Planetree: A Radical Model for New Healthcare/Healing/ Wellness Excellence Tom Peters/

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If one didnt know better, one might think that hospitals set out to design systems that provide the most sophisticated technical care but deliver the worst possible experience to sick people.Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

It was the goal of the Planetree Unit to help patients not only get well faster but also to stay well longer.Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Those of us working in healthcare have an obligation to be of service in this world, to be bringers of light and hope. Our work is spiritual by its nature, as the Planetree model has acknowledged for decades. Our definition of spirituality is coming into a right relationship with all that is, establishing a loving, nurturing, caring relationship. Planetrees has been to refocus our attention on the power of relationships, and, in particular, the mind-body-spirit relationship essential to healing. It has opened a door that will never be closed. Leland Kaiser, Holistic Hospitals Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Much of our current healthcare is about curing. Curing is good. But healing is spiritual, and healing is better, because we can heal many people we cannot cure. Leland Kaiser, Holistic Hospitals Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The curative model narrowly focuses on the goal of cure. … From many quarters comes evidence that the view of health should be expanded to encompass mental, social and spiritual well-being. Institute for the Future

Determinants of Health Access to care: 10% Genetics: 20% Environment: 20% Health Behaviors: 50% Source: Institute for the Future

The 9 Planetree Practices 1. The Importance of Human Interaction 2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information 3. Healing Partnerships: The importance of Including Friends and Family 4. Nutrition: The Nurturing Aspect of Food 5. Spirituality: Inner Resources for Healing 6. Human Touch: The Essentials of Communicating Caring Through Massage 7. Healing Arts: Nutrition for the Soul 8. Integrating Complementary and Alternative Practices into Conventional Care 9. Healing Environments: Architecture and Design Conducive to Health Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

1. The Importance of Human Interaction

There is a misconception that supportive interactions require more staff or more time and are therefore more costly. Although labor costs are a substantial part of any hospital budget, the interactions themselves add nothing to the budget. Kindness is free. Listening to patients or answering their questions costs nothing. It can be argued that negative interactionsalienating patients, being non-responsive to their needs or limiting their sense of controlcan be very costly. … Angry, frustrated or frightened patients may be combative, withdrawn and less cooperativerequiring far more time than it would have taken to interact with them initially in a positive way. Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Press Ganey Assoc/1999: 139,380 former patients from 225 hospitals 0 of top 15 factors determining Patient Satisfaction referred to patients health outcome PS directly related to Staff Interaction PS directly correlated with ES (Employee Satisfaction) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Mgrs re staff: wages, security, promotion opportunities Staff re staff: interesting work (M:5 of 10), appreciation (5 of 10), sense of being in about whats going on (10 of 10) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Customer Comes Second: Put your People First and Watch Em Kick Butt, Hal Rosenbluth (and Diane McFerrin Peters)

100 Best Places to Work/RLevering/2001 Get straight answers Appreciation Collaboration Interest in me as a person Camaraderie (Fun place to work)

Perhaps the simplest and most profound of all human interactions is kindness. … But if it is so simple, it is surprising how frequently it is absent from our healthcare environments. … Many staff members report verbal abuse by physicians, managers and coworkers.Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

An estimated 60 to 90 percent of doctor visits involve stress-related complaints.Newsweek/ Health for Life/

Planetree is about human beings caring for other human beings. Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel (Ladies and gentlemen serving ladies and gentlemen4S credo)

2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information

Planetree Health Resources Center/1981 Planetree Classification System Consumer Health Librarians Volunteers Classes, lectures (CR) Health Fairs Griffins Mobile Health Resource Center Open Chart Policy Patient Progress Notes Care Coordination Conferences (Est goals, timetable, etc) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

3. Healing Partnerships: The importance of Including Friends and Family

When hospital staff members are asked to list the attributes of the perfect patient and family, their response is usually a passive patient with no family.Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Family members, close friends and significant others can have a far greater impact on patients experience of illness, and on their long-term health and happiness, than any healthcare professional. Through the Patients Eyes Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

A 7-year follow-up of women diagnosed with breast cancer showed that those who confided in at least one person in the 3 months after surgery had a 7-year survival rate of 72.4%, as compared to 56.3% for those who didnt have a confidant. Institute for the Future

