Quality Care Paradigm

Goals of This Presentation
Participants will:
Understand the findings and conclusions of the Patientand FamilyCentered Care (PFCC) Benchmarking Project Learn about effective methods for implementing the core concepts of PFCC across the organization
Dignity
and respect sharing
Information
Participation Collaboration
2007 University HealthSystem Consortium VermochUHC PFCC Project.ppt 1
What Is PFCC?
The Institute for FamilyCentered Care (IFCC) defines* patientand familycentered 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
The IOM Supports PatientCenteredness
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. IOMs Six Aims for Healthcare Improvement are safety, patientcenteredness, 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
PFCC Is a Business Decision
3 years ago MCG Health, Inc. began implementing PFCC in neurosciences:
The units 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 Decision
After implementing PFCC concepts in MCGs 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.

MCGs neurosciences market share has increased 12% in 3 years.
PFCCNot 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
MCGs leaders feel that the organizations commitment to PFCC is a significant factor in the dramatic decrease in malpractice suits theyve experienced in recent years (see next slide).
Source: *Beckman et al., Archives of Internal Medicine, 1994
MCG: Favorable Trend in Variances, Claims, and Litigation

Files, Claims, and Litigation
90
Number of Recorded Incidents
80 70 60 50 40 30 20 10
Most UHC members report regular, annual increase in malpractice pay-outs
Litigation Claims Files
0 2001 2002 2003 2004 2005 2006 (YTD)
Years
Source: MCG Health, Inc.
Project Findings
Goals of the PFCC Project
The projects 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 PFCCs core concepts to address the principles of quality care as outlined by the Institute of Medicine
Project Participation and Data Collection
26 organizations completed a PFCC survey/assessment.*
Part 1, Self-assessmenta rating of the organizations current PFCC status across the entire enterprise (excluding behavioral health and prisoner care) Part 2, Drill-down on current practicesrespondents 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 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%
Source: Survey Q 1 (one outlier response was trimmed)
11
Disconnects Exist Between PFCC Goals and the Efforts Made to Achieve Those Goals
65% indicated that PFCC is part of the organizations 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 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 caregiversincluding 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
13
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*
Methodists 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.
Source: *The Institute for FamilyCentered Care
14
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 dcor.
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
15
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 Childrens 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.
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
Source: The Institute for Family Centered Care
17
Paper Records Are Common and May Hinder Patient, Family, and Provider Communications
Medical Record Format Primarily electronic Primarily paper Partially electronic/partially paper Inpatient 8% 12% 80% Outpatient 12% 28% 60% ED 25% 29% 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.
Source: Survey Qs 93, 94, 95, 96
18
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)
Vanderbilts 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; theyve incorporated PFCC goals into improvement initiatives to increase safety
Source: Survey Qs 98, 99
19
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 conceptsthen monitor compliance and hold them accountable.
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.
Colorados Diabetes Star Web system offers access to personal health information and guides patients in goal setting. At OSUs 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.
21
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
Patients and Families Have Limited Opportunities for Presence or Participation in Rounds
In accordance with patient preferences: Families remain with inpatients: General care rounds = 85% Inpatients/Families participate in: General care rounds = 50%
Critical care rounds = 62%

End-of-life care rounds = 62% ED rounds = 31% Not allowed to remain = 8%
Critical care rounds = 35%

End-of-life care rounds = 54% ED rounds = 15% Not allowed to participate = 23%
58% of respondents have no process in place to accommodate family schedules but at UH Cases Rainbow Babies and Childrens 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
23
Room Design and Visitation Policies Often Dont 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% Mean = 35% Minimum = 0% Maximum = 100%
Median = 50% Mean = 52% Minimum = 5% Maximum = 100%
31% dont 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
VermochUHC PFCC Project.ppt 24
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 waybiologically, 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
25
Collaboration
PFCC Core Concept: Collaboration
Collaboration:
Patients, families, health care practitioners and hospital leaders collaborate in:
Policy
and program development
Implementation
Health
and evaluation
care facility design education
Professional
The
delivery of care
Source: The Institute for FamilyCentered Care
26
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
Source: Survey Qs 74, 75
27
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 wont 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 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 dont 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 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

