® © 2007 University HealthSystem Consortium VermochUHC PFCC Project.ppt Partnering With Patients...

®

© 2007 University HealthSystem ConsortiumVermochUHC PFCC Project.ppt

Partnering With Patients and Families Partnering With Patients and Families to Ensure Safety and Quality Careto Ensure Safety and Quality Care Highlights of the 2007 Patient–and Highlights of the 2007 Patient–and Family–Centered Care Benchmarking ProjectFamily–Centered Care Benchmarking Project

Kathy VermochMay 4 and 7, 2007

©2007 University HealthSystem Consortium

VermochUHC PFCC Project.ppt 2

Goals of This PresentationGoals 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



What Is PFCC?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.

Source: *http://www.familycenteredcare.org/faq.html



The IOM Supports The IOM Supports PatientPatient––CenterednessCenteredness

• 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.

Source: Institute of Medicine — Crossing the Quality Chasm: A New Health System for the 21st Century

Many health care professional, regulatory, and quality improvement organizations also support or require PFCC

concepts, e.g., AHA, Joint Commission, and ACGME



PFCC Is a Business DecisionPFCC 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…



……PFCC Is a Business DecisionPFCC 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.



PFCC–Not Just a Nice Thing to Do!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

Source: *Beckman et al., Archives of Internal Medicine, 1994

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).



MCG: Favorable Trend in MCG: Favorable Trend in Variances, Claims, and LitigationVariances, Claims, and Litigation

Files, Claims, and Litigation

2001 2002 2003 2004 2005 2006 (YTD)

Years

Nu

mb

er o

f R

eco

rded

In

cid

ents

ClaimsLitigation

Files

0

10

20

30

40

50

60

70

80

90

Most UHC members report regular, annual

increase in malpractice pay-outs

Source: MCG Health, Inc.



Project FindingsProject Findings



Goals of the PFCC ProjectGoals 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



Project Participation and Data CollectionProject 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



Though Status VariesThough Status VariesAll Respondents Are EngagedAll Respondents Are Engaged

In PFCC ImplementationIn 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%

Source: Survey Q 1 (one outlier response was trimmed)



Disconnects Exist Between PFCC Disconnects Exist Between PFCC Goals and the Efforts Made to Goals and the Efforts Made to

Achieve Those GoalsAchieve 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.

Source: Survey Qs 2, 3, 5, 12, 71, 73



PFCC Leadership StrategiesPFCC 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

Source: UHC PFCC project



PFCC Core Concept:PFCC Core Concept: Dignity and Respect 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*

Source: *The Institute for Family–Centered 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.

Dignity and Respect



Dignity and Respect:Dignity and Respect: Improvement Opportunities 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.

Source: Survey Qs 22, 24, 30, 31, 36, 46



PFCC Dignity and PFCC Dignity and Respect StrategiesRespect 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.



PFCC Core Concept: PFCC Core Concept: InformationInformation SharingSharing

• 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

Source: The Institute for Family Centered Care

Information Sharing



Paper Records Are Common and Paper Records Are Common and May Hinder Patient, Family, May Hinder Patient, Family,

and Provider Communicationsand 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%

Source: Survey Qs 93, 94, 95, 96

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.



Not All Are Compliant With Joint Not All Are Compliant With Joint Commission Safety Requirements for Commission Safety Requirements for Error Communication and ReportingError 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)

Source: Survey Qs 98, 99

• 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



Confidentiality Is Not New!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.



PFCC Information Sharing StrategiesPFCC Information Sharing StrategiesPartner 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.




PFCC Core Concept: PFCC Core Concept: ParticipationParticipation

• 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

Participation



Patients and Families Have Limited Patients and Families Have Limited Opportunities for Presence or Opportunities for Presence or

Participation in Rounds 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.

Source: Survey Qs 83, 83a, 84, 85, 85a



Room Design and Visitation Policies Room Design and Visitation Policies Often Don’t Provide Privacy, Family Often Don’t Provide Privacy, Family

Sleep Space, or Access to InpatientsSleep Space, or Access to Inpatients• Total staffed inpatient

acute care rooms that are private rooms:

– Median = 50%

– Mean = 52%

– Minimum = 5%

– Maximum = 100%

• Inpatient rooms with family sleep space:

– Median = 10%

– Mean = 35%

– Minimum = 0%

– 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



PFCC Participation StrategiesPFCC Participation StrategiesPartner 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




PFCC Core Concept: PFCC Core Concept: CollaborationCollaboration

• Collaboration:

– Patients, families, health care practitioners and hospital leaders collaborate in:

Policy and program development

Implementation and evaluation

Health care facility design

Professional education

The delivery of care

Source: The Institute for Family–Centered Care

Collaboration



Only Half of Respondents Have Only Half of Respondents Have Patient/Family Advisory CouncilsPatient/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.

Source: Survey Qs 74, 75

But…But…



……Some Organizations Have Some Organizations Have Developed Collaborative Partnerships Developed Collaborative Partnerships

with Patients and Familieswith 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



Effective Patient/Family AdvisorsEffective 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.



