Achieving Medicine of the
Highest Order – Cultural
Transformation Based on
“Horton Hears a Who”
Bradford C. Berk, MD, PhD
May 22, 2013
Faculty Institute for Teaching and Learning
May 30, 2009
Back to work
Thanksgiving 2009
I’ve learned what’s important
• Treating patients and families with dignity and
respect
• Showing compassion and attentiveness
• Valuing the patient and family
as an integral part of the
health care team
• Listening to our patients
and their families
2007-12 URMC Mission and Vision
• Mission: Using Education, Science and Technology
to Improve Health.
• Vision: Develop a high quality, cost-effective patientcentered healthcare delivery; lead by our world class
researchers, educators and clinicians.
2013-18 URMC Mission and Vision
• Mission: The University of Rochester
Medical Center is a home of healing,
learning, research and innovation committed
to improving health and quality of life for our
patients, families and community.
• Vision: To be nationally recognized by 2020
for improving community health through
transformative approaches in compassionate
care, education and research.
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8
9
Strategy Map
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People and CultureKey Component of Strategic Plan
Enhancing Standard HR duties — benefits, hiring, payroll
NewImplement Business Partners:
 who understand the specific HR challenges that their clients face
 to learn time-tested tactics for fostering employee engagement
 to be able to help managers structure incentives that drive peak
performance
Talent management software to function with existing HRMS system
Boost Evaluation Process and Tools
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The healing power of touch
 Compassion – We need to show we care
 Attentiveness – We need to pay attention to
show we care
My personal experiences:
• as a leader,
• a care provider and
• a patient
Patient and Family Centered Care (PFCC)
A set of principles and values
that when implemented
successfully improve quality,
safety, and long-term
outcome. In addition, data
shows improvement in
patient, family, care provider,
and staff satisfaction.
Transforming a culture
Patients and families are repeatedly telling us we need
to do better in these areas:
• Response to your concerns/complaints
• Staff addressed your emotional needs
• Staff included you in decisions regarding treatment
• Nurses and Physicians kept you informed
• Staff worked together to care for you
• Time physician spent with you
Communication, Compassion and Attentiveness are Critical
URMC components of PFCC
Safety
Courage
Patient and
FamilyCentered
Care
Quality
Caring
Creating value enhances PFCC
 Create Value (Quality/Cost) by implementing
LEAN process improvement strategy
 Eliminate waste in our system without diminishing
the patient experience
• remove extra steps in patient flow
• simplify operational processes
• eradicate duplicate and unnecessary
paperwork
results in better patient and staff satisfaction
 Utilize LEAN approach to help create a patient and
family-centered care culture
Building a PFCC Culture
Areas of Focus:
•
•
•
•
•
Facility
Medical Advances
Information Technology
Delivery of Care
People
Facility
PFCC requires a comfortable supportive environment
 private rooms with family
sleeping spaces
 atmosphere that promotes healing
• Cancer Center Expansion
• New Children’s Hospital
• Upgrade of Current Facilities
Information Technology
eRecord will promote PFCC
 provides immediate and more thorough understanding
 provides improved communication among providers
 can identify high-risk patients to ensure comprehensive care plan
and enhanced communication
 can encourage attentiveness and compassion
o i.e. electronic sticky notes can enhance patient and provider’s bond by
reminding care providers to engage in topics most important to patient
“I am very sorry to know that you recently lost a loved one”
“I understand you are anxious to return home to care for your cat”
Transforming the way we Deliver Care

encourage patient/ family involvement

promote practices to improve patient/family
and provider communication (i.e. rounding
and shift change at the bedside)

breakdown silos – enhance communication
among providers and multidisciplinary care
teams

develop specialized Hospitalists to promote
efficient, but compassionate care

shift from episodic approach to care to full
continuum of care

advanced medical homes
People are the most important part of PFCC
Train all medical staff and employees to be respectful
and offer compassion
• How we communicate determines
how effectively we convey
compassion and attentiveness
• We need to convey to our patients
compassion and attentiveness by
communicating about things that
matter to them
• The healing power of touch
Caring for the caregivers
Our employees need to feel cared for
to provide patient/family-centered care
Staff need to be:
 treated with respect
 supported
 empowered
 recognized
PFCC across URMC delivery system
Patient and Family Members
URMC PFCC Steering Committee
SMH
Highland
GCHAS
VNS
Highlands Highlands
at Brighton
at Pittsford
Creating an ICARE Culture
Integrity - Compassion - Accountability - Respect - Excellence
Influences on Patient Experience

Personal – behaviors/culture

Operational – systems/processes

Physical – environment/facility
focus of
PFCC
initiative
Coordination of 3 broad efforts
- medical center-wide
- department/unit level
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PFCC efforts are making a difference
• 2010 - 2 of the 8 HCAHPS domains at national
average
• 2012 - 6 of the 8 HCAHPS domains exceeded
national avg.
 Hospital Environment
 Pain Management
Making progress but
still below national average
• 2013 - Hospital wide rollout – next stage of PFCC
initiative
 Clearly defining ‘desired patient experience’
 Focus on ‘consistent delivery’ of the experience
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Patients’ Overall Score for Hospital is Improving
HCAHPS Overall Hospital Rating
Strong Memorial Hospital
74
73
72
70.5
69.4
70
67.6
% 9 or 10
68
66
64
67
65.7
69.9
70.4
Achievement
Threshold
63.1
62
60
Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012
Achievement Threshold = CMS Value Based Purchasing minimum (National Median) / 50th Percentile
Displayed by Discharge Date / All Surveys
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Nursing Communication continues to rise
HCAHPS Nurse Communication
Strong Memorial Hospital
84
82
80
% Always
77.9
78
78
78.9
78.7
77.7
76.5
75.3
76
73.6
74
72
Achievement
Threshold
71.7
70
Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012
Achievement Threshold = CMS Value Based Purchasing minimum (National Median) / 50th Percentile
Displayed by Discharge Date / All Surveys
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Staff Responsiveness exceeds national average
HCAHPS Staff Responsiveness
Strong Memorial Hospital
66
64
64
61.2
62
60
58.6
% Always
58
64
62.1
Achievement
Threshold
56.5
56
54
52
53.7
52.7
51.6
50
48
46
Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012
Achievement Threshold = CMS Value Based Purchasing minimum (National Median) / 50th Percentile
Displayed by Discharge Date / All Surveys
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Employee Engagement/Commitment Scores
Measuring Workforce Commitment
Difference from:
2012
URMC
Clinical
Entrprs
43. I am proud to tell people I work for
this organization.
%
Unfav
Natl
UHC
Avg
Natl HC
Avg
2011
URMC
Clinical
Entrprs
4.38
3%
+.02
+.02
+.06
49. I would recommend this organization
to family and friends who need care.
4.34
3%
+.05
+.01
+.05
56. I would like to be working at this
organization three years from now.
4.34
5%
+.08
+.06
+.06
59. I would stay with this organization if
offered a similar job elsewhere for slightly
higher pay.
3.71
15%
.00
-.01
+.07
64. I would recommend this organization
as a good place to work.
4.29
3%
+.14
+.11
+.10
65. Overall, I am a satisfied employee.
4.10
6%
+.06
+.03
+.09
Workforce Commitment Item
Top 10 NYS value based / readmission penalty
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“I’ve learned that people
will forget what you said,
people will forget what you did,
but people will never forget
how you made them feel.”
- Maya Angelou
Thank You