planetreemodelofcare …6 planetalk w w w. p l a n e t r e e . o r g...

A Newsletter for Planetree: Providing Patient-Centered Care in Healing Environments

PlanetalkPlanetree Model of Careand the Outpatient Environmentat Hospital Israelita Albert Einstein

O c t o b e r 2 0 0 9w w w . p l a n e t r e e . o r g

Photographed by Daniel Ducci

Planetalk Editorial BoardDaniel le Swif t , Managing EditorSara Guastel lo, Edi tor, Designat ion and Resource DevelopmentMichael Rosen, Contr ibut ing Editor, Aff i l iate ResourcesLisa Donnarumma, Chief Creat ive Off icerCindy Jecusco, Contr ibut ing Author, Environmental StewardshipKimberly Montague, Contr ibut ing Author, Archi tecture and DesignNicole Fi tzgerald, Designer

Welcome New Planetree AffiliatesCarson Valley Medical Center

Gardnerville, NV•

Delnor GlenSt. Charles, IL

•VA Heart of Texas Health Care Network (VISN 17)

Arlington, TX

Planetalk

2009 PlaneKnowledgeTeleconference

In This IssuePage 3 - Regional Patient and FamilyEngagement Forum

Pages 4-5 - Commitment to Corporate andSocial Responsibility

Pages 6-7 - Planetree Model of Care andthe Outpatient Environment

Page 8 - Developing a Green Team at YourHospital

Page 10 - Measuring Outcomes forComplementary Therapies

Pages 11-12 - Overcoming CommonBarriers to Implementing Patient-DirectedVisitation

Page 13 - Maternity Access Makeover –with Planetree Flair

Page 14 - Twelve Days of HolidayCelebration

Page 15 - Planetree QuébecPrinciples in Our Own Image

Psge 16 - October is Patient-Centered CareAwareness Month

October 28Raising Expectationsby Decreasing YourTolerance: How to Dealwith Negative Energy

November 4Griffin Hospital’sPatient-CenteredCare Council

December 2Gathering EmployeesFeedback through aStaff Advisory Council

December 16Bringing Talents Alivein a Continuing CareEnvironment

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All calls are held at 12 Noon Eastern Time. Please register forthese teleconferences online at www.planetree.org/membersand click on “conference calls.”

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Patients, Families, HospitalStaff and Leadership Dis-cuss Effective Partnershipsat First Regional Patientand Family EngagementForum

By Sara Guastello, Manager, Designation andResource Development, Planetree

Focus groups, patient satisfaction surveys,ombudsman programs and patient and fam-ily advisory councils (PFACs) are all staplesof a patient-centered culture, and just a fewof the ways that Planetree affiliates are tap-ping into the expertise of patients and fami-lies in order to improve delivery of care at anorganizational level. However, while in the-ory, integration of the patient perspective is acentral tenet of a patient-centered approach,in reality many health care providers strug-gle with the operational aspect of incorporat-ing patient and family feedback inmeaningful ways into hospital operations.Questions of confidentiality, limited comfortwith transparency, fears that our expertisemay be challenged, and concerns over whatit may mean if we can’t give patients every-thing they ask for can thwart efforts to effec-tively partner with patients and families.Nonetheless, as patient-centered providers,we are obliged to find ways to overcomethese barriers and to seek out multiple andvaried ways to integrate patient and familyvoices into hospital operations.

Strategies for effectively involving patientsand their family members at an organiza-tional level was the topic of the first Plane-tree Regional Patient and FamilyEngagement Forum co-hosted on June 11th,2009 by Planetree and affiliate Elmhurst Me-morial Healthcare (Elmhurst, Illinois). Gen-erously funded by the Hulda B. and MauriceL. Rothschild Foundation, the day-long

meeting drew more than 45 participantsrepresenting 15 Planetree hospitals andhealth care systems from throughout theMidwestern United States. Attendees in-cluded staff, leadership and patient/familyrepresentatives, and the dialogue that en-sued confirmed that while the importance ofheeding the patient and family perspective iswidely acknowledged, there remains muchwork to be done to amplify the consumervoice to improve how health care is delivered.

Much of the focus of the meeting was onmaximizing the effectiveness of patient andfamily advisory councils, andmost of the par-ticipants either were currently working with aPFAC or were actively working on the devel-opment of one. Marlene Fondrick, programspecialist with the Institute for Family-Cen-tered Care, provided introductory remarksthat set the stage for four Planetree affiliatesto share their experiences with initiating, sup-porting, sustaining and optimally utilizing apatient and family advisory council.

Representatives from Elmhurst MemorialHealthcare, Delnor Hospital, ClevelandClinic and Alberta Health Services each im-parted lessons they have learned over timeworking with their PFACs, including the sig-nificant distinction between inviting patientsand family members to serve as advisorsversus as partners; the importance of trans-parency; and strategies for cultivating an en-vironment that encourages an open

exchange of ideas. Discussion, however,was not limited to PFACs. A number of pan-elists and attendees shared additional ap-proaches for integrating the patient andfamily perspective at an organizational level,including inviting patient participation onstanding hospital committees, engaging pa-tients to help train staff and residents, and in-volving them in hiring processes.

A number of patient/family advisors werealso in attendance to contribute their per-spectives on what makes the experience ofparticipating on a PFAC so meaningful.Among the insights shared was their desirefor opportunities for meaningful engagementand dialogue on important hospital issues,as opposed to essentially token opportuni-ties for input on initiatives already well un-derway.

Other insights from the patient/family advi-sors and Planetree affiliates that participatedin the Regional Patient and Family Engage-ment Forum are summarized in a new whitepaper, Patients as Experts, Patients as Part-ners: Integrating the Patient and FamilyVoice into Hospital Operations, available atwww.planetree.org. The paper spotlights af-filiates’ experiences with partnering with pa-tients as part of an overall culture ofpatient-centered care, the lessons they havelearned along the way, and how those part-nerships have yielded important results foreach hospital. C

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Commitment to Corporateand Social Responsibility

By Susan Frampton, President, Planetree

In a year fraught with stories of corporategreed, federal bailouts and irresponsibility, Ithought shedding light on a few of our Plan-etree leaders (and I know there are manymore) who are devoted to corporate socialresponsibility (CSR) may lift our spirits whilefurther inspiring each of us to consider build-ing upon our existing programs.

