A Focus on Family
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Involving those closest to the patient can improve outcomes.
To improve outcomes and increase satisfaction among patients in a variety of settings, Anthony M. DiGioia, MD, medical director of the University of Pittsburgh Medical Center's (UPMC) Innovation Center and a practicing orthopedic surgeon, has found an inexpensive but powerful tool: incorporating a patient's family into what he calls the "care experience home."
"None of us know what healthcare is going to hold in the future, but I think we have a process that actually engages patients, families, and staff to help us determine what are the best care platforms for the future," says DiGioia. The methodology is called patient- and family-centered care, and it's now being used among more than a dozen different sites at eight UPMC hospitals.
In its 2001 report, Crossing the Quality Chasm, the Institute of Medicine cited "patient-centered care" as one of six domains of quality—where orienting a health system around the preferences and needs of patients had the potential to improve patients' satisfaction with care and their clinical outcomes. PFCC stretches this definition.
"It is a different approach. When we introduced the idea, we called it a 'disruptive' or 'transformational' approach because even though it sounds like the basics of what we were doing for years, we really haven't been taking care of patients and families the way we should be," he says. "It's not just a process improvement tool, it's a performance improvement tool."
With PFCC, families take on new roles: They are no longer observers but rather participants in the care of the patients both inside and outside the hospital. For instance, with the program on total joint and hip replacement led by DiGioia at 278-bed UPMC Magee-Womens Hospital in Pittsburgh, family members become a "coach" in the care experience—before the patients are even admitted to the hospital.
If inpatient surgery is required, the family members continue as coaches—even accompanying the patients to the gym for group therapy following surgery. The patients and families are encouraged to work together to manage pain. As one example, they can use ice (obtained from small refrigerators in the patients' rooms) to relieve pain. This relationship continues through discharge.
Under PFCC, caregivers are defined as not only nurses and physicians, but other hospital staff such as housekeepers, dieticians, or even human resources staff. "It's everyone. It may not be a direct link to the care experience, but it certainly affects the care experience," he says. "That changes the mind-set of the organization because everyone—no matter what your job—is focused on the patient and family."
Caregivers with each project team meet once a week to talk about what is or is not working. "This is a true grassroots effort. Once the process has started, you don't have to have someone there day in and day out from outside the organization making changes, keeping the process going," DiGioia says.
Positive results were seen during the first year of Magee-Womens program in 2006. As an example:
- Average length of stay was 2.7 days for total hip replacement, compared with the nationwide average of 5.0 days; for total knee replacement, it was 2.8 days compared with 3.9 days.
- 91% of patients undergoing total joint replacement directly returned home, compared with the national average of 29% getting total knee replacement and 23% undergoing total hip replacement.
PFCC working groups have spread to other parts of Magee-Womens, such as bariatrics and women's cancer care. And it has moved to other UPMC hospitals.
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