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PFCC Partners @
The Innovation Center of UPMC
July 13, 2012
PFCC 1000 Lives
Plus Webinar (Part I)
Patient and Family Centered Care
Methodology and Practice
PFCC 1000 Lives Plus Webinar
Meet the Presenters
Anthony DiGioia III, MD Michelle Yakelis
Medical Director Project Coordinator
Learning Objectives• Understand that we need a new operating
system for delivering care in order to
achieve the Triple Aim
• View all care experiences through the eyes
of Patients and Families
• Co-design experiences with Patients,
Families and Care Givers
• PFCC will also improve outcomes, quality,
safety and reduce waste
16.00 – 16.05
Welcome and Introduction Annette Bartley
16:05 – 16:10
Introduction to PFCC M/P Dr. Anthony DiGioia
16:10 – 16:40
Steps 1-3 Dr. Anthony DiGioia
Dr. Grant Robinson
16:40 – 16:55
Q & A All
16:55 – 17:00
Closing Remarks Annette Bartley
Agenda
Just Ask Our Patients and Families
• We are not delivering the basics ina very complex system
• We must focus on providing a full cycle of care
• Real Value? Transitions of Careand Communications
Why Change?
It’s time for a new
Operating System
(OS) for the
delivery of care…
The Three Keys to Success for
Operating System v2.0
Key #1
View All Care as an
Experience
and Through the Eyes of
Patients and Families
Key #2
Complaining
Consulting and Advising
Experience-
Based
Co-Design
Giving Information
Listening and Responding
Co-Design
Engagement to
Partnerships
Current State
Simple Solutions
in a Complex
System
Key #3: Implementation
- Methodology
- Co-Design
- Overcome Hurdles
Ideal Experience
Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Shadow, Current State, Urgency
4. Working Group thru Touchpoints
5. Shared Vision of the Ideal
6. PFCC Project Teams
to Close the Gap
The PFCC Methodology and Practice
Provides the Steps to Success
Care GiverAny person within a care setting whose work
touches a patient’s or family’s experience
(i.e.—It’s a team effort)
TouchpointsKey moments and places in any care setting
where patient and family care experiences
are directly or indirectly affected by any
Care Giver
We need to define
and build our teams!
Workshop Format
Learning
Aneurin Bevan
Health Board
Real World Example
Go Live!
Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Shadow, Current State, Urgency
4. Working Group thru Touchpoints
5. Shared Vision of the Ideal
6. PFCC Project Teams
to Close the Gap
The PFCC Methodology and Practice
Provides the Steps to Success
Step 1 Select a Care Experience
• How do we define “Care
Experience?”
• How do you choose one?
–Patient and Family
Feedback
–Areas of Need
• Consider Scope
–Broad/Narrow
Step 1: Aneurin Bevan Health Board
Hip Fracture
Begins: On admission to A+E
Ends: Transfer to the ward
―The acute pathway‖
Step 1: Aneurin Bevan Health Board
Diabetes Inpatient Care Experience
Begins: When the patient
arrives in A&E department
(? When the patient/family
first contact emergency
services)
Ends: When the patient is
discharged from hospital
Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Shadow, Current State, Urgency
4. Working Group thru Touchpoints
5. Shared Vision of the Ideal
6. PFCC Project Teams
to Close the Gap
The PFCC Methodology and Practice
Provides the Steps to Success
Guiding Council Responsibilities
• Set the Stage to expand to the
full Working Group (Care
Team)
• Review the Segments of the
Care Experience
• Clinical Co-Champion(s), who will inspire
colleagues to make and sustain needed changes
• Coordinator(s), who will help organize shadowing,
track your journey and manage Working Group
Communications
Step 2Establish a PFCC Care
Experience Guiding Council
• Administrative Co-
Champion(s), such as a VP,
COO or CEO since this can
be a “disruptive” process
• Administrative Champion = Denise Llewellyn,
Nurse Director, Dr Grant Robinson Medical
Director
• Co-Clinical Champion = Mr Gordon Gillespie,
Consultant Orthopaedic Surgeon• Co-Clinical Champion = Vicky Williams,
Ward Manager
Step 2: Aneurin Bevan Health Board
Hip Fracture
• PFCC Coordinator =
Julie Poole,
Directorate Manager,
T and O
• Administrative Champion = Denise Llewellyn,
Director of Nursing , Dr Grant Robinson
Medical Director
• Clinical Co-Champion = Leo Pinto,
Consultant
Clinical Co-Champion = Josephine Ross,
Specialist Nurse
Step 2: Aneurin Bevan Health Board
Diabetes Guiding Council
• PFCC Coordinators =
Charlie Fleming
Kate Hooton
Jane Thornton
What Care Experience
would you choose for your
organization and who
would be on the
Guiding Council?
Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Shadow, Current State, Urgency
4. Working Group thru Touchpoints
5. Shared Vision of the Ideal
6. PFCC Project Teams
to Close the Gap
The PFCC Methodology and Practice
Provides the Steps to Success
Evaluate the Current State
using the PFCC Tool BoxStep 3
• Go Shadow
• Determine the Care
Experience Flow Map
• Establish Your Current State
• Develop a Sense of Urgency
to Drive Change
Informal Surveys
Dashboards
Comment Cards
Existing Reports
Interactive A.I.
Shared Decision Making
Patient and Family
Advisory Councils
Focus Groups
Voice of Experience
Adopt a Patient
Video Booths
Patient Letters
Journaling/Diaries
Discovery Interviews
Shadowing and
Care Experience
Flow Mapping
Storytelling
Shadowing
Reports
Active Interaction
―PFCC Apps‖ to View Care
(and to be used over and over)
Key ―PFCC Apps‖: Shadowing and
Care Experience Flow Mapping
• Walk the walk of patients and
families…
• Shadow patients and families
throughout the selected care
experience, as well as for recording
observations and insights
• High impact for the $’s and effort
Shadowing and PFCC OS
Observations
Empathy
Insights
PFCC Actions and
Implementation Thru
Working Groups
Shadowing is Changing
Our Perspective
--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.
Who Can Shadow?… Anyone!
• Guiding Council and Care Givers
• Shadowing resources: health
profession students,
volunteers, summer interns,
patient advocates
• Shadowing for new hires and
light duty staff
The First Steps Toward Co-Design…
• Shadowing Continuously Engages and
Partners with Patients, Families
and Care Givers
• Creates ―Real-Time‖ Patient and
Family Advisory Councils
• Shadowing is one of the Best Ways to
Assess Your Current State and the
Way to Get Started
Shadowing Report
Patient story :84 yr old lady fell at home the day before admission
Looked after by her daughter who was in attendance
Main concerns on admission – who will look after granddaughter, pain,
thirsty
Triaged and sent for X-ray. Diagnosis confirmed – hip fracture
Ilio-fascial block and IV fluids administered
Delay in admission due to complete heart block and medical
intervention needed. Total time from A+E to ward – 3 hours.
Step 3: Aneurin Bevan Health Board
Hip Fracture
Shadowing Report
Key learning points :Patient shadowing unmasks key touch points
Butterfly effect is very apparent
How information is communicated is more important than what is
said
Failure of PFC may occur when too many individuals are involved in
the care of one patient due to distribution of responsibility
The action of one member of staff may radically change the
patient’s perception of care
Step 3: Aneurin Bevan Health Board
Hip Fracture
Key observations :Multiple touch points (14 in total), all contribute toward patient
experience
The first touch point is the most important – paramedic giving
information
Pain relief resulted in a step change in patient perception
Perception of ―caring‖ was very dependent on staff attitude e.g smiling,
how they communicated rather than what was said and meeting basic
human needs e.g food and drink
Medical staff were least communicative
Patient experience was very positive despite not meeting performance
target times. Patient satisfaction 10/10.
Step 3: Aneurin Bevan Health Board
Hip Fracture
Key actions :Conduct further PFCC shadowing to refine understanding of
touch points and their impact
Engage WAST to highlight their role in PFCC
Bring forward pain relief in front end pathway
Incorporate food & drink into pathway
Is there a role for a single ―patient advocate‖?
Determine metrics
Step 3: Aneurin Bevan Health Board
Hip Fracture
Step 3: Aneurin Bevan Health Board
Diabetes Shadowing report (Real-time)
Touch
Point
Care Givers Patient and Family feedback
A & E Triage Nurse
A&E Doctor
• Appreciated that the patient and the family
were kept informed
• Cleanliness
• Cup of tea!
EAU Nursing Auxiliary
Staff Nurse
• Took details, answered their questions
satisfactorily
• Kept informed about the next steps
Medical
Ward
Staff Nurses
Medical Team
Tissue viability Nurse
Kitchen Staff
Porter
Cleaners
• Shadowing during the vascular assessment
by TVN
• Explanation and reassurance
• Discomfort/pain during the
assessment/procedure
Before admission
Touch Point Care Givers Patient and Family Feedback
Daughter called GP
Surgery
• Receptionist
• GP
• Took the call and said that the
GP will call her back
• Called back one-and – a half
hours later, and asked her to
dial 999 !
Daughter called 999 • Paramedics • Arrived quickly
• Rapid assessment and transfer
to A&E
• Family felt they were
professional and very efficient,
and wished she had called them
earlier !
Current State
Ideal Experience
1. Define Care Experience
2. Guiding Council
3. Shadow, Current State, Urgency
4. Working Group thru Touchpoints
5. Shared Vision of the Ideal
6. PFCC Project Teams
to Close the Gap
Webinar Part II
Steps 4 – 6
You Will Have Questions!
Join the PFCC Ready
Set…Go Live! Webinars:
August 16, 2012 – Steps 1-3
September 13, 2012 – Steps 4-6
We are just a
click away at…
www.pfcc.org
Email:
Are you ready to get started?
Come to VisionQuest!For additional resources,
information and the tools to
help you get started,
please visit:
www.pfcc.org
Questions?