Although many business executives havediffering perspectives of CSR, well-knownauthors on the topic, Philip Kotler and NancyLee, provide this simple definition: Corporateand social responsibility is a commitment toimprove community well-being through dis-cretionary business practices and contribu-tions of corporate resources. The good newsis that despite the global recessionmore andmore organizations are committed to incor-porating principles of CSR into their businessstrategies to improve business performance,societal contribution and reputation.

It is not surprising to me that organizationsthat have embraced the Planetree philoso-phy also embrace the principles of CSR;many Planetree components relate directlyto fundamental elements of CSR. We es-pouseAccess to Information and Education,which includes an organizational commit-ment to transparency and accessibility of in-formation, particularly openmedical records.Human Interactions, especially caring for thecaregiver, is integral to CSR. Actively pro-moting health and improving our employees’well being is not only the right thing to do forstaff, it may ultimately be the smart thing todo for the organization as a whole. Employ-ers benefit from increased productivity and aloyal workforce as well as improved corpo-rate reputation that leads to better recruit-

ment and retention. Griffin Hospital’s dedi-cation to providing an extraordinary work-place culture and environment has led tobeing named by “Fortune” Magazine as oneof the 100 best places to work in the U.S. forthe past 10 years and regularly receivingthousands of applications for open positions.At Planetree, our staff is given a financial in-centive to pursue personal wellness goals.The incentive can be used toward gymmemberships, yoga classes or aerobics.

Green initiatives have been playing increas-ingly larger roles in Architectural and Interiordesign as well as Nutrition and Planetree hasmade it a priority to facilitate conversations,provide expertise and share members’ bestpractices. To that end, each issue of Plan-etalk features a “Going Green” story spot-lighting member sustainability programs andproviding how-to information to the PlanetreeNetwork. See Carol Chandler’s article aboutforming aGreenTeam in this issue on page 8.

Perhaps the most obvious component relat-ing to CSR is Healthy Communities and pro-viding leadership to improve the health of thecommunity by partnering with schools, sen-ior centers, churches and other non-profitsto provide health screenings and health ed-ucation. Our members excel in this area andhave developed numerous outreach pro-grams. Northern Westchester Hospital,which was awarded Planetree’s Patient-

Centered Hospital Designation in 2007, hasfound a number of ways to partner with or-ganizations and individuals to improve thehealth of its community through educationand screening programs. According to CEOJoel Seligman, last year these efforts ex-panded the hospital’s reach significantly,reaching nearly 3,000 people through com-munity health fairs alone.

Planetree affiliates have found numerousways to leverage their resources and com-munity goodwill to contribute to their com-munities’ overall health. Our 2009 Spirit ofPlanetree Award winner for Healthy Com-munities Programming, Carolinas MedicalCenter-Mercy, was acknowledged for its dy-namic partnership with the YMCAof GreaterCharlotte. A variety of services are offeredboth within the YMCA as well as in localchurches and other organizations, to bringhealth education, fitness coaching, preven-tion programs, screenings and seminars tothe community. In 2008, Aurora Health Carewas honored for its support of the KradwellSchool to help kids thrive and learn in a non-traditional school environment. The 2007Spirit of Planetree winner was Saint ThomasHospital for its innovative “Dispensary ofHope,” a goodwill pharmacy program thatprovides medication to underserved and lim-ited income patients. An implementationmanual detailing how the hospital developedthis innovative program is available to affili-


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ates on the Members’ Section of the Plane-tree Web site.

Businesses with well-managed, strategicCSR that truly supports business objectiveshas many benefits including increasingbrand awareness, recruiting and retainingtop talent, and improving relations with com-pliance regulators to name a few. Moreover,according to the 2009 EdelmanTrust Barom-eter survey, trust in business is at a 10-yearlow in the U.S. and 77 percent of survey re-spondents said they refused to buy productsor services from a company they distrusted,

demonstrating that CSR can also impact thebottom line.

Clearly, investments in CSR not only havethe potential to generate significant commu-nity goodwill, but they also make good busi-ness sense. Alegent Health, a healthcaresystem based out of Omaha, Nebraska rec-ognizes that, over time, such investmentscan result in considerable dividends. Duringfiscal year 2008,Alegent’s community bene-fit donations exceeded $80.5 million, reflect-ing an increase of 35.7 percent over the pastthree years. $27.6 million was allocated to


C O R P O R A T E R E S P O N S I B I L I T Y A C T I V I T I E S

Northern Westchester Hospital

• Patient Navigator Program—ensures uninsured or underin-sured have access to prevention, diagnosis and treatmentprograms by assisting with paperwork, language translation,transportation and child care

• Breast Health Initiative including free exams and mammo-grams

• Presidents Junior Leadership Council—27 9th-12th gradestudents meet twice a month and serve as a voice betweencommunity youth and the hospital

• Employee Fitness Challenge

• Massage and tea carts for caregivers

• Farmer’s Market

• Award for car pooling participation (Nuride)

• Community bicycle access and walking paths

• Physical Activities Guide listing local fitness opportunitiessuch as health clubs, trails, yoga, etc.

• Coalition for Healthy Kids—nutrition and exercise assess-ments and programs for area schools and daycare centers

Griffin Hospital

• Staff food donation of 1,649 cases of food to local food banksand a homeless shelter

• Department of Community Outreach and Parish Nursing(Boys and Girls Club Safety Fair, Valley Safe Kids Chapterproviding bike helmets, booster car seats, free ID kits for chil-dren, automated external defibrillators at 48 community sites)

• Support Groups for bereavement, breast cancer, other formsof cancer, diabetes, MS, heart disease and more.

• Mobile Health Resource Center visited 722 sites in FY2008

• Mini Med School taught by medical staff for community“students”

• Yale-Griffin Prevention Research Center and CommunityHealth Profile

• Nutrition Detectives DVD for school age children

• Ansonia High School Charger Health Clinic

• Senior Meals Choice Program

• Healthy Valley Project

• Griffin Go Green Team

Planetree Model of Careand the OutpatientEnvironment

By Arthur Brito, LEED AP, EDAC, Diretorde Projetos, Kahn do Brasil Ltda.

