Planetree: A Radical Model for New Healthcare/Healing/ Wellness Excellence Planetree: A Radical Model for New Healthcare/Healing/ Wellness Excellence Tom Peters/17 September 2006

“It was the goal of the Planetree Unit to help patients not only get well faster but also to stay well longer.” “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

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

1. The Importance of Human Interaction Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information Healing Partnerships: The importance of Including Friends and Family Nutrition: The Nurturing Aspect of Food Spirituality: Inner Resources for Healing 6. Human Touch: The Essentials of Communicating Caring Through Massage 7. Healing Arts: Nutrition for the Soul 8. Integrating Complementary and Alternative Practices into Conventional Care 9. Healing Environments: Architecture and Design Conducive to Health The 9 Planetree Practices 1. The Importance of Human Interaction 2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information 3. Healing Partnerships: The importance of Including Friends and Family 4. Nutrition: The Nurturing Aspect of Food 5. Spirituality: Inner Resources for Healing 6. Human Touch: The Essentials of Communicating Caring Through Massage 7. Healing Arts: Nutrition for the Soul 8. Integrating Complementary and Alternative Practices into Conventional Care 9. Healing Environments: Architecture and Design Conducive to Health Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Importance of Human Interaction 1. The Importance of Human Interaction

Kindness is free. “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

none of THE top 15 factors determining P atient S atisfaction referred to patient’s health outcome PS directly related to Staff Interaction PS directly correlated with Employee Satisfaction Press Ganey Assoc: 139,380 former patients from 225 hospitals: none of THE top 15 factors determining P atient S atisfaction referred to patient’s health outcome PS directly related to Staff Interaction PS directly correlated with Employee Satisfaction Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

of THE top 15 factors determining Patient Satisfaction referred to patient’s health outcome Staff Interaction ES Press Ganey Assoc: 139,380 former patients from 225 hospitals of THE top 15 factors determining Patient Satisfaction referred to patient’s health outcome PS directly related to Staff Interaction PS directly correlated with ES (Employee Satisfaction) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

But if it is so simple, it is surprising how frequently it is absent from our healthcare environments. ‘abuse ’ “ 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

“ Planetree is about human beings caring for other human beings.” “ 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)

Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information 2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information

Planetree Health Resources Center/1981 Planetree Classification System Consumer Health Librarians Volunteers Classes, lectures Health Fairs Griffin’s Mobile Health Resource Center Open Chart Policy Patient Progress Notes Care Coordination Conferences (Est goals, timetable, etc.) Planetree Health Resources Center/1981 Planetree Classification System Consumer Health Librarians Volunteers Classes, lectures Health Fairs Griffin’s Mobile Health Resource Center Open Chart Policy Patient Progress Notes Care Coordination Conferences (Est goals, timetable, etc.) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Healing Partnerships: The Importance of Including Friends and Family 3. Healing Partnerships: The Importance of Including Friends and Family

“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

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.” 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

“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.” “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

confided in at least one person 72.4%, 56.3% “A 7-year follow-up of women diagnosed with breast cancer showed that those who confided in at least one person 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

Respect for preferences Involvement in Decision Making Access to care Coordination of care Information and education Physical comfort Emotional support Involvement of Friends and Family Continuity of care Institute of Medicine/ “Crossing the Quality Chasm” Respect for preferences Involvement in Decision Making Access to care Coordination of care Information and education Physical comfort Emotional support Involvement of Friends and Family Continuity of care Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Care Partner Programs Unrestricted visits Collaborative Care Conferences Clinical Guidelines Discussions Family Spaces Pet Visits 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 Conferences Clinical Guidelines Discussions Family Spaces Pet Visits (POP: Patients’ Own Pets) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

Meals are central events Meals are central events vs “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

Kitchen Beautiful cutlery, plates, etc. Chef reputation Kitchen Beautiful cutlery, plates, etc. Chef reputation Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

Spirituality: Inner Resources for Healing 5. Spirituality: Inner Resources for Healing

1. Connected to supportive and caring group 2. Sense of mastery and control 3. Make meaning out of disease/ find meaning in suffering Spirituality: Meaning and Connectedness in Life 1. Connected to supportive and caring group 2. Sense of mastery and control 3. Make meaning out of disease/ find meaning in suffering Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

Human Touch: The Essentials of Communicating Caring Through Massage 6. Human Touch: The Essentials of Communicating Caring Through Massage

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

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

7. Healing Arts: Nutrition for the Soul

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

People say the effect is only on the mind. It is no such thing. The effect is on the body, too.” 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

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

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

83M in US (42%) CAM visits 243M, greater than to PCP (Primary Care Physician) (With min insurance coverage) W-Educated-Hi inc Don’t tell PCP (40%) OTA: <30% procedures used in conventional medicine have undergone RCTs (randomized clinical trials) 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 inc Don’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

Massage Acupuncture Meditation Chiropractic Nutritional supplements Aroma therapy Griffin IMC/Integrative Medicine Center Massage Acupuncture Meditation Chiropractic Nutritional supplements Aroma therapy Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Healing Environments: Architecture and Design Conducive to Health 9. Healing Environments: Architecture and Design Conducive to Health

Woods and natural materials Indirect lighting Homelike settings Goals: 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 beauty “Planetree Look” Woods and natural materials Indirect lighting Homelike settings Goals: 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 beauty Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Sound Texture Lighting Color Smell Taste Sacred space Sound Texture Lighting Color Smell Taste Sacred space Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“Happen to” “Happen with” Patient Access to Nurses Station/In General: “Happen to” vs “Happen with” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Eden Alternative* The Eden Alternative* *ElderCare

1. 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. The Ten Principals of the Eden Alternative 1. 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

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

5. 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. The Ten Principals of the Eden Alternative 5. 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

8. 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. The Ten Principals of the Eden Alternative 8. 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

Is this a loving act?” “ 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

Conclusion: Caring/Growth “Experience”

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

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

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Financially successful. Expanding programs- physically. Growing market share. Only hospital in “100 Best Cos to Work for”— 7 consecutive years, currently #6. Griffin Hospital/Derby CT (Planetree Alliance “HQ”) Results: Financially successful. Expanding programs- physically. Growing market share. Only hospital in “100 Best Cos to Work for”— 7 consecutive years, currently #6. —“Five-Star Hospitals,” Joe Flower, strategy+business (#42)

EXCELLE ALWAYS.