Humanizing the Hospital

Open medical records, patient-determined visitations and home-like, soothing surroundings are part of the Planetree (Derby, Connecticut, USA) quest to make health care more healing 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’ full human needs.
 
Planetree’s model of patient- and family-centered care includes the following components:
  • Human interaction
  • Family, friends, and social support
  • Information and education
  • Nutritional and nurturing aspects of food
  • Architectural and interior design
  • Arts and entertainment
  • Spirituality
  • Human touch
  • Complementary therapies
  • Healthy communities
 
An early clinical study published in 1990, demonstrated that the Planetree approach brought dramatically better patient satisfaction levels, received a great deal of attention. Planetree now partners with hundreds of hospitals in their network and with a growing number of long term care facilities, outpatient services, as well as ambulatory care and community health centers.
 
This improvement story provides a quick summary of the Planetree philosophy and practice, which are documented in Susan Frampton and Patrick Charmel's Putting Patients First, 2nd Edition (2009).
 
A Human Touch
The key to Planetree thinking is to promote the development and implementation of innovative models of healthcare that focus on healing and nurturing body, mind and spirit; 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 making it as simple as possible to find your way in the hospital and easy access to parking. “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 if waiting is required. 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,”  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.” Planetree holds that everyone is a caregiver.
 
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.  These family members or friends are often the ones who provide ongoing care and support once the patient goes home so it is essential they learn and are supported in their caregiving role.
 
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 $40,000 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.
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