Turning Patient-Centeredness From Ideal to Real

Abstract

The Institute of Medicine's 2001 Crossing the Quality Chasm report established patient-centeredness as 1 of 6 core principles for health system redesign. Yet, turning aspiration into accomplishment has proven arduous. Patient-centered care has components that challenge established professional norms, and the term itself has not always been clearly defined. However, these barriers can be overcome using Rogers' principles of diffusion of innovation, as is shown by 2 case histories. One involves care at an urban academic medical center, the other outpatient care at multiple physician sites located in urban, suburban, and rural locations. At the University of Pittsburgh Medical Center, the Patient- and Family-Centered Care Methodology and Practice has become the new "operating system" in 60 clinical areas, using a 6-step approach to engage patients and families as codesigners of ideal care. Meanwhile, the Health Coach Program at Mercy Clinics, Inc, Des Moines, Iowa, has used a "high-tech/high-touch" combined approach to change the organizational culture through patient-centered initiatives. By doing so, it has put the organization in a position to accept risk for populations of patients. Importantly, both programs have been financially and clinically successful, are accepted by frontline physicians and senior management, and are nationally recognized. Common principles include physician leadership, comfort with uncertainty during innovation, organizational structures that send a consistent message about expectations, and quality improvement as a constant cycle with no end point.

Promoting Patient and Family Partnerships in Ambulatory Care Improvement: A Narrative Review and Focus Group Findings

“…Co-design and delivery of practitioner training on supporting people with CKD in self-management Marshall and Nelson [13]CF Foundation QI, launched in 2002Patient/family advisory boards at CF care centers, patients/families on clinical practice guidelines committees. Provide input on improvement opportunities“Enriched the improvement work and motivated the clinicians.” Patients and families received center-level access to outcome measures because “it became clear that it was the right thing to do and it would likely help us accelerate improvement” Millenson et al [34]Mercy Clinic, US; also describes University of Pittsburgh Medical Center’s Patient- and Family-Centered Care [23]Patient Advisory Workgroups on Quality at every clinic location. Patients comment on ongoing improvement plans.…”

“…In addition to improving organizational processes, several articles said patient partnerships benefited patients directly by encouraging deeper communication with providers and motivating improvement and management of personal health [14, 15, 31]. No study reported changes in clinical outcomes associated with engaging patient partners, although three [17, 33, 34] reported correlation with improvements in quality-of-care process measures, including health coaching and care coordination.…”

Determining the True Cost to Deliver Total Hip and Knee Arthroplasty Over the Full Cycle of Care: Preparing for Bundling and Reference-Based Pricing

“…Combining TDABC + PFCC M/P proved to be an effective means of identifying the major cost drivers, capacity utilization, areas of opportunity for improving efficiencies, and experiences for this patient population, and all of the information required to participate successfully in bundling and RBP programs for THR and TKR. While the PFCC M/P has already been shown to improve value in health care [4][5][6][7][8][9][10][11], knowing the major cost drivers over a full cycle of care and having the tools to drive down these costs while protecting outcomes and experiences provides the mechanism to further improve value in health care. We are now beginning to build teams to pilot and operationalize identified improvement opportunities.…”

“…Identifying the current state of a care experience through the PFCC M/P approach involves process mapping (which in PFCC terms is called Care Experience Flow Mapping) using a tool called Shadowing, which is the real-time observation of patients and families through each segment of their health care journey. The PFCC M/P has been found to improve all three components of value in health care -experience, outcomes, and costs [4][5][6][7][8][9][10][11] -what we call the PFCC Trifecta.…”

“…Identifying the current state of a care experience through the PFCC M/P approach involves process mapping (which in PFCC terms is called Care Experience Flow Mapping) using a tool called Shadowing, which is the real-time observation of patients and families through each segment of their health care journey. The PFCC M/P has been found to improve all three components of value in health care -experience, outcomes, and costs [4][5][6][7][8][9][10][11] -what we call the PFCC Trifecta.Our goals for this project were three-fold, to: (1) identify the true cost of care delivery for THR and TKR over the full cycle of care (the full bundle being defined as 30 days before surgery to 90 days postsurgery), (2) take advantage of the inherent synergies between TDABC and the PFCC M/P by using Shadowing (prior to face-to-face discussion among department heads and subject experts) as the link between the two approaches, and (3) show how one tool with a patient centered focus can determine the necessary information to drive improvements …”