Strategies for Leadership2lqlcl3xk1mm2ddadq3qg9bx.wpengine.netdna-cdn.com/wp-content/… · A Quick...

Improving Communicationswith Patients and Families

A B L U E P R I N T F O R A C T I O N

LeadershipStrategies for





I N T R O D U C T I O N

In 2001, the American Hospital Association (AHA) undertook a two-year initiative to make the organization’sA Patient’s Bill of Rights a more contemporary statementof the expectations of patients and hospitals. The AHABoard of Trustees appointed a task force to lead this effort.The result: The Patient Care Partnership: UnderstandingExpectations, Rights and Responsibilities, a straightforward,plain language statement that clearly outlines what patientsshould expect during their hospital visit.

While a successor to the old “Bill of Rights” was importantand a statement of what hospitals wanted their relationshipswith patients to be was necessary, a deeper issue neededattention – better communication. However, today’s environment makes good communication among patients,families and caregivers harder to achieve – hospital stays areshorter, medical care more complex, and there is a growingneed for patients and families to be more involved in caredecisions. The AHA task force, focus groups and otherresearch told us that we needed to do more to fosterclearer, more frequent and more satisfying communica-tions during the hospital experience.

In addition to creating The Patient Care Partnership, theAHA has developed a resource folder – Strategies forLeadership: Improving Communications with Patientsand Families – to help hospitals do a better job talkingwith patients and families. This workbook, A Blueprint forAction, is one of the tools included in the resource folder.

A Blueprint for Action has two parts:

• O R G A N I Z A T I O N A L C H E C K L I S T : A short assess-ment designed to help hospitals gauge their strengths and weaknesses around communicating with patients andfamilies. It’s not intended to provide a “pass/fail” grade,but rather to spark discussion among hospital leaders and identify opportunities for improvement.

• C A S E S T U D I E S : Real-world examples highlightingvarious initiatives some hospitals have undertaken tofoster better communication among patients, familiesand caregivers. Additional case studies will be added tothe AHA Web site, www.aha.org, under “Communicatingwith Patients.”

We hope this workbook, along with the other tools includedin the Strategies for Leadership resource folder, serves as a catalyst to help hospitals do a better job talking withpatients and their families, and thereby, enhance patienttrust and communication.

LeadershipStrategies for



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`e Patient Care Partnership:

A Quick Assessment Tool for Leaders

This checklist focuses on leadership strategies to enhance communication among hospital staff, patients,

families and the community. It’s designed to help you spark a discussion with your management team,

take a look at your policies and activities and develop strategies for improvement.

It Begins With Good Communication

C H E C K L I S T



Understanding communication needs

and issues for your organization and patients

• Have you assessed your internal communications –how information is shared among departments andindividuals, particularly those involved in patientsafety, quality and education?

• Do members of your management team do “patientrounds” to find out firsthand about patients’ andfamilies’ hospital experience and how well your staffis communicating with them?

• Do you monitor your community for changes in itsethnic and cultural demographics and how they affect communications with patients and families?

• Do you have a process in place to respond toinquiries from patients, families and the communityabout your hospital’s charges?

• Do the tools you use to measure patient satisfactiongive you information on how well you are communi-cating with patients and families at all stages of theirhospital experience?

• Are your written communications with patients andfamilies available in a variety of languages that reflectsthe ethnic and cultural fabric of your community?

• Have you tested your Web site for language level and ease of use to be certain its useful and accessibleto everyone in your community?

Establishing and reinforcing patient

communication as an organizational priority

• Do your employees, medical staff, and volunteersknow that excellence in communications withpatients and families is an integral part of the hospital’s quality and patient satisfaction goals?

• Have you reviewed all of your written communica-tions for patients and families to ensure that the language, format and distribution make themaccessible to everyone in your community?

• Do you have an ongoing initiative in place to informpatients, families, visitors and the community at largeabout the new medical privacy regulations and whatyou do to protect the privacy of your patients?

• Does your hospital have a written policy aboutcommunicating unexpected or adverse outcomes to patients and families?

• Do the agencies that collect past due bills on behalf of your hospital do so in a way that reflects the valuesof your hospital and with respect and dignity?

• Do you have help available to patients and familiesconcerned about Medicare, Medicaid or other coverage issues, including filing claims, understanding benefits, co-pays, and deductiblesand the complicated medical billing process?