The Patient-Family Experience Patients are stripped of control, their clothes are taken away, they have little say over their schedule, and they are deliberately separated from their family and friends. Healthcare professionals control all of the information about their patients bodies and access to the people who can answer questions and connect them with helpful resources. Families are treated more as intruders than loved ones.Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Institute of Medicine/ Crossing the Quality Chasm Respect for preferences Involvement in Decision Making Access to care Coordination of care Information and education Physical comfort Emotional support Involvement of Friends and Family Continuity of care Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Care Partner Programs (IDs, discount meals, etc) Unrestricted visits (Most Planetree hospitals have eliminated visiting restrictions altogether.) (ER at one hospital has a policy of never separating the patient from the family; and there is no limitation on how many family members may be present.) Collaborative Care Conferences Clinical Guidelines Discussions Family Spaces Pet Visits (POP: Patients Own Pets) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

4. Nutrition: The Nurturing Aspect of Food

Meals are central events vs There, youre fed.* *Irony: Focus on nutrition has reduced focus on food and service Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Kitchen Beautiful cutlery, plates, etc. Chef rep Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Aroma therapy (e.g., smell of baking cookies) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

5. Spirituality: Inner Resources for Healing

Spirituality: Meaning and Connectedness in Life 1. Connected to supportive and caring group 2. Sense of mastery and control 3. Make meaning out of disease/find meaning in suffering Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Spirituality body-mind-spirit prayer-meditation-visualization Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Griffin: redesign chapel (waterfall, quiet music, open prayer book) Other: music, flowers, portable labyrinth Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

6. Human Touch: The Essentials of Communicating Caring Through Massage

Massage is a powerful way to communicate caring.Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Mid-Columbia Medical Center/Center for Mind and Body Massage for every patient scheduled for ambulatory surgery (Go into surgery with a good attitude) Infant massage Staff massage (caring for the caregivers) Healing environments: chemo! Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

7. Healing Arts: Nutrition for the Soul

Planetree: Environment conducive to healing Color! Light! Brilliance! Form! Art! Music! Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Florence Nightingale/Notes on Nursing/patients need for beauty, windows, flowers: People say the effect is only on the mind. It is no such thing. The effect is on the body, too Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Griffin: Music in the parking lot; professional musicians in the lobby (7/week, 3-4hrs/day) ; 5 pianos; volunteers ( hrs arts & entertainment per month). Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

8. Integrating Complementary and Alternative Practices into Conventional Care

CAM (Complementary & Alternative Medicine): 83M in US (42%) CAM visits 243M greater than to PCP (Primary Care Physician) (With min insurance coverage) W-F-Educated-Hi inc Dont tell PCP (40%) OTA: <30% procedures used in conv med have undergone RCTs (randomized clinical trials) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Griffin IMC/Integrative Medicine Center Massage Acupuncture Meditation Chiropractic Nutritional supplements Aroma therapy Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

9. Healing Environments: Architecture and Design Conducive to Health

Planetree Look Woods and natural materials Indirect lighting Homelike settings Goals: Welcome patients, friends and family … Value humans over technology.. Enable patients to participate in their care … Provide flexibility to personalize the care of each patient … Encourage caregivers to be responsive to patients … Foster a connection to nature and beauty Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Sound Texture Lighting Color Smell Taste Sacred space Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Access to nurses station: Happen to vs Happen with Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Eden Alternative

The Ten Principals of the Eden Alternative 1. The three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among Elders. 2. Life in an Elder-centered community revolves around close and continuing contact with children, plants, and animals. These ancient relationships provide young and old alike with a pathway to a life worth living. 3. Companionship is the antidote to loneliness. In an Elder- centered community we must provide easy access to human and animal companionship. 4. A healthy Elder-centered community seeks to balance the care that is being given with the care that is being received. Elders need opportunity to give care and caregivers need opportunities to receive care. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Eden paradigm allows elders to care for animals, birds, and children as well as each other. Susan Eaton, Harvard/JFK school Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Ten Principals of the Eden Alternative 5. Variety and Spontaneity are the antidotes to boredom. The Elder-centered community is rich in opportunities to sample these ancient pleasures. 6. An Elder-centered community understands that passive entertainment cannot fill a human life. 7. The Elder-centered community takes medical treatment down from its pedestal and and places it into the service of genuine human caring. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Ten Principals of the Eden Alternative 8. In an Elder-centered community, decisions should be made by the Elders or those as close to the Elders as possible. 9. An Elder-centered community understands human growth cannot be separated from human life. 10. Wise leadership is the lifeblood of any struggle against the Three Plagues. For it, there can be no substitute. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The most basic question we need to pose in caring for others is this: Is this a loving act? Leland Kaiser, Holistic Hospitals Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Conclusion: Caring/Growth Experience

Care! Control! Connect! Engage! Grow! De-stress!

The single best way to predict the future is to create it. anon