®
Partnering With Patients and Families
to Ensure Safety and Quality Care
Highlights of the 2007 Patient–and
Family–Centered Care Benchmarking Project
Kathy Vermoch
May 4 and 7, 2007
© 2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
Goals of This Presentation
•
Participants will:
–
Understand the findings and conclusions of the
UHC Patient–and Family–Centered Care (PFCC)
Benchmarking Project
–
Learn about effective methods for implementing the
core concepts of PFCC across the organization
 Dignity
and respect
 Information
sharing
 Participation
 Collaboration
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
2
What Is PFCC?
The Institute for Family–Centered Care (IFCC) defines*
patient–and family–centered care (PFCC) as:
“An innovative approach to the planning, delivery, and
evaluation of health care that is grounded in mutually
beneficial partnerships among health care patients, families,
and providers.”
Successfully implementing PFCC concepts requires a
major paradigm shift:
PFCC means developing collaborative partnerships with
patients and families to improve care and operational
efficiency and recognizing patients and families as equal,
important members of the care team.
©2007 University HealthSystem Consortium
Source: *http://www.familycenteredcare.org/faq.html
VermochUHC PFCC Project.ppt
3
The IOM Supports
Patient–Centeredness
•
•
•
•
•
•
Health care should be based on continuous healing
relationships.
Care should be individualized.
It is important for patients to be involved in their own care
decisions.
Patients and families should have better access to information.
Health care should become more transparent.
IOM’s “Six Aims for Healthcare Improvement” are safety,
patient–centeredness, efficiency, effectiveness, timeliness,
and equity.
Many health care professional, regulatory, and quality
improvement organizations also support or require PFCC
concepts, e.g., AHA, Joint Commission, and ACGME
Source: Institute of Medicine — Crossing the Quality
Chasm: A New Health System for the 21st Century
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
4
PFCC Is a Business Decision
•
3 years ago MCG Health, Inc. began implementing PFCC
in neurosciences:
–
The unit’s Press Ganey satisfaction was at the 10th
percentile (the lowest across the medical center.) Staff
morale was poor and there were 7.5 FTE open
positions.
–
MCG had poor market share in neuroscience.
•
Patient/family advisors worked with caregivers on fixing
problems, facility design, and interviewing staff, including
medical staff; every staff member signed a commitment to
PFCC concepts.
•
Dramatic improvements were seen almost immediately…
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
5
…PFCC Is a Business Decision
•
After implementing PFCC concepts in MCG’s
Neurosciences unit:
–
Unit Press Ganey satisfaction = 95th percentile.
–
The unit has low turnover with a waiting list of quality
candidates.
–
The unit has experienced a significant decrease in
medication errors.
–
MCG’s neurosciences market share has increased
12% in 3 years.
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
6
PFCC–Not Just a Nice Thing to Do!
•
Communication problems may lead to legal action for
malpractice:*
–
Failing to understand patients’ or families’ perspectives
–
Delivering information poorly
–
Devaluing patient and/or family views
–
Desertion
MCG’s leaders feel that the organization’s commitment to PFCC
is a significant factor in the dramatic decrease in malpractice
suits they’ve experienced in recent years (see next slide).
©2007 University HealthSystem Consortium
Source: *Beckman et al., Archives of Internal Medicine, 1994
VermochUHC PFCC Project.ppt
7
MCG: Favorable Trend in
Variances, Claims, and Litigation
Files, Claims, and Litigation
Number of Recorded Incidents
90
80
Most UHC members
report regular, annual
increase in
malpractice pay-outs
70
60
50
40
30
20
10
Litigation
Claims
Files
0
2001
2002
2003
Years
Source: MCG Health, Inc.
2004
2005
2006 (YTD)
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
8
Project Findings
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
9
Goals of the PFCC Project
•
The project’s steering committee focused the study on the
following key objectives:
–
To assist UHC members in determining their PFCC
strengths and improvement opportunities
–
To identify useful metrics for monitoring progress in
achieving PFCC goals
–
To develop an aggregate database of PFCC practices
in academic health centers
–
To discover how organizations are successfully
implementing PFCC’s core concepts to address the
principles of quality care as outlined by the Institute of
Medicine
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
10
Project Participation and Data Collection
•
26 organizations completed a PFCC survey/assessment.*
–
Part 1, Self-assessment–a rating of the organization’s
current PFCC status across the entire enterprise (excluding
behavioral health and prisoner care)
–
Part 2, Drill-down on current practices–respondents had the
option to respond for the entire organization or to select the
unit or facility most successful in implementing PFCC
•
Organizations recommended by the steering committee were
interviewed about their PFCC initiatives and practices (MCG,
Vanderbilt, Washington, Colorado, Methodist, and Denver).
•
77 innovative strategy reports describing PFCC-related
initiatives were submitted.
•
The PFCC health care literature was researched.
*Many survey questions were adapted from “Strategies
for PFCC: A Hospital Self-Assessment Inventory.” IFCC
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
11
Though Status Varies
All Respondents Are Engaged
In PFCC Implementation
•
Overall organizational PFCC status:
–
Have not yet begun to implement PFCC = 0%
–
Early stages of PFCC implementation = 32%
–
Partial PFCC implementation in selected locations = 68%
©2007 University HealthSystem Consortium
Source: Survey Q 1 (one outlier response was trimmed)
VermochUHC PFCC Project.ppt
12
Disconnects Exist Between PFCC
Goals and the Efforts Made to
Achieve Those Goals
•
65% indicated that PFCC is part of the organization’s mission
and values and 68% include PFCC goals in strategic planning,
but…
–
68% responded “none” or “unknown” for the annual budget
devoted to supporting PFCC initiatives.
–
42% agreed that PFCC is part of the philosophy of care
(POC), but none included patients/families in POC
development.
–
36% reported that PFCC is included in job descriptions and
performance evaluations.
–
20% have created a paid patient and family leader position.
©2007 University HealthSystem Consortium
Source: Survey Qs 2, 3, 5, 12, 71, 73
VermochUHC PFCC Project.ppt
13
PFCC Leadership Strategies
Collaborate with patients and family advisors to:
•
Incorporate PFCC concepts into mission, vision, values, plans,
safety initiatives, philosophy, and scope of care for each area
•
Create and describe a paid patient and family leader position
(supported by appropriate budget and resources) and with primary
responsibility for overseeing, coordinating, and implementing PFCC
initiatives across the enterprise
•
Select leaders and providers who practice PFCC concepts, e.g.,
outsourced service/equipment vendors, administrative leaders, and
caregivers–including medical staff
–
•
Leaders must believe in and practice PFCC concepts and act as
role models for the organization
Hold staff and vendors accountable by including PFCC goals in job
descriptions, evaluations, credentialing procedures, and contracts
©2007 University HealthSystem Consortium
Source: UHC PFCC project
VermochUHC PFCC Project.ppt
14
Dignity and
Respect
•
PFCC Core Concept:
Dignity and Respect
Dignity and Respect:
–
Health care practitioners listen to and honor patient and
family perspectives and choices
–
Patient and family knowledge, values, beliefs, and
cultural backgrounds are incorporated into the planning
and delivery of care*
Methodist’s International Department includes speakers of 12
languages and represents 14 ethnicities to improve
communication and assist in understanding cultural concerns and
enhancing the care experience for patients and families.
©2007 University HealthSystem Consortium
Source: *The Institute for Family–Centered Care
VermochUHC PFCC Project.ppt
15
Dignity and Respect:
Improvement Opportunities
•
64% agreed that effective processes are in place to ensure
patients/families are greeted in a friendly manner.
•
52% agreed that the ethnic/cultural diversity of staff is
consistent with the patient populations served.
•
40% agreed that the facility offers a healing, supportive décor.
•
40% agreed that conversations about patients are conducted
away from public areas.
–
•
52% agreed that confidential registration discussions are
held in private locations.
32% agreed that care settings provide privacy.
©2007 University HealthSystem Consortium
Source: Survey Qs 22, 24, 30, 31, 36, 46
VermochUHC PFCC Project.ppt
16
PFCC Dignity and
Respect Strategies
Partner with patients and family advisors to:
• Put effective processes in place to ensure all staff and
employees always introduce themselves to the patient and
family and explain their roles in his/her care
• Implement friendly policies and procedures that respect the
cultural and lifestyle needs of patients and families
• Implement practices to encourage family participation in the
care team and endure that other team members listen to and
respect their opinions
• Put organization-wide practices in place that are designed to
provide patient/family privacy and respect confidentiality
Fairview Children’s Hospital has open visitation and
digital camera technology is used to create picture
ID badges for parents, who are viewed as equal
members of the care team.
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
17
Information
Sharing
•
PFCC Core Concept:
Information Sharing
Information Sharing:
–
Health care practitioners communicate and share
complete and unbiased information with patients and
families in ways that are affirming and useful
–
Patients and families receive timely, complete, and
accurate information to allow them to effectively
participate in care and decision making
©2007 University HealthSystem Consortium
Source: The Institute for Family Centered Care
VermochUHC PFCC Project.ppt
18
Paper Records Are Common and
May Hinder Patient, Family,
and Provider Communications
Medical Record Format
Inpatient
Outpatient
ED
Primarily electronic
8%
12%
25%
Primarily paper
12%
28%
29%
Partially electronic/partially paper
80%
60%
46%
31% of survey respondents offer few or no electronic systems for patients and
families but Duke, UAMS, MCG, Oregon, OSU, Vanderbilt, Colorado, and
others have invested in electronic systems that offer patients and families many
communication options and resources, e.g., personal health information, test
results, education, scheduling and registration, billing, e-mail providers.
©2007 University HealthSystem Consortium
Source: Survey Qs 93, 94, 95, 96
VermochUHC PFCC Project.ppt
19
Not All Are Compliant With Joint
Commission Safety Requirements for
Error Communication and Reporting
•
88% have a standard procedure in place to communicate errors,
near misses, and adverse events to patients/families.
•
84% have a process in place for patients and families to report
safety concerns consistent with National Patient Safety Goal 13
(Patient Involvement)
• Vanderbilt’s patient safety initiatives are strongly aligned with PFCC goals;
separate communications and educational programs were designed (with
advisor input) for both staff and patients/families e.g., patient identification
• Denver Health discovered that 80% of errors were due to
miscommunication; they’ve incorporated PFCC goals into improvement
initiatives to increase safety
©2007 University HealthSystem Consortium
Source: Survey Qs 98, 99
VermochUHC PFCC Project.ppt
20
Confidentiality Is Not New!
•
HIPAA regulations do not prevent sharing personal health
information with patients and families (in accordance with
patient preferences).
–
•
Organizations that have made a strong commitment to
PFCC are also bound by HIPAA regulations and have
learned how to respect confidentiality and promote
information sharing.
Put processes in place to provide privacy and protect
confidentiality and train staff and patient/family advisors to
respect these concepts–then monitor compliance and hold
them accountable.
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
21
PFCC Information Sharing Strategies
Partner with patients and family advisors to:
• Encourage patients and families to dialogue, share information,
and embrace their roles as members of the care team, including
participation in rounds, goal-setting, safety, and care decisions.
Provide patients and families with easy access to educational and
personal health information and the medical record.
• Implement electronic systems to facilitate communication,
information sharing, and education.
• Routinely follow-up with patients/families to ensure that care
instructions were understood and if additional support is needed.
• Colorado’s “Diabetes Star” Web system offers access to personal health
information and guides patients in goal setting.
• At OSU’s Ross Hospital, patient relations staff and nurse managers conduct
proactive rounds to meet patients and families, encourage communication
and participation, and identify and address concerns and complaints quickly.
©2007 University HealthSystem Consortium
Source: UHC PFCC project
VermochUHC PFCC Project.ppt
22
Participation
•
PFCC Core Concept:
Participation
Participation:
– Patients and families are encouraged and supported in
participating in care and decision-making at the level they
choose
 The caveat “at the level they choose” above indicates
that flexible care systems must be in place that can be
adjusted as needed according to patient and family
preferences (e.g., family preference for remaining with
the patient during a code).
 Only 35% of survey respondents agreed that flexible
care delivery systems are in place to accommodate
patient and family preferences.
Sources: The Institute for Family Centered Care
and Survey Q 6
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
23
Patients and Families Have Limited
Opportunities for Presence or
Participation in Rounds
In accordance with patient preferences:
Families remain with inpatients:
Inpatients/Families participate in:
General care rounds = 85%
General care rounds = 50%
Critical care rounds = 62%
Critical care rounds = 35%
End-of-life care rounds = 62%
End-of-life care rounds = 54%
ED rounds = 31%
ED rounds = 15%
Not allowed to remain = 8%
Not allowed to participate = 23%
58% of respondents have no process in place to accommodate family
schedules but at UH Case’s Rainbow Babies and Children’s Hospital, if families
cannot be present during rounds then the attending, fellow, bedside nurse, and
charge nurse round with families when they arrive.