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

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Y N

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Giving your staff the tools to support

good communication with patients and

their families

• Do you provide in-service training for employees toimprove their ability to communicate with patientsand families?

• Has your hospital developed a “language bank,”identifying people inside and outside your organiza-tion who could help your staff communicate withpatients and families from a wide variety of nationali-ties and ethnic backgrounds?

• Does your hospital have an internal ethicscommittee available as a resource to caregivers facedwith difficult medical decisions? How do you makeits availability known?

• Has your hospital considered using the resourcesavailable from the Patient Friendly Billing Projectsponsored by the AHA and the HealthcareFinancial Management Association to simplifybilling and make the system easier for patients andfamilies to navigate?

Providing your patients with tools to assist

them in talking with their caregivers while

using your hospital

• Does your hospital’s Web site have a section dedicated to information about patients’ rights,patient advocates and other service and assistanceavailable to patients and families?

• Does your hospital have an internal ethicscommittee available as a resource to patients andfamilies faced with difficult medical decisions?How do you make its availability known?

• Does your hospital have an easy, well-communicatedprocess to enable patients and families to follow upon any concerns they have about care, services orother aspects of their hospital experience?

• Are your hospital’s charity care and bill paymentpolicies readily available to patients and familieswho may need help in easy-to-understand languageand in languages appropriate to your community?

• Does your hospital make available and promote inyour community outreach and education the use ofadvanced directives and living wills as a safeguardfor patients and families?

A Quick Assessment Tool for Leaders

C H E C K L I S T

S t r a t e g i e s f o r L e a d e r s h i p



Y N

Y N

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Y N

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B A C K G R O U N D

SSM Health Care, based in St. Louis, is one of the largestCatholic health systems in the country. It owns, manages andis affiliated with 21 acute care hospitals and three nursinghomes in Missouri, Illinois, Wisconsin and Oklahoma.

In November 2002, SSM Health Care became the firsthealth care organization in the country to be named a Malcolm Baldrige National Quality Award winner. The Baldrige Award, given by the U.S. Department ofCommerce, is the highest honor a U.S. company can receivefor quality management and performance improvement.SSM Health Care has used the Baldrige model for the pastseven years as a foundation to help achieve their mission ofproviding exceptional health care services. Their numerousquality and performance achievements are summarized on www.nist.gov/public_affairs/releases/ssmhealth.htm.Highlighted below are some of the key patient-focused initiatives at SSM Health Care.

I N I T I A T I V E S

SSM Health Care has worked diligently to build a cultureof continuous quality improvement. This deeplyembedded culture, integrated with leadership’s unwaveringcommitment and a continual focus on mission, are keysuccess factors for the organization. Alignment of system,network, entity, department, and employee goals helpseveryone to focus on the five defined characteristics ofexceptional health care: exceptional clinical and financialperformances, and exceptional patient, physician, andemployee satisfaction. All the initiatives support one ormore of these essential elements.

Bringing Patients and Their Families into the Care Team

At SSM St. Mary’s Health Center in St. Louis,patient/family care team conferences are designed to

enhance the communication between thepatient and his or her family and the treatment team, soeveryone involved in the patient’s care is working toward aunified goal. The conferences include the patient, family,physicians, nursing personnel, pastoral care, case manager,social worker and other disciplines as appropriate, such asphysical, respiratory or speech therapy. The family alsopicks one or two spokespersons to represent their interests.

Anyone involved in the patient’s care can initiate theseconferences if they feel that more in-depth communica-tion is needed to raise concerns or issues with the familyand/or the care team. The family and the patient areencouraged to articulate their questions and concerns.The increased communication and unified approach canreduce the patient’s and family’s anxiety in what is often ahighly charged environment during which life-and-deathdecisions are made.

Involv ing Parents in Their Chi ldren’s Care

At SSM Cardinal Glennon Children’s Hospital, part of the SSM Health Care system, parents are asked for infor-mation about their child when the child is hospitalized.Parents offer insight into how their child responds to pain,what he or she likes to eat, and behaviors the hospital staffshould be aware of. When the child is a newborn who hasbeen in the neonatal ICU, this kind of information flowsthe other way – from nurses to parents – since in mostcases, at this early point in an infant’s life, the hospital staffknows more about the baby than the parents.

