In our aging yet still active population, total joint replacements have become one of the leading Medicare expenditures. In 2010 in the United States, there were 900,000 total joint replacements—600,000 knees and 300,000 hips—at a cost of $4.8 billion. The number of patients needing such replacements is approaching what Dr. D calls “epidemic” levels, and it is expected that demand will increase exponentially in the years ahead. DiGioia is a pioneer in developing new technology for such surgery. In his Pittsburgh practice he performs hundreds of such procedures each year. More than that, though, DiGioia is an innovator who has created a new approach to treating patients, not only in orthopedics but in numerous other care experiences as well.

The essence of Dr. D’s work is his determined effort to solve one of the most challenging and pressing problems in healthcare today: its lack of patient centeredness.

The Patient Centered Value System is predicated on the belief that there is more than enough capacity in the system as it is; that there is no need for any additional resources or spending. The method depends not on new resources but on refocusing existing resources.

At it’s core, PCVS combines shadowing to map the current state of any pathway,  patient centered process improvement teams to co-design care and Time Driven Activity Based Costing (TDABC) to understand the true cost to deliver that care experience. The PCVS is a new operating system that will help hospitals, healthcare systems, clinicians and insurance companies to co-design and achieve value-driven clinical outcomes while improving patient experience and reducing cost.  The cornerstone tool of this approach is called shadowing.

Shadowing is the direct, real-time observation of patients/ families, customers, or products as they move through an experience in any virtually any setting (doctor’s office, retail store, airport, food delivery system, pharmacy etc.). Shadowing is the process by which we capture and document objective and subjective details of the way patients and families, customers or products move through and view their experiences. In 2010, Dr. DiGioia developed a digital shadowing tool, goShadow (add linke), to capture and aggregate shadowing information to quickly share with patient centered process improvement teams. Using the automatically created reports, it is easy to map the current state, spot areas for improvement in any process and to run tests of change to create the ideal experience.

The use of PCVS as the step-wise system for easy adoption makes it an ideal operation solution for any doctor or hospital. It is currently in use in seventy care experiences throughout University of Pittsburgh Medical Center (UPMC), twenty-seven hospitals in the United States and seven countries across the globe. In order to continue to share the success of PCVS with colleagues and others across with US and around the world, Dr. DiGioia recently published his new book, The Patient Centered Value System: Transforming Healthcare Through Co-Design.




Medical Director, The Bone and Joint Center of Magee Women’s Hospital of UPMC and the Innovation Center of UPMC


Founder, goShadow LLC


President, AMD3 Foundation (not-for-profit)


Faculty, Institute for Healthcare Improvement