©2007 University HealthSystem Consortium
Source: Survey Qs 83, 83a, 84, 85, 85a
VermochUHC PFCC Project.ppt
24
Room Design and Visitation Policies
Often Don’t Provide Privacy, Family
Sleep Space, or Access to Inpatients
•
Total staffed inpatient
acute care rooms that
are private rooms:
•
Inpatient rooms with family
sleep space:
–
Median = 10%
–
Median = 50%
–
Mean = 35%
–
Mean = 52%
–
Minimum = 0%
–
Minimum = 5%
–
Maximum = 100%
31% don’t provide family sleep
space in critical care units
Only 12% of respondents strongly agreed that families have
24/7 access to inpatients
©2007 University HealthSystem Consortium
–
Maximum = 100%
Source: Survey Qs 14, 107, 109, 110
•
VermochUHC PFCC Project.ppt
25
PFCC Participation Strategies
Partner with patients and family advisors to:
• Implement effective procedures for the competent, mature
patient to define his/her family and to declare preferences for
involvement (The IFCC defines family as “two or more persons
who are related in any way—biologically, legally, or
emotionally”)
• Provide 24/7 family access to inpatients
• Build flexibility into standardized procedures that can be
adapted to meet patient and family preferences (including
preferences for family presence during painful, invasive, and
emergency procedures)
• Encourage family presence and participation because families
are the patients’ support system and are knowledgeable about
his/her care and condition; their input is necessary for quality,
safety, information sharing, and satisfaction
©2007 University HealthSystem Consortium
Source: UHC PFCC project
VermochUHC PFCC Project.ppt
26
PFCC Core Concept:
Collaboration
Collaboration
•
Collaboration:
–
Patients, families, health care practitioners and hospital
leaders collaborate in:
 Policy
and program development
 Implementation
 Health
care facility design
 Professional
 The
and evaluation
education
delivery of care
©2007 University HealthSystem Consortium
Source: The Institute for Family–Centered Care
VermochUHC PFCC Project.ppt
27
Only Half of Respondents Have
Patient/Family Advisory Councils
•
It is essential for caregivers to collaborate with patients and
families at all levels of the organization. Each group contributes
unique perspectives and experiences important to shaping
organizational policies, programs, practices, and facility design.
–
52% of survey respondents have functional patient/family
advisory councils in place.
 Of
these, 77% include the regular participation of senior
leaders.
But…
©2007 University HealthSystem Consortium
Source: Survey Qs 74, 75
VermochUHC PFCC Project.ppt
28
…Some Organizations Have
Developed Collaborative Partnerships
with Patients and Families
•
At Duke, patient/family advisors participate on more than 15
organizational committees and other initiatives.
•
At Vanderbilt patient/family advisors accompany senior
executives on rounds and they also act as “secret shoppers”
reporting on their service experiences.
•
MCG won’t “bid out” construction jobs until patient/family
advisors have signed off on the blueprints.
•
At Washington patient and family advisors on the aesthetics
committee regularly provide feedback on facility environment
and design.
36% of respondents agreed that patient and
family advisors participate in facility design.
Source: UHC PFCC
project and survey Q 101
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
29
Effective Patient/Family Advisors
•
Ask doctors, nurses, and other staff for recommendations and
put notices hospital and newspapers to find potential advisors.
•
Look for individuals who have a genuine interest in improving
care but without a strong personal agenda or “an axe to grind.”
•
Candidates must be carefully interviewed and trained as
volunteers (including safety, HIPAA, and confidentiality training).
•
Most project participants don’t pay advisors but they may offer a
teaching stipend and other perks, e.g., free parking, meals, or
tickets to university sporting events.
•
Some organizations set a time limit/term for advisor participation
while others find that there is a natural attrition process.
•
It is essential to also train staff to successfully work with advisors
to achieve mutual improvement goals.
Washington pairs advisors with committee members
for follow-up, advice, and to answer questions.
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
30
•
PFCC Is Not Often Included in
Health Care Education and Patients/
Families Rarely Serve as PFCC
PFCC principles are included in
Teachers
curriculum:
Nursing = 50%
– School of medicine = 27%
– Allied health = 23%
– Dental = 8%
Patients/families participate as
faculty in orientation/education:
– 15% of employees
– 12% of volunteers
– 8% of temporary staff and
students/trainees
– 8% of medical staff
– 4% of trustees
–
•
Only 19% of survey
respondents agreed that
patient and family
advisors helped to
develop patient, family,
and staff PFCC
educational materials
Source: Survey Qs 9, 78, 79
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
31
Patients and Families
Rarely Collaborate in
Provider Selection Practices
•
8% invite patient/family advisors to interview clinical and
administrative leaders.
•
4% ask patient/family advisors to help in the selection of
residents.
