planetree: a radical model for new healthcare/healing/ wellness excellence planetree: a radical...

PlanetreePlanetree:: A Radical Model for A Radical Model for

New New Healthcare/Healing/Healthcare/Healing/Wellness Wellness ExcellenceExcellence

Tom Peters/17 September 2006

““It was the goal of It was the goal of the Planetree Unit to the Planetree Unit to

help patients not help patients not only get well faster only get well faster but also to stay well but also to stay well longer.”longer.” —Putting Patients First,

Susan Frampton, Laura Gilpin, Patrick Charmel

““Much of our current Much of our current healthcare is about healthcare is about curing curing . . Curing is good. But Curing is good. But healinghealing is spiritual, and healing is is spiritual, and healing is

better, because we can heal better, because we can heal many people we cannot many people we cannot

cure.”cure.” —Leland Kaiser, “Holistic Hospitals”

The 9 Planetree Practices

1.1. The Importance of Human InteractionThe Importance of Human Interaction2. Informing and Empowering Diverse Populations: Consumer Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information Health Libraries and Patient Information3. Healing Partnerships: The importance of Including Friends Healing Partnerships: The importance of Including Friends and Family and Family4. Nutrition: The Nurturing Aspect of Food Nutrition: The Nurturing Aspect of Food5. Spirituality: Inner Resources for Healing Spirituality: Inner Resources for Healing6.6. Human Touch: The Essentials of Communicating Human Touch: The Essentials of Communicating Caring Through Massage Caring Through Massage7.7. Healing Arts: Nutrition for the Soul Healing Arts: Nutrition for the Soul8.8. Integrating Complementary and Alternative Practices Integrating Complementary and Alternative Practices into Conventional Care into Conventional Care9.9. Healing Environments: Architecture and Design Conducive Healing Environments: Architecture and Design Conducive to Health to Health

Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

1. The The Importance of Importance of

Human Human InteractionInteraction

“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 Kindness is freefree.. Listening to patients or answering their

questions costs nothing. It can be argued that negative interactions—alienating patients, being non-responsive to their needs or limiting their sense of control—can be very costly. …

Angry, frustrated or frightened patients may be combative, withdrawn and less cooperative—requiring 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: 139,380 former patients from 225 hospitals:

nonenone of THE top 15 factors of THE top 15 factors

determining determining PPatient atient SSatisfaction atisfaction referred to patient’s health referred to patient’s health outcomeoutcome

PSPS directldirectly related to y related to StaffStaff InteractionInteraction

PSPS directldirectly correlated with y correlated with Employee Employee SatisfactionSatisfaction


Press Ganey Assoc: 139,380 former patients from 225 hospitals

of THE top 15 factors of THE top 15 factors determiningdetermining

PPatient atient SSatisfaction referred to atisfaction referred to patient’s health outcomepatient’s health outcome

PS directly related to Staff InteractionStaff Interaction

PS directly correlated with ESES (Employee Satisfaction)


“Perhaps the simplest and most profound of all human interactions

is KINDNESS. … But if it is so But if it is so simsimpple, it is surle, it is surpprisinrisingg how how

frefreqquentluentlyy it is absent from our it is absent from our healthcare environmentshealthcare environments.. … Many

staff members report verbal

‘abuse‘abuse’’ by physicians,

managers and coworkers.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

““Planetree is Planetree is about human about human

beings caring for beings caring for other human other human

beings.”beings.”

—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel (“Ladies and gentlemen serving ladies

and gentlemen”—4S credo)

2. Informing and Informing and Empowering Diverse Empowering Diverse

Populations: Populations: ConsumerConsumer Health Libraries and Health Libraries and

Patient InformationPatient Information

Planetree Health Resources Center/1981Planetree Health Resources Center/1981Planetree Classification SystemPlanetree Classification System

Consumer Health LibrariansConsumer Health LibrariansVolunteersVolunteers

Classes, lecturesClasses, lecturesHealth FairsHealth Fairs

Griffin’s Mobile Health Resource CenterGriffin’s Mobile Health Resource CenterOpen Chart PolicyOpen Chart Policy

Patient Progress NotesPatient Progress NotesCare Coordination Conferences (Est Care Coordination Conferences (Est

goals, timetable, etc.)goals, timetable, etc.)


3. Healing Healing Partnerships: Partnerships: The The

Importance of Importance of IncludingIncluding

Friends and Friends and FamilyFamily

“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

The Patient-Family Experience

“Patients are stripped of Patients are stripped of control, their clothes are control, their clothes are

taken away, they have little taken away, they have little say over their schedule, and say over their schedule, and

they are deliberately they are deliberately separated from their family separated from their family

and friends. Healthcare and friends. Healthcare professionals control all of professionals control all of the information about their the information about their patients’ bodies and access patients’ bodies and access

to the people who can to the people who can answer questions and answer questions and

connect them with helpful connect them with helpful resources. Families are resources. Families are

treated more as intruders treated more as intruders than loved ones.”than loved ones.” —Putting Patients First,


““Family members, close friends Family members, close friends and ‘significant others’ can and ‘significant others’ can

have a far greater impact on have a far greater impact on patients’ experience of illness, patients’ experience of illness, and on their long-term health and on their long-term health

and happiness, than any and happiness, than any healthcare professional.”healthcare professional.”

