Unsatisfactory stay sparks Planetree care model

Nurturing environment valued

One woman's vision of a new type of hospital — sparked after the lack of personalized care she experienced during treatment for a serious illness — resulted in the creation of the Planetree organization, which has become became a leader in pioneering patient-centered care.

Named for the tree that Hippocrates sat under as he taught students in ancient Greece, the organization stresses the value of providing a nurturing environment, in addition to medical expertise and technology, and of listening to what the patient has to say about his or her condition.

The woman behind Planetree — Angelica Thieriot — began her efforts in that direction after concluding that the hospital at which she was treated provided good medical care, but didn't address any of her other needs as a human being, explains Gillian Cappiello, CHAM, a consultation services specialist for Planetree, which is based in Derby, CT.

Caregivers would talk over her, take her to have tests without telling her what they were doing, and come in and out of her room without familiarizing themselves with her or her chart, Cappiello says. The hospitalizations of Thieriot's father-in-law and son allowed her to experience these communication and education issues from a family member's perspective, she adds.

In the Planetree model that Thieriot's vision helped create, every employee is considered a caregiver — not just the nurse or the therapist, but also the housekeeper and the person talking to the patient about the bill, Cappiello points out.

Much of the focus is on creating a healing environment for patients, families, and visitors — and also for employees, she says. "A lot of what we talk about is care for the caregiver."

There are many applications for access services professionals, notes Cappiello, who previously served as senior director of access services and chief privacy officer at Swedish Covenant Hospital in Chicago.

"From the access side, it's focusing on how you can make your environment more welcoming for the patient," she says. "The human interaction piece is huge, and the physical environment comes into that as well."

Warm colors, comfortable furniture, and soft lighting contribute to a soothing environment, Cappiello points out, as do features that are reminiscent of nature, such as aquariums. She recommends having furniture arranged in conversational groups rather than a row of chairs, she advises.

Removing clutter and reducing noise levels also helps provide a more pleasant experience for patients, Cappiello adds.

Waiting and reception areas should be barrier-free, she says. "If there's a desk, it should be low, so it doesn't create a barrier between [employee and patient]. Always have somebody there smiling.

"Communication is key," Cappiello says. "Keep patients informed if there are delays." If there is wait time, she suggests, use conveniences such as roaming pagers to give patients more flexibility.

Making wait time more enjoyable

During the wait, she adds, "offer something other than two-year-old magazines." Provide choices for the patient, she adds: "'Do I want to wait here? Do I want to get a cup of coffee?' Have those things easily accessible."

Make the hospital stay more like a hotel stay, Cappiello says, by determining some of the patient's preferences: What newspaper do they want delivered? What is their preference for food service?

Instead of serving meals when it's convenient for hospital staff, she advises, do it when the patient is ready to eat.

CarePages, a program in place at Swedish Covenant Hospital and at several hundred other hospitals throughout the country, is a perfect example of the kind of customer service initiative that Planetree endorses, Cappiello notes.

The program allows patients or family members to send updates on the patient's condition over the Internet and receive messages in return, she says. "Families can post photos or write that Uncle Joe had surgery today and is doing fine. It provides a virtual gathering place, a secure web page that is managed by the patient or a family member or friend."

Another way to make the hospital experience easier, says Cappiello, is to provide — starting with preadmission testing — a binder for collecting information regarding the entire process, from testing to follow-up care.

"Have sections for diagnosis, medications, diet, physical exercise or physical limitations, and cards for physicians," she adds. "It's very applicable for people who have a disease that requires [ongoing treatment]."

Having a resource center in a place — possibly in the preadmission area — where it is convenient for patients to go to get information is another way to help them be partners in their own care, Cappiello says.

There are now about 125 hospitals that are Planetree affiliates, Cappiello says, ranging from small rural facilities to large, complex health systems. "The program is not a cookie cutter," she adds. "Every model is going to look a little different."

The Planetree organization gleans ideas and best practices from all the hospitals with which it is affiliated, Cappiello says. "Even with new affiliates, we find things they are doing that are creative and help [other facilities] look at what they might do in a similar fashion."

There is an annual fee for being affiliated with Planetree, she says, and it covers a certain amount of consulting hours — depending on the specific contract — and other resources.

"If a hospital is interested, the chief executive officer would come out and do a presentation for the board of directors and other decision makers," Cappiello says. "Once the facility is signed on, staff like myself would come onsite and do a presentation for all employees, talking about specifics — like a best practice presentation."

An organizational assessment is done — including focus groups with employees and patients — that helps identify the hospital's strengths and where there are opportunities to improve the experience of the patient, she adds. "One of the biggest things hospitals use is patient satisfaction scores and [measurements] of employee satisfaction and staff retention. Typically, Planetree hospitals have much less turnover than the national averages."

Other areas of interest, Cappiello says, are issues of patient safety, such as processes for handling medication errors.

In addition to acute-care hospitals, Planetree encompasses other kinds of facilities, such as long-term care homes and health resource libraries, she notes. The idea behind the libraries — which may be independent or connected with hospitals — is to give patients the opportunity to take some responsibility for their own care by finding out about their medical conditions, Cappiello adds.

Resource for 'cyberchondriacs'

This is a better alternative, she points out, than the popular practice of consulting Internet sites for medical advice and the "cyberchondriacs" that sometimes fosters. "There is so much bad information out there," Cappiello says, that it is helpful to have a librarian and staff to assist with the research.

Access departments often oversee hospital transport, she notes, which offers an opportunity to enhance the person's initial impression of the facility. Some hospitals, Cappiello adds, pipe music into the parking area and take patients to the front door in golf carts.

Ideally, she says, a hospital "ambassador" is waiting to greet them.

Wayfinding is another area in which the Planetree philosophy can be employed, Cappiello says. "If there are multiple entrances, how do you make sure that patients have the easiest and most relaxing way to get where they're going?

"Signage is horrible in most hospitals," she notes. To make finding the way easier for patients, many Planetree hospitals use visual clues, Cappiello adds. "There might be a water fountain in the corner, or a piece of artwork, and the signage is directed to those things, which transcend language."

[Editor's note: More information on the Planetree organization is available at www.planetree.org or by calling (203) 732-1369.]