The 4 Arch-Enemies of Patient-Centered Care

Last year, when my daughter Jess was hospitalized for a rare and paralyzing nerve disorder, her room was an aging, cluttered cubicle with no shower. There were no gourmet meals, Egyptian cotton sheets, or concierge services.

What mattered most, though, was the chair next to Jess’ bed that folded flat so I could catch some sleep. A private room. Acceptance from staff that we would stay with Jess around the clock. A medical team that listened when we found new research. And an angel in the form of a caring nurse named Lisa.

It frustrates me when people see high-end amenities as the best indicators of patient-centered care. If you rate your hospital poorly because you don’t like the mashed potatoes, trust me, that’s the thing they’ll spend money on fixing. It’s sure a lot easier than rooting out the true arch-enemies of patient-centered care: Ego, Inertia, Agenda and Excuses. Do you really think free slippers trump having a doctor who listens?  Wake up, patients! After you’re all better, blessing that nurse who held your hand at 3 AM when you were terrified, you can plan a trip to that 5-star hotel with the 600-thread count bedsheets.

Some hospitals get it, which I’ve written about before in my book. But one organization, Planetree, “gets it” by asking patients what they want, every day, as a kind of religion. In a recent ten-year period, Planetree talked to 50,000 patients, families and caregivers, in some 6,000 focus groups. They also go around the world, actively teaching other hospitals and nursing homes how to implement the things patients care most about. Committing to become “Planetree-certified” is the patient-centered care equivalent of training to win an Olympic Decathlon. There are dozens of specific, evidence-based criteria to meet and measure. Planetree hospitals must outperform on publicly reported safety and satisfaction measures. Undaunted (or perhaps attracted) by these high hurdles, Planetree’s international membership today is made up of 500 organizations in sixteen countries.

One reason Planetree is different: it was actually founded by a patient, back in 1978. When Angelica Theriot got sick and went into the hospital, she found her clinical care was good. But, says Planetree President Susan Frampton, “she was really horrified by the human experience that she had. So she founded Planetree with a very lofty goal: to change the health care system to be more patient- and family-centered. And that’s been our mission … for the last three and a half decades.”

I’ve worked with Susan Frampton on quality improvement committees. Which is how I recently came to visit Planetree’s flagship hospital, Griffin Hospital, in Derby Connecticut. Here are some things I would love as a patient:

Virtually every staffer I walked by met my eyes and smiled.

Patients and families can see and question their charts any time. Their treatment plans are made and modified together with the medical team. Religious preferences, spiritual needs, even hobbies, are accommodated to the greatest extent possible.

Every patient unit has a real, full-size kitchen, so families can actually cook there and sit down to a meal with the patient. Visiting hours are 24/7. Even visits by the family dog can be arranged.

In the morning, volunteers bake goodies in the ovens. The smell of baking breads and cakes in the halls sure beats…you know, other hospital smells.

There are no laundry carts, IV poles, computers on wheels, etc. in the halls outside patient rooms. It’s all housed away from view. A nurse’s station, meantime, is visible from every patient room. The cafeteria food is all fresh and locally sourced whenever possible.

To maximize patient privacy, the ICU wing is built in a big horseshoe pattern: nursing functions in the inner ring, private patient rooms in the next ring, and family waiting areas along the outer perimeter.

Any patient  worried about losing their hair from cancer treatment can pick out a wig of their choice at the hair salon, free of charge.

It was kind of like Emerald City, where every patient is Dorothy with magic ruby slippers.

All this must come with a big price tag, right? Nope. Frampton says this kind of care can actually cut costs. She says that one hospital system that includes Planetree hospitals as well as some that aren’t, compared its orthopedic patients. “And they found that the length of stay was actually shorter” in the Planetree hospitals, she says. “People healed quicker, they were discharged more quickly, and so the cost of care came down.” Adds Griffin Hospital CEO Patrick Charmel, “We get very high ratings from patients. Our costs are lower because we don’t do unnecessary tests and treatments, we don’t make as many errors, so our malpractice insurance doesn’t cost as much.”

Don’t get me wrong. The biggest thing we need from our medical care– is to get better. But that means the medical team is open to a patient or family member when they say something doesn’t seem right. Or respecting that though a certain treatment plan may prolong life, it’s not always worth the human cost to that patient.

It can take some digging to know if your local hospital is on the right track.  Ego, inertia, agenda and excuses thrive in organizations big and small. They can hide behind the stunning waterfall in the hospital lobby, or lurk in the halls of that gorgeous new orthopedic wing. Nice things cost money; are they bought with nursing staff cuts? Or high rates of unnecessary medical procedures? Consider bringing a more discerning eye to your next hospital experience. Ask friends who work there or have been treated there what they think. Look at hospital safety scores and Hospital Compare online. Find out if the Great Wizard is really all he says he is.

And to hospitals and nursing homes, consider heading over to the Planetree annual conference this fall, and seeing what the fuss is all about.

Planetree offers free assessment tools (IPFCC and other groups do, too), so any hospital can get a free road map to making care more patient-centered.