In first of two-part series, Pamela Greenhouse explores the differences and similarities of the Patient and Family Centered Care Methodology and Practice (PFCC M/P) and leean process improvement approachs, such as Lean, Six Sigma and Toyota. She believes that the PFCC M/P can be the unifying theme for health care, incorporating both process improvement and performance improvement.

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

2. Many health care organizations have invested time and money into using lean-type process
improvement approaches (e.g., Lean, Six Sigma, Toyota, etc.) but are increasingly interested in
the Patient and Family Centered Care Methodology and Practice (PFCC M/P), as well. The
question, then, becomes, why and how? We suggest that integrating the two approaches can
achieve together what lean alone has not; what’s more, the integration can be achieved quickly
and without additional cost.
There are a number of overlapping features between the two approaches, each of which seeks
to fundamentally embed a new way of thinking into the organization’s DNA. Both are
methodical, replicable, and build sustainability into the foundation of the implementation. Both
use flow maps to identify the true current state and both have tool kits for implementing
change. And, finally, both approaches cross departments in order to tap into the power of
cross-functionality to create high performance teams. Yet, there are also differences, and the
nature of these differences suggests that there is a place for both approaches even in a single
organization.
Difference #1: Focus on Patients and Families vs. Processes. The PFCC M/P focuses, first and
foremost, on viewing all care as experiences through the eyes of patients and families. The end
user that matters most in the PFCC M/P is the patient. Lean approaches include patient
experience as a component of value; however, the goal of decreasing waste does not focus
solely, or even primarily, on the patient experience. The patient is not the most fundamental
component of the approach and therefore can sometimes be lost or minimized.
Difference #2: Language. The language difference is important in engaging care providers,
creating a true urgency to drive change, and maintaining ongoing energetic commitment. Care
providers are highly motivated when the focus is clearly on doing what’s right for patients and
families. It may be more difficult to achieve high performance engagement and sense of
urgency using an approach that has less human-oriented language such as value stream
mapping, flow, and pull.
Difference #3: Time. Education and Training. Although the foundation of the PFCC M/P is built
on the work of experts in many fields, the methodology is quick to learn and simple to
implement. There is no long lead-time needed for education and training. Implementation.
The time from implementation to results is also short. Typically, the time between Steps 1 and
6 of the PFCC M/P is four weeks. The PFCC Project Teams then address the low hanging fruit –
the “just do its” -- immediately and timelines for the rest of the projects range from < 30 days
(Fast Track), 30-60 days, and > 60 days. Ongoing Meetings. Finally, the time required to devote
to meetings is limited to ~1 hour/week. While even an hour a week may feel like a problematic
time commitment, we suggest that much more time is spent (wasted) in the work-arounds and

3. inefficient systems care givers face on a daily basis – time that can be eliminated through the
PFCC M/P.
Difference #3: Money. The PFCC M/P does not require any new financial resources. Training
materials are free to download from www.pfcc.org. Shadowing does not need to have an
associated cost, either, as Shadowers can be students, interns, new hires, volunteers, and light
duty staff. PFCC Projects, themselves, are low-tech and often incur no cost. Current resources
are simply re-focused. High performance cross-functional care teams, such as PFCC Working
Groups and PFCC Project Teams, understand that the answer is rarely bringing on increased
staff or building new facilities.
Difference #4: Depth and Breadth: Breaking Down Silos. Although lean process improvement
approaches include select front line staff members, especially during value stream mapping,
only Shadowing will identify all of the touch points (places where any care giver impacts a
patient’s or family’s experience in any way) of the true current state. In addition, the PFCC M/P
care experience covers the full cycle of care and may include pre-hospital, outpatient, inpatient,
procedural, and post-hospital segments of the health care continuum. This broader make-up of
PFCC Working Groups provides the mechanism for breaking down hurdles and silos that
prevent us from providing ideal care delivery. The depth and breadth of PFCC Working Groups
harnesses the power of the group to pursue solutions when a single care giver would struggle
to pursue solutions on his or her own.
Next month’s edition of the PFCC Press will offer recommendations for organizations already
invested in lean-type approaches but interested in integrating the PFCC M/P as well. There are
enough significant challenges in transforming health care delivery that there is room for more
than one improvement approach in an organization, particularly if they build on and
complement each other and fill in gaps that one approach alone does not successfully address.
The PFCC M/P can be the unifying theme for health care, incorporating both process
improvement and performance improvement.
© 2013 PFCC