PFCC Is Not Often Included in PFCC Is Not Often Included in Health Care Education and Patients/ Health Care Education and Patients/

Families Rarely Serve as PFCC Families Rarely Serve as PFCC TeachersTeachers• PFCC principles are included in

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

Source: Survey Qs 9, 78, 79

Only 19% of survey respondents agreed that

patient and family advisors helped to

develop patient, family, and staff PFCC

educational materials



Patients and Families Patients and Families Rarely Collaborate in Rarely Collaborate in

Provider Selection PracticesProvider 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.




PFCC Collaboration StrategiesPFCC Collaboration StrategiesPartner 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




PFCC in Ambulatory Care and PFCC in Ambulatory Care and Business Office PracticesBusiness Office Practices



PFCC and Ambulatory CarePFCC 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



PFCC and the Business OfficePFCC 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



PFCC Performance Measures: PFCC Performance Measures: Self-Assessment Scores, Self-Assessment Scores,

Satisfaction Surveys, and Other Satisfaction Surveys, and Other Outcomes MeasuresOutcomes Measures



Much PFCC Improvement Is Needed Much PFCC Improvement Is Needed in Every Area Evaluatedin Every Area Evaluated

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

*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

Average PFCC Self-Assessment Scores(Maximum Possible Score = 1.0*)

Source: Survey Qs 2 through 67

• Many felt that the self-assessment 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.



Measures Most Commonly Used Measures Most Commonly Used by Respondents by Respondents

to Monitor PFCC Performanceto 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

Source: Survey Q 113



PFCC Satisfaction Scores Show PFCC Satisfaction Scores Show Improvement Opportunities 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)

Source: Survey Q 115



New Press Ganey PFCC MeasuresNew Press Ganey PFCC MeasuresUHC 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 needsSource: Press Ganey PFCC Metrics Task Force (including a Univ. of Washington representative)



HCAHPS MeasuresHCAHPS Measures• HCAHPS measures that may be used as indicators of patient-

centeredness 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?



PFCC Measurement StrategiesPFCC 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



Next StepsNext Steps

Implementation



Project ConclusionsProject 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



The Most Important Take-Aways The Most Important Take-Aways From This StudyFrom 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



PFCC–Not Just a Nice Thing to Do!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% – Emergency room visits reduced by 30% – Home care use increased by 22% – Hospice use increased by 62% – Higher satisfaction rates for 92% of the PCM members

Source: LSweeney, et al, The American Journal of Managed Care, Feb 2007



Implement PFCC Concepts Through Implement PFCC Concepts Through Partnerships With Patients and Families 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.

Source: The Institute for Family Centered Care



Where To Start?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/long-term care, scheduling, registration, billing, support services, outsourced vendors, etc.



PFCC Advice for BeginnersPFCC 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...



PFCC Advice For BeginnersPFCC 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.



Next StepsNext 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.”

Implementation



PFCC Implementation CollaborativePFCC 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



PFCC Project Deliverables*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.”



The Success of Benchmarking The Success of Benchmarking Comes From Implementation, Comes From Implementation,

Not the DataNot the Data

Dignity and Respect

Information Sharing

Participation Collaboration

Implementation

For more information about the UHC Patient-and Family- Centered Care Project contact Kathy Vermoch at [email protected] or 630/954-1030



AppendixAppendix



PFCC Project ParticipantsPFCC 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



UHC PFCC Benchmarking UHC PFCC Benchmarking Project Steering CommitteeProject Steering Committee

• J. Philip Baroni, Associate Hospital Director of Outpatient Services, UAMS

• Sandra Cockram, Patient Care Advocate Coordinator, University Hospitals Case

• Cezanne Garcia, Associate Director, Washington

• Kim Harper, VP, Human Resources and Public Affairs, Wishard

• Holly Johnson, Project Administrator, Utah

• Julie Moretz (formerly with MCG as Director of Family Services Development)

• Terrell Smith, Director, PFCC, Vanderbilt

• Patricia Sodomka, Senior Vice President, PFCC, MCG

• Thinh Tran, MD, VP, Chief Quality and Patient Safety Officer, Methodist



There Are Many Opportunities to There Are Many Opportunities to Improve Scheduling, Registration, Improve Scheduling, Registration,

and Access to Servicesand 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.

Source: Survey Qs 37, 39, 41, 42, 44, 47, 51



Charge, Billing, and Payment PFCC Charge, Billing, and Payment PFCC Improvement Opportunities ExistImprovement 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.

Source: Survey Qs 55, 60, 64, 65, 66, 67



PFCC Scheduling, Registration, PFCC Scheduling, Registration, and Billing Strategiesand 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

Methodist provides concierge services to coordinate transitions and the scheduling of multiple appointments during visits.



International Conference on PFCCInternational 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.familycenteredcare.org/index.html

® © 2007 University HealthSystem Consortium VermochUHC PFCC Project.ppt Partnering With Patients...

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