—Through the Patient’s Eyes

“A 7-year follow-up of women diagnosed with breast cancer

showed that those who confidedconfided inin atat leastleast oneone personperson in the 3 months after surgery had a 7-year survival

rate of 72.472.4%%,, as compared to 56.3%56.3% for those who didn’t have

a confidant.” —Institute for the Future

Institute of Medicine/ “Crossing the Quality Chasm”

Respect for preferencesRespect for preferencesInvolvement in Decision MakingInvolvement in Decision Making

Access to careAccess to careCoordination of careCoordination of care

Information and educationInformation and educationPhysical comfortPhysical comfort

Emotional supportEmotional supportInvolvement of Friends and FamilyInvolvement of Friends and Family

Continuity of careContinuity of care


Care Partner ProgramsCare Partner Programs (IDs, discount meals, etc.)

Unrestricted visitsUnrestricted 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 ConferencesCollaborative Care ConferencesClinical Guidelines DiscussionsClinical Guidelines Discussions

Family SpacesFamily SpacesPet VisitsPet Visits (POP: Patients’ Own Pets)


4. Nutrition: Nutrition: The Nurturing The Nurturing Aspect of FoodAspect of Food

Meals are central Meals are central eventsevents

vs

“There, you’re fed.” *

*Irony: Focus on “nutrition” has reduced focus on “food” and “service”


KitchenKitchen

Beautiful cutlery,Beautiful cutlery, plates, etc. plates, etc.

Chef reputationChef reputation


Aroma therapyAroma therapy (e.g., “smell of baking cookies”)


5. Spirituality: Spirituality: Inner Resources Inner Resources

for Healingfor Healing

Spirituality: Meaning and Connectedness in Life

1. Connected to supportive and1. Connected to supportive and caring group caring group2. Sense of mastery and control2. Sense of mastery and control3. 3. Make meaning out of Make meaning out of disease/disease/ find meaning in suffering find meaning in suffering


Griffin: redesign chapelredesign chapel (waterfall, quiet music, open prayer book)

Other: music, flowers, portablemusic, flowers, portable labyrinth labyrinth


6. Human Touch: Human Touch: The Essentials of The Essentials of CommunicatingCommunicating

Caring Through Caring Through MassageMassage

“Massage is a Massage is a powerful way to powerful way to

communicate communicate caring.”caring.” —Putting Patients First,


Mid-Columbia Medical Center/Center for Mind and Body

Massage for every patient scheduled for Massage for every patient scheduled for ambulatory surgery ambulatory surgery (“Go into surgery with(“Go into surgery witha good attitude”) a good attitude”) Infant massageInfant massageStaff massage Staff massage (“caring for the caregivers”)(“caring for the caregivers”)Healing environments: chemo!Healing environments: chemo!


7.7. Healing Arts: Healing Arts: Nutrition forNutrition for

the Soul the Soul

Planetree: “Environment conducive to healing”

Color!Color!Light!Light!

Brilliance!Brilliance!Form!Form!Art!Art!

Music!Music!


Florence Nightingale/Notes on Nursing/patient’s need for beauty,

windows, flowers: “People People say the effect is only say the effect is only on the mind. It is no on the mind. It is no

such thing. The effect such thing. The effect is on the body, too.”is on the body, too.”


Griffin: Music in the parking Music in the parking lot; professional musicians in lot; professional musicians in

the lobbythe lobby (7/week, 3-4hrs/day) ;

5 pianos5 pianos ;

volunteersvolunteers (120-140 hrs arts &

entertainment per month).


8. Integrating Integrating Complementary and Complementary and

Alternative Practices Alternative Practices into Conventional into Conventional

CareCare

CAM (Complementary & Alternative Medicine):

83M in US83M in US (42%)(42%)

CAM visits 243M, greater than to PCPCAM visits 243M, greater than to PCP (Primary (Primary Care Physician) (With min insurance coverage)Care Physician) (With min insurance coverage)

W-Educated-Hi incW-Educated-Hi incDon’t tell PCP Don’t tell PCP (40%)(40%)

OTA: <30% procedures used in OTA: <30% procedures used in conventional medicine have undergone conventional medicine have undergone

RCTsRCTs (randomized clinical trials)(randomized clinical trials)


Griffin IMC/Integrative Medicine Center

MassageMassageAcupunctureAcupunctureMeditationMeditation

ChiropracticChiropracticNutritional supplementsNutritional supplements

Aroma therapyAroma therapy


9. Healing Healing Environments: Environments:

Architecture andArchitecture and Design ConduciveDesign Conducive

to Healthto Health

“Planetree Look”

