Open medical records, open visitations and home-like surroundings are part of the Planetree (Derby, Connecticut, USA) quest to make health care more comfortable for patients, their families, and staff.  

When Angelica Thieriot left the hospital, she was traumatized. Her clinical care had been excellent but otherwise her treatment was horrendous: The hospital gave her limited information on what was happening, barred her family and friends from visits, and paid no attention to her privacy or comfort.

Shocked and energized by her experience, in 1978 Thieriot founded Planetree to focus on patients’ human needs.

Among Planetree’s key concepts:

• Emphasizing human interactions
• Providing information and education for patients and families Encouraging support from family and friends
• Giving attention to spiritual issues
• Providing massage
• Fostering positive distractions through arts and entertainment Creating suitable architecture and interior designs for medical buildings
• Offering nurturing food

A clinical study published in 1990, which demonstrated that the approach brought dramatically better patient satisfaction levels, received a great deal of attention. Planetree now partners with 90 hospitals, says president Susan Frampton.

This story provides Frampton’s quick summary of the Planetree philosophy and practice, which are documented in Putting Patients First: Designing and Practicing Patient-Centered Care (Jossey-Bass, 2003).

A Human Touch

The key to Planetree thinking is to produce a health care environment in which patients experience caring, kindness, and respect — and so do their families and the hospital staff.

That experience starts with issues such as easy access to parking and making it as simple as possible to find your way in the hospital. “We offer challenges to hospitals to do away with the concept of a waiting area,” Frampton says. Instead, they can provide lounges, libraries, or activity centers so that people can make good use of their time while waiting. Another issue is dress: “A number of our hospitals have patented some nice alternatives to the open-backed johnny.”

“We also do a lot of work on changing the staff attitudes, encouraging respect and sensitivity,” Frampton says. At a minimum, most Planetree hospitals hold a full-day offsite staff retreat that helps employees “reconnect with the meaning of the work they do,” Frampton says. “It’s like graduate school in customer service.” Planetree also works on improving communication among the entire medical staff.

Training is crucial for “every employee of the hospital, from the CEO to the food service providers to the physicians to the Board members and volunteers,” she adds. “You change the culture one person at a time.”

Open Information

“In the traditional model, patients don’t have open access to what is being done to them, and how and why,” Frampton notes. Planetree has long supported the concept of open medical records, used as a tool to educate patients as to what is happening and why.

“This is probably the single most-fought initiative that we have with hospitals,” Frampton notes. She blames a fear of lawsuits, which she calls misplaced. Planetree has found just the opposite, with decreased numbers of liability cases.

She cites two reasons for this. First, “who better to find potential errors in the medical history than the patient?” Second, taking the secrets away creates a bond of trust, which can minimize patient anger.

In hospitals that encourage this practice, Frampton estimates, 40 to 60 percent of patients want to see their own charts.

Planetree also promotes on-site patient libraries, and the practice of giving patients versions of health pathways so that they can understand what to expect.

Friends and Family

“We believe in total open visitation throughout the hospital environment, particularly in critical care environments,” Frampton declares. (Visitors, of course, must wear gowns when needed.) This open door policy can extend even to pets — either the patient’s own pet, or a “pet in residence.”

Family and friends also can find meaningful roles in caring for the patient (such as dressing wounds, feeding or giving bed baths) if they so choose. “We often find they want to provide some of that support to their loved ones,” Frampton comments.

A Healing Environment

Each hospital should ask itself if it meets the criteria for a truly healing environment, Frampton advises. Does the building include appropriate spaces, privacy, and comfort for patients? For instance, are the colors, paints, and fabrics home-like?

“You can now have both a safe environment and an aesthetically pleasing environment,” Frampton says. Plants, fish tanks, fountains and other nice touches can all find an appropriate place. Carpeting is also worth pursuing — for one thing, it can dramatically minimize noise.

Hospitals all question the expense of taking these steps, but those that have embraced the model have found that costs mirror those of typical renovations, Frampton says. More pleasant space also helps with staff retention, she says, remarking that “it costs upwards of $30,000 every time they turn over a nurse.”

Hospitals should also encourage other aids to healing. One is to bring in art and entertainment as positive distractions for patients. Another is to deal with spiritual issues. “In so many hospitals, for so long, it was kind of a taboo to talk about spirituality,” she says. But she explains that this is not necessarily talking about religion. Instead, it’s about the experience of the illness on the person’s life, which may include great moments of learning, she says. Access to chapels, meditation gardens, labyrinths, or other suitable spaces may help.

Hospitals also should “try to create a more meaningful, less horrendous experience for a patient and family when the patient is going to die in a hospital,” Frampton says. For instance, some make harpists available in the patient’s room. In the past 30 years, hospitals have done a good job in “de-medicalizing” the childbirth experience. They should aim to do the same for the dying experience, she suggests.

Riding the Consumer Wave

Health consumerism is giving the patient-centered model a huge boost, Frampton says. “Consumers are paying more out of pocket, and they’re getting more demanding because of that.” Baby boomers are more likely to demand an active role than their parents, and they can tap into sophisticated medical information on the Internet. In one study of ten Planetree-affiliated hospitals, the number of patients who want to read their medical charts has climbed 40 percent in ten years.

Additionally, in a competitive environment, hospitals can aid their market share by increasing patient satisfaction, Frampton notes. Higher patient volume can help to offset any extra costs, she says, and it’s very difficult for insurance providers to drop hospitals that are highly popular with their customers.