•
4% include patient/family advisors in selecting outsourced
service and equipment vendors.
–
16% indicated that processes are in place to ensure
that outsourced service and equipment vendors
practice PFCC principles.
©2007 University HealthSystem Consortium
Source: Survey Qs 7, 80, 81, 82
VermochUHC PFCC Project.ppt
32
PFCC Collaboration Strategies
Partner with patients and family advisors to:
•
Develop a functional patient/family advisory council(s) that
meets at least quarterly, includes senior leaders, and makes
recommendations to the leadership
•
Design a healing, supportive environment that encourages
family presence/involvement-including family resource centers,
sleeping spaces, training labs, and easily understood signage
•
Develop understandable educational materials and include
patients and families in training programs designed for patients,
families, and staff
•
Select leaders and providers who practice PFCC concepts, e.g.,
outsourced service/equipment vendors, administrative leaders,
and caregivers–including medical staff
©2007 University HealthSystem Consortium
Source: UHC PFCC project
VermochUHC PFCC Project.ppt
33
PFCC in Ambulatory Care and
Business Office Practices
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
34
PFCC and Ambulatory Care
•
Most PFCC-initiatives are focused on inpatient care units
-
Primarily in maternal and child care and end-of-life care
•
In ambulatory care, PFCC care concepts are most likely to be
implemented in selected settings such as pediatric or
oncology clinics
•
A study* evaluating the affects of PFCC on outpatient visits
concluded that when patients and doctors find common
ground:
–
Physical health status improved
–
Emotional health improved
–
Fewer referrals and diagnostic tests were needed two
months after the visit
* Source: Stewart, et al. The Impact of Patient-Centered
Care on Outcomes, Journal of Family Medicine, 2000
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
35
PFCC and the Business Office
•
Self-assessment and survey data revealed many
opportunities to implement PFCC concepts in non-clinical
areas:
–
Registration, scheduling, and access to services, e.g., the
need for simple, consistent, and confidential registration
and scheduling procedures; convenient access to
services; coordinated support during scheduling and care
transition, etc.
–
Finance, charge, billing, and payment procedures, e.g., the
need for consistent, easy and convenient practices (simple
language, combined copay, flexible, online payment
options, etc.)
–
See appendix for survey data
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
36
PFCC Performance Measures:
Self-Assessment Scores,
Satisfaction Surveys, and Other
Outcomes Measures
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
37
Much PFCC Improvement Is Needed
in Every Area Evaluated
• Many felt that the selfassessment process was
beneficial; getting key
stakeholders to discuss the
issues is eye-opening.
• None of the respondents
achieved the maximum
score in any PFCC topic.
*Scoring:
• Strongly agree = 1.0
• Agree = 0.5
• Neutral = 0.0
• Disagree = -0.5
• Strongly disagree = -1.0
• Average score: sum of
scores divided by the
number of responses
Source: Survey Qs 2 through 67
Average PFCC Self-Assessment Scores
(Maximum Possible Score = 1.0*)
Self-Assessment Topics
Mean
Leadership
-0.1
Patient and family involvement
0.2
Communications
0.2
Environment/facility and patient/family support
0.0
Scheduling and registration
-0.1
Finance, charge, and payment practices
0.1
Billing practices
-0.1
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
38
Measures Most Commonly Used
by Respondents
to Monitor PFCC Performance
•
•
•
Vendor surveys (national
benchmarks):
–
92% Inpatient
–
58% Outpatient
Internal surveys (internal
benchmarks) :
–
54% Inpatient
–
38% Outpatient
4% Patient satisfaction not
measured
•
•
Complaint Process:
–
73% Inpatient
–
65% Emergency department
–
54% Outpatient
Other outcomes measures:
–
65% Employee turnover
–
65% Length of stay
–
62% Fall rates
–
54% Errors
–
42% Financial measures
©2007 University HealthSystem Consortium
Source: Survey Q 113
VermochUHC PFCC Project.ppt
39
PFCC Satisfaction Scores Show
Improvement Opportunities
•
•
18 organizations that participate in Press Ganey Adult Inpatient
Satisfaction Surveys submitted their most recent scores for key
PFCC questions:
– Explanation of tests and treatments
– Information given to family about condition and treatment
– Instructions given for care at home
– Inclusion in treatment decisions
– Nurses kept you informed
– Physician’s concern for questions and worries
Average PFCC scores were calculated:
– 4 organizations (22%): > 85.0 (range 85.2 to 88.5)
– 10 organizations (56%): > 80.0 and < 85.0 (range 81.0 to 84.6)
– 4 organizations (22%): < 80.0 (range 76.5 to 79.4)
©2007 University HealthSystem Consortium
Source: Survey Q 115
VermochUHC PFCC Project.ppt
40
New Press Ganey PFCC Measures
UHC members using PG surveys are encouraged to use these
new questions to evaluate and benchmark PFCC practices
•
Effective March 2006 Press Ganey added PFCC custom
questions to all 13 PG survey instruments:
–
How well staff explained their roles in your care
–
Degree to which the staff supported your family throughout
your health care experience
–
Degree to which your choices were respected to have
family members/friends with you during your care
–
Degree to which you and your family were able to
participate in decisions about your care
–
Degree to which staff respected your family's cultural and
spiritual needs
Source: Press Ganey PFCC Metrics Task Force
(including a Univ. of Washington representative)
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
41
HCAHPS Measures
•
HCAHPS measures that may be used as indicators of patientcenteredness for UHC’s key organizational reports:
–
How often did nurses treat you with courtesy and respect?