Hospital IsraelitaAlbert Einstein (HIAE) is theleading care provider in the Brazilian privatehealthcare market. Offering a full range ofhealth services to insured and private pay-ing customers, HIAE also contributes toBrazil’s universal healthcare system, provid-ing significant services to the governmentand uninsured patients without compromis-ing the quality of patient-centered services.

On its way to becoming Brazil’s first Plane-tree affiliate hospital, HIAE is celebrating theopening of its first expansion building on theMorumbi Campus in São Paulo, Brazil –Pavilhão Vicky e Joseph Safra, an ambula-tory center identified in the hospital’s masterplan. The project team – a collaboration be-tween HIAE and Kahn offices from SãoPaulo, Brazil, Detroit, Michigan and Birming-ham, Alabama – envisioned a healing envi-ronment designed around the outpatient

experience, which is often brief and intense,and supported by Planetree’s model of carecomponents. The team’s goal – to create theultimate patient-centered experience fromthe moment visitors first approach the build-ing, to follow-up visits and each step alongthe way.

First ImpressionUpon approaching the building, patients and

visitors drive around a glass cylinder that re-veals a wonderful view to the city over theoutdoor plaza and is directed to stop insidethe building avoiding a confrontation to itsmassive 750,000 square feet, minimizing ap-prehension and anxiety typically associatedwith entering a hospital. The ground floor isfully dedicated to non-medical services, in-cluding an information and navigation sta-tion, café, bank and retail shops combined


collaboration with partners to “benefit for thebroader community.” One key program iscalled “Activate Omaha Kids,” a communitycoalition which supports active livingthrough physical activity, healthy eating andchanges to the built environment throughawareness, education, programs and policychanges.

Like Alegent Health, Griffin Hospital priori-tizes CSR activities. In fact, Griffin’s boardof directors and senior management is de-veloping its 2010-2013 strategic plan with

the goal of expanding the already ambitiousCSR program even further.

By becoming Planetree members each ofyou has already demonstrated your dedica-tion to improving the lives of patients andcaregivers. We will continue to facilitate col-laboration and share fresh ideas to encour-age our network to keep on improvingcorporate and social responsibility activities.

C

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with an indoor lounge that welcomes patientsand family. Lounges and activity rooms werecreated in lieu of waiting rooms, allowing thehospital to offer information, spiritual comfortor simply a nice place to watch TV while pa-tients prepare for exams or wait for a lovedone receiving treatment. An outdoor plazadedicated to patients, visitors, staff and thesurrounding residential community alsoserves as a design amenity yet helps to in-tegrate the hospital within the context of itsneighboring environment.

Outpatient ExperienceAlthough the culture of family involvement intreatment is a Brazilian tradition, the numberof new features added to this facility and theamount of space allocated to treatmentspaces set a new precedent for Brazilianhealth care facilities. Consultation and examrooms were planned to accommodate up tothree family members, and all 42 bedroomsin the 24-hour-stay patient unit include dedi-cated space for family. In addition to accom-modating typical patient recovery needs,these bedrooms are also used as prepara-tion for procedures and exams, minimizinganxiety associated with preparation in cubi-cles.

Access to nature and natural light were usedto minimize claustrophobia and anxiety inrooms housing enclosed “tube-like” equip-ment, such as CT or MRI, in medical examrooms, and in one of the minimally invasiveORs. In an effort to understand the impactand benefits these features may have on pa-tients, HIAE and the design team will bestudying patients’ reactions and results.

Planetree and Staff SupportHaving opened its doors in June 2009, thisambulatory center embodies an entirely newmodel of care for HIAE – one that continuesto evolve. Without embracing Planetree’s

philosophy and mission, Pavilhão Vicky eJoseph Safra is merely a compilation of fea-tures.

As planners and designers, we understandthat an organization’s staff must embracePlanetree’s components if they are to trulyprovide patient-centered care. For HIAE, pa-tient-centered design has proven to bemorethan prioritizing patient or family needs andexpectations. Although the hospital has al-ways fully respected its employees, its pas-sion for advancing the Planetree initiative isinfusing new energy into all of its activities. Itis this passion that drives us to make furtherstrides to enhance our design solutions. It isour inspiration to create environments thatnurture and support staff in providing patient-centered care while also dissolving socialtensions – typical in an environment thatmixes demanding patients and a full rangeof staff profiles. This passion is what helpsus to create facilities that enhance the pa-tient, family and staff experiences; to createa design that is all about the people!C


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Developing a GreenTeam at Your Hospital

By Carol Chandler, MSN, RN,Shady Grove Adventist Hospital

Hospitals work diligently to provide qualitypatient experiences, while delivering safeand efficient care to their patients. Initiativesfor the provision of patient care are driven bysafety campaigns, patient satisfactionscores, financial reports and demographics,among others. The core principle underlyinghealth care initiatives is the creed of “First DoNo Harm.” With this creed in mind, and aspublic scrutiny of health care’s impact on theenvironment increases, hospitals have theopportunity to add environmental steward-ship as an initiative of patient care delivery.

The Value of a Green Team:Making the CaseThe health care industry represents the sec-ond largest generator of waste in the UnitedStates, producing more than 2.5 million tonsof waste annually. Of further concern, the in-dustry has transitioned from reusable to dis-posable resources and supplies, causingrising concern over the handling of medicalwaste and its impact on the environment andhealth of surrounding communities. As forenergy consumption, hospitals are majorconsumers of resources such as electricityand water.

However disconcerting the facts are, theypresent rationale for the development of en-vironmentally appropriate policies and prac-tices, opportunities for hospitals to step up tothe plate and do the right thing. The devel-opment of environmentally responsible poli-cies regarding the procurement, use anddisposal of supplies has its financial rewardsas the cost of energy consumption andwaste disposal are minimized. Proper useand disposal of supplies improves safety and

employee satisfaction. Community aware-ness of environmentally driven policies im-proves the perception of the organizationand patient satisfaction.A “stewardship men-tality” leads to efficiency and effectivenessthroughout an organization.