Also in the neonatal ICU, parents are very involved in thecare of their children. The physician or nurse practitionermeets with the parents during every visit to keep theminformed about the plan for the child’s care. Nurses checkon the kinds of training the family may need, such asCPR, feeding instruction, information on medications

C A S E S T U D Y : S S M H E A L T H C A R E



“(Y)our doctor and the nurses and other professionals at our hospital

are committed to working with you and your family

to meet your health care needs.”– The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities

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or dealing with a monitor at home. Parents can findadditional information about their child’s illness throughthe library in the neonatal ICU, which contains bookswritten especially for lay readers. For neonatal patientssuffering from complicated conditions that involve severaldifferent illnesses, parents attend care conferences with all the specialists involved in the infant’s care, as well as therest of the care team.

Improving Cl in ical Outcomes

SSM Health Care has several systems in place that facilitaterapid improvements in patients’ clinical outcomes. Teamsof physicians, clinicians and administrators from across thesystem choose collaboratives in specific clinical areas (e.g.,congestive heart failure) and set in motion a process toexceed national benchmarks in that area. Collaborativesimprove the quality and value of patient care, while creatinga network of clinical experts. In addition, care pathways,clinical guidelines and protocols and standing orders areused to outline a standardized plan of care for patients withcertain diagnoses. These tools are designed with patientinput, creating partnerships with physicians to improvepatient care.

SSM Health Care uses an automated system to make clinical,financial, operational and customer information available to all of its sites. Data is made available to manyphysician partners by using personal computers, personaldigital assistants, pagers and fax machines.

Listening to and Understanding Customers

High patient satisfaction and loyalty are major contributorsto SSM Health Care’s success. Key patient requirementshave been identified using impact analyses: responsiveness,accuracy, good communication and good health outcomes.Loyalty is measured by considering overall satisfaction,willingness to recommend the organization to others, andthe patient’s experience compared to his or her expectations.

Every three years, SSM Health Care identifies potentialcustomers and future markets during its strategic planningprocess. The assumptions are validated annually. A sophis-ticated analysis of market research, market share by productline, and population trends helps define the current and projected environment for customers. Data fromannual medical staff surveys, patient satisfaction surveys,

physician contacts, telephone surveys, and focus groupsare also studied to ensure that the system responds tocustomer requirements.

Formal and informal listening and learning tools are used to learn from former and current patients and theirfamilies. Surveys are customized for key segments:inpatient, outpatient, emergency department, long-termcare, and home care. Other tools such as comment cards,patient follow-up phone calls, focus groups, and asystem-wide complaint system also are used to ensure thatcustomer needs are met and exceeded. Finally, employeejob descriptions and performance evaluations includerequired service standard competencies.

O U T C O M E S

The following are among the successful results of these SSM Health Care initiatives:

• In 1999, SSMHC started a clinical collaborative programwith four teams to improve patient outcomes. By 2002,85 teams have been involved in six clinical collaboratives.

• Physicians connected to an automated informationsystem have increased steadily from 3,200 in 1999 to7,288 in 2002.

C O N T A C T I N F O R M A T I O N

For more about SSM Health Care’s patient-focusedinitiatives, please contact Eunice Halverson, corporatevice president, Quality Resource Center, [email protected] or (314) 994-7747. For more information about SSM Health Care, pleasevisit www.ssmhc.com.

C A S E S T U D Y : S S M H E A L T H C A R E


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B A C K G R O U N D

Northwestern Memorial Hospital is a 720-bed teachinghospital serving the Chicago area. More than 1,200 physi-cians are affiliated with the hospital. One of the hospital’sstrategic goals is to provide the “Best Patient Experience”from the patient’s perspective. In practice, this meanspatients will receive the care they want, when they wantit, how they want it, and where they want it. Putting thosewords into action, in November 1999, NorthwesternMemorial set out to completely re-organize the operationson one floor of its outpatient facility where patients camefor services provided by eight different diagnostic areas –nuclear medicine, nuclear cardiology, stress testing, echo,vascular, pulmonary, cardiac cath and electrophysiology,and ECG services.

