In Part II, Ms. Greenhouse provides suggestions for integrating the Patient and Family Centered Care Methodology and Practice (PFCC M/P) in those healthcare organizations where Lean process improvement approaches (Lean, Six Sigma and Toyota, etc.) are already in use.

1. The Patient and Family Centered Care Methodology and Practice Meets “Lean”
Part II
Pamela K. Greenhouse, MBA, Executive Director, PFCC Innovation Center of UPMC
PFCC Press
November, 2013

2. Last month’s article described many of the similarities and differences between Lean process
improvement approaches (e.g., Lean, Six Sigma, Toyota, etc.) and the Patient and Family
Centered Care Methodology and Practice (PFCC M/P). For organizations already invested in
Lean but interested in exploring the PFCC M/P as well, the overlapping features of replicability,
and sustainability along with creation of process maps and high performance cross-functional
teams suggests the compatibility of the approaches. There are also significant differences. The
PFCC M/P: 1) focuses on people and processes vs. primarily processes, 2) uses language and
tools that motivate care providers, 3) creates urgency to drive change, 4) requires limited time
commitments and costs, and 4) provides additional depth and breadth of high performance
teams to break down silos and create true culture change.
With the similarities and differences in mind, we have a few suggestions for how organizations
already using Lean can begin to integrate the PFCC M/P:
1. Integrate Shadowing with Value Stream Mapping (Lean’s 2 P and 3 P events) and Rapid
Improvement Events by adding additional team members to Lean improvement teams to
provide a more complete picture of the patient and family experience and to elevate the
experience of care as an equal goal with eliminating waste. Visualizing the “ideal state”
from the patients’ and families’ perspective can lead to new, simpler processes that
improve care and experience while lowering costs.
2. Lean projects are prioritized by hospital or medical practice leadership. PFCC M/P projects
are prioritized by what’s important to patients and families. Integrating the two approaches
will enhance your ability to address what’s important to patients, families, care providers,
and organizations.
3. Before staff engage in any Lean training, have them identify a process they care deeply
about and have that process Shadowed. Once staff sees care through the patients’ and
families’ eyes, increasing value to patients and families and eliminating waste take on a new
urgency.
4. Include PFCC M/P stories and metrics on Managing for Daily Improvement boards. These
would bring data boards to life and engage staff around what they care about most --- the
improved well-being and experiences of the patients and families.
5. Incorporate the PFCC M/P as the overarching approach to transforming care delivery,
thereby taking advantage of the language and the emotional hook of direct observation
that engages caregivers in driving change. This can be done by initiating PFCC Guiding
Councils, PFCC Working Groups, and PFCC Project Teams in keeping with the six steps of the
PFCC M/P.
6. Remember that the PFCC M/P encompasses every segment of every care experience across
the full cycle of care whereas Lean focuses on individual segments and processes and rarely
across the entire healthcare journey.

3. With health care reform upon us, it becomes both more necessary and seemingly more difficult
– as health care resources become even scarcer – to achieve meaningful patient and family
centeredness throughout the health care continuum. Part of the challenge in achieving patient
and family centeredness is #1 defining it and #2 having a replicable implementation mechanism
for achieving it. The PFCC M/P provides both. Through Shadowing, we identify and define
exactly what patients want and need and we continue to do so over time as those wants and
needs change. The PFCC M/P also puts the operational teeth to the concept – providing six
simple and sustainable steps to closing the gaps between current and ideal care delivery.
Lean process improvement has an important role to play in transforming health care by
providing a laser focus on waste and perfecting processes that otherwise unnecessarily exhaust
our increasingly scarce resources. Lean approaches also bring measurement rigor to settings
where it has been significantly lacking. Yet, telling the stories and painting the picture is what
excites people. The PFCC M/P changes hearts and minds, harnessing the power of
collaboration to quickly improve care experiences and clinical outcomes while decreasing waste
and cost. There is an important place for the PFCC M/P in organizations already committed to
using Lean process improvement approaches. The PFCC M/P can be the unifying and simple
theme that every stakeholder in health care can understand and embrace. We suggest that the
PFCC M/P and Lean together can achieve what Lean alone has not in quickening the pace of
improvement with the goal of creating ideal care delivery.
© 2013 PFCC