Griffin is world class in patient-centered care

Its philosophy is reflected in everything, A to Z

As a buzzword, patient-focused care has lost its sex appeal; but as a daily practice, it makes Griffin Hospital in Derby, CT, one of the best in the country. In fact, visitors often mistake it for something other than a hospital when they see the artwork on the walls and sniff the aroma of home-baked goodies wafting through the halls. Nurses have been known to move to Derby just to get a job at Griffin. Patients say they are crazy about the place. What’s more, it turns a profit every year.

That’s not easy for a 161-bed hospital that competes with seven other hospitals — including Yale University’s teaching facility — within a 15-minute drive. "We could never compete technologically with the Yales of this world," concedes Lynn Werdal, vice president of patient care services. Instead, Griffin carved its market niche as a world-class model of patient-centered care.

The turnaround started in 1990 with renovation of the buildings that dated back to the 1920s. At the same time, the nurses rebuilt their care model to align with the primary nursing philosophy. Each nurse is responsible for total care from bathing to discharge planning. Patient feedback and focus groups guided Griffin’s transformation — a badly needed metamorphosis.

In 1981, 28% of the respondents to a community survey said they would avoid Griffin if possible. During 1993, the first full year after the new building opened, admissions were 4,360. Admissions climbed to 4,398 for each of the years since, a 1% rise. At press time, Bill Powanda, vice president of support services at Griffin, estimates that fiscal year 1997-1998, which ended Sept. 30, will see a 2% rise in admissions. He notes, "Even if our admission rates remained flat since 1993, we would be bucking the trends both nationally and for the state of Connecticut."

Is this really a hospital?’

The environment at Griffin is modeled after the Planetree philosophy, explains Michael Gaeta, EdD, Planetree’s executive director. Planetree is a nonprofit organization dedicated to the principle of individuals participating in their care. The term planetree means sycamore tree. Hippocrates, the father of modern medicine, sat beneath a sycamore and taught his medical students.

Features of this approach, which you’ll find at Griffin, resemble those you’d see in a loving home:

• Patients administer their medications if they’re able.

• Visitors of all ages are welcome around the clock, even in the intensive care unit.

• Volunteers offer massages to patients upon request and hold their hands as they undergo cataract surgery.

• Relatives, volunteers, and patients use the unit’s kitchens to cook meals or favorite treats.

• Patients read and write notes on their records if they choose.

• Music from the lobby’s piano in the graces the otherwise quiet atmosphere.

• The resource library is stocked with 250 tapes, 150 consumer magazines, and a growing collection of health-related CDs. Every year, 1,400 consumers visit from all over New England.

• Two nurse educators check the admissions list every morning, prepare a diagnosis-specific information packet for each new patient, and deliver it to the respective primary nurse. If patients wish other information, for example, for a spouse who has gall bladder problems, all they have to do is ask.

• The architecture of the nursing stations fosters close patient-caregiver interaction. Each nurse works out of a pod surrounded by four patient rooms. The computer and all the supplies are there so the nurse is never more than eight feet from any of his or her patients.

• Visitors’ lounges have open-air balconies. Showers are available as well. Throughout the hospital, aquariums afford anxious visitors, patients, or staff peaceful diversions from pressing concerns.

While Griffin is toured by hundreds of visitors a year, they’re warned that they should not expect to achieve its results by copying its programs or architecture. To create a life-enhancing environment like Griffin’s, "an organization has to value the dignity of the human being and organize its policies around that value," advises Wayne Ruga, president and CEO of the Martinez, CA-based Center for Health Design. Such an environment, whether in a grocery store, bank, or manufacturing facility, emerges from the culture of the organization and the surrounding community.

At Griffin, it started with a two-day staff retreat with representatives from each department. They lived as patients — sleeping in hospital beds, eating hospital food, and being bathed by strangers. Then, on April 15, 1992, the changes went into effect. Werdal calls it "the Day of Infamy."

No looking back

"I took a lot of abuse when people realized how much they were going to have to change," Werdall remembers. Those comments include:

• Nurses complained about the hard work involved in primary nursing. Werdal says, "I reminded them that they chose it."

• Physicians grumbled about patients reading their medical records. "I reminded them that JCAHO regulations allow it," she says.

For the first few months, everyone regarded the changes as just another nursing fad that would go away. Today, reactions include:

• Nurses rave that they get to do the kind of care that brought them into their careers.

• Physicians say that open charts are a non-issue.

• As for staff turnover, Werdal does not cite numbers, but notes that it’s low. She says at least 70% of Griffin’s employees get three weeks vacation, a perk generally earned after five years on the payroll.

"Our philosophy is easy — it’s just being kind to people," Werdal explains. "But we have to work at it every single day." To that end, she conducts six to seven staff retreats a year for 25 employees at each retreat — some are new hires and others are veteran employees. For two days, employees live as patients, being wheeled around on gurneys for tests and eating hospital food. The retreats pay off big. Griffin’s patients’ surveys come back with 93% excellent ratings for inpatient care and 97% for outpatient care.

Ruga praises Griffin Hospital for its track record of enhancing the lives of its employees and customers. Satisfying both criteria is a key to sustainable and ever-improving quality. If, on the other hand, "you set quality as your goal and do the interventions to improve it, you will get some improvement," he concedes. "Then it dies rather than sustaining itself and growing from there on its own."