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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.

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achieving medicine of the highest order cultural transformation based on horton hears a who

Achieving Medicine of theHighest Order – Cultural Transformation Based on “Horton Hears a Who”

Bradford C. Berk, MD, PhD

May 22, 2013

Faculty Institute for Teaching and Learning

i ve learned what s important
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
2007-12 URMC Mission and Vision
  • Mission: Using Education, Science and Technology to Improve Health.
  • Vision: Develop a high quality, cost-effective patient-centered healthcare delivery; lead by our world class researchers, educators and clinicians.
2013 18 urmc mission and vision
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.
people and culture key component of strategic plan
People and Culture- Key Component of Strategic Plan
  • Enhancing Standard HR duties — benefits, hiring, payroll
  • New-
  • Implement 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

the healing power of touch
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
My personal experiences:

as a leader,

a care provider and

a patient

patient and family centered care pfcc
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



Patient and






creating value enhances pfcc
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

Areas of Focus:


Medical Advances

Information Technology

Delivery of Care


Building a PFCC Culture


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
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

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
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




Caring for the caregivers

PFCC across URMC delivery system

Patient and Family Members

Highlands at Brighton



URMC PFCC Steering Committee




at Pittsford

creating an icare culture
Creating an ICARE Culture

Integrity - Compassion - Accountability - Respect - Excellence


Influences on Patient Experience

  • Personal – behaviors/culture
  • Operational – systems/processes
  • Physical – environment/facility

focus of



Coordination of 3 broad efforts

-medical center-wide

- department/unit level


pfcc efforts are making a difference
PFCC efforts are making a difference

Making progress but

still below national average

  • 2010 - 2 of the 8 HCAHPS domains at national average
  • 2012 - 6 of the 8 HCAHPS domains exceeded national avg.
        • Hospital Environment
        • Pain Management
  • 2013 - Hospital wide rollout – next stage of PFCC initiative
        • Clearly defining ‘desired patient experience’
        • Focus on ‘consistent delivery’ of the experience



“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