–
How often did nurses listen carefully to you?
–
How often did nurses explain things in a way you could
understand?
–
How often did doctors treat you with courtesy and respect?
–
How often did doctors listen carefully to you?
–
How often did doctors explain things in a way you could
understand?
–
Using any number from 0 to 10, where 0 is the worst hospital
possible and 10 is the best hospital possible, what number
would you use to rate this hospital?
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
42
PFCC Measurement Strategies
•
Establish, evaluate, and routinely monitor PFCC performance
measures
–
•
Regularly collect complaint and customer satisfaction
information in all care settings, including comparative
external satisfaction benchmarks versus other providers
Work with patients and families to review data, identify
opportunities, and design, implement, and monitor performance
improvements
–
It may be difficult to discuss satisfaction data with patients
and families but this is essential to better understand the
information and create solutions that will successfully
address patient and family needs
–
The Institute of Medicine endorses transparency in health
care organizations to improve quality and safety
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
43
Implementation
Next Steps
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
44
Project Conclusions
•
•
Many PFCC improvement opportunities exist in the areas of:
–
Leadership
–
Patient and family involvement in strategic planning,
operations, and care delivery
–
Communications and information sharing
–
Facility design
–
Support and resources for patients and families
–
Education of patients/families and staff
–
Scheduling, registration, access, care transitions, and
charge, billing, and payment practices
–
Many other aspects of service and care delivery
All project participants have improvement opportunities
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
45
The Most Important Take-Aways
From This Study
•
Patients and families are important, equal members of the
care team and have the right to participate in decisions
affecting the planning, delivery, and evaluation of care.
•
Don’t assume that you understand and can effectively address
patient and family needs and concerns without sharing the
data, asking their opinions, and involving them in designing
solutions to create a friendlier, more effective, efficient, and
safer health care organization.
“The doctors and nurses focus on my physical health and on treating
my condition and that’s very important, but quality of life is also very
important to me and they don’t always think about that.”
Terry H, MCG’s Neurosciences Patient/Family Advisory Council
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
46
PFCC–Not Just a Nice Thing to Do!
•
Blue Shield of California conducted an 18-month study of 756 HMO
members (all with late-stage illness and access to the same
benefits and provider network). Half were blindly assigned to
receive usual case management (UCM) and half received patient
centered management (PCM) including working with a care
manager to develop goals based on disease state, treatment
options, pain management, and end-of-life decisions. Survival rates
were the same for both groups; the study concluded that PCM
effectively reduced overall costs by 26%:
– $18,000 cost reduction per patient
– Hospital admissions reduced by 38%
– Hospital days reduced by 36%
Source: LSweeney, et al,
– Emergency room visits reduced by 30%
The American Journal of
– Home care use increased by 22%
Managed Care, Feb 2007
– Hospice use increased by 62%
– Higher satisfaction rates for 92% of the PCM members
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
47
Implement PFCC Concepts Through
Partnerships With Patients and Families
•
•
•
•
Dignity and Respect: Health care practitioners listen to and honor
patient and family perspectives and choices. Patient and family
knowledge, values, beliefs, and cultural backgrounds are incorporated
into the planning and delivery of care.
Information Sharing: Health care practitioners communicate and
share complete and unbiased information with patients and families in
ways that are affirming and useful. Patients and families receive timely,
complete, and accurate information to allow them to effectively
participate in care and decision making.