Patients coming to the ambulatory care tower (a 22-storybuilding) for diagnostic services encountered a variety of difficulties. There were six different points of entry foroutpatient services on the eighth floor. The registrationprocess was complicated and patients often experiencedlong waits before they were called for appointments.Patients in the waiting area were not always informed ofdelays or changes in appointments. When it was time for a scheduled service, patients found their names called outin crowded public waiting areas in a way that compromisedtheir privacy. Finally, the parking validation procedure wasconfusing and time-consuming.

I N I T I A T I V E S

A steering committee made up of the management team on the eighth floor, a patient representative, a physician representative, and the director of professional servicesdeveloped a patient-focused operational project plan.Initially, the team interviewed patients and staff to identifykey opportunities for improvement. The team also reviewedhistorical patient satisfaction scores, paying particularattention to patients’ written comments. The patientexperience was analyzed from start to finish (i.e., fromthe parking garage to the production of the bill).

Managers spent time working at each of the receptiondesks. Their experiences made it clear that the team neededto think less departmentally and more organizationally. Inresponse to patient feedback, the eighth floor operationswere dramatically changed. Six check-in points werereduced to two check-in points strategically adjacent to themain visitor elevators. Hospital signage and the parkingprocesses were simplified. Scheduling and report dissemi-nation functions were moved out of the waiting area andout of view. Staff wearing the same uniform as the customerservice officers stationed throughout the hospital becameidentified as trusted sources of information.

Electronic seating charts were created to identify wherepatients were seated so that the patient escort (a new staffrole) could bring patients to the procedures. The patientescort uses an intercom headset to provide constantcommunication to patients about updates in their appoint-ment status. A new position, resource coordinator, wascreated to communicate directly with patients who havewaited more than 10 minutes from the time of a scheduledappointment. The resource coordinator is also a liaisonbetween the waiting area and procedure area and is empow-ered to solve any problems.

Staff attended a comprehensive two-week orientationprogram modeled after a customer service program used bya leader in the hotel industry. Hours of operation wereextended into the evenings and weekends in order toprovide timely reports. Scheduling personnel were cross-

C A S E S T U D Y : N O R T H W E S T E R N M E M O R I A L H O S P I T A L

“Your comfort and confidence in your care are very important to us.”– The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities



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trained to schedule any diagnostic procedure offered by anydepartment on the eighth floor. Computers with Internetaccess were installed in one of the public waiting areas sopatients could research health topics.

O U T C O M E S

Patients reported satisfaction on a number of levels includingservice, communication and the streamlined processimprovements. In particular, patients were pleased to beable to schedule multiple procedures with a single phonecall. Technological changes increased availability andtimeliness of reports provided to medical professionals.The overall initiative has become a model for enhancing

patient satisfaction hospital-wide. Finally, for this initia-tive, Northwestern Memorial won the Patient ServiceExcellence award given by Sodexho Health Care Servicesand Modern Healthcare, as well as the 2002 ChicagoInnovation Award.


For more about Northwestern Memorial’s patient-centeredoperations, please contact Larry Goldberg, vice president,Hospital Operations, at [email protected]. For moreinformation about Northwestern Memorial Hospital,visit www.nmh.org.

C A S E S T U D Y : N O R T H W E S T E R N M E M O R I A L H O S P I T A L


O R G A N I Z A T I O N

Woodwinds Health Campus opened its 70-bed hospital inAugust 2000 after four years of planning. Located on30 acres of pristine wetlands in Woodbury, Minnesota,the not-for-profit hospital is a collaboration betweenHealthEast Care System and Children’s Hospitals andClinics of Minneapolis and St. Paul. Working closely with adesign team, a physician leadership group and a communityadvisory board, HealthEast and Children’s boldly devel-oped an innovative hospital and outpatient center thatincorporates integrative healing therapies into a broadscope of medical services to meet the growing needs of thesoutheast metropolitan area of the Twin Cities.

T H E I N I T I A T I V E

When community members were asked what their idealhospital setting would be, they responded that they wanted a balance of physical, emotional and spiritual attention as part of their care. They also wanted a care team that wasresponsive to their individual needs and allowed patientsand their families to be actively involved in care decisions.This input drove the purpose of the Woodwinds HealthCampus – promoting the health and healing of body, mindand spirit for all through relationships, choices andlearning. The hospital set out to achieve these goals by usinga three-pronged approach: compassionate care, patient-centered care and a healing environment.

