Journey to patient-centered care: Rural hospital adopts Planetree model
MCMC uses art, music, integrative therapies to nurture healing
The Planetree model is almost 30 years old but its essence is timeless, says Janet Powell Morin, RN, chief culture officer and former vice president, patient care services at Mid-Columbia Medical Center (MCMC) in The Dalles, OR.
"It is timeless and timely and one of the reasons patient-centered care around the country is what all hospitals are working toward," she asserts. And she should know. Since the mid '90s, the 49-bed rural hospital has had visits from more than 2,000 hospitals seeking to learn how MCMC does it.
"For a small community hospital, we really have a progressive board of directors and really forward-thinking," she says. "It frequently surprises people when they come to visit us."
The Planetree methodology was born in 1978 after a patient, Angelica Thieriot, dissatisfied with the care she received while in the hospital, sought to change the way hospitals approach care. Thieriot envisioned a hospital environment that promoted communication, making patients and their family members partners in the care they receive in a healing, nurturing environment.
One of only five designated Planetree patient-centered hospitals, the hospital first learned of the model in the late '80s when its then-president Mark Scott attended a conference with Tom Peters, a writer, business guru, and management consultant who espouses the Planetree philosophy. One of the speakers was an administrator with the Planetree organization. She related the story of a model patient care unit in San Francisco where the rooms are muted in soft colors and embellished with pleasing artwork and the smell of fresh-baked cookies emanates from the kitchen on the unit. MCMC's Scott was so taken with the concept, he rallied to adopt such a model.
After that, Morin recounts, the hospital sent an exploration team to Pacific Presbyterian Hospital in San Francisco to visit the first Planetree-modeled unit. "We took what we saw and modified it for what made sense in our community. We made a decision," she says. "Rather than having just one 11-bed unit or one 40-bed unit, we would implement the Planetree philosophy throughout the whole organization."
Seeing through patients' eyes
Since the facility already was invested in the process of remodeling and upgrading patient rooms, it was a perfect time, Morin says. "Literally, the architect spent the night in the patient room right across from the nurses' station so he could experience what they heard, what they saw, what they felt."
In preparation, MCMC held multiple focus groups with patients, family members, physicians, and nurses. This first step involved "a real good cross section of individuals that experienced what it felt like to walk into these patient rooms or in the hallway free of clutter with a real focus on making the environment healing, trying to decrease noise, having a real focus on making the environment healing," Morin says.
The primary lesson learned from the focus groups was that people needed space space for families to gather for quiet times or for time to be together or time to listen to music or watch television. In response, the hospital created a solarium as a quiet room that overlooks the Columbia River gorge, taking advantage of the natural wonders that surround it, Morin says.
One of the questions posed to the focus groups was: "If you could have anything, what would it be?" Morin says physicians wanted quiet places where they could speak with patients and their families about confidential issues without worrying about anyone overhearing, without answering questions in busy hallways. Another item was storage spaces that were easily accessed by staff, having plenty of them, and placing supplies such as linens near patient rooms. Oak shelves were put at the feet of patients' beds so they could see any items they viewed important cards sent by families, flowers, mementos from home. Each room now also boasts a DVD player and a television with access to more than 60 channels. Patients are also empowered by choosing when and what they'd like to eat.
Catering to specific populations
Because The Dalles has a large Spanish-speaking population, the hospital began offering a Spanish and an English menu. Now they are combined into one "so everything is available to everyone," Morin says. She says they also have a lot of Samoan patients. "We know that they like to gather in the atrium and play the piano and sing. If the patient is able, we'll put him in a wheelchair and take him down to the atrium. Sometimes the singing is just done around the patient's beds. For Native American patients, it's often important that they be placed near open windows, and staff are quick to help."
Other offerings include a number of "soothing and aesthetic" gardens used by cancer patients, inpatient rehab guests, and even members of The Dalles community. Yoga and tai chi classes are offered regularly. "In our Center for Mindfulness, which is a part of our cancer center, there is a wonderful meditation room, and we have regularly scheduled relaxation opportunities, meditation with guided imagery, and aromatherapy," Morin says.