Participation: Patients and families are encouraged and supported in
participating in care and decision making at the level they choose.
Collaboration: Patients, families, health care practitioners, and
hospital leaders collaborate in policy and program development,
implementation and evaluation; health care facility design; professional
education; as well and in the delivery of care.
©2007 University HealthSystem Consortium
Source: The Institute for Family Centered Care
VermochUHC PFCC Project.ppt
48
Where To Start?
•
•
Begin partnering with patients/families to implement PFCC
concepts in locations that make sense for your organization:
–
Maternal/child services because family participation is expected
and natural
–
Units with the greatest opportunity to improve customer
satisfaction
–
Locations with the greatest opportunity to improve safety
–
Units with a PFCC champion who is receptive to change
–
Construction projects that bring key stakeholders together
Share PFCC success stories and work with others to foster and
implement a PFCC culture across the organization
–
PFCC applies to every facet of health care–inpatient, outpatient,
ED, ancillary, home care, hospice, behavioral, subacute/longterm care, scheduling, registration, billing, support services,
outsourced vendors, etc.
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
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PFCC Advice for Beginners
•
Stories change culture; ask patients, families, and staff to
share their (positive and negative) health care experiences.
•
Senior leadership buy-in is essential to provide role models
and resources, and to hold staff accountable for practicing
PFCC concepts.
•
Select PFCC performance measures (including safety
measures), collect baseline data, monitor performance,
and then share the results.
•
Look for early adopters and work with them to successfully
implement PFCC concepts and help others to learn from
their example.
Continued...
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
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PFCC Advice For Beginners
•
Help staff confront their fears about patient and family
presence, participation, and collaboration by starting small
and working with one unit. Show staff the data and provide
examples of other AMCs that have implemented PFCC
concepts. Prepare staff to deal with a variety of issues and
scenarios through training and scripting.
•
Recruit a physician champion(s) to convince other doctors
that PFCC doesn’t deter medical education, it enhances
learning. Incorporate PFCC concepts into education
through the use of patient/family advisors as faculty in
training doctors, caregivers, and other providers.
•
Constantly ask “have we gotten patient/family input on this
plan?” before moving forward to implement changes.
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
51
Implementation
Next Steps
Review project materials* to identify 1 or more best practices that your
organization will implement:
1. Network with colleagues who are successful in this area to
understand their practices and processes.
2. Identify/organize a team that includes all key stakeholders including
physician champions, senior leaders, and patient and family advisors.
3. Formulate an improvement plan based on relevant data, with
resources focused on your priorities.
4. Implement the plan.
5. Monitor changes and report results throughout the organization.
6. Share your success stories with others in your organization and with
your UHC colleagues to help them to improve.
*All project materials will be available on the UHC Web site at
www.uhc.edu; select “Improvement & Effectiveness,”
“Benchmarking,” and “Patient-and Family-Centered Care.”
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
52
PFCC Implementation Collaborative
•
UHC is currently enrolling members in a PFCC implementation
collaborative (due June 1st). Participant will work in any/all of 3
work groups to implement improvement strategies related to:
Patient and family participation in care
– Patient and family advisors and councils
– Special PFCC initiatives (ambulatory/non-acute care, business office,
PFCC measures, etc.)
–
•
•
Members can take part in any/all workgroups at no charge;
participation in the original project is not required.
Implementation Support Project process:
– Members enroll and identify executive sponsor, team leader,
team members, and select performance goals and measures
– Monthly networking conference calls for 6 months with team
leaders of all organizations enrolled in the work group
– Web conference to present strategies and learnings
– Field Brief document summarizing work done by workgroups
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
53
PFCC Project Deliverables*
•
Survey results
•
Project results and findings
•
Knowledge transfer presentations/Web conferences
•
Compendium of Innovative Strategy reports
•
Performance Opportunity Summary/Scorecard
•
Field Book, Executive Summary, and Action Plan
•
UHC’s PFCC listserver, providing a networking forum for members
•
UHC PFCC Implementation Support Collaborative (enroll by 6/1)
•
Also see the many PFCC resources, assessments, and training
materials available from the Institute for Family-Centered Care at
http://www.familycenteredcare.org/index.html.
*All project materials will be available on the UHC Web site
at www.uhc.edu; select “Improvement & Effectiveness,”
“Benchmarking,” and “Patient-and Family-Centered Care.”