Compassionate Care

An important prerequisite to delivering compassionate carein a healing environment is the right employee and leader-ship culture – one that is based on listening and opencommunication. The Woodwinds’ culture was designed to bea place where patients and staff are treated as highly respectedcustomers. The chief executive officer considers herself thecustomer expectations officer. As such, her customers are hermanagers and staff. Their customers are the patients.

All employees must sign a CompassionateService Promise Statement that reinforces their commit-ment to the compassionate service philosophy. Thepromise statement outlines specific actions that support thephilosophy including helping others, looking up to greetpatients or visitors, and going beyond their normal dutiesto assist a patient or co-worker in need.

Although it is the job of every staff member to make thepatients’ experiences as positive as possible, a full-timeservice quality consultant assists staff and managers withservice initiatives if customer service problems arise. Staffmembers are motivated to support physicians in providingcompassionate care and physicians are asked for their inputabout how patients’ experiences can be improved. Inaddition, the senior management team has systems in placeto improve ongoing service initiatives and analyze newinitiatives that could enhance patient care.

A unique and very active concierge-type of volunteerprogram provides traditional and non-traditional patientservices. For example, volunteers escort patients andfamilies to their service destinations, and make mail andflower deliveries each day. Volunteers also may stay withpatients until family arrives from out of town. Or theymight visit with or read to patients who do not have regularvisitors. Woodwinds’ volunteer corps includes more than250 active community members.

P a t i e n t - c e n t e r e d C a r e

All hospital procedures and routines are positioned to keepboth clinical care outcomes and patients’ needs as the focusof attention. Staff and physicians are encouraged tochallenge the status quo about how any service is provided ifit will improve patient care. No standard procedure orroutine is accepted as the only or best way to conductbusiness just because it has always been done that waybefore. The entire health campus functions as a learninglaboratory to improve patient care.

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“Our first priority is to provide you the care you need, when you need it,with skill, compassion, and respect.”

– The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities

C A S E S T U D Y : W O O D W I N D S H E A L T H C A M P U S

Patients are offered a variety of options to make their stay aspleasant as possible. For example, the inpatient roomphones feature a button to immediately connect patientswith the Guest Service department, which can respond to a variety of non-clinical needs, such as extra blankets, videocart, etc. Food service is designed around a restaurantmodel, where dietary hostesses take patient orders at the bedside and then prepare each tray in a small kitchenlocated on every patient floor. Family and friends cancomfortably spend the night in the patient’s room andsupport their loved one.

Hospital employees, led by the nursing staff, practice aholistic model of care that recognizes the importance ofbody, mind and spirit in the healing process. A menu of integrative therapies are offered to patients, includingthe use of essential oils, healing touch, guided imagery,acupressure, massage and music therapy. Spiritual care,education and self-care programs also are presented asoptions in the patient’s treatment plan.

Heal ing Environment

The Woodwinds Health Campus supports patients andfamilies throughout the healing process with an environ-ment that has a direct connection to nature. The hospital’spublic corridors feature two-story atrium spaces with floorto ceiling walls of windows. Fireplaces, aquariums,beautiful views and comfortable seating are locatedthroughout the waiting areas, and all patient rooms havelarge windows that frame views of the wetlands. Healinggardens and walking trails will soon be available thanks tocommunity donations. CD players help reduce environ-mental stresses in the operating room. Individual beepersare provided to family and visitors, and overhead paging isrestricted to emergency/code situations only. A locatorsystem, including wireless phones, is used for staff.

A range of social services are offered to patients and theirfamilies to support their stay and their transition back tothe community. At the hospital, an interdenominationalchapel and resource center are the backdrop for quietmeditation or research on medical conditions. Some areasin the resource center allow patients to view videotapesrelated to medical and social conditions.

O U T C O M E S

Listening to customer input and effectively implementingsuggested improvements have been key to Woodwinds’success. According to satisfaction surveys conducted by thePicker Institute, patients are extremely happy with the careand services provided in the hospital. Employee and physi-cian satisfaction scores also are very high, as documented byinternal hospital surveys.