Successful development, implementationand sustainability of environmental policiesrely on the development of a “Green Team,”a team of individuals within the organizationwho work collectively to achieve the hospi-tal’s stewardship goals.

Developing the Team: Having theRight People at the TableConvene a task force made up of represen-tatives from all departments throughout thehospital. Widespread representation allowsthe team to develop hospital-wide strategiesfor action. Every hospital department pres-ents opportunities for process improvement,as well as opportunities to role model bestpractices to others.

Identification of key members for the team ishelped by looking at the “life cycle” and“waste stream” of hospital resources. Everysupply item used by a hospital has a life

cycle from the time the decision to buy theitem was made to the disposal of the item.The cumulative handling of hospital re-sources makes up the hospital’s wastestream.

Invite a member of the hospital’s executiveteam to sponsor the Green Team. This per-son attends team meetings and acts as anadvocate for stewardship initiatives. AtShady Grove Adventist Hospital, the chiefoperating officer serves as the team’s exec-utive sponsor, and is extremely helpful insuccessfully driving stewardship initiatives tohigh levels of decision making. She providesbroad oversight of hospital initiatives and en-sures the feasibility and prioritization of theteam’s objectives/action plans.

Key members of effective green teams arerepresentatives from: nursing, surgical serv-ices, NICU, education, labor and delivery,pharmacy, food services, environmentalservices, materials management, purchas-ing, finance, safety officer (environment ofcare), infection control, radiology, and lab.This group can develop collaborative, house-wide strategies for action with key stake-holder input.

First Things First: Conduct aWaste AuditIn order to establish goals for waste reduc-tion and efficient use of resources, an orga-nizational waste audit should be conducted.Close scrutiny is applied to everything thatcomes into the hospital through purchasingand materials management, as well aseverything that exits the hospital as waste.Hospital waste will include recyclables, mu-nicipal waste, red bag waste, chemothera-peutic agents, pharmaceuticals andpathologic waste. Recyclables may includepaper, plastic, aluminum, cardboard, batter-ies, electronics, fryer grease, light bulbs andblue wrap. The waste stream audit providesvaluable information on the composition of


Planetalk 9

the hospital’s waste, as well as action areasfor greatest impact. Once the waste audit iscompleted, the Green Team can get down tobusiness. A baseline is established, oppor-tunities for improvement are recognized andaction plans are developed.

Resource consumption also takes place inthe form of electricity and water use. Oncethe Green Team is established, membersmay wish to conduct an audit of electricity,water and sewage records to identify oppor-tunities for savings.

Develop a Mission Statementand ObjectivesOnce the waste audit is complete, the GreenTeam must decide what its primary objec-tives are for the organization. The develop-ment of a Green Team mission statementgives the team an identity and purpose, bothin conducting their work and in communicat-ing with others regarding their work. Oppor-tunities for environmental stewardship areassessed and prioritized in order to establishshort term and long term goals of the organ-ization.A long term goal may state, “Hospitalrecycling will increase 50 percent by 2011.”Short term goals will contribute to the long-term goal and may include, recycling bins inevery department by the end of 2009 orwaste reduction will be a part of every de-partment business plan in 2010. Every de-partment is encouraged to do anassessment and contribute to the overallhospital goal.

Promote the Team’s Objectivesand Gain Buy-InCommunication with hospital employees isessential to successful initiatives. Employeesneed to be informed of the Green Team andits objectives. Fun and creative methods canbe used to communicate the hospital’s envi-ronmentally appropriate practices and goalsfor improvement. Contests can be held for“Most Improved Department” or “Most Inno-

vative Idea for Environmen-tal Stewardship.” The GreenTeam at Shady Grove Ad-ventist Hospital held a con-test among employees tocreate a logo for the team.As part of the hospital’s cel-ebration of Earth Day in2009, hospital employeeswere asked to submit origi-nal designs for a GreenTeam logo. Members of theGreen Team reviewed sub-missions and selected thewinner. The Pathology De-partment designed the winning logo and re-ceived T-shirts imprinted with the logo towear on Earth Day. The logo is now a fixtureon all Green Team communications.

Measure Success: Gather Data andReport OutcomesData collection andmeasurement should bea key piece in every process re-design orstrategic initiative considered by the GreenTeam. Hospital leadership and decisionmakers consider environmental stewardshipor waste minimization initiatives in the con-text of how they impact overall hospital op-erations and outcomes, and must prioritizeor balance competing proposals in makingdecisions.

Data that demonstrates cost savings,return on investment or improvement in qual-ity/safety measures provides a backbone towaste minimization efforts. Among provenwinners at Shady Grove Adventist Hospitalare: recycling, which reduced the cost ofwaste disposal (since waste disposal cost isbased on weight, recycled items removedfrom general waste reduces the weight andcost of disposal); investment in technologysuch as water savers in sterile processingthat saved 70 percent of water consumptionfor the department; changing patient traysfrom Styrofoam to dishes that saved the hos-

pital $50,000; and reduction of red bag wastein the OR resulting in huge cost savings inwaste disposal (red bag disposal can cost upto five times more than clear bag disposal).

In ConclusionGrowing concern over the magnitude andimpact of resource management in thehealth care industry makes environmentallyappropriate strategic initiatives all that moreimperative. Hospital-based Green Teamsprovide a centralized forumwhere key stake-holders are represented in organizational as-sessment and action planning. Effectivepolicies and processes are championed andadopted throughout the hospital, resulting inenvironmentally appropriate and cost-effec-tive practices. A cohesive and well-repre-sented Green Team is vital to creating andsustaining a culture of stewardship.C

Resources:Practice Green Health Organization.http://www.practicegreenhealth.org/tools.Accessed 08/20/09.

Shaner, H. and Botter, M. (2003). Pollution:Health Care’s Unintended Legacy: It’s an Avoid-able Legacy. Nurses can protect the environ-ment. American Journal of Nursing, 103, 79-84.

Healthcare Without Harm.http://www.noharm.org/us. Accessed 08/21/09.