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
54
The Success of Benchmarking
Comes From Implementation,
Not the Data
Dignity and
Respect
Information
Sharing
Implementation
Participation
Collaboration
For more information about the UHC Patient-and FamilyCentered Care Project contact Kathy Vermoch at
[email protected] or 630/954-1030
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
55
Appendix
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
56
PFCC Project Participants
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Harbor-UCLA Medical Center
Harborview Medical Center
The Johns Hopkins Hospital
MCG Health, Inc.
The Methodist Hospital
New York-Presbyterian Hospital
NYU Medical Center
The Ohio State University Medical
Center
Oregon Health & Science
University
UC Irvine Medical Center
University Hospitals Case Medical
Center
University Health Systems of
Eastern Carolina (Pitt County
Memorial Hospital)
University Hospital of the SUNY
Upstate Medical University
University Medical Center of
Southern Nevada
•
•
•
•
•
•
•
•
•
•
•
University of Colorado Hospital
University of Maryland Medical
System (University of Maryland
Medical Center)
University of Minnesota Medical
Center, Fairview
University of Missouri Hospitals and
Clinics
University of Pennsylvania Health
System (Hospital of the University of
Pennsylvania)
University of Utah Hospitals and
Clinics
University of Virginia Health System
(University of Virginia Medical Center)
University of Washington Medical
Center
University of Wisconsin Hospital &
Clinics
Vanderbilt University Medical Center
Wishard Health Services
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
57
UHC PFCC Benchmarking
Project Steering Committee
•
J. Philip Baroni, Associate
Hospital Director of
Outpatient Services, UAMS
•
Julie Moretz (formerly with
MCG as Director of Family
Services Development)
•
Sandra Cockram, Patient
Care Advocate Coordinator,
University Hospitals Case
•
Terrell Smith, Director,
PFCC, Vanderbilt
•
Patricia Sodomka, Senior
Vice President, PFCC,
MCG
•
Thinh Tran, MD, VP, Chief
Quality and Patient Safety
Officer, Methodist
•
Cezanne Garcia, Associate
Director, Washington
•
Kim Harper, VP, Human
Resources and Public Affairs,
Wishard
•
Holly Johnson, Project
Administrator, Utah
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
58
There Are Many Opportunities to
Improve Scheduling, Registration,
and Access to Services
•
•
•
•
•
•
36% agreed that scheduling and registration procedures are
consistent across the organization.
28% agreed that patients complete the full registration process
when appointments are scheduled.
24% indicated that online registration is available.
20% reported that business hours for scheduling appointments
include off-hours, e.g., weekends and evenings.
8% agreed that commonly requested appointments are available
during off-hours, e.g., weekends and evenings (12% agreed that
commonly requested ambulatory and ancillary appointments are
available within 2 weeks).
4% included patient/family advisors in the design of scheduling and
registration procedures and materials.
©2007 University HealthSystem Consortium
Source: Survey Qs 37, 39, 41, 42, 44, 47, 51
VermochUHC PFCC Project.ppt
59
Charge, Billing, and Payment PFCC
Improvement Opportunities Exist
•
28% agreed that easy-to-understand, patient-friendly
descriptions are used on billing statements.
•
24% indicated that patients are able to pay a single copay for
services provided by multiple departments.
•
16% reported that patients receive a combined billing
statement for services provided by multiple departments.
•
16% stated that billing statements are available in the primary
languages of the communities served.
• 12% agreed that patient/family input is used to design and
enhance billing statements and other communications.
•
8% reported that patients/families are able to check accounts
and pay bills online.
©2007 University HealthSystem Consortium
Source: Survey Qs 55, 60, 64, 65, 66, 67
VermochUHC PFCC Project.ppt
60
PFCC Scheduling, Registration,
and Billing Strategies
Partner with patients and family advisors to:
•
Design and implement simple, consistent, and confidential
registration and scheduling procedures with convenient access
to services and coordinated support during scheduling and
care transition
•
Implement consistent finance, charge, billing, and payment
practices that are easy and convenient for patients and
families, e.g., simple language, combined copay, flexible,
online payment options
•
Regularly obtain feedback on billing statements to make sure
they make sense and are easy-to-read
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
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International Conference on PFCC
•
Partnerships for Enhancing
Quality and Safety
–
Jul 30 - Aug 1, 2007
–
Seattle, WA
–
With leadership support
from Children's Hospital &
Regional Medical Center,
University of Washington
Medical Center, and Seattle
Cancer Care Alliance
–
http://www.familycenteredca
re.org/index.html
©2007 University HealthSystem Consortium
VermochUHC PFCC Project.ppt
62
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