research roots of planetree patient-centered design

Research Roots of Planetree Patient-Centered Design:

Embodying Respect for Individuals

Presenter• Marc studied with Roslyn Lindheim and designed 4 Planetree

model sites, including San Jose Hospital, Mid-Columbia, Delano Regional and Beth Israel Medical Centers.

• Planetree design consultant for many additional Affiliates translating Planetree design principles into a variety of settings, including emergency departments and critical care areas.

• Marc has always believed that hospitals are emotional spaces and need to provide places to both celebrate and grieve. Marc often stays overnight in the hospital to more fully appreciate the patient’s perspective.

Ma r c S c h w e i t z e rM. A r c h . , A I A , N C A R B

Senio r Hea l t hca re A rch i tec tSec re tary P lanet ree VDN

Learning ObjectivesAt the end of this course, participants will be better able to:1. Explain and present the original research behind

Planetree patient centered design.2. Understand how a physical plan and key spaces

are critical to the patient centered Planetree operations.

3. Evaluate the differences between simply attractive spaces and those that support patients, families, and all users.

Contents“A Bad Place to Heal”

The Planetree Model

Patient Centered Place

1st Model Hospital Project

A Forest of Plane Trees

“Death’s head continually shows in the present-day hospital. Why is the hospital not as humanely practical in aesthetic effect* as it tries to be in physical support?”

• Frank Lloyd Wright

* And social support


The Planetree Model




“…. The ideal hospital would combine the best of modern medicine, with the best possible patient care experience to become a truly healing environment, where just being there is healing.”

• Angelica Thieriot

Planetree Components• Human Interactions • Education : Patient & Family• Healing Partnerships: Family, Friends • Nutrition : Nurturing Aspects of Food• Spirituality : Inner Resources for Healing• Human Touch• Healing Arts : Nutrition for the Soul• Integrating Complementary & Alternative Practice• Healing Environments : Architecture & Design

2003

Patient Centered Components

Copyright Planetree 2012

Healing Environme

nts

Access to Information

Social Support

Arts & Entertainment

SpiritualityCaring Touch

Integrative Therapies

Food & Nutrition

Healthy Communities

Human Interactions

Design Matters


• Environment is significantly related to recovery rates• Patients behave better in well designed rooms.• Design of a hospital makes a difference to staff

morale.– 2003 CABE/ICM Survey (Great Britain)

• Physical improvements may improve patient’s perceptions of care.– Swan JE, Richardson LD, Hutton JD Health Care Manage Rev. 2003

• Physical improvements may shorten length of patient stay and reduce need for analgesics– Lawson B, Phiri M. Health Serv Journal. 2000


The Planetree Model




Patient Centered Place“the artist must penetrate into the world, feel the fate of human beings, of peoples, with real love. There is no art for art’s sake. One must be interested in the entire realm of life”

Mark Chagall

“Anyone who has a Passion for design should also have a passion

for humanity.”Earl S. Swensson, FAIA

Carnaval of Flowers from Nice and The Côte D’Azur - Marc Chagall 1967

Evidence Based Design• Personal Space • Quiet• Complexity• Ventilation• Natural Daylight• Circadian rhythms• Viewing Nature• Visual Art• Music• Positive Distractions

• Smell

• Sounds• Temperature• Fresh Air• Color• Experiencing Nature• Beauty

Minimal ResearchStrong Research

“Healing Spaces: Elements of Environmental Design That Make an Impact on Health”; Schweitzer, et.al. 2004

Evidence Based Design

Planetree Research Roots• Lindheim & Syme

“…..unless people can, in some way, create, manage, change, or participate in activities that affect their lives, dissatisfaction, alienation, and even

illness are likely outcomes.” S. Leonard Syme, UC Berkeley School of

Public Health

Lindheim’s revolutionary ideas emanated from a deeply held conviction that living environments should reflect a respect for human beings and enhance their quality of life.