Measuring Outcomes forComplementary Therapies

By Julie Norko,Planetree Continuing Care Specialist

Southington CareCenter in Southington,CT is a 130-bed facilityspecializing in short-term inpatient rehabili-tation and rehabnursing care, long-term care and outpa-tient rehab services.This is the second partof a two part series onthe Center.

Southington Care Center’s ten Planetreegoals include benchmarks formeasuring suc-cess to ensure that evaluating the outcomesis not an afterthought. Among the goals for2009-2010 are:

• The engagement of at least 50 percent ofemployees inmeaningful wellness activitiesand programs

• Reaching the 80 percent threshold for em-ployees attending a Planetree experientialretreat

• Continued education and use of comple-mentary therapies including pathways forreferrals and measurement of their out-comes.Measuring and evaluating outcomes for com-plementary therapies like aromatherapy, pettherapy, and music therapies can be chal-lenging. However, approaching the evaluationprocess by examining the referral mecha-nisms and expected outcomes, and with agoal of reducing PRN medications, hashelped to hone the program’s focus. In musictherapy, for example, the music therapistmeasures pain and observes behaviors be-fore and after the music. She also assesses

whichmusic has themost beneficial effect oneach participant.

Dave Santoro, Southington’s administrator,has also been able to capitalize on his rela-tionships with area universities. He is an ad-junct faculty member in the occupationaltherapy department at Quinnipiac Universityand has mentored dozens of students in hiscareer. All of his recent occupational therapygraduate students have completed their cap-stone projects at Southington and have givenhim a bank of outcomes data with which tomeasure the success of Southington CareCenter’s programs. Some of the projects un-dertaken by the OT students included meas-ures around the use of massage therapy andsomatosensory breathing techniques for painmanagement in short-term care, aquatherapyfor pain management in outpatient rehabilita-tion, and the effectiveness of yoga on pain re-duction. The Center sees these initiatives asvital for effective pain management and alsoto provide a menu of options through a com-prehensive complementary therapy program.

While Southington Care Center makes it alllook easy, Dave acknowledges, “There is somuch work behind the scenes. Similarly, de-spite our extensive outreach, there were stillpeople who, when they hear about one of oursuccessful programs, say, ‘I had no idea thatwe are doing that!’ It’s, of course, a work inprogress but that is what Planetree and per-formance improvement is all about. The im-portant point is that everything, in concert,works toward the same end.”

Southington Care Center is part of Connecti-cut Senior Health Services, a continuum thatincludes two skilled nursing facilities and threerental assisted living communities that pro-vide a wide range of services from independ-ent living to memory care, adult day careservices, and the CT Center for HealthyAging.

TrishWalden, vice president of operations forConnecticut Senior Health Services, detailsthe organization’s rationale for embracingPlanetree: “Because our organization is aleader in our industry, several of our key staff

Southington Care CenterOutcomes from Occupa-tional Therapy studentCapstone Projects(Spring, 2009)

Efficacy of massage therapy onpain management and activity ofdaily living (ADL) performance:• 2x/week for 30 min session massage by alicensed massage therapist yielded a 31%decrease in self-reported pain (0-10 scale)• Outcomes forADL performance showedincrease in function of average of 1 FunctionalIndependence Measure (FIM) level (16%)• All clients reported improved sleep onnight of massage

Efficacy of SRI (somatorespiratoryintegration) on pain and function• SRI (deep breathing) yielded a 42.5%decrease in self-reported pain• Average increase of 1.5 levels on FIMscale for physical performance (24%)

Efficacy of aquatic therapyperformance and pain management• Reduction in self-reported pain of27% average• Average increase in occupational perform-ance per scale of 1.27 points (17%)

Efficacy of yoga on quality of life andpain management• Reduction in self-reported pain of 17%• Average increase in occupationalperformance of 1.25 points (16%)

Efficacy of Snoezelen sensoryprogram on managing behaviors andPRN pain and anxiety medicationreduction in persons with dementia• 75% improvement in areas of improvedposture, appropriate gaze and verbalizationnoted for Snoezelen intervention• Average reduction of 1 PRN pain and/oranxiety medication per day for persons withdementia on days of Snoezelen interventionversus other sensory approaches

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Overcoming CommonBarriers to ImplementingPatient-Directed Visitation

By Jeanette Michalak, RN, MSN, Vice Presidentof Planetree Consultation Services andSara Guastello, Manager, Designation andResource Development, Planetree

As Planetree members are quite aware, pa-tients routinely identify the involvement offamily and friends as among the most valu-able of aspects of the care they receive inhospitals that have adopted a patient-cen-tered approach. Those who have embarkedon changing this aspect of care find that it isnot always an easy process. Visiting hoursat hospitals around the country have been inplace from the time the first brick was placedin the hospital structure, and over time theyhave become an expected part of hospitalroutines and culture.

Although nursing staff routinely “break therules” of visitation policies in order to ac-commodate individual patient and visitor cir-cumstances, doing away with themaltogether may be seen as taking away avaluable tool. In the words of one staff focusgroup participant, “We are very loose interms of when people can visit. I like to havethe policy in my back pocket for times whenfamilies get out of hand…as something to fallback on.” This and other concerns contributeto an interesting phenomenon wherein staff

may resist implementing a rule to allow visi-tors, while the same caregivers may consis-tently demonstrate a willingness to break arule restricting visitation. This results in fam-ily members looking for the “nice nurse” wholets them stay when they come to visit, whichcan unfortunately cause friction with othernurses and between nursing peers. Formal-izing a welcoming and flexible approach tovisitation provides a consistent process andsends powerful messages about an organi-zation's patient-centered culture and theimportant role that family (however family isdefined by the patient) plays.

Since involving family and friends in patientcare and including staff in creating policiesimpacting them are basic tenets of the Plan-etree model, specific strategies to facilitatethe implementation of patient-directed visita-tion are much-needed tools for organiza-tions. A thorough understanding of thebarriers to implementation is essential. Thisarticle presents elements in the health careenvironment that challenge patient-directedvisitation and strategies to consider whenworking toward this goal.

