Team concepts
Working together to improve the patient experience By Richard Billingsley, MHA, MSN, RN
F
orming partnerships with patients and families promotes high-quality healthcare, resulting in a positive impact on the patient experience. One method noted to improve the patient experience is the implementation of patient- and family-centered care (PFCC). Here we discuss 10 steps for improving the patient experience. The importance of a quality patient experience Healthcare has always been associated with change, but, in recent years, the focus on value instead of volume, technological innovations,
expanded services, increased regulatory mandates, and major reductions in reimbursement rates has created change at an unprecedented rate. To be successful in today’s healthcare market, we must form strong partnerships between hospital providers, physicians, and patients to achieve the necessary outcomes and expectations. One method to meet these goals is to improve the experience of the patient and family in the delivery of their www.nursingmanagement.com
healthcare. This is at the heart of the patient experience movement. The patient experience is defined as the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.1 In trying to improve the patient experience, we need to ask some important questions: Do we allow our patients and family members to be involved in the care delivery process, or do we make decisions about what’s best for them? Do we consider them partners in the provision of healthcare, or just as passive participants? To make our patients more involved in their care, we need to make our care delivery model more patient-centric. One method to encourage and support this involvement of patients and families is the implementation of PFCC at your organization. What’s PFCC? In 2001, the Institute of Medicine published its sentinel work Crossing the Quality Chasm: A New Health System for the 21st Century, identifying six aims for a high-quality healthcare system: (1) safety, (2) effectiveness, (3) timely, (4) patientcentered, (5) efficient, and (6) equitable.2 This recommendation, along with others, provided a strategic roadmap for healthcare reform efforts. Currently, major changes are taking place to reform how healthcare is designed and delivered, and one innovation being adopted to accomplish this goal is the implementation of PFCC in the acute care setting. PFCC was first introduced by Balint and colleagues in the 1970s, so it isn’t a new concept but one that has received a renewed emphasis in recent years due to the patient experience becoming a component of Value-Based Purchasing and being tied to reimbursement rates.3 PFCC is defined as an approach and philosophy to the planning, delivery, and evaluation of healthcare that’s grounded in mutually beneficial partnerships among providers, patients, and families.4 Nursing Management • April 2015 11
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Team concepts The Institute for Patient- and Family-Centered Care identifies the key concepts of the PFCC model as respect and dignity, information sharing, participation, and collaboration.5 PFCC is composed of many different practices, all with the goal of building and improving the relationship between the provider and the patient and family. One of the most popular examples of successful practice at our organization is the implementation of bedside change-of-shift reporting combined with communication boards in patient rooms to promote better communication among patient, families, and staff. Open visiting hours also show remarkable
Key steps in PFCC implementation The success of any new endeavor depends on in-depth planning, support, communication, education, and enculturation with a plan for sustainability. The following 10 steps have been successful in my organization and will be supportive for the successful implementation of PFCC in other community hospital settings. 1. Communicate, communicate, communicate. Making this initiative a topic of continuous conversation is a requirement to ensure that all team members know what it means, how to practice it, and that this goal is important to the success of the organization. Creating standards and scripting allows staff to adopt
By holding staff accountable to produce exceptional patient experiences, you make it everyone’s responsibility and set the goals for all team members to meet. results in the improvement of communication between the families, providers, and staff. Although a challenge to implement, purposeful hourly rounding has been useful in the reduction of call lights and patient falls, and has decreased the use of as-needed pain medications in some patients. Focus on care transition planning processes, including postdischarge telephone calls, has demonstrated a reduction in readmissions. Additional ways to improve the patient experience include promoting access to patient health information via health portals, multidisciplinary rounds, and the use of patient and family advisory councils. All of these elements of PFCC have improved the patient experience in our organization. 12 April 2015 • Nursing Management
these practices easier and with better results. Having a welldeveloped communication plan, complete with timelines and objectives, will advance the PFCC initiative. 2. Adopt an executive sponsor to provide strong leadership support. Strong senior leadership involvement is mandatory. Having a member of the executive team lead this initiative is imperative. This individual may be the CEO, chief operating officer, or CNO. Whoever is chosen to lead this initiative, he or she must be highly visible, dedicated, and willing to work to create a culture around the patient and family experience. Because this initiative is multidisciplinary, the executive sponsor must have broad
