Care Experience-based Methodologies: Performance Improvement Roadmap to Value-driven Health Care

Abstract

The literature contains proposals for creating value by creating exceptional patient experiences rather than simply improving services. However, few articles describe replicable applications focused on the patient experience. We (1) describe the refinement and exportation of an approach that focuses on the patient and family experience; and (2) report changes in patient satisfaction, infection rates, length of stay, mortality rates, clinical indicators, staff turnover, and cost. The Patient and Family-Centered Care Methodology and Practice (PFCC M/P) is a six-step process: (1) selecting a care experience needing improvement; (2) establishing a guiding council; (3) evaluating the current state; (4) developing a permanent working group; (5) creating a shared vision of the ideal experience; and (6) identifying improvement projects to address the gap between the current and ideal experience. We assessed patient satisfaction, changes in clinical indicators, staff turnover, and cost in three clinical programs. In TJA, patient satisfaction is at the 99th percentile; length of stay, infection rates, and mortality rates are substantially better than the national average. In trauma, patient satisfaction increased, time in cervical collars decreased, staff turnover decreased, and the incidence of lost patient belongings was eliminated. In orthopaedic spine, patient satisfaction is higher than the national average, average time for transfer to bed decreased (%), length of stay decreased, and average discharge time decreased. Each of these would have a positive impact on cost. PFCC M/P offers a road map for redefining value as what is important to patients and families.