Inclusion of family and friends andcreating a welcoming environmentEvidence-based information is generally thecornerstone upon which initiatives are builtin hospitals; yet in the case of flexible visita-tion, providing the existence of “proof” thatinclusion of family and friends benefits thepatient is often not enough. In the current

health care environment staff may resist in-creasing contact with visitors for a variety ofreasons including frustrations with staffinglevels, the inefficiency of their working envi-ronment, safety concerns and a lack of un-derstanding of the purpose of open visitationwhen nursing judgment is still required tomanage the process.

IDENTIFIED FRUSTRATIONSINCLUDE BUT ARE NOTLIMITED TO:

STAFFING• Reduction in staffing levels

• Unwillingness of team members to workas a team, e.g. personal care/call lights rel-egated to one or two nursing assistants onthe unit

• A silo effect of ancillary departments inwhich patient care is seen as the work ofnursing

EFFICIENCY ISSUES INTHE ENVIRONMENT• Centrally located supplies

• Insufficient stock of supplies andnourishment

• Lack of equipment or equipmentnot in working order

• Lack of standardization of location ofsupplies/equipment from one unitto another

SAFETY CONCERNS• Multiple entrances open off shift

and board members initially felt that we werealready ‘Planetree’ in nature, so why did weneed to improve on what was already consid-ered outstanding? This is perhaps the mostsignificant reason why we decided to becomePlanetree affiliates. We have an excellent rep-utation and history; Planetree is a way to en-sure that we continue that legacy long into thefuture. It is because we are innovators and

change-agents that we saw Planetree as anatural partner in the process of caring for sen-iors throughout our region. Iron sharpens iron.”

Trish and Dave are enthusiastic about Plane-tree’s impact on Southington and are eagerto participate in an exciting new project tomeasure and evaluate the impact of Plane-tree Continuing Care in a variety of settings.Dave explains: “I truly believe that in spite of

the challenges of the global health care sys-tem and shrinking reimbursement on stateand federal levels, Planetree Continuing Carehas and will continue to help us to focus onwhat is important: people and relationships.If you can satisfy your customers – residents,employees, health provider partners – you’llcreate a solid foundation on which to build forthe future.”C

Planetalk12

• Fear of discovering a visitor on theunit that staff is unaware of

• Incidences of crime in thecommunity (based upon location)

OPEN VISITATION POLICIES THATBECOME A FREE-FOR ALL• Large numbers of visitors in asemi-private room

• Large families taking over a waiting area

These factors are basic concerns in the day-to-day work environment of nurses andmustbe sufficiently addressed in order to set thestage for effective implementation of a pa-tient-directed approach to visitation.

Visitation practices in a patient-centeredhealth care environment allow for individual-ization to accommodate each patient’sneeds and flexibility to personalize each ex-perience. The question to ask patients to ac-complish this is, “Who do you need to visityou and when do you need this support?”This inquiry allows for individual patientneeds and preferences to inform the param-eters for the number, frequency, and hoursof visitors. This approach to visitation isknown as patient-directed visitation. The ul-timate goal is to meet the psychological andemotional needs of the patient and thosewho are the patient’s support system throughvisitation that is ideally defined and directedby the patients themselves, to the extentpossible. Whereas common staff fearsaround open visitation may evoke images ofvisitation free-for-alls, with this patient-di-rected approach to visitation, the ability ofnurses and other staff to support patients’physical care needs are also taken into con-sideration in order to deliver a truly holisticcare experience.

Safety concerns raised by staff can be ad-dressed by limiting the number of entrancesopen to the public at night, installing callboxes and adequate lighting in parking lots,

implementing processes to identify allvisitors entering the building during offhours and calling the unit to inform staff thatvisitors are on the way. These measuresensure a safe environment without unnec-essarily compromising patients’ access totheir loved ones.

Changing Attitudes About VisitationForming action teams including staff fromeach unit along with a Planetree staffmember, the Planetree coordinator and/orCNO can lead to the identification of specificissues that are barriers to flexible visitation atthe organization. This approach has provensuccessful in changing attitudes about visita-tion because staff may share information witha consultant from outside the organizationthat has not been sharedwith their leadership.Planetree staff can also reassure those at thebedside that their issues are indeed beingheard and that administration genuinely wantsto develop a policy with their input.

The team at Northern WestchesterHospital, a Designated PlanetreePatient-Centered Hospital locatedin Mount Kisco, New York, devel-oped the following implementationguidelines that may provide addi-tional guidance to sites :

Step 1:Educate staff and physicians. Many studieshave been conducted and articles writtenabout the positive effects for both familiesand clinicians when restrictions on visitationare lifted. Reviewing the evidence-basemaybe helpful in establishing consensus. Med-ical Boards and Hospital Infection ControlCommittees also serve as pivotal commit-tees for discussion, guidance and support.

Step 2:Identify physician and nursing champions.These champions serve a vital role as cred-ible subject matter experts andmeet with de-

partments to listen and respond to concernswith the ultimate goal of moving the institu-tion toward adoption.

Step 3:Conduct a pilot study. Identify a specificarea(s) that is willing to pilot patient-directedvisitation for a specified period of time. Usethe experience of these pilot areas to refinethe practice, develop appropriate policies,and educate other departments. Interviewpatients, families and staff during this periodto obtain feedback. Document perceptionsand lessons learned for educationalpurposes.

Step 4:Establish a time frame for house-wideimplementation and finalize visitationpolicies. Use the feedback from pilot sitesand, whenever possible, have staff from pilotareas accompany champions to new areasto discuss their experiences. Use newslet-ters, communication boards, etc. to publicizefeedback from patients and families abouthow being with their family, whenever theywanted to, benefitted them.

Step 5:Publicly recognize your champions for theirparticipation as pilot starters. Recognition ofstaff who step out on a limb to support thesepatient-centered practices is important foracknowledgment and empowerment of staffto embrace and lead other patient-centeredinitiatives.C


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Maternity Access Makeover– with Planetree Flair

By Susan Franklin, CHAM, Patient AccessCoordinator, Halifax Regional Hospital

Entering the hospital on that big day shouldbe an exciting and wonderful time for newmothers, yet the registration and admittanceprocess has not always been smooth andpleasant for the patients or the staff atHalifax Regional Hospital.