Key Planetree ResearchENVIRONMENTS, PEOPLE, AND HEALTHAnnual Review of Public Health 1983◦Focus in this paper is on those factors that affect host

resistance rather than on disease agents.◦All of the findings have as a common element the

importance to health of being "connected": • with others (social relationships & hierarchal status)• with one’s biological heritage.• with one’s cultural heritage• with Place

Key Planetree ResearchNEW DESIGN PARAMETERS FOR HEALTHY PLACES

Places, Vol 2, No. 4 1985• Published after first Planetree Model Hospital completed.• Explores implications for environmental design based on new

findings of importance of social factors.• Social Connectedness• Hierarchy, Self-Esteem, and Meaning• Participation and Control• Connection to the Natural Order• Contact with Nature• Connection to the Life Cycle• Connection to Place

Patient Centered Process• Putting Patients First• Giving Patients a “Seat at the Table”• Advocating for what patients want

Patient Centered Values• Welcome the patient ’s family and friends• Value human beings over technology• Enable patients to fully participate as partners 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.

Arneill and Frasca-Beaulieu, 2003 in “Putting Patients First”

Patient Centered Specifics• COMFORT & SAFETY

– Minimize environmental stressors– Familiar materials and design

• DIGNITY & PERSONAL CONTROL– Bedside controls– Patient’s privacy– Self medication– 24hr access to food– Barrier free– Complementary therapies– Personal expression

• EDUCATION & PARTICIPATION– On-unit Library– Health Resource Center– Open Nurses’ Station– Satellite Support Services

• ACCESS TO SOCIAL SUPPORT– Care Partner space– Variety of Social, Community space– Dining rooms and kitchens

• POSITIVE DISTRACTIONS– Entertainment– Healing Touch– Beauty

• CONNECTION TO NATURE– Atrium, Skylights & Gardens– Fountains, Aquariums– Patios & Balconies

– Indoor fresh air

Patient Centered Specifics

Contents

“A Bad Place to Heal”

The Planetree Model




Patient Centered Design - Places


Planetree Model at CPMC• “Planetree, an organization

dedicated to humanize health care, is restructuring a hospital nursing unit physically, socially, and organizationally to increase the control patients have over their own health and to reduce the traditional hierarchical attitudes of staff.”– “nurses are no longer separated from

patients and families”

– “Families encouraged to participate in patient care”

Planetree Model at CPMC

First Planetree Model

Planetree Model at CPMC“To reinforce these changes the physical form of the nursing station was altered. The nurses are no longer separated from patients and families by a high counter.

Instead the workspace is opened up, making charts available to patients and families as well as to physicians and nurses. To motivate patients to greater mobility and personal control, a lounge has been located directly adjacent to patients' beds.”

Planetree Model at CPMCFamilies will be encouraged to participate in patient care. There is a place for them to stay overnight, and even a small kitchen has been constructed so that patients can have their own favorite foods on their own schedules.”

Planetree Model at CPMCTo personalize and deinstitutionalize the environment and create a more familiar and relaxed atmosphere, careful attention has been given to the quality of light, the use of natural woods, and the selection of paintings, plants, and fabrics.

HCAHPS Comparison

Assessment• University of Washington conducted a four-year

randomized evaluation that ultimately demonstrated both patient and employee satisfaction were significantly higher in the Planetree unit.

• A second study focusing on twelve Planetree hospitals pre- and post-implementation of the model also demonstrated significant increases in patient satisfaction with their hospital stay within a 12 to 24 month period.

Original Research Refs• Lindheim R., Syme S. Leonard, Environments, People, and

Health, Ann. Rev. Public Health 1983; 4:335-59• Lindheim R., New Design Parameters for Healthy Places,

Places 1985; Vol. 2, Number 4 • Lindheim, Roslyn and Helen H. Glaser and Christie Coffin.

Changing Hospital Environments for Children. Harvard University Press, 1972

• Lindheim, Roslyn. Birthing centers and hospices: Reclaiming birth and death. Ann. Rev. Public Health, 1981 2:1-29

• Lindheim, Roslyn. Factors Which Determine Hospital Design, American Journal of Public Health Oct 1966;(56)10:1668-1675

Design Checklist


The Planetree Model




Planetree Components 2014• Compassionate Human Interactions • Access to Meaningful Information • Support & Participation of Family, Friends • Healing Environment • Support for body, mind & spirit

– Arts and Entertainment – Spirituality – Caring Touch – Integrative Therapies – Healthy Food and Nutrition

• Healthy Communities

History & Future

Source: DNV GL / Sustainia

Samueli Institute

Duke Integrative Medicine

VA Patient Aligned Care Team1. Honor the veteran’s expectations of safe, high-quality, accessible care.