authority to initiate goals, set standards, and hold employees accountable for meeting the initiative timeline. 3. Obtain governance board buy-in and support. Members of the board of governance must receive regular updates on the status of specific component implementation to support the initiative. This keeps them engaged in the progress of the initiative and provides continued support to the senior leadership team. Our experience to best engage the board is to include a board member on the steering committee of the patient and family advisory council, which assists in keeping the board involved with the successes of the initiative. 4. Begin building a new culture with the principles of PFCC. Review and modify the organization’s mission, vision, and values to identify and support the goals of PFCC. This may be as simple as adding language to the existing mission and vision statement, but may require a new mission, vision, and values statement to be drafted. Although changing an organization’s culture requires time, having set objectives built into the timeline will help guide this initiative through the culture change process. 5. Review and revise all policies to include the concepts of PFCC. The addition of PFCC language demonstrates the support for and importance of this initiative, and allows staff to begin implementing changes in the method of care delivery on an individual basis. Adjustments in visiting hours and communication methods for families must be communicated widely. This element of PFCC has been very successful in demonstrating that family members are considered a part of the decision-making process and respected in our facility. Involving frontline staff in the www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Team concepts policy changes allows for the staff vision and buy-in to occur. 6. Create behavioral expectations to support a quality patient experience in your facility. Develop a set of behavioral expectations for staff to follow, provide training to meet established goals, and monitor adherence to these behaviors. By setting expectations and making them known, staff members are knowledgeable that this initiative is important and adherence to these standards is expected for all team members. Making purposeful hourly rounding and bedside shift reports a behavioral standard demonstrates to staff that these behaviors are expected and assists in creating mandatory practices. These new behavioral expectations should be introduced during the onboarding process for new employees and included in the performance evaluation process for all staff. 7. Hold staff accountable to standards that create exceptional patient experiences. By holding staff accountable to produce exceptional patient experiences, you make it everyone’s responsibility and set the goals for all team members to meet. If a single staff member doesn’t achieve the standard, the team has the responsibility to counsel those not meeting their performance expectations. 8. Implement a patient and family advisory council. The advisory council composed of former patient and family members promotes improved mechanisms for providing input and guidance in redesigning the healthcare environment. These councils are strictly advisory in nature, but can provide new ideas and support for changes within the organization. They provide input to designated hospital sponsors and receive feedback www.nursingmanagement.com
about the value and status of their recommendations. In my organization, this council is chaired by a former patient or family member and sponsored by a member of the executive leadership team. Currently, frontline staff members don’t participate in the council meetings, but it’s a consideration for the future. 9. Celebrate successes along the way. Schedule celebrations to highlight individual employees’ and departments’ successes related to this initiative. Provide awards and rewards highlighting exemplars of the benefits of PFCC and its outcomes. 10. Evaluate opportunities for improvements. Leadership must follow up by evaluating how the implementation is progressing and identifying new opportunities for additional improvements in outcome measures. Monitoring improvement in Hospital Consumer Assessment of Healthcare Providers and Systems (hcahps) scores and positive patient comments are indicators that these measures are successful. Expected outcomes Research has demonstrated that patient and family involvement in care delivery has a direct relationship on adherence to treatment plans, improved communications, decreased healthcare costs, and overall improved outcomes.6,7 Some anticipated outcomes of increasing the patient experience with the implementation of PFCC may be improved patient and family satisfaction, decreased patient lengths of stay, lower readmission rates for the same medical condition, and potentially improved hcahps scores. Additionally, increased patient loyalty and positive public relations may increase market share and develop repeat users of patient services offered.
Engage your patients Establishing a culture of PFCC allows for patients and families to become partners in planning and implementing their care, and results in better participation, compliance, and satisfaction in overall outcomes. The positive correlation between patient engagement and the implementation of PFCC provides a benefit for the hospital, the provider, and the patient, making it a strong strategy for becoming more “patient-centric” and meeting the changing goals of healthcare. NM
REFERENCES 1. The Beryl Institute. Defining patient experience. http://www.theberylinstitute.org/ ?page=DefiningPatientExp. 2. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001:1-61. 3. Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. Cambridge, MA: Institute for Healthcare Improvement; 2011. 4. Abraham M, Moretz JG. Implementing patient- and family-centered care: part I— understanding the challenges. Pediatr Nurs. 2012;38(1):44-47. 5. Institute for Patient- and Family-Centered Care. Frequently asked questions. http:// www.ipfcc.org/faq.html. 6. Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008; 20(12):600-607. 7. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9): 796-804. Richard Billingsley is the chief operating officer/chief nursing officer at Mena Regional Health System in Mena, Ark. The author has disclosed that he has no financial relationships related to this article.