For more about Woodwinds’ ongoing work in creating the“ultimate experience for patients,” please contact DinaFassino, executive lead – marketing, Woodwinds HealthCampus, at [email protected] or (651) 232-6861.For more information about the Woodwinds HealthCampus, visit www.woodwinds.org.

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C A S E S T U D Y : W O O D W I N D S H E A L T H C A M P U S


T H R E E E X A M P L E S

O F T H E P L A N E T R E E M O D E L I N A C T I O N

Since its founding in 1978 as a nonprofit organization,Planetree has been a pioneer in personalizing, humanizing,and demystifying the health care experience for patientsand their families. The Planetree model is patient-centeredrather than provider-focused, and is committed toimproving medical care from the patient’s perspective. It empowers patients and families through informationand education, and encourages “healing partnership”with caregivers.

One of the major components of the Planetree model is“empowering patients through information and education.”The model’s emphasis on patient and family education iscarried out through programs such as customized informationpackets, collaborative care conferences, and patient pathways.The open chart policy enables patients to read and write in their medical records. In the self-medication program,patients, who are able, can keep their medications at thebedside and assume responsibility for their administration.

A variety of educational materials are available topatients, families, and the community throughconsumer-friendly health resource centers and satellitelibraries. The Planetree Classification System aids thosein search of information as they review broad collectionsof medical texts and journals, video and audiotapes, andcomputer services.

The model’s approach integratescomplementary medical therapies with conventionalmedical therapies, and incorporates access to the artsand nature into the healing environment. The modelrecognizes the importance of architectural and interiordesign in the healing process and points to a growingbody of scientific data that indicates improved patientoutcomes and satisfaction as a result of “design factorsthat are home-like, barrier free, support patient dignity,and encourage family participation in care.” “PuttingPatients First” a new book published by Josey BassPublishing, is an in-depth exploration of the PlanetreeModel of Care. It explains the origins and uses ofpatient-centered care and successful strategies for imple-menting it in any health care organization with caseexamples drawn from hospitals and health care organiza-tions that have successfully implemented it. For moreinformation on Planetree, see www.planetree.org.

Three health care organizations – Griffin Hospital, Mid-Columbia Medical Center, and HighlineCommunity Hospital – each illustrate a different way toput the Planetree model into action.

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C A S E S T U D Y : T H E P L A N E T R E E M O D E L



“To serve as a catalyst in the development and implementation

of new models of health care which cultivate the healing of mind, body, and spirit;

are patient-centered, value-based, and holistic; and integratethe best of western scientific medicine with time-honored healing practices.”

– The mission of Pl anetree


Griffin Hospital, a 160-bed acute care facility located inDerby, Connecticut, arrived at success by embracing thepatient-centered Planetree model. Their comprehensiveapproach has transformed the organization into a recog-nized health care leader and a flagship Planetree hospital.Griffin Health Services Corporation is the not-for-profitparent corporation of both Griffin Hospital and Planetree.The Planetree Alliance consists of more than 75 memberhospitals across the country, including Griffin Hospital.

I S S U E A D D R E S S E D B Y T H E I N I T I A T I V E

Griffin Hospital’s patient-centered redesign initiativeincluded several elements, such as a “healing environment”strategy that culminated in a new 100,000-square-footbuilding addition, a focus on total patient satisfaction,continuing programs that gather patient comments andfind ways to address them, and employee empowerment.However, arguably the most important piece of theinitiative – and the one most relevant to the Patient CarePartnership – is the empowerment of patients and familiesthrough information and education.

I N I T I A T I V E D E S C R I P T I O N

Griffin Hospital employs the Planetree principle that ifpatients have access to information regarding their illnessand hospitalization, they will become more active partici-pants in making their own health decisions. Patients aregiven a range of choices and are encouraged to participateas partners in their care. Patients are provided with a packetof current information about their illness upon admission.Within 48 hours of admission, a patient care conference is

held with the attending physician, primarycare nurse, specialists, other staff and family members.Patient care pathways are made available to patients toexplain daily treatments and procedures in lay terms. Theprimary nurse model is implemented so that each patient isassigned one nurse who acts as an advocate and coordinatesthe patient’s care for the length of his or her stay. Onpatient units, nurses encourage patients to read andunderstand their medical records.

