Griffin’s design, care make it a hot benchmark
Is this a hospital or a hotel?
Many hospitals claim to practice patient-focused care, but few actually do to the degree that Griffin Hospital in Derby, CT, does. At Griffin, which has been called the best-designed hospital in America, the very walls were built around its patient-driven philosophy.
This has made it one of the hottest benchmarked hospitals in the country. (See "Only the best: Griffin’s great design hunt," p. 48.)
An average of two health care organizations a week visit Griffin to benchmark the system’s exceptional patient-focused care model and its award-winning architecture. It’s easy to understand why.
Griffin’s care model includes medical records in which patients can note their comments; unrestricted visiting in all areas; double beds in the childbirth center for dads or others to stay over with moms; a self-medication program to help patients learn how to take their medicine when they return home; and a "care partner" program in which family members learn to care for the patient.
The care model has led Griffin to provide full kitchens for patient and family use and for volunteers to bake cookies and breads for patients; music lounges with pianos on each unit to accommodate the arts and entertainment program with musicians, magicians, and other performers; quiet lounges with salt water aquariums; and a pet therapy program with trained greyhounds retired from racing.
The hospital also provides patients with a hotel-like room service program, through which they can get cafeteria or gift shop items and a variety of services, including massages. Then there’s the hospital’s library, which has more than 4,000 books, health magazines, audio- and videotapes for the public. More than 4,000 community residents hold library cards and more than 1,000 use them monthly.
Griffin’s hospital television system includes a patient information bulletin board; a patient information channel featuring videos on Griffin’s patient care philosophy and patient services; and a relaxation channel with soothing music and nature-scene videos. Videos cover such topics as patients’ rights, living wills, access to medical records, and spiritual care. Griffin does not charge for television, telephone service, or parking.
If all this sounds like a recipe for happy patients, it is. Contrary to state and national trends, Griffin’s admissions have been growing by 2% to 4% since renovations were completed in 1995, and inpatient satisfaction now hovers around 93% (95% for the childbirth center) and outpatient satisfaction is in the 94% to 96% range. A recent accreditation inspection produced only six recommendations for improvement on 3,000 standards and a grid score of 93%. And wonder of wonders, this hospital operates in the black.
In November 1996, Griffin completed the first-ever sweep of four national health care design and construction awards, prompting some to observe that this 160-bed, not-for-profit, acute care facility is not only the best-designed hospital in America today, but probably the model for the 21st century.
In his newsletter, On Achieving Excellence, management guru Tom Peters writes Griffin has "earned bragging rights as the best health care environment in the country." And Wayne Ruga, president of The Center for Health Design, commenting on Griffin’s 1995 International Award, said: "A visit to Griffin is a must. The environment is invitingly personal, appropriate for its community context, and expressive of caring, nurturing, and love. Griffin has gone far beyond what is normally characterized as patient-focused’ design."
But the architectural awards are the least of Griffin’s story. "First, there was the care model," says William C. Powanda, Griffin’s vice president of support services, "and it was the care model that drove the physical design." That care model evolved from necessity, he says. In 1981, Griffin was awash in red ink. Hospital administrators, some with their own unhappy inpatient experiences, knew they had to radically change the way Griffin operated, and quickly if it was to avoid becoming another bankruptcy statistic.
The old Griffin care model was based on team nursing, but when Griffin managers began to research new models, they did something very smart. They asked their patients. Through patient surveys and focus groups, hospital leaders got a good picture of what their customers liked and disliked about care at Griffin. It was not a pretty picture, admits Powanda: Some 28% of those surveyed said they’d like to avoid being admitted to Griffin.
Among the care models they investigated was the San Francisco-based Planetree Model, a patient-driven program with a heavy emphasis on empowering the patient and the caregiver. Named for the tree under which Hippocrates taught medicine in ancient Greece, Planetree was established in 1978 by Angelica Thierot, an Argentinean woman whose own experience with American health care left her convinced it had to be changed.
Thierot has three principles for the Planetree Model:
• that health care providers give consumers broad access to health and medical information;
• that they encourage patients to become active agents in decisions related to their own health treatment and maintenance;
• that following the patient’s wishes, they allow friends and relatives to be involved in the health care process.
Planetree has 25 affiliated hospitals in 11 states, Norway, and England. Griffin became its first affiliate in 1992 and today is the single largest all-Planetree facility. The next largest is a 49-bed hospital in Oregon.