DOI-10.1097/01.NUMA.0000462377.03723.ee
Nursing Management • April 2015 13
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Working together to improve the patient experience By Richard Billingsley, MHA, MSN, RN
F
orming partnerships with patients and families promotes high-quality healthcare, resulting in a positive impact on the patient experience. One method noted to improve the patient experience is the implementation of patient- and family-centered care (PFCC). Here we discuss 10 steps for improving the patient experience. The importance of a quality patient experience Healthcare has always been associated with change, but, in recent years, the focus on value instead of volume, technological innovations,
expanded services, increased regulatory mandates, and major reductions in reimbursement rates has created change at an unprecedented rate. To be successful in today’s healthcare market, we must form strong partnerships between hospital providers, physicians, and patients to achieve the necessary outcomes and expectations. One method to meet these goals is to improve the experience of the patient and family in the delivery of their www.nursingmanagement.com
healthcare. This is at the heart of the patient experience movement. The patient experience is defined as the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.1 In trying to improve the patient experience, we need to ask some important questions: Do we allow our patients and family members to be involved in the care delivery process, or do we make decisions about what’s best for them? Do we consider them partners in the provision of healthcare, or just as passive participants? To make our patients more involved in their care, we need to make our care delivery model more patient-centric. One method to encourage and support this involvement of patients and families is the implementation of PFCC at your organization. What’s PFCC? In 2001, the Institute of Medicine published its sentinel work Crossing the Quality Chasm: A New Health System for the 21st Century, identifying six aims for a high-quality healthcare system: (1) safety, (2) effectiveness, (3) timely, (4) patientcentered, (5) efficient, and (6) equitable.2 This recommendation, along with others, provided a strategic roadmap for healthcare reform efforts. Currently, major changes are taking place to reform how healthcare is designed and delivered, and one innovation being adopted to accomplish this goal is the implementation of PFCC in the acute care setting. PFCC was first introduced by Balint and colleagues in the 1970s, so it isn’t a new concept but one that has received a renewed emphasis in recent years due to the patient experience becoming a component of Value-Based Purchasing and being tied to reimbursement rates.3 PFCC is defined as an approach and philosophy to the planning, delivery, and evaluation of healthcare that’s grounded in mutually beneficial partnerships among providers, patients, and families.4 Nursing Management • April 2015 11
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Team concepts The Institute for Patient- and Family-Centered Care identifies the key concepts of the PFCC model as respect and dignity, information sharing, participation, and collaboration.5 PFCC is composed of many different practices, all with the goal of building and improving the relationship between the provider and the patient and family. One of the most popular examples of successful practice at our organization is the implementation of bedside change-of-shift reporting combined with communication boards in patient rooms to promote better communication among patient, families, and staff. Open visiting hours also show remarkable
Key steps in PFCC implementation The success of any new endeavor depends on in-depth planning, support, communication, education, and enculturation with a plan for sustainability. The following 10 steps have been successful in my organization and will be supportive for the successful implementation of PFCC in other community hospital settings. 1. Communicate, communicate, communicate. Making this initiative a topic of continuous conversation is a requirement to ensure that all team members know what it means, how to practice it, and that this goal is important to the success of the organization. Creating standards and scripting allows staff to adopt
By holding staff accountable to produce exceptional patient experiences, you make it everyone’s responsibility and set the goals for all team members to meet. results in the improvement of communication between the families, providers, and staff. Although a challenge to implement, purposeful hourly rounding has been useful in the reduction of call lights and patient falls, and has decreased the use of as-needed pain medications in some patients. Focus on care transition planning processes, including postdischarge telephone calls, has demonstrated a reduction in readmissions. Additional ways to improve the patient experience include promoting access to patient health information via health portals, multidisciplinary rounds, and the use of patient and family advisory councils. All of these elements of PFCC have improved the patient experience in our organization. 12 April 2015 • Nursing Management
these practices easier and with better results. Having a welldeveloped communication plan, complete with timelines and objectives, will advance the PFCC initiative. 2. Adopt an executive sponsor to provide strong leadership support. Strong senior leadership involvement is mandatory. Having a member of the executive team lead this initiative is imperative. This individual may be the CEO, chief operating officer, or CNO. Whoever is chosen to lead this initiative, he or she must be highly visible, dedicated, and willing to work to create a culture around the patient and family experience. Because this initiative is multidisciplinary, the executive sponsor must have broad
