Building Personalized Orthopaedic Care with PCVS Tools

The Patient Centered Value System, or PCVS, is an operating system around which any care experience can be built. With PCVS, patient/provider teams create and manage all aspects of care - from scheduling and logistics, to safety, to communication and clinical outcomes. PCVS coordinates the sometimes detached moments of healthcare to create a seamless and harmonized experience. The results? Patients become involved in their own care. Providers are re-energized by the feeling of making a difference. Care teams set goals and meet them. Outcomes improve, value is restored, and caring becomes the focus again.

Think these are big claims?

Read on to see how one orthopaedic practice built a bone and joint wellness program using PCVS tools and team building approaches.

Designed for patients, with patients, the Center for Bone & Joint Health program at UPMC Magee-Womens Hospital offers personalized, non-operative care to help patients manage their symptoms, meet their specific health goals, and live an active life to the fullest. “The Center” personalizes each patient’s care plan and coordinates services, resources, education and programs that lead to better bone and joint wellness. It meets each person’s needs by building care around what matters most to the individual. Patients in the Center have one-on-one health coaching and goal setting sessions with a provider. They use Telehealth and in-person visits to ensure follow-through. A Care Coordinator connects them to specialists who help them manage chronic disease, reduce their weight, and build a sense of confidence and accomplishment in their own well-being. And, though this sounds like a complex and almost un-sustainable model, PCVS lets the Center team focus their energy on the most important factor - the patient.

At the Center for Bone and Joint Health, PCVS keeps the focus on the patient.

An opportunity to be better.

The non-operative, wellness pathway idea was born out of a busy orthopaedic surgery practice where providers recognized that many patients coming through the doors were not surgical candidates…sometimes their joint degeneration was not advanced enough to warrant surgery. Sometimes obesity or other comorbidities made surgery a risky option. Sometimes, despite years of pain and waning mobility, the patient did not want (or could not opt for) surgery. But in all cases, the patients who were non-surgical candidates left the practice with temporary solutions and no plan for getting better. Patients felt hopeless, destined to live in pain and with poor quality of life. Providers felt ineffective. The team saw the potential to do better and they started with PCVS.

Here’s how they did it and why it worked:

First, they started with “what matters.”

“What matters to you?” surveys were distributed to all patients who walked through the doors of the orthopaedic surgery practice. In paper and digital forms, patients were asked questions like What matters to you? What went well today? and What could have gone better today? In the waiting room, a large poster was displayed asking What matters? and stacks of sharpies and colorful post-its were available by every seat. Employees in the practice were surveyed, as well. They answered questions like What makes you most proud in your role? What is the biggest barrier to patients having an excellent experience here? and What is the greatest barrier to finding satisfaction in your work?

Starting with “What matters?” helps us understand the patient’s point of view.

• How can we provide care that meets the patients expectations if we never ask their preference?

• How can we expect patients to adhere to care plans that were designed without their input?

• Why would we ask a patient to rate their satisfaction at the end of a care experience when we haven’t taken the steps to co-design the experience with them?

“What matters?” gives patients a voice and creates a space for them to be a full partner in their own care. It does away with one-size-fits-all treatments and opens the patient/provider conversation that leads to better care, better compliance and better outcomes.

Next, they shadowed the care experience.

Shadowers accompanied patients in the outpatient practice to observe the subtle nuances that make healthcare experiences excellent (or completely unsatisfactory). Shadowing sheds light on both the qualitative and quantitative factors that make up an experience.

Shadowing helps us map out and visualize the care pathway. In this case, the office care pathway was efficient and smooth. However, although patients travelled easily through their appointments, shadowers noticed that many expressed negative emotions like hopelessness, defeat and worry when they realized a surgical “fix” wouldn’t happen. Shadowing provided the fuel and the energy that motivated leaders to create a new program offering non-operative wellness solutions. The power of the human voice, the stories of real people collected through shadowing, helped re-energize the care team and renewed their passion for creating better health (not just higher satisfaction scores) for all patients.

What matters and shadowing showed them the current state. Their next step? Mapping out where they’re going with the Ideal Story.

With the current state in hand, and with renewed energy and a sense of urgency, the team got to work setting goals. They used the Ideal Story activity to create a narrative and to give a visual representation of what they were aiming for. The Ideal Story allowed everyone involved to aim high, to use their creativity and write the story of care that is ideal for both the patient and the provider. No limits, no boundaries, no restrictions - just the very best care possible. Over the course of a few half-hour sessions, the team brainstormed the elements that would add up to an ideal experience. What they discovered was that their imagined ideal care was actually a road map for creating their new wellness program.

The team wrote their story, then broke it down into pieces. The pieces became projects and the projects became teams. Over time, the project teams worked in tandem to build a care experience centered around the needs of patients, families and frontline providers. No detail in the story was overlooked and no project was too big or small to be included.

The tools of the Patient Centered Value System make it easy to co-design care experiences that have value to patients and providers. The team at the Center for Bone and Joint Health used these tools to hear and see their patients in a unique way and to make their patients’ needs the primary focus of their efforts. With “What matters?" surveys, shadowing and the Ideal Story, patients, families, frontline employees and leaders worked together to create a meaningful experiences.

For more details on how the Center for Bone and Joint Health used PCVS Team Building, read on to the next blog.