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Why patient-centered care just makes sense Accountability, transparency, consumer choice. HCACPS, and Hospital Compare. These are your challenges. How are you going to measure up? Beyond being a humanitarian and logical step for hospitals, patient-centeredness is more than an ideal, and as value-based purchasing as a method grows, it's becoming more of a necessity. But why else should you focus on the patient and his or her individual experience? A 2007 study sought to quantify the effects of adopting the Planetree model of patient-centered care.1 Two comparable hospital inpatient units were recruited, and over the five-year period, one hospital implemented an extensive patient-centered program while the other did not. The patient-centered unit in each of the five years consistently showed:
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey brought patient satisfaction again to the forefront, making codifying patient opinions a requirement for hospitals and tying it to reimbursement. The indicators reflect the Planetree model's emphasis on the patient experience, communication between patient and family and providers, and responsiveness of hospital staff. It is said that patient-centered hospitals also see less staff turnover. And there is something to say about malpractice risks. Many believe that lawsuits result when patients feel a lack of communication or understanding was present. If your staff are focused on making the patient felt heard and part of their care, patients are less likely to jump to sue, many experts say. A 2005 white paper by Press Ganey reads: "Quality, loyalty, revenue, malpractice claims, philanthropy, retention, employee morale/satisfaction and patient/resident satisfaction, all tend to move together. The interconnectedness of service and product quality, employee satisfaction, customer satisfaction, and organizational performance is widely accepted in the business world. In comparison, health care lags in recognizing the interrelated nature of its primary outcomes quality of care, satisfaction with care, and financial outcomes."2 Reference 1. Stone, S. A Retrospective Evaluation of the Planetree Patient-Centered Model of Care Program's Impact on Inpatient Quality Outcomes, PhD dissertation, Hahn School of Nursing and Health Science, University of San Diego, 2007. 2. Clark, P. Drain, M. Malone, M. Return on Investment in Satisfaction Measurement and Improvement. Volume 1, Edition 2. Aug. 31, 2005. |
Windows more important than you think
In redesigning patient rooms, one of the most significant yet understated changes, Morin says, was windows. Though it's "something the common person might not think of," she admits, it's one of the things that "just made a huge difference." Windows make the space more inviting, she says. Fish tanks also were placed in "strategic spots, so that really draws you into the rooms. One of them is in our main lobby, and it's really a focal point."
Besides expansive windows, all patient rooms now have large digital clocks, at patients' request, displaying the date, day, time, and temperature. Carpet buffers the hallways, Morin says, lending to the quiet that guests appreciate and find soothing. Patients are encouraged to invite family members; there are kitchens in each of the resting units for home cooking. "It's a very welcome environment," Morin says.
One of the most popular provisions is massage. "Literally every patient that is going in to scheduled surgery is offered a massage," she says, "and it's rare that they don't take them up on it." In the cancer center, radiation patients are offered a head, neck, and shoulder massage before they go in for treatment. Roving therapists visit patients in the acute care nursing department. Doctors can request massages for their patients and often do.
Morin says it's a rigorous process to be designated a patient-centered hospital by Planetree, and to maintain the designation is a continuous practice. MCMC has a Planetree advisory council comprised of various staff members and a Planetree action team. "We have several systems in place to really involve the staff and keep the staff informed and active in furthering each of their departments how we can further implement human interaction and access to information and be very cognizant of the healing environment."
In order to maintain the designation, MCMC has to maintain records of what it's doing and what it's offering and continue to have focus groups. One of the things emphasized to nursing staff is to always ask the patient before leaving the room, "is there anything else I can do for you?"
What about the financial implications of offering more amenities to uphold the patient-centered philosophy?
"You're going to have to paint the wall, so you might as well have a beautiful color. When you see things that remind you of pleasant thoughts or memories, it's just healing. Yeah, maybe some things cost a bit more, but if it helps the patient feel special and helps with their feelings, they're going to recover faster.
"Our sense is that [the cost] really balances out."
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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. |
She acknowledges that resources are now much tighter than when MCMC began implementing Planetree practices, and they were lucky to begin the process when they did. But "it really doesn't matter what your environment looks like. The basic tenets of the Planetree philosophy are within each employee and that's the compassion and personalizing the experience, remembering people's names and what's special about them, and the relationship between employees and the patients and families. Helping them be as comfortable as possible, helping them understand what's going on, answering their questions and fears, and using staff as instruments of love and compassion." It all starts at hello.
"Over the years since we implemented Planetree," Morin says, "just as we went to the model site in California, hospitals all across the country come here to spend the day at our hospital to learn from us, and we know we have impacted health care not just in our community, but hospitals all across the country."
[For more information, contact: Joyce Powell Morin at [email protected] or (541) 296-7266.]
The Planetree model is almost 30 years old but its essence is timeless, says Janet Powell Morin, RN, chief culture officer and former vice president, patient care services at Mid-Columbia Medical Center (MCMC) in The Dalles, OR.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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