With its shift to Planetree, Griffin also adopted the primary nurse model, wherein each patient is assigned one nurse who acts as an advocate and coordinates the patient’s care for the length of his or her stay. A care conference, held within 48 hours of admission, includes the patient, primary nurse, physicians, and others who discuss the care plan.
As hospital managers undertook renovations of its childbirth center in 1987 and its medical/surgical units in 1990, they scoured the country for architectural designs that complimented Griffin’s new patient-driven care model. This led to rooms in the childbirth center that would put good hotels to shame, as well as specially designed double beds to accommodate dads staying overnight, and a jacuzzi for moms in labor.
The average length of stay in these delivery units is about 2.4 days, says Powanda, a little longer than the national average. But he’s proudest of a two-year-old post-partum return visit project, so far involving more than 2,000 mothers. About 90% of the mothers take advantage of this opportunity to meet with the same staff that delivered their babies within 72 hours of the births. "We actually identify problems in about one in four cases and refer the mother and child to an appropriate source of care," says Powanda.
The new medical/surgical suites were designed in pods of four rooms around a central nursing station, which gives the primary nurse quick access to each room. This configuration also increased patient satisfaction and drastically cut the number of times patients used their call buttons. Because they can see the nursing station from their rooms, patients no longer feel isolated or forgotten as they did on the old long hallways, where many rooms were quite a hike from the nursing station.
Design reflects patient preferences
Initially, hospital managers toyed with the idea of having all private rooms, says Powanda, but changed their minds when focus groups and surveys told them that some patients liked the comfort of being in a room with someone else. At Memorial Hospital in Hollywood, FL, Griffin administrators found a model for their own semiprivate rooms. It features an L-shaped room with the bathroom in the middle, which serves as a natural divider. Cabinets are arranged so there is no direct line of sight between patients, but both have an outside view through window.
Griffin’s intensive care rooms have separate access for caregivers and visitors. The rooms are designed around a horseshoe-shaped corridor with access to the nursing stations. This accommodates equipment and lets nurses and doctors come and go without wading through visitors. An outside corridor gives access to the rooms from the visitors’ lounges. The lounges have a kitchen and showers for visitors, and they open onto a fresh air balcony.
In February 1995, Griffin completed its $30 million facilities improvement project featuring a new 100,000-square-foot, 87-bed patient care building. Inside the four-building complex you find carpet, more than 500 pieces of original artwork most done by local artists and lots of warm wood and soothing colors. So did Griffin pay a lot more for all of this?
"When we were negotiating with the hospital commission, their only requirement was that we achieve our designs for the same cost per square foot we would have spent on a more traditional design," says Powanda. By diligently shopping for materials and services, Griffin was able to do just that. Not only did the renovations come in within budget, but the hospital’s shift to a patient-driven care model has put it firmly in the black for the past six years, he says.
"We don’t see these things as fluff, but as the right thing to do," says Lynn Werdal, RN, MS, vice president of patient services. A big part of her job is directing the recruitment, training, and retention of staff dedicated to the patient-driven care model.
Toward that end, Werdal oversees retreats for employees and volunteers. Almost 800 of the 1,100 employees, including directors, have attended a retreat, some of which are held in an old abbey on Long Island. There, in groups of about 30, employees and volunteers role-play to learn what it’s like to be a patient and helpless. They share semiprivate rooms, feed one another, lead each other blindfolded, and participate in other trust-building exercises. "They come away with a different perspective altogether," says Werdal.
The vast majority of the staff and volunteers take to the care model wholeheartedly, says Werdal. Those who don’t are quickly weeded out. "Nurses cannot be controlling," she asserts. "It is the patients who control. That doesn’t mean we let people run rampant through the place, however." For example, nurses will intervene if a small child bangs on the pianos or a patient on IV wants to play the piano.
Care model is dynamic
As good as the hospital’s patient-driven care model is, it’s not static, Powanda says. Griffin continues to search out new patient-driven initiatives, such as a joint project with Yale University to give the hospital’s patient education programs a community focus. Another new project is a school-based health center that already has provided health screening and counseling to more than 800 high school students.
But one aspect will remain constant, Powanda says: "We will always make the patient our priority and strive to truly involve and educate patients so they can be active partners in their care and treatment."
[Editor’s note: For more information, contact William C. Powanda, vice president of support services, Griffin Health Services Corp., Derby, CT. Telephone: (203) 732-7515. Or visit Griffin on the World Wide Web at www.invalley.org/griffin.]
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