has converted to a comprehensive electronic health record system, known as eRecord, in a short time. The authors describe key factors that were critical to the success of the conversion, along with positive results on quality of care.

A case for integrating the Patient and Family Centered Care Methodology and Practice in Lean healthcare organizations

Many healthcare organizations using Lean are becoming interested in the Patient and Family Centered Care Methodology and Practice (PFCC M/P). We suggest that integrating the two approaches can accelerate the pace of improvement and provide a powerful mechanism to keep the patient and family as the primary focus of improvement activities. We describe the two approaches and note the ways in which they are complementary. We then discuss the ways in which integrating the PFCC M/P adds value to patients, families, providers, and organizations and accelerates transformation. Finally, we suggest ways to implement PFCC M/P within Lean healthcare organizations.

Academic Cardiology Division in the Era of Managed Care A Paradigm for Survival

The ability of academic divisions of cardiology to pursue educational and research missions in an era of market-driven managed care is being increasingly jeopardized. Indeed, several academic medical centers have been sold to for-profit entities, and many cardiology divisions have been forced to decrease staff and faculty reimbursements. Despite these threats, the academic division has unique strengths: (1) premium quality of care, (2) a single employer, (3) a somewhat uniform practice culture, (4) high-volume operators performing interventional procedures, (5) expertise in highly technical aspects of cardiology, and (6) the availability of physicians for outreach ventures. Therefore, we hypothesized that the cardiology division could be strengthened by collaborating with the medical center in the development of an aggressive and proactive managed care strategy. To this end, we developed a cardiovascular network having the academic center as its central focus but including a group of high-quality and geographically dispersed community-based physicians. These physicians were attracted by an economic package that provided protection from downside risk, participation in our managed care initiatives, and geographic exclusivity in an over-crowded market. In turn, the community-based physicians increasingly used the academic medical center for tertiary care, resulting in increased volumes and incremental profitability. Using this paradigm, we have now recruited approximately 40 community cardiologists. The resulting network provides access to a university cardiologist in most of the surrounding urban and rural counties and will allow us to compete effectively for capitated contracts.

Patient- and Family-Centered Care: A Systematic Approach to Better Ethics and Care.

The Patient- and Family-Centered Care Methodology and Practice follows six steps to improve clinical results and accountability and to reduce costs.

Creating Value with the Patient- and Family-Centered Care Methodology and Practice: What Trainees Need to Know, Why, and Strategies for Medical Education.

Implementing the six-step Patient- and Family-Centered Care Methodology and Practice would improve experiences and outcomes while decreasing costs.

A paradigm shift toward systemwide quality improvement education: meeting the needs of a rapidly changing health care environment: meeting the needs of a rapidly changing health care environment.

Background: Widespread changes in the health care landscape require a paradigm shift from an educational model where quality improvement (QI) expertise is centralized to a model where foundational and functional QI knowledge is widespread through all levels of a health care organization. Methods: To support a new educational structure prioritizing QI education as a stand-alone priority, a 6-month educational course was introduced for operational leaders (requiring completion of a real-life improvement project) and a second, introductory QI education set of 5 stand-alone classes was introduced for managers and frontline staff; the latter is provided at centralized sites, on-site, and via webinars. Additional QI courses have been introduced for board members. Results: Sixty operational leaders attended the first 2 offerings of the 6-month course and completed 50 associated QI projects, as of July 2012; nearly 1500 participants have attended the “Just-in-Time” classes, representing 13 University of Pittsburgh Medical Center hospitals and affiliated facilities. Eighty-three percent of recent participants rated the 6-month course a 4 or 5 in terms of efficacy. Two-thirds of participants from both 6-month series reported that they continued to work on their project once the class was over. Discussion: The number of course attendees and their feedback regarding efficacy of this educational approach, as well as the volume of associated completed projects, indicate success in providing greater numbers of staff at all levels of the organization with QI education and tools. This educational format shows promise for further refinement and replicability.