Woods and natural materialsWoods and natural materialsIndirect lightingIndirect lighting

Homelike settingsHomelike settings

Goals: Goals: Welcome patients, friends and Welcome patients, friends and family … Value humans over technology .. family … Value humans over technology .. Enable patients to participate in their care Enable patients to participate in their care

… Provide flexibility to personalize the … Provide flexibility to personalize the care of each patient … Encourage care of each patient … Encourage

caregivers to be responsive to patients … caregivers to be responsive to patients … Foster a connection to nature and beautyFoster a connection to nature and beauty


SoundSoundTextureTextureLightingLighting

ColorColorSmellSmellTasteTaste

Sacred spaceSacred spaceSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Patient Access to Nurses Station/In General:

“Happen to”“Happen to”vs

“Happen with”“Happen with”Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Eden The Eden Alternative*Alternative*

*ElderCare

The Ten Principals of the Eden Alternative

1.1. The three plagues of The three plagues of loneliness, helplessness, and loneliness, helplessness, and boredomboredom account for the bulk of suffering among Elders. account for the bulk of suffering among Elders.2.2. Life in an Elder-centered community revolves around Life in an Elder-centered community revolves around close and close and continuing contact with children, plants, and animalscontinuing contact with children, plants, and animals.. These ancient relationships provide young and old alike with a These ancient relationships provide young and old alike with a pathway to a life worth living.pathway to a life worth living.3.3. CompanionshipCompanionship is the antidote to loneliness. In an Elder-is the antidote to loneliness. In an Elder-centered community we must provide easy access to human and centered community we must provide easy access to human and animal companionship.animal companionship.4.4. A healthy Elder-centered community seeks to balance the care A healthy Elder-centered community seeks to balance the care that is being given with the care that is being received. that is being given with the care that is being received. Elders Elders need opportunities to give careneed opportunities to give care and caregivers need and caregivers need opportunities to receive care.opportunities to receive care.


““The Eden paradigm The Eden paradigm allows elders to care allows elders to care

for animals, birds, and for animals, birds, and children as well as children as well as each other.”each other.” —Susan Eaton,

Harvard/JFK school

Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel`


5.5. Variety and SpontaneityVariety and Spontaneity are the antidotes to are the antidotes to boredom. The Elder-centered community is rich in boredom. The Elder-centered community is rich in opportunities to sample these ancient pleasures.opportunities to sample these ancient pleasures.6.6. An Elder-centered community understands that An Elder-centered community understands that passive entertainment cannot fill a human passive entertainment cannot fill a human life.life.7.7. The Elder-centered community The Elder-centered community takes medical takes medical treatment down from its pedestal and and treatment down from its pedestal and and places it into the service of genuine human places it into the service of genuine human caringcaring..



8.8. In an Elder-centered community, In an Elder-centered community, decisions should decisions should be made by the Elders or those as close to the be made by the Elders or those as close to the Elders as possible.Elders as possible.9.9. An Elder-centered community understands human An Elder-centered community understands human growth cannot be separated from human life.growth cannot be separated from human life.10.10. Wise leadership is the lifeblood of any struggle Wise leadership is the lifeblood of any struggle against the Three Plagues. For it, there can be no against the Three Plagues. For it, there can be no substitute.substitute.


“The most basic question we need to

pose in caring for others is this: Is this Is this a lovina lovingg act act?”?” —Leland Kaiser,

“Holistic Hospitals”


Conclusion: Conclusion: Caring/Growth Caring/Growth “Experience“Experience””

Care!/Love!/Spirit!Care!/Love!/Spirit!

Self-Control!Self-Control!

Connect!/learn!/Connect!/learn!/involve!/Engage!involve!/Engage!

Understanding!/Growth! Understanding!/Growth!

De-stress!/heal! De-stress!/heal!

Whole patient & family Whole patient & family & friends! & friends!

be well!/stay well!be well!/stay well!

Determinants of Health

Access to care: 10%Access to care: 10%Genetics: 20%Genetics: 20%

Environment: 20%Environment: 20%

Health Behaviors:Health Behaviors: 5050%%Source: Institute for the Future

Learn more about Planetree/ Learn more about Planetree/ The Planetree Alliance:The Planetree Alliance:

www.planetree.orgwww.planetree.org

F.Y.I.F.Y.I.

Griffin Hospital/Derby CT (Planetree Alliance “HQ”) Results:

Financially successful. Financially successful. Expanding programs-Expanding programs-

physically.physically. Growing market Growing market share. share. Only hospital in Only hospital in

“100 Best Cos to Work for”—“100 Best Cos to Work for”—7 consecutive years, 7 consecutive years,

currently #6.currently #6.

—“Five-Star Hospitals,” Joe Flower, strategy+business (#42)

EXEXCELLE CELLE ALWALWAYSAYS..

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