The Bone and Joint Center
UPMC Magee Womens Hospital
- Located in a world-class women's hospital, this program adds value to the larger organization through treatment of arthritis and hip, knee, and back pain.
- At the beginning of this project, the Bone and Joint Center was already performing in the top tier with programs similar to it.
- The program utilizes a patient-centered approach to increase efficiency, reduce cost, and maintain high patient and family satisfaction.
Application of “What Matters to You?” to a High-Volume Total Joint Replacement Program
The Bone and Joint Center at UPMC Magee-Womens Hospital engaged pre and post operative patients to ask “What Matters to You?” (WMTY) in their healthcare experience. Patients’ qualitative comments were bucketed into areas such as surgical outcomes, functional outcomes, pre-operative education and pain management. From this initial feedback, shadowing allowed the team to document patient pathway and experience that allowed for presentation of a more targeted “What Matters to You?” question to collect additional qualitative feedback to incorporate into a comprehensive patient education pathway and consistent staff messaging across the 90-day episode of care.
Through the development and implementation of this pathway, patient reported outcomes and measures such as length of stay, 30-day readmissions and patient experience improved. Length of stay remains at or under 1 day for primary total joint replacement and the orthopaedic program enjoys patient experience scores in the top decile nationally.
Qualitative shadowing data from patients and clinicians revealed opportunities for improvement and actionable solutions that required no additional resources.
Comprehensive patient education materials led to a reduction in readmissions and average length of stay. Barriers to reducing length of stay and 30-day readmission were identified early in the pathway.
Through asking patient and staff “What Matters to You” across the siloed care pathway, multi-disciplinary teams were engaged to create consistent messaging and talking points to answer patient questions and allay fears much earlier in the process.
The Project Design
Phase 1: Defining ‘What,’ in “What Matters to You?”
This project intended to enhance the focus on patient-centered care delivery by first asking patients a simple question: “What Matters to You?” The pilot project began with shadowing 54 patients during their care experience at the Bone and Joint Center (BJC) to better understand the reality of their patient pathway. The question was asked during both pre and post operative appointments to identify any opportunities for improvement in the current patient pathway. During Phase 1 total joint replacement (TJR) patients were asked the following: “What matters to you before surgery, during your hospital stay, and in the first three months following surgery?” and “What matters to you moving forward after you’ve recovered from your joint replacement?”
Four weeks after their operation the same patients were asked, “Now that you’ve been through the surgery and first four weeks of recovery, can you identify new concerns that you didn’t have before?” and “What matters to you moving forward after you’ve recovered?” After aggregating the qualitative responses of patients, the team identified six categories pertaining to patient’s concerns, priorities, and experience evaluation. The categories included: surgical results, quality of life, reduction in pain, quality of care/staff, medical conditions, education and environment. These categories were identified through goShadow’s analysis of patient responses and became the driving framework for the project.
Phase 2: Quantifying What Matters Most
Phase 2 began with a new group of 49 patients scheduled for a TJR surgery with the same physician as the group in Phase 1. Phase 2 presented a redefined project goal: which of the six thematic categories stated in Phase 1 were the most important to patients. The six categories were reworded and a seventh, ‘medical conditions,’ was added to elicit better statistical outcomes from the responses. These categories were accompanied by a clarifying phrase (e.g., Surgical results = I want a good outcome., Medical Conditions = I want my other medical conditions to be controlled). Patients ranked these seven options in order of importance preoperatively, and again postoperatively, which offered insight into which factors were of greatest concern. These segmented responses allowed the team to measure any changes in ranking from pre-operative patient responses. (Figure 2)
At their post-operative appointment patients were instructed, “Now that you’ve gained experience from going through a joint replacement, please rank the categories in terms of how important it would have been to know in your pre-operative interview with what you know now.” Shadowing offered real-time data to inform differences between pre-operative and post-operative responses.
Using real-time patient feedback, surgeons, clinical staff, patients and families co-designed a more ideal state and identified gaps in education and experience that could be addressed without adding additional resources. Incorporating WMTY+shadowing with other process improvement efforts proved to be a valuable method to integrate into existing efforts to identify and scale opportunities for improvement and more ideal practices from one episode of care to another.
Put yourself in a patient’s shoes — build empathy. Authentically understand Why and What matters to your patients, their families, and your team. Use shadowing and goShadow to ask patients standardized questions related to any topic, such as patient education, quality of staff, and discharge planning to understand information patients would like to know and when, as well as opportunities for change within the pathway. Anticipating patient questions will make the process more efficient. Create clinician and patient-reviewed resources that patients have at home to reduce readmissions and to expedite discharge. Increase value to patients and system. goShadow is ready to provide a means to identify what matters to your patients. Are you?