authority to initiate goals, set standards, and hold employees accountable for meeting the initiative timeline. 3. Obtain governance board buy-in and support. Members of the board of governance must receive regular updates on the status of specific component implementation to support the initiative. This keeps them engaged in the progress of the initiative and provides continued support to the senior leadership team. Our experience to best engage the board is to include a board member on the steering committee of the patient and family advisory council, which assists in keeping the board involved with the successes of the initiative. 4. Begin building a new culture with the principles of PFCC. Review and modify the organization’s mission, vision, and values to identify and support the goals of PFCC. This may be as simple as adding language to the existing mission and vision statement, but may require a new mission, vision, and values statement to be drafted. Although changing an organization’s culture requires time, having set objectives built into the timeline will help guide this initiative through the culture change process. 5. Review and revise all policies to include the concepts of PFCC. The addition of PFCC language demonstrates the support for and importance of this initiative, and allows staff to begin implementing changes in the method of care delivery on an individual basis. Adjustments in visiting hours and communication methods for families must be communicated widely. This element of PFCC has been very successful in demonstrating that family members are considered a part of the decision-making process and respected in our facility. Involving frontline staff in the www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Team concepts policy changes allows for the staff vision and buy-in to occur. 6. Create behavioral expectations to support a quality patient experience in your facility. Develop a set of behavioral expectations for staff to follow, provide training to meet established goals, and monitor adherence to these behaviors. By setting expectations and making them known, staff members are knowledgeable that this initiative is important and adherence to these standards is expected for all team members. Making purposeful hourly rounding and bedside shift reports a behavioral standard demonstrates to staff that these behaviors are expected and assists in creating mandatory practices. These new behavioral expectations should be introduced during the onboarding process for new employees and included in the performance evaluation process for all staff. 7. Hold staff accountable to standards that create exceptional patient experiences. By holding staff accountable to produce exceptional patient experiences, you make it everyone’s responsibility and set the goals for all team members to meet. If a single staff member doesn’t achieve the standard, the team has the responsibility to counsel those not meeting their performance expectations. 8. Implement a patient and family advisory council. The advisory council composed of former patient and family members promotes improved mechanisms for providing input and guidance in redesigning the healthcare environment. These councils are strictly advisory in nature, but can provide new ideas and support for changes within the organization. They provide input to designated hospital sponsors and receive feedback www.nursingmanagement.com
about the value and status of their recommendations. In my organization, this council is chaired by a former patient or family member and sponsored by a member of the executive leadership team. Currently, frontline staff members don’t participate in the council meetings, but it’s a consideration for the future. 9. Celebrate successes along the way. Schedule celebrations to highlight individual employees’ and departments’ successes related to this initiative. Provide awards and rewards highlighting exemplars of the benefits of PFCC and its outcomes. 10. Evaluate opportunities for improvements. Leadership must follow up by evaluating how the implementation is progressing and identifying new opportunities for additional improvements in outcome measures. Monitoring improvement in Hospital Consumer Assessment of Healthcare Providers and Systems (hcahps) scores and positive patient comments are indicators that these measures are successful. Expected outcomes Research has demonstrated that patient and family involvement in care delivery has a direct relationship on adherence to treatment plans, improved communications, decreased healthcare costs, and overall improved outcomes.6,7 Some anticipated outcomes of increasing the patient experience with the implementation of PFCC may be improved patient and family satisfaction, decreased patient lengths of stay, lower readmission rates for the same medical condition, and potentially improved hcahps scores. Additionally, increased patient loyalty and positive public relations may increase market share and develop repeat users of patient services offered.
Engage your patients Establishing a culture of PFCC allows for patients and families to become partners in planning and implementing their care, and results in better participation, compliance, and satisfaction in overall outcomes. The positive correlation between patient engagement and the implementation of PFCC provides a benefit for the hospital, the provider, and the patient, making it a strong strategy for becoming more “patient-centric” and meeting the changing goals of healthcare. NM
REFERENCES 1. The Beryl Institute. Defining patient experience. http://www.theberylinstitute.org/ ?page=DefiningPatientExp. 2. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001:1-61. 3. Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. Cambridge, MA: Institute for Healthcare Improvement; 2011. 4. Abraham M, Moretz JG. Implementing patient- and family-centered care: part I— understanding the challenges. Pediatr Nurs. 2012;38(1):44-47. 5. Institute for Patient- and Family-Centered Care. Frequently asked questions. http:// www.ipfcc.org/faq.html. 6. Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008; 20(12):600-607. 7. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9): 796-804. Richard Billingsley is the chief operating officer/chief nursing officer at Mena Regional Health System in Mena, Ark. The author has disclosed that he has no financial relationships related to this article.
DOI-10.1097/01.NUMA.0000462377.03723.ee
Nursing Management • April 2015 13
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
