The path to good health is typically a more modest one. That does not rule out the many benefits of the new discoveries in medicine, the advanced technologies and the numerous wonders of medical science. The shortcoming of the science-side of medicine is the tendency to lose the patient; we still need to keep an eye on the art of medicine when caring for our patients.
This philosophy was highly valued by Hippocrates, the father of medicine, who taught his medical students the art of medicine 24 centuries ago. According to tradition, he instructed his students under the “plane tree” in the town of Kos, Greece (http://www.kos.gr/en/sights/SitePages/view.aspx?nID=49).
Forty years ago, a patient named Angelica Thieriot was bedridden in a hospital and discovered the missing parts of the art of caring. She spoke up, and her insight about patient-centered care resulted in a movement for a model of care called Planetree. Patient-centered care is defined by the Institute of Medicine as: “Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”
Planetree started with a 13-bed unit of a hospital in San Francisco, CA. But the first institution to develop this model of care on an interdisciplinary level was Griffin Hospital, right in our own backyard, in Derby, CT. There are now 700 allied organizations in numerous countries, and Planetree will be celebrating its 40th anniversary with the upcoming Planetree International conference, being held October 7-10th of this year in Boston (https://planetree.org/). The Planetree movement is spreading even more in our current milieu that requires hospitals to focus on “improved patient experiences” in order to be reimbursed by government funding.
How does Planetree operate? It makes sense to create healing environments for our patients. Finding yourself in a hospital bed in a sterile environment with no privacy, no control, and strangers telling you what to do, can be disorienting and frightening. Healing environments do not only entail a redesign of rooms, but there is a redesign in care. With a switch in focus to the patient, rather than the provider, the patient is recognized on a personal level with his/her uniqueness. What works for one person does not necessarily work for others. Customizing care that is tailored to the individual typically results in better outcomes. The patient and family are involved in the decision-making. It becomes a human experience, and the patient feels less like a specimen placed in a science lab.
The training of staff involves “hearing the patient’s voice,” which not only focuses on respect but also values the roles of the patient and family in the healing process. When staff members develop skills that create an empowering and supportive environment for patients, they become effective change agents. There is no value in patients who become dependent on doctors and other providers; instead, we want the patient and provider to become partners. With this change in culture, there is not only improvement in healthcare, there is more satisfaction among all parties involved.
What does a Planetree facility look like? Many hospitals are now recognizing that private rooms are a necessity for the healing process. Griffin Hospital recognized this need in the 1970s. In addition to promoting infection control, a private room provides a more personal, safer, and less stressful space that is unique to the individual. In addition to the room design, some specifics of the approaches to care include (https://planetree.org/):
Planetree offers a certification process. In order to participate in this philosophy, there must be a team approach with all departments involved in the training. The elements focus on the development of an environment that is nurturing for the patient with a focus on wellness, safety and personalized choices. Some of the elements of certification include (https://planetree.org/):
1. Organizational culture: a change in customs that, simply said, focuses on patient expectations.
Providers learn what it is like to be a patient. As part of training, key staff members (including hospital administrators) spend 24 hours in a hospital bed: eating hospital food, trying to sleep with all the noises, being interrupted for required testing and monitoring, and overall managing the boredom.
2. Patient Activation: creates mechanisms that engage the patients and their support systems in the care process.
3. Staff Engagement recognizes that a staff-centered organization is going to be able to support and engage a patient-centered organization. Staff members have to reconnect and develop an interdisciplinary team approach that is unified in patient- centered care. Thus, all departments in a hospital or organization must participate.
4. Leadership must engage in the same behaviors and cultural change as the rest of the facility. The framework for success is dependant on quality leadership, who serve as mentors.
5. Performance: Hospitals are being measured for improved patient experiences, higher standards, and increased services. The Planetree model is a perfect match for this mission.
6. Design is key. A healing environment demonstrates a positive caring experience for patients and visitors. The environment is nurturing and supports dignity, personalized choice and control by the patient.
Planetree allows for a holistic approach to health care that is also progressive, incorporates the latest techniques of modern medicine, and supports designs and operations that are innovative and evidence-based in the patient-centered care model.
Thank you to Maria Hale, VP of Patient Advocacy Services at Northern Westchester Hospital, who presented much of this information at last month’s meeting of the Hudson Valley Care Transitions Coalition. The goal of this coalition is to enhance the patient experiences as people in our community transition from one facility to the next for care.
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