Planetree: A Radical Model for Healthcare Excellence

1. Planetree: A Radical Model for New Healthcare/Healing/Wellness ExcellenceTom Peters/30 March 2007

2. NOTE:To appreciate this presentation [and ensure that it is not a mess], you need Microsoft fonts:“Showcard Gothic,”“Ravie,”“Chiller”and“Verdana”

3. "All sane persons agree that 'healthcare needs an overhaul.' And that's where the agreement stops. Healthcare issues are thorny, and system panaceas are about as likely as the sun rising in the West. But there is good news here and there--and great news courtesy the Planetree Model. "In the midst of ceaseless gnashing of teeth over 'healthcare issues,' the patient and frontline staff often get lost in the shuffle. Enter Planetree. While oceanic systemic solutions remain out of reach, Planetree provides a remarkable demonstration of what healthcare--with the patient at the center--can be all about; and is all about among Planetree Alliance members. "I know this may sound ridiculous, but everything about the 'model' works. It is great for patients and their families--and is truly about humanity and healing and health and longterm wellness, not just a 'fix' for today's problem. It is great for staff--Planetree-Griffin is rightly near the top of the 'best places to work in America' list, year in and year out. And Planetree also works as a 'business model'--any effectiveness measure you can name is in the Green Zone at Griffin. "For 25 years my 'gig' has been 'excellence.' Put simply, there is no better exemplar of customer-centered, employee-friendly excellence, in any industry, than Griffin-Planetree. The Planetree model works--and in my extensive work in the health sector, I 'sell' it shamelessly, and pray that my clients are taking it all in." tom peters/response to request for comment on Planetree

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

5. “Much of our current healthcare is about curing . Curing is good. But healingis spiritual, and healing is better, because we can heal many people we cannot cure.”—Leland Kaiser, “Holistic Hospitals”

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

7. The 9 Planetree Practices1.The Importance of Human Interaction2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information3. Healing Partnerships: The importance of Including Friends and Family4. Nutrition: The Nurturing Aspect of Food5. Spirituality: Inner Resources for Healing6. Human Touch: The Essentials of Communicating Caring Through Massage7. Healing Arts: Nutrition for the Soul8. Integrating Complementary and Alternative Practices into Conventional Care9. Healing Environments: Architecture and Design Conducive to HealthSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

8. 1.The Importance of Human Interaction

9. Press Ganey Assoc:139,380 former patients from 225 hospitals:noneof THE top 15 factors determining Patient Satisfaction referred to patient’s health outcomePSdirectly related to StaffInteractionPSdirectly correlated with Employee SatisfactionSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

10. “There is a misconception that supportive interactions require more staff or more time and are therefore more costly. Although labor costs are a substantial part of any hospital budget, the interactions themselves add nothing to the budget. Kindness is free. Listening to patients or answering their questions costs nothing. It can be argued that negative 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

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

12. “Planetree is about human beings caring for other human beings.”—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel (“Ladies and gentlemen serving ladies and gentlemen”—4S credo)

13. 2.Informing and Empowering Diverse Populations: ConsumerHealth Libraries and Patient Information

14. Planetree Health Resources Center/1981Planetree Classification SystemConsumer Health LibrariansVolunteersClasses, lecturesHealth FairsGriffin’s Mobile Health Resource CenterOpen Chart PolicyPatient Progress NotesCare Coordination Conferences (Est goals, timetable, etc.)Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

15. 3.Healing Partnerships: The Importance of IncludingFriends and Family

16. “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

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

18. “Family members, close friends and ‘significant others’ can have a far greater impact on patients’ experience of illness, and on their long-term health and happiness, than any healthcare professional.”—Through the Patient’s Eyes

19. “A 7-year follow-up of women diagnosed with breast cancer showed that those who confidedinatleastoneperson in the 3 months after surgery had a 7-year survival rate of 72.4%, as compared to 56.3% for those who didn’t have a confidant.” —Institute for the Future

20. Institute of Medicine/ “Crossing the Quality Chasm”Respect for preferencesInvolvement in Decision MakingAccess to careCoordination of careInformation and educationPhysical comfortEmotional supportInvolvement of Friends and FamilyContinuity of careSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

22. 4. Nutrition:The Nurturing Aspect of Food

23. Meals are central eventsvs“There, you’re fed.” **Irony: Focus on “nutrition” has reduced focus on “food” and “service”Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

24. KitchenBeautiful cutlery, plates, etcChef reputationSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

26. 5. Spirituality: Inner Resources for Healing

27. Spirituality: Meaning and Connectedness in Life1. Connected to supportive and caring group2. Sense of mastery and control3. Make meaning out of disease/ find meaning in sufferingSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

29. 6.Human Touch: The Essentials of CommunicatingCaring Through Massage

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

31. Mid-Columbia Medical Center/Center for Mind and BodyMassage for every patient scheduled for ambulatory surgery (“Go into surgery witha good attitude”) Infant massageStaff massage (“caring for the caregivers”)Healing environments: chemo!Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

32. 7. Healing Arts: Nutrition for the Soul

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

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

35. Griffin:Music in the parking lot; professional musicians in the lobby(7/week, 3-4hrs/day) ; 5 pianos; volunteers(120-140 hrs arts & entertainment per month).Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

36. 8.Integrating Complementary and Alternative Practices into Conventional Care

37. Griffin IMC/Integrative Medicine CenterMassageAcupunctureMeditationChiropracticNutritional supplementsAroma therapySource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

38. CAM (Complementary & Alternative Medicine):83M in US(42%)CAM visits 243M, greater than to PCP(Primary Care Physician) (With min insurance coverage)W-Educated-Hi incDon’t tell PCP (40%)OTA: <30% procedures used in conventional medicine have undergone RCTs(randomized clinical trials)Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

39. 9. Healing Environments: Architecture andDesign Conduciveto Health

40. “Planetree Look”Woods and natural materialsIndirect lightingHomelike settingsGoals: Welcome patients, friends and family … Value humans over technology .. Enable patients to participate in their care … Provide flexibility to personalize the care of each patient … Encourage caregivers to be responsive to patients … Foster a connection to nature and beautySource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

41. SoundTextureLightingColorSmellTasteSacred spaceSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

43. The Eden Alternative**ElderCare

44. The Ten Principals of the Eden Alternative1. The three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among Elders.2. Life in an Elder-centered community revolves around close and continuing contact with children, plants, and animals. These ancient relationships provide young and old alike with a pathway to a life worth living.3. Companionship is the antidote to loneliness. In an Elder-centered community we must provide easy access to human and animal companionship.4. A healthy Elder-centered community seeks to balance the care that is being given with the care that is being received. Elders need opportunities to give care and caregivers need opportunities to receive care.Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

46. The Ten Principals of the Eden Alternative5. Variety and Spontaneity are the antidotes to boredom. The Elder-centered community is rich in opportunities to sample these ancient pleasures.6. An Elder-centered community understands that passive entertainment cannot fill a human life.7. The Elder-centered community takes medical treatment down from its pedestal and and places it into the service of genuine human caring.Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

47. The Ten Principals of the Eden Alternative8. In an Elder-centered community, decisions should be made by the Elders or those as close to the Elders as possible.9. An Elder-centered community understands human growth cannot be separated from human life.10. Wise leadership is the lifeblood of any struggle against the Three Plagues. For it, there can be no substitute.Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

49. Conclusion: Caring/Growth “Experience”

50. Care!/Love!/Spirit!Self-Control!Connect!/learn!/involve!/Engage!Understanding!/Growth! De-stress!/heal! Whole patient & family & friends! be well!/stay well!