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Planetree: A Radical Model for New
Healthcare/Healing/Wellness Excellence
Tom Peters/10.04.2004
Learn more about Planetree/The
Planetree Alliance:
www.planetree.org
“If one didn’t know better, one might think that hospitals set out to design
systems that provide the most sophisticated technical care but
deliver the worst possible experience to sick people.” —Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
“It was the goal of the Planetree Unit to help
patients not only get well faster but also to stay well longer.” —Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
“Those of us working in healthcare have an obligation to be of service in this world, to be bringers of light and
hope. Our work is spiritual by its nature, as the Planetree model has acknowledged for decades.”
“Our definition of spirituality is coming into a right relationship with all that is, establishing a loving,
nurturing, caring relationship. Planetree’s has been to refocus our attention on the power of relationships, and, in particular, the mind-body-spirit relationship essential to healing. It has opened a door that will
never be closed.” —Leland Kaiser, “Holistic Hospitals”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“Much of our current healthcare is about curing.
Curing is good. But healing is spiritual, and healing is
better, because we can heal many people we cannot
cure.” —Leland Kaiser, “Holistic Hospitals”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“The ‘curative model’ narrowly focuses on the goal of cure. …
From many quarters comes evidence that the view of health
should be expanded to encompass mental, social and
spiritual well-being.” Institute for the Future
Determinants of Health
Access to care: 10%Genetics: 20%
Environment: 20%
Health Behaviors: 50%Source: Institute for the Future
The 9 Planetree Practices
1. The Importance of Human Interaction2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information3. Healing Partnerships: The importance of Including Friends and Family4. Nutrition: The Nurturing Aspect of Food5. Spirituality: Inner Resources for Healing6. Human Touch: The Essentials of Communicating Caring Through Massage7. Healing Arts: Nutrition for the Soul8. Integrating Complementary and Alternative Practices into Conventional Care9. Healing Environments: Architecture and Design Conducive to Health
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1. The Importance of Human Interaction
“There is a misconception that supportive interactions require more staff or more time and are therefore more costly. Although labor costs are a substantial part of any hospital budget, the interactions themselves add nothing to the budget. Kindness is free. Listening to
patients or answering their questions costs nothing. It can be argued that negative interactions—alienating
patients, being non-responsive to their needs or limiting their sense of control—can be very costly. …
Angry, frustrated or frightened patients may be combative, withdrawn and less cooperative—requiring far more time than it would have taken to interact with them initially in a positive way.” —Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
Press Ganey Assoc/1999: 139,380 former patients from 225 hospitals
0 of top 15 factors determining Patient Satisfaction referred to patient’s health outcome
PS directly related to Staff Interaction
PS directly correlated with ES (Employee Satisfaction)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Mgrs re staff: wages, security, promotion opportunities
Staff re staff: interesting work (M:5 of 10), appreciation (5 of 10), sense of being “in” about
what’s going on (10 of 10)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
The Customer Comes Second: Put your People First and Watch ’Em Kick Butt, Hal Rosenbluth (and
Diane McFerrin Peters)
“100 Best Places to Work”/RLevering/2001
Get straight answers
Appreciation
Collaboration
Interest in me as a person
Camaraderie (“Fun place to work”)
“Perhaps the simplest and most profound of all human interactions is kindness. … But if it is so simple, it is surprising how
frequently it is absent from our healthcare environments. … Many staff members report verbal ‘abuse’ by physicians,
managers and coworkers.” —Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
“An estimated 60 to 90 percent of doctor
visits involve stress-related
complaints.” —Newsweek/
“Health for Life”/09.27.2004
“Planetree is about human beings caring
for other human beings.” —Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel (“Ladies and gentlemen serving ladies and gentlemen”—4S credo)
2. Informing and Empowering Diverse
Populations: Consumer Health Libraries and
Patient Information
Planetree Health Resources Center/1981Planetree Classification System
Consumer Health LibrariansVolunteers
Classes, lectures (CR)Health Fairs
Griffin’s Mobile Health Resource CenterOpen Chart Policy
Patient Progress NotesCare Coordination Conferences (Est goals, timetable,
etc)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
3. Healing Partnerships: The
importance of Including Friends
and Family
“When hospital staff members are asked to list the attributes of the ‘perfect patient and family,’ their
response is usually a passive patient with no family.” —Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
“Family members, close friends and ‘significant others’ can have a far
greater impact on patients’ experience of illness, and on their
long-term health and happiness, than any healthcare professional.” —Through
the Patient’s Eyes
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“A 7-year follow-up of women diagnosed with breast cancer
showed that those who confided in at least one person in the 3
months after surgery had a 7-year
survival rate of 72.4%, as compared to 56.3% for those who
didn’t have a confidant.”Institute for the Future
The Patient-Family Experience
“Patients are stripped of control, their clothes are taken away, they have little say over their schedule, and they are deliberately separated
from their family and friends. Healthcare professionals control all of the information
about their patients’ bodies and access to the people who can answer questions and connect
them with helpful resources. Families are treated more as intruders than loved ones.”
