PFCC 1000 Lives Plus Webinar (Part I) · 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 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!

Your Resources…

www.pfcc.org

http://www.pfcc.org/

Workshop Format

Learning

Aneurin Bevan

Health Board

Real World Example

Go Live!

Current State

Ideal Experience


2. Guiding Council





to Close the Gap



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‖


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


2. Guiding Council





to Close the Gap



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


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


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


2. Guiding Council





to Close the Gap



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.


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


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.


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


Hip Fracture


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


2. Guiding Council





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:

[email protected]

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

http://www.pfcc.org/

Questions?

Documents

PFCC 1000 Lives Plus Webinar (Part I) · Shadow, Current State, Urgency 4. Working Group thru Touchpoints 5. Shared Vision of the Ideal 6. PFCC Project Teams to Close the Gap The