Page also liked that UPMC is engaging patients more in their post-operative care and educating them about what each day will be like after surgery, with realistic expectations set for when they can go back to work and their normal routines.
Dr. William Ward, chairman of the American College of Surgeons' advisory council for orthopedic surgery, cautioned that patients may feel that they are being hurried out the door. Ward, orthopedics chairman for the three-hospital Guthrie Healthcare System in Sayre, Pa., said patients need to be taught that the sooner they leave the hospital, the less likely they will be to develop an infection. They also need to know that the sooner they are mobile, the less likely they will be to get blood clots.
Ward liked that UPMC uses college interns and others just starting their healthcare careers to shadow the patient experience. He said the fresh eyes of observers without preconceived notions may spot problems for patients and their families that others might accept as part of the daily routine.
Pais said the biggest barrier to implementing the Patient and Family Centered Care methodology was staff resistance to change. But, with the PFCC's focus on empowering frontline caregivers to make improvements, the system has become both a patient and staff satisfier.
DiGioia said the process cannot work without shadowing because it helps determine a hospital area's “current state” and forms the baseline from which to measure improvement. “That is the most critical tool of the methodology,” he said. “It forces you to look through the eyes of the patient.”
Though shadowing began with interns and inexperienced personnel, DiGioia said he is now seeking volunteers from UPMC's executive and managerial ranks. “It's eye-opening for them,” he said.
His methodology for process improvement has six basic steps: Select a care experience and define its beginning and end points; establish a guiding council; evaluate the current state using shadowing and care-flow mapping; establish a care experience working group; create a shared vision of the ideal care experience from the patient's and their family's perspective; and form project improvement teams to close the gaps between current care experiences and the ideal.
“None of this is new, but it's repackaged in a way healthcare people can use,” DiGioia said. “It allows for creativity—that's something you don't always get in healthcare.”
DiGioia added that the methodology is now in place for 65 care experiences at eight UPMC hospitals. He frequently hosts “vision quest” workshops to teach the process to other UPMC departments and institutions across the country. Since its start in elective back surgery, the methodology has since expanded into women's cancer care, breast care and bariatric surgery. It has been used to improve patient trauma care experiences, outpatient mental health services, oncology, home healthcare and joint replacement.
These efforts are also part of expanding the focus of the PFCC program beyond clinical and patient satisfaction improvement. The program also wants to bring in finance department staff to work on calculating the true cost of care.
“Of all the silos we have in healthcare, the financial silo is the most separate,” DiGioia said. “For the first time, we are bringing financial people in with clinical people to have a conversation.”
Follow Andis Robeznieks on Twitter: @MHARobeznieks