Best Practices and Methodologies

Redesigning the Surgical Care Experience: Patients and Families Lead the Way at UPMC

This is the second in a series of guest blog posts, spotlighting how hospitals are engaging their patients to transform care delivery, using the six-step Patient and Family Centered Care Methodology and Practice (PFCC M/P).  

 In 2007, I became a PFCC Champion of one of the first PFCC Working Groups formed at the University of Pittsburgh Medical Center, the PFCC Day-of-Surgery Experience Working Group at UPMC’s flagship hospital, UPMC_PresbyterianUPMC Presbyterian.  With momentum from our first two years of activity, we expanded in 2009 into a broader PFCC Surgical Care Working Group, encompassing the full-cycle of surgical care.  Engaging patients and families as full partners in redesigning care delivery, the PFCC Surgical Care Working Group (still going strong six years after the initial meeting), has spawned dozens of PFCC Project Teams, each of which has transformed care delivery for patients and families.  It is my pleasure to take you through a step-by-step look at our real-world PFCC Working Group and one of its PFCC Project Teams. 

 

Step 1: Define the Care Experience for Improvement

Our PFCC Working Group looks at the entire cycle of surgical care beginning at the physician’s office when the decision is made to have surgery until the patient is either discharged from the ambulatory center or the inpatient unit.

Step 2: Create The PFCC Guiding Council

Our PFCC Guiding Council consists of the Administrative Champion: Executive Director, Surgical Services; the Clinical Champion: Unit Director, Ambulatory Surgery; and the PFCC Coordinator: Administrative Specialist.

Step 3: Define the Current State through Shadowing

Shadowing patients and families through the surgical care experience revealed opportunities for improving the experience of care, opportunities which, of course, are also tied to improved clinical outcomes and decreased cost. These opportunities included: workflow issues relating to the timing of blood draws and the way laboratory orders were entered into the electronic health record, suboptimal meal selection options for patients transferred between units, pain control issues, staff communication issues around shift report, and delays in patients’ filling discharge prescriptions (especially on weekends). 

Step 4: Expand the PFCC Guiding Council into a PFCC Working Group

The PFCC Working Group is comprised of all those who impact the patient and family experience either directly or indirectly. The PFCC Surgical Care Working Group includes our PFCC Guiding Council members along with staff from physician offices, pre-testing, anesthesia, the ambulatory unit, transport, the operating room, the recovery unit, the volunteer office, a Chaplain and the pharmacy.

Step 5: Create a Shared Vision by Writing the Ideal Story

The PFCC Surgical Services Working Group developed a shared vision by creating the ideal care story, based on Shadowing observations, letters, surveys, patient and family input, and ideas provided by care givers (anyone in the health care setting who touches the patient and family experience). The ideal story was written in first person from the patient and family point of view and covered the time from when the patient arrived to the surgeon’s office until they were discharged from either the ambulatory surgical unit or the inpatient stay.

Step 6: Create PFCC Project Teams

PFCC Project Teams close the gaps between the current state identified through Shadowing and the ideal story. While PFCC Working Groups are permanent, PFCC Project Teams have beginnings and endings. This table highlights the gaps we uncovered by Shadowing and the projects implemented by the Post-Operative Care Experience Project Team.     

GAP

PROJECT

Blood work was drawn too late in the day for the results to be available during morning clinical rounds, leading to delayed plans of care.   New laboratory order sets were created in the electronic health record that supported earlier blood draws and availability of results in time for morning clinical rounds.
Patients who were transferred between units sometimes missed regular meal delivery and therefore had suboptimal meal choices.  Patients can now order room service electronically at any time and have a tray delivered directly to their room.
Patients did not always experience optimal post-operative pain control. Improved pain control protocols were initiated, including intravenous Tylenol.
Written shift reports and voice care reports were not optimal for clear communication. We implemented verbal shift reports which are completed at the bedside with the staff, patient and family.
Patients and families were unable to leave with discharge medications, especially on weekends, leading to delays in medication compliance and potentially associated complications.  We implemented a new prescription filling process so that all discharge medications are filled before patients leave.  We also provide pill organizer boxes at discharge.

The PFCC Methodology and Practice (PFCC M/P) has enabled us to identify opportunities to improve, experiences, processes and workflow, some of which have clinical and cost ramifications.  Through the weekly meetings of PFCC Working Groups, which bring together care givers from every relevant function and level within the health care setting, we have made great strides in partnering with patients and families to re-design care delivery.  

The fact that the PFCC Surgical Services Working Group is still active and motivated years after our initial meeting is significant.  Far from a “flavor of the week” improvement approach, the PFCC M/P provides the tools to view all care through the eyes of patients and families and an implementation mechanism to move care from the current state ever closer to the ideal. We see no end in sight because re-Shadowing over time continually reveals new opportunities for improvement.   For more information, please feel free to contact me at rocks@upmc.edu

 

Readers can see how this same methodology was applied to the outpatient setting in a October 10 blog post by Noreen Fredrick of Mon-Yough Community Services.  

 

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Suzanne Rocks, MSN,RN Suzanne Rocks, RN, BSN, MSN, is the Patient and Family-Centered Care (PFCC) Clinical Champion for the PFCC Surgical Services Working Group at UPMC Presbyterian, a 500+ bed tertiary academic hospital at the University of Pittsburgh Medical Center. With over 20 years of clinical and management experience, Ms. Rocks is currently the Administrative Director of Perioperative Services at UPMC Presbyterian. She has spoken at numerous PFCC conferences, management forums, and quality board meetings and is the recipient of the Transformational Leadership Award announced during National Nurse’s Week activities at UPMC Presbyterian.

Suzanne Rocks, MSN,RN has 1 post(s) at EngagingPatients.org

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