—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Institute of Medicine/ “Crossing the Quality Chasm”
Respect for preferencesInvolvement in Decision Making
Access to careCoordination of care
Information and educationPhysical comfort
Emotional supportInvolvement of Friends and Family
Continuity of care
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Care Partner Programs (IDs, discount meals, etc)
Unrestricted visits (“Most Planetree hospitals have eliminated visiting restrictions altogether.”) (ER at one hospital “has a policy of never
separating the patient from the family; and there is no limitation on how many family members may be present.”)
Collaborative Care ConferencesClinical Guidelines Discussions
Family SpacesPet Visits (POP: Patients’ Own Pets)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
4. Nutrition: The Nurturing Aspect
of Food
Meals are central events
vs
“There, you’re fed.”*
*Irony: Focus on “nutrition” has reduced focus on “food” and “service”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
KitchenBeautiful cutlery, plates, etc.
Chef rep
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Aroma therapy (e.g., “smell of baking cookies”)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
5. Spirituality: Inner Resources for Healing
Spirituality: Meaning and Connectedness in Life
1. Connected to supportive and caring group2. Sense of mastery and control3. Make meaning out of disease/find meaning in suffering
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Spirituality
body-mind-spirit
prayer-meditation-visualization
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Griffin: redesign chapel (waterfall, quiet music, open prayer book)
Other: music, flowers, portable labyrinth
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
6. Human Touch: The Essentials of Communicating
Caring Through Massage
“Massage is a powerful way to communicate caring.” —Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick Charmel
Mid-Columbia Medical Center/Center for Mind and Body
Massage for every patient scheduled for ambulatory surgery (“Go into surgery with a good attitude”)
Infant massageStaff massage (“caring for the caregivers”)
Healing environments: chemo!
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
7. Healing Arts: Nutrition for the Soul
Planetree: “Environment conducive to healing”
Color!Light!
Brilliance!Form!Art!
Music!
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Florence Nightingale/Notes on Nursing/patient’s need for beauty, windows, flowers: “People say the
effect is only on the mind. It is no such thing. The effect is on the body, too”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Griffin: Music in the parking lot; professional musicians in the lobby
(7/week, 3-4hrs/day) ; 5 pianos; volunteers (120-140 hrs arts & entertainment
per month).
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
8. Integrating Complementary and
Alternative Practices into Conventional Care
CAM (Complementary & Alternative Medicine):
83M in US (42%)CAM visits 243M greater than to PCP (Primary Care
Physician) (With min insurance coverage)W-F-Educated-Hi incDon’t tell PCP (40%)
OTA: <30% procedures used in conv med have undergone RCTs (randomized clinical trials)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Griffin IMC/Integrative Medicine Center
MassageAcupuncture
MeditationChiropractic
Nutritional supplementsAroma therapy
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
9. Healing Environments: Architecture and
Design Conducive to Health
“Planetree Look”
Woods and natural materialsIndirect lighting
Homelike settings
Goals: Welcome patients, friends and family … Value humans over technology .. Enable patients to participate in their care … Provide flexibility to
personalize the care of each patient … Encourage caregivers to be responsive to patients … Foster a
connection to nature and beauty
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
SoundTextureLighting
ColorSmellTaste
Sacred space
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Access to nurses station:
“Happen to”vs
“Happen with”Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
The Eden Alternative
The Ten Principals of the Eden Alternative
1. The three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among Elders.2. Life in an Elder-centered community revolves around close and continuing contact with children, plants, and animals. These ancient relationships provide young and old alike with a pathway to a life worth living.3. Companionship is the antidote to loneliness. In an Elder-centered community we must provide easy access to human and animal companionship.4. A healthy Elder-centered community seeks to balance the care that is being given with the care that is being received. Elders need opportunity to give care and caregivers need opportunities to receive care.
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“The Eden paradigm allows elders to care for animals,
birds, and children as well as each other.” —Susan Eaton, Harvard/JFK school
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
The Ten Principals of the Eden Alternative
5. Variety and Spontaneity are the antidotes to boredom. The Elder-centered community is rich in opportunities to sample these ancient pleasures.6. An Elder-centered community understands that passive entertainment cannot fill a human life.7. The Elder-centered community takes medical treatment down from its pedestal and and places it into the service of genuine human caring.
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
The Ten Principals of the Eden Alternative
8. In an Elder-centered community, decisions should be made by the Elders or those as close to the Elders as possible.9. An Elder-centered community understands human growth cannot be separated from human life.10. Wise leadership is the lifeblood of any struggle against the Three Plagues. For it, there can be no substitute.
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“The most basic question we need to
pose in caring for others is this: Is this a loving act?” —Leland Kaiser, “Holistic
Hospitals”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Conclusion: Caring/Growth “Experience”
Care!Control!Connect! Engage!Grow!
De-stress!
“The single best way to predict the future is to
create it.” —anon