PFE, PFCC, and PX: OH MY!

In the healthcare world, we are on a mission. Actually, we are on many missions, and it often seems that we find ourselves trying to find the way forward in the midst of a dizzying rate of change. Although we often point to new developments in technology as the drivers of change, much of this evolution is more philosophical in nature. In particular, the move toward more patient-centered care is, fundamentally, a return to the very heart of our mission in healthcare—to help our patients.

In its publication, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine called upon us to provide “care that is respectful of, and responsive to, individual patient preferences, needs, and values; and ensuring that patient values guide all clinical decisions”. In response to that call, there has been a massive response, with organizations like the Institute for Healthcare Improvement and CMS issuing guides and publications and hospitals establishing whole departments devoted to the cause. In the midst of all of this movement, it often seems that we are lacking consensus on exactly WHERE we are moving to. While it’s clear that we should strive to put the patient at the center of everything we do, we are left to sort through seemingly analogous concepts including “patient and family engagement” (PFE), “patient- and family-centered care” (PFCC), and “patient experience” (PX) and to decide how best to operationalize these approaches in our own organizations. Taken individually, each of these philosophies is comprehensive, and yet, their definitions haven’t been wholly agreed upon. And how do all of these concepts relate to each other? Is the best approach to stick with the approach best fits for our organization’s culture and strategic vision?

Let’s look first at the idea of PFE. One of the more widely recognized definitions from Ann Coulter focuses on a cooperative relationship between patients and providers that enables them to improve health and healthcare at both the individual and collective levels. On the individual level, if we want our patients and families to successfully manage their health conditions, there must be effort on the part of the provider and importantly, on the part of the patient. This idea extends beyond the concept of “compliance” to sharing information, participating in decision-making, and ultimately, co-designing treatment plans. It’s no surprise that this approach leads to reduced complication rates and better “adherence” (in the PFE world, that term is much more agreeable than “compliance”). After all, when patients are encouraged to participate in a conversation about what treatment plan works best for them, they feel much more invested in seeing it through.

On a broader scale, utilizing a patient and family engagement approach can help us to ensure that we develop policies and programs that are relevant and necessary for the people we serve. Essentially, we are asking the very people who consume our healthcare services to help us to make them better. This is something that private industry has been doing for a long time. Think of breakfast cereal manufacturers: before marketing a new cereal or changing an existing recipe, they convene a focus group of consumers to test it first. Our cereal manufacturer certainly understands the peril in marketing a kids’ cereal that kids won’t actually eat. In the healthcare world, our equivalent of cereal consumers are patient and family partners who bring the patient/family voice to internal committees and task forces and who sit on patient/family advisory councils. They advise us on everything from brochures to building design.

“Patient- and family-centered care” as described by the Institute for Patient- and Family-Centered Care (IPFCC) calls us to “redefine the relationships in healthcare” to encourage “mutually beneficial partnerships among healthcare providers, patients and families”. Care that is truly patient- and family-centered recognizes the role of families in our overall wellbeing and includes emotional, social, and developmental support. Many of the ideas embraced in a PFCC approach overlap with PFE—information-sharing and including patients and families not only in treatment conversations, but also in organizational policy and operational discussions. PFCC places a particular emphasis on the importance of including families in care for patients of all ages. Open family presence policy is one PFCC best practice, recognizing that patients fare best when they are in the company of loved ones. Story-telling is another tool in the PFCC toolbox. Giving patients and healthcare providers a venue to share their personal stories is a powerful way to help providers reconnect to purpose and even to combat burnout.

“Patient experience”, according to The Beryl Institute defines as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care”. It includes everything from encounters with physicians and environmental services staff to noise levels on inpatient units to the ease of the registration process. Also, incorporated in the concept of PX is engaging patients in their own care and tailoring that care to fit each person’s individual needs. PX also includes discussion about patient expectations. Did we communicate clearly and in a way the patient could understand? Were those expectations met? As the patient experience movement is still relatively new, there is still a great deal of discussion regarding the scope of the definition. So, while there is a need for continued exploration in this field, it is certain that PX will remain a top priority, not just for healthcare organizations, but for also patients. In 2015, the Beryl Institute surveyed healthcare consumers and found that over 90% of respondents identified the patient experience as extremely important in their healthcare decision-making.

So, we find ourselves back again, exploring the themes that PFCC, PFE, and PX share in common: communication, information-sharing, and partnership. While the conversations continue and we explore ways to not only define, but to operationalize these concepts, I find it helpful to think about the relationship this way: