Patient Centered Innovation

How Synergies in Methodologies Can Add Value

A Case for Integrating the Patient and Family Centered Care Methodology and Practice in Lean Healthcare Organizations

By Anthony M. DiGioia III, M.D. , Pamela K. Greenhouse, Tanya Chermak, & Margaret A. Hayden

HospitalThere is widespread agreement among policy makers and healthcare providers that patient-centeredness is an imperative moving forward

But how can we operationalize “patient-centered care,” taking it from concept to execution?  How do we engage care providers in partnering with patients and families to co-design the ideal experience? And if our organization already uses Lean or other process improvement approaches, is there something to be gained from integrating the Patient and Family Centered Care Methodology and Practice (PFCC M/P)?

The two approaches – Lean + the PFCC M/P – can be used together to improve outcomes and experiences while lowering costs.  What the PFCC M/P adds to Lean is an enhanced emphasis on the patient and family; an expanded depth and breadth of patient-centered transformation; and tools that allow staff to partner with patients and families in co-designing ideal care delivery. The latter allows staff to re-connect with their mission, restoring joy in the workplace.

The basic principles of Lean in healthcare organizations have their origins in the Toyota Production System that was developed over 50 years ago to streamline manufacturing processes and remove waste. The central idea of Lean in healthcare is to improve quality to patients by eliminating inefficiencies and achieving zero- waste.  Small teams of Lean-trained staff work together to improve the flow of services and, in the best case scenario, deploy this strategy horizontally, vertically, and longitudinally throughout the organization.

The PFCC M/P, a six step approach to viewing all care through the eyes of patients and families and closing the gaps between current and ideal care delivery, has been shown to improve outcomes and experiences while decreasing costs.  Developed in 2006 and grounded in a wealth of practical underpinnings from experts in organizational behavior and design science, it is simple to understand and implement and can be integrated in Lean healthcare organizations.

Six Step Patient and Family Centered Care Methodology and Practice

Step 1 Select a care experience (e.g., total joint replacement, trauma services, bariatrics, etc.) for improvement and define the beginning and end points of the care experience on which to focus
Step 2 Establish a 3-4 person Guiding Council to launch the PFCC M/P
Step 3 Identify the current state of each step of the care experience through patient and family shadowing and Care Experience Flow Mapping
Step 4 Establish a cross-functional and cross-hierarchical PFCC Care Experience Working Group
Step 5 Create a shared vision by writing the ideal care story from the patient’s and family’s point of view
Step 6 Form PFCC Project Teams to close the gaps between the current and ideal state of the care experience

The similarities between Lean and the PFCC M/P make them compatible for adoption within organizations and, indeed, the two together can be leveraged to create a more comprehensive approach to improving care delivery.  Among these similarities are embedding innovative improvement approaches into the DNA of the organization, defining value according to the end user, using the science of improvement (testing and learning cycles), and going to where the work is done.

We suggest that  by focusing on the patient and family, the PFCC M/P humanizes and augments (or can even precede and serve as catalyst for) process improvement approaches (Lean, Six Sigma, TPS, the Institute for Healthcare Improvement’s Transforming Care at the Bedside, etc.).  If you’re already using Lean, the PFCC M/P can be integrated into your work by:

  1. Incorporating Shadowing with value stream mapping (Lean’s 2P and 3P events) and rapid improvement events. Shadowing will provide a more complete picture of the patient and family experience and in a way that creates an urgency to drive change.
  2. Prioritizing your improvement projects by what’s important to patients and families (which you will learn through Shadowing). This can be achieved by incorporating Lean approaches at Step 6 (the project level) of the PFCC M/P.
  3. Having staff identify a project they care deeply about before they engage in Lean training and having them Shadow that process; they will enter the process improvement world with a mindset that improving experiences of patients and families is of equal importance to, and compatible with, eliminating waste.
  4. Incorporating PFCC M/P stories and metrics into Managing for Daily Improvement Boards to bring data boards to life, engaging staff around what they care about most – caring for patients and families.

There are excellent examples of success using Lean in healthcare; the PFCC M/P complements and builds upon Lean, helping to keep the patient and family as the primary focus across the full cycle of care. Integrating the PFCC M/P in Lean healthcare organizations can accelerate the pace of improvement – creating true transformation in care delivery by improving outcomes and experience while lowering cost.


Dr. DiGioia is the Founder and Medical Director at the Bone and Joint Center, Magee-Women’s Hospital of UPMC and the PFCC Innovation Center of UPMC in Pittsburgh, PA.
Pamela Greenhouse is the Executive Director at the PFCC Innovation Center of UPMC in Pittsburgh, PA.
Tanya Chermak is a Principal at East End Associates in Boston, MA.
Margaret A. Hayden is an Administrative Director of Nursing Practice and Research at UPMC Passavant in Pittsburgh, PA.

Photo by Connor Ashleigh, used under CC BY / Cropped and filtered from original

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