2. Enhance the quality of human interactions and therapeutic alliances.

3. Solicit and respect the veteran’s values, preferences and needs.

4. Systemise the co-ordination, continuity and integration of care.

5. Empower veterans through information and education.

6. Incorporate nutritional, cultural and nurturing aspects of food.

7. Provide for physical comfort and pain management.

8. Ensure emotional and spiritual support.

9. Encourage involvement of family and friends.

10. Ensure that architectural layout and design are conductive to health and healing.

11. Introduce creative arts into the healing environment.

12. Support and sustain an engaged workforce as key to providing patient-centered care.

12 principles of patient-centered care

Great BritainIMPROVES• Patient satisfaction by improving patient experience and effectiveness of treatment• Patient experience by involving patients in the delivery of their care • Work satisfaction among healthcareprofessionals• Treatment compliance as patients co–design and self–manage• Health outcomes for patients as they are better able to manage their long-term condition• Social capital by building networks of support around the patient• Use of primary care by improving patients’ ability to self–manage

REDUCES• Rate of medication errors• Number of hospital admissions and• Re-admissions• Length of stay at hospitals• Need for primary and secondary care• Cost of healthcare

Design References• Stone, S. A Retrospective Evaluation of the Planetree Patient-Centered

Model of Care Program’s Impact on Inpatient Quality Outcomes. Health Enviroments Research and Design Journal 2008;1(4): 55-69.

• Nesta. People Powered Health: Health For People, By People And With People, 2013

• Nesta: The Business Case for People Powered Health. 2013.• Golembiewski, Jan. Salutogenic Design: The neurological basis of health-

promoting environments. World Health Design, October 2012• Ulrich, Roger et.al. A Review of the Research Literature on Evidence-Based

Healthcare Design. Healthcare Leadership White Paper Series 5 of 5, September 2008

• Ulrich, Roger S. Evidence Based Environmental Design for Improving Medical Outcomes. Texas A&M University,

• Huelat, Barbara J. Healing Environments: What’s the Proof?. Medezyn, 2007

Design References• Schweitzer, M, Gilpin L., Frampton S., Healing Spaces: Elements of

Environmental Design That Make an Impact on Health The Journal of Alternative and Complementary Medicine 2004; Vol. 10, Supplement 1: S71-S83

• Ulrich R., Zimring C., et.al. The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity. Report to The Center for Health Design; Sept 2004;

• Evans Gary W. The Built Environment and Mental Health. Journal of Urban Health: Bulletin of the New York Academy of Medicine; 2003; 80(4): 536-555

• Karlin, Bradley E and Robert A. Zeiss. Best Practices: Environmental and therapeutic issues in psychiatric hospital design: Toward best practices. Psychiatric Services, 57, October 2006

• Erik Rasmussen, Kalle Jørgensen, Stephen Leyshon. PERSON-CENTRED CARE – Co-creating a Healthcare Sector for the Future. DN V GL and Monday Morning / Sustainia; March 2014

• Putting Patients First, 1st 2nd and 3rd Editions

Design Research Resources

• MyPlanetree Planetree Visionary Design Network (PVDN)

http://community.planetree.org/communities/viewcommunities/groupdetails/?CommunityKey=e31e6966-0097-476d-b9a2-9f960b1c4cb1

• PubMed

• The Center for Health Design Knowledge Repository

http://www.healthdesign.org/search/articles



Visionary Design Network VDN firms are specialists inevidence-based health care design following the Planetree philosophyand its core components of healing design.

Members are leaders in the practice of healing design. Planetree’s philosophy of building and designing healing environmentsthat provide the greatestopportunity for caring of thebody, mind and spirit is the basis of their designs

Through the integration ofevidence-based design principles into their design projects each firm has excelled in their implementation of Planetree philosophy.

Certification establishes thesefirms as specialists in Planetree patient-centered healing design. Members of theNetwork are working to further educate the public about the connection between culture and the environment.

Virtual Education Presented by PlanetreeThe global leader in advancing patient-centered care solutions

www.planetree.org

Thank You!

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