A Glimpse at the Old ProcessJane Doe’s routine visit to her obstetricianreveals some reason for concern, sendingher to the hospital for observation. She waitsfor 20 minutes and then arrives at the deskand frantically has to dig through her bagsfor insurance and ID cards while impatientlyconfirming her information. After another 10minutes, she reaches the labor and deliverysuite.

Patient Access TodayToday Jane and her husband go directly tothe Family Birthing Center and soon she is inher bed with a fetal monitor attached. Therewere no papers to sign, no cards to bepresented and no delays.

Recognizing the ProblemTwo years ago, the first scenario was com-monplace. Obstetrical patients could arriveat all hours for observation – including formultiple “false alarms” and each time theyhad to register. During the day, womenwaited in the Patient Access area to be reg-istered. After hours and on weekends, pa-tients presented to the EmergencyDepartment. From there nursing escortedthem to the Family Birthing Center withoutallowing Patient Access staff time to com-plete the registration. Staff was limited dur-ing non-peak hours, yet had to leave thework area and go to the Family Birthing Cen-

ter for long periods of time to complete theregistration process. This procedure wastime consuming and awkward, resulting innumerous complaints. From the patient’sperspective it seemed as if our facility wasmore concerned with financial matters thanthe significance of the event. And patientsand families with multiple admissions wereannoyed at having to give the same infor-mation more than once.

Playing DetectiveOur first step was to evaluate the currentprocess, identifying any policies, rules or reg-ulations that would prevent us from makingany changes.After consulting with staff of theFamily Birthing Center, Health InformationServices, Corporate Compliance and PatientFinancial Services, we discovered that thisprocess, like many others, was practiced forno other reason than because that was theway it had always been done. Not findingany identifiable barriers to change, we beganto explore a new work flow.

Choosing Person-Centered CarePatients now pre-register for their deliveryany time within the last trimester of their

pregnancy. At that time they provide theircurrent insurance and ID cards. The staffverifies all demographic, financial and con-tact information, patients sign consent formsand provide a password for HIPAA compli-ance.Along with the insurance and ID cards,the staff scans the signed forms into the sys-tem, ready for future visits.As always, the of-fice staff confirms the patient’s insurancebenefits and eligibility with each new visitusing the pre-registration information. Aslong as the patient is admitted for a preg-nancy related condition, she does not haveto register again. Upon arrival in the FamilyBirthing Canter, nursing notifies the patientaccess staff for verification that the pre-reg-istration process is completed. The newprocess eliminates stress and allows par-ents-to-be to focus on their new arrival.

A few, very simple policy changes refreshedan outdated, inefficient process at no cost tothe organization and further demonstratedHalifax Regional’s vision to be a leader inproviding person-centered care.C

Planetalk14

Twelve Days of HolidayCelebration

By Lisa Reese, Director of Ethics andCompliance and Planetree Coordinator,Bert Fish Medical Center

This past holiday season, our CEO chal-lenged our Care for the Caregiver Team toconsider creating an alternative to our annualholiday party. The off-campus party hadbeen held for many, many years, but staffwho had to work on that particular eveningwere often disappointed that they had tomiss the single-night celebration. The mis-sion (should the team choose to accept it)was to create something involving more staffover a longer period of time, providing forgreater participation, expanded creativity,and extra joy for the season. And maybe,while they were at it, bring the staff togetherand relieve some of the stress that comeswith an increased census and their own per-sonal holiday planning. So the idea wasbrought to the team for consideration. Nosmall task, but our Care for the Caregiverteam rose to the challenge.

The team began by surveying the staff togauge if it really was time for a change. Loand behold, it seemed people were open to

some new experiences, so the planningbegan. The eight person team expanded toinclude the concierge, representatives frompublic relations and the foundation, and staffwho had served on a prior events commit-tee. After reviewing the input from the sur-veys and some intensive brainstorming, theteam created 12 Days of Holiday Celebra-tion that were enjoyed by staff, volunteers,physicians, and the community.

Day 1: Department DecoratingContestAcompetition to provide spectacular themeddecorations from Candy Cane Lane to theSweet Treats Shops; 1st prize was $200 forthe entire department, 2nd prize was $150and 3rd prize was $100. This was so the win-ning departments could host a luncheon orfunction for everyone such as a pizza party,ice cream social etc.

Day 2: Arts and Crafts FairStaff coordinated an arts and crafts fair andsold their artistic creations, just in time forholiday shopping.

Day 3: All Day Gourmet Coffee andCocoa BarYummy gourmet coffees, cocoa, and biscotti.

Day 4: Lights of LoveThis foundation-sponsored annual fundraiser features local talent (high schooldancers, auxiliary bed-pan band, local rockband, etc.) and the community can purchaselights (by bulb or by strand) to decorate thehospital in memory of someone, or just makea donation to the hospital.

Day 5: The Great AmericanGingerbread Bread RelayTeam building and decorating of a kit house– add your own edible accessories. 17teams participated.

Day 6: Holiday De-Stress Day #1Ten minute chair, head, neck, shoulder andhand pressure point massages for everyone.

Day 7: Holidays Around the WorldTour the story boards of holiday celebrationsthroughout the world.

Day 8: Cookie Bake Off ContestJudges requested milk for next year!

Day 9: Toys for Tots/MilitaryAppreciation DayContributions of Toys for Tots as well as pho-tos of our soldiers (family members and em-ployees) for storyboards; Christmas cardswere filled out to send to the troops.

Day 10: Holiday De-Stress Day #2A repeat of the initial event to ensure every-one on all shifts participated.

Day 11: A Festival of Musicand DanceBallroom dancers from a nearby danceschool throughout the house, a harpist,karaoke, and Girl Scout carolers.

Day 12: Holiday GalaAn on site festival of scrumptious hors d’oeu-vres, mingling, music and lots of prizes.