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.
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 caregiversincluding medical staff
PFCC in Ambulatory Care and Business Office Practices
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
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
PFCC Performance Measures: Self-Assessment Scores, Satisfaction Surveys, and Other Outcomes Measures
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
Leadership
Patient and family involvement Communications Environment/facility and patient/family support Scheduling and registration Finance, charge, and payment practices Billing practices
Mean
-0.1
0.2 0.2 0.0 -0.1 0.1 -0.1
2007 University HealthSystem Consortium 37
Measures Most Commonly Used by Respondents to Monitor PFCC Performance
Vendor surveys (national benchmarks):

Complaint Process:

73% Inpatient 65% Emergency department 54% Outpatient 65% Employee turnover 65% Length of stay 62% Fall rates 54% Errors 42% Financial measures
92% Inpatient 58% Outpatient
Internal surveys (internal benchmarks) :

Other outcomes measures:

54% Inpatient 38% Outpatient
4% Patient satisfaction not measured
Source: Survey Q 113
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 Physicians 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
39
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)
HCAHPS Measures
HCAHPS measures that may be used as indicators of patientcenteredness for UHCs 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 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
Implementation
Next Steps
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
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. Dont 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 thats very important, but quality of life is also very important to me and they dont always think about that. Terry H, MCGs Neurosciences Patient/Family Advisory Council
PFCCNot 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
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.
Source: The Institute for Family Centered Care
47
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 careinpatient, 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 48
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...
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 doesnt 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.
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.
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
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 UHCs 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 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 vermoch@uhc.edu or 630/954-1030
Appendix
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.
Source: Survey Qs 37, 39, 41, 42, 44, 47, 51
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.
Source: Survey Qs 55, 60, 64, 65, 66, 67
57
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
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

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Goals of This Presentation

and respect sharing

VermochUHC PFCC Project.ppt

The IOM Supports PatientCenteredness

2007 University HealthSystem Consortium VermochUHC PFCC Project.ppt 3

PFCC Is a Business Decision

3 years ago MCG Health, Inc. began implementing PFCC in neurosciences:

MCG had poor market share in neuroscience.

PFCC Is a Business Decision

After implementing PFCC concepts in MCGs Neurosciences unit:

Unit Press Ganey satisfaction = 95th percentile.

The unit has experienced a significant decrease in medication errors.

2007 University HealthSystem Consortium VermochUHC PFCC Project.ppt 5

PFCCNot 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

2007 University HealthSystem Consortium

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

VermochUHC PFCC Project.ppt

MCG: Favorable Trend in Variances, Claims, and Litigation

Number of Recorded Incidents

Most UHC members report regular, annual increase in malpractice pay-outs

Litigation Claims Files

0 2001 2002 2003 2004 2005 2006 (YTD)

2007 University HealthSystem Consortium VermochUHC PFCC Project.ppt 7

Source: MCG Health, Inc.

2007 University HealthSystem Consortium VermochUHC PFCC Project.ppt 8

Goals of the PFCC Project

Project Participation and Data Collection

26 organizations completed a PFCC survey/assessment.*

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%

2007 University HealthSystem Consortium

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

VermochUHC PFCC Project.ppt

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

PFCC Leadership Strategies

Source: UHC PFCC project

VermochUHC PFCC Project.ppt

Dignity and Respect

PFCC Core Concept: Dignity and Respect

Dignity and Respect:

Source: *The Institute for FamilyCentered Care

VermochUHC PFCC Project.ppt

Dignity and Respect: Improvement Opportunities

32% agreed that care settings provide privacy.

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

VermochUHC PFCC Project.ppt

PFCC Dignity and Respect Strategies

2007 University HealthSystem Consortium VermochUHC PFCC Project.ppt 16

PFCC Core Concept: Information Sharing

2007 University HealthSystem Consortium

Source: The Institute for Family Centered Care

VermochUHC PFCC Project.ppt

Source: Survey Qs 93, 94, 95, 96

VermochUHC PFCC Project.ppt

Source: Survey Qs 98, 99

VermochUHC PFCC Project.ppt

Confidentiality Is Not New!

PFCC Information Sharing Strategies

Source: UHC PFCC project