Because much of our celebrating was donein our main hospital lobby, the communityalso participated in whatever events mightbe going on. Patients were amazed by thegingerbread houses, bringing their familiesback to take a look and asking if they werefor sale! For one contest we asked a waitingguest in our lobby to be a judge. Feedbackfrom the staff was impressive. Commentswere made stating that it was “the best timeI can remember in my 25 years here,” and“thanks for making us all feel so special andhonored.” The team went out of their way toprovide activities at times where all shiftscould participate. And the cost? 32 percentless money was spent on these festivitiesthan for a single party! Considered a hugesuccess, the Care for the Caregiver Team isalready working on their plans for 2009.C


Planetalk 15

Planetree QuébecPrinciples in Our OwnImage

By Isabelle Malo, General Director ofCSSS del la MITIS

The CSSS de la Mitis combines three mis-sions: offering acute care and services to thepopulation, long-term residential care andspecialized rehabilitation services in physi-cal impairment.

It has adopted five principles to support thepeople-centered philosophy within the es-tablishment. Combining the Planetree com-ponents into five statements, these principleswere developed and sponsored by the steer-ing committee to help the organizationalcommunity appropriate the process. Ourprinciples represent markers on the path wewill be following during this wonderful ad-

venture. They will guide us and support usdaily in our decision making process, in ouractions and in our relations. The Board of Di-rectors formally adopted the principles onMay 12th. All members of the managementteam took part in two memorable one-dayleadership seminars and worked hard ontheir own appropriation process.

1. Caring for human beings in all their di-mensions

2. Cultivating attentive listening and open-ness in our relations

3. Promoting individual empowerment

4. Drawing inspiration from nature and theenvironment as sources of well-being

5. Working in solidarity with each other,with our patients’ families and friends, ourpartners and our community.

Vibrant Leadership Seminars forthe CSSS de La MitisThe management team of the CSSS de laMitis took an important step in the imple-mentation of its people-centered approach:together, the team members attended lead-ership seminars to appropriate the principlesrecently adopted by the Board of Directors.During two inspirational days, the 27 teammembers got together in an enchanting lo-cation by the sea to think about the future ofthe organization and the leadership roleeach person could play. We discovered thestrength of our relations and of our commit-ment to people-centered care, services andmanagement. The presence of our friendsfrom the Planetree Québec Network, whoprovided the training and shared their expe-rience of this process, was highly stimulatingand relevant. Upon our return, we feel readyto continue the process. In particular, we willremember that, to succeed, we need to workin solidarity.C


VA Syracuse Community Living Center

The entire interdisciplinary staff of the Community Living Center has a col-lective commitment to resident-centered care. This has resulted in a muchmore home-like culture for both the residents and staff. They are compas-sionate and excel in the delivery of their profession-specific responsibilities.

From the organized pizza parties to inclusion of pets, as well as the cryingand laughing with residents, it is evident when observing resident-staffinteractions that there is a close camaraderie. For example, staff hasinvolved their own children in establishing “foster families” for residents.Additionally, many compliments have been received from the families ofdeceased residents, current CLC residents and staff alike about theme-morial services held at the CLC being truly honorable and loving ex-pressions of the care this staff has for its residents. The support andcaring that is given and the attention to the wishes and needs of each

resident when he/she is at the end of life, and the extension of this com-passion to his/her friends and family can only come from special people. Our Community Living

Center may be situated in a hospital setting, but it is truly home.C

The Planetree Mission is to create patient-centered care in healing environments.

130 Division StreetDerby, Connecticut 06418

www.planetree.org

© PlaneTalk, 2009

FIRST CLASSPRESORT

U.S. POSTAGE

PA I DPERMIT NO. 347BRIDGEPORT, CT

Patient-Centered PerspectivesPresented by Picker Institute

This month's “Perspective” is Picker Instituteboardmember Gail Warden, president emer-itus of Henry Ford Health System. He servedas president and chief executive officer ofHenry Ford Health System from 1988 to2003 and has been a member of the PickerInstitute board since 2000. Mr. Warden wasthe closing speaker at the Patient-CenteredCare CEO Summit in 2008 sponsored byPicker Institute and Planetree. This is a com-pilation of his remarks, a call to action chal-lenging attendees to translate what theylearned at the summit into tangible drivers ofchange within their organizations.

In his book Finding Your True North: A Per-sonal Guide, Bill George, a professor of man-agement practice at Harvard BusinessSchool and the former president and CEO ofMedtronic, talks about the need to align peo-ple around common missions and values inorder to define and solve difficult problems.

Each of us needs to know his or her own “truenorth”—what is important to us, what we arepassionate about. The importance of livingthese concepts has been reinforced by thespeakers we heard today as they discussedtheir passion for elevating the patient experi-ence and creating patient-centeredorganizations and tools to produce better out-comes. Among the important points thatemerged are:

• The willingness to accept the changes thatmust be made• The need to understand the relationshipswithin an organization• A constant emphasis on the patient-cen-tered-care vision and its values• The necessity of always thinking in termsof change and constant renewal• The need for a “chief experience officer”as a coach and facilitator• The importance of keeping the focus onquality• Encouraging employee commitment topatient-centeredness instead of demand-ing compliance• Empowering people at all levels of anorganization to understand and advancethe principles of patient-centered care• Developing a strategy, designing a struc-ture and defining a culture to fosterpatient-centeredness.• Strong patient-centered care is conta-gious—it can lead to success.

Planetree has contributedfour in-depth articles recentlypublished in the AmericanJournal of Nursing “PatientsFirst” series that are nowavailable on thePlanetree Web site,www.planetree.org.

Frampton, Susan B. “Creating aPatient-Centered System.” AJN TheAmerican Journal of Nursing.109(3):30-33, March 2009.

Spatz, Michele A. “Personalized HealthInformation.” AJN TheAmerican Journalof Nursing. 109(4):70-72, April 2009.

Frampton, Susan B.; Horowitz,Sheryl; Stumpo, Barbara J. “OpenMedical Records.” AJN TheAmericanJournal of Nursing. 109(8):59-63,August 2009.

Montague, Kimberly N.; Blietz, ConnieM; Kachur, Mandy. “Ensuring QuieterHospital Environments.” AJNAmerican Journal of Nursing.109(9):65-67, September 2009.

October is Patient-Centered Care Awareness MonthHow are you celebrating and spreading the word among staff, patients, families and the public about yourcommitment to patient-centered care? Email Sara Guastello at [email protected].

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