To further foster education, communication, and patientcare, there are no central nurse stations or “restrictedzones.” There are workstations for every four beds wherenurses are based. The workstations include computerterminals, patient medical records and basicmedical/surgical supplies. A Community Health ResourceCenter, a lending library adjacent to the main entrance,offers nearly 7,000 health-related books, audiotapes,videocassettes, magazines and scientific journals, as wellas computer stations. Each patient unit has a satelliteresource center.

“Care Partners” – family members, companions, andfriends of the patient – are encouraged to assist the nursesin the day-to-day care of their loved ones. Patients haveaccess to computers with high-speed Internet connectionsso they can stay connected to their families and friends and visit Web sites for medical information.

Griffin Hospital designed its new Childbirth Center aroundpatients’ wish lists – a private entrance and separation frommedical/surgical patients, skylights, Jacuzzi, family rooms,double beds so loved ones could sleep with the patient, andservices like grandparent and infant CPR classes.

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“When decision-making takes place, it should include: (d)iscussing your medical condition and

information about medically appropriate treatment choices.”– The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities

I M P L E M E N T I N G T H E P A T I E N T - C E N T E R E D M O D E L



G R I F F I N H O S P I T A L


Mid-Columbia Medical Center (MCMC), a 49-bedmedical facility, is located in The Dalles, 80 miles east ofPortland, Oregon, and has been serving approximately24,000 residents in the surrounding county for morethan 50 years. A team of more than 500 employees, over 50 physicians, and 200 volunteers currently provide healthservices for the community. For the past 12 years, MCMChas brought the Planetree model of care to life within itsservice area.


At MCMC, the first step to personalizing health care was tocreate a safe, barrier-free, and welcoming environment atthe facility. Over the years, the medical facility has beenre-designed to support the well being of patients, theirfamilies, and their visitors. In fact, patients report that itfeels more like a hotel or home than a hospital. Physicalfeatures include a spacious high-ceiling entry atrium,beautiful gardens, and patient rooms with outside views ofthe Columbia Gorge and the apple orchards. The hallways

are painted in soothing tones, chair railsaccent hallways and rooms, and unique accessories suchas quilts and bedspreads add to the feeling of a trulycomfortable setting.

Each patient floor features a kitchen, family room, diningroom and library for patients and their families. Thehomelike dining room serves as the setting for seriousdiscussions among physicians, patients and families, as wellas a spot for patients to celebrate special meals or holidayswith their families and friends.

Environmental changes were not limited to the patientfloors and public areas. Upon learning of a study thatpatients who are kept warmer seem to fight infectionsbetter, physicians at MCMC suggested that the temperaturein the pre-operative and operating rooms should bewarmer, despite the inconvenience to surgeons who werechronically too warm in these areas. They realized therewere options for them (e.g., wear a cooling vest) in order to benefit the patients.

O U T C O M E S

Today, patient satisfaction consistently hits the mid-toupper 90th percentile, and Griffin has boosted admissions27 percent over the past three years. Staff turnover andvacancy rates are well below the regional average. Also,Fortune Magazine ranks the hospital among its “100 BestCompanies to Work for in America.”

Griffin Hospital has been recognized by numerous organiza-tions for its sweeping patient-focused achievements. Thehospital won the Sodexho/Marriott Service Excellence Awardfor patient satisfaction, and the hospital’s childbirth centerand emergency department won the Connecticut Quality

Improvement Award Platinum and Gold prize, respectively,for innovation. In 2001, AARP’s Modern Maturitymagazine recognized Griffin as one of 15 “Hospitals WithHeart” in the country.


For more information about Griffin Hospital, visitwww.griffinhealth.org. For more about how Griffin Hospitalcreated a healing environment and a consumer-responsivecare model, please contact Bill Powanda, vice president,Griffin Hospital, at [email protected] or at (203) 732-7515.

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G R I F F I N H O S P I T A L

M I D - C O L U M B I A M E D I C A L C E N T E R

“Involvement in your care.”– The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities

C R E A T I N G S U C C E S S F U L H E A L I N G P A R T N E R S H I P S



T H E O R G A N I Z A T I O N

The Highline Community Hospital serves the communityof Burien, Washington, which is part of the Seattle,Bellvue, and Everett metropolitan area. The 286-bedhospital employs 1,500 staff to serve the community of 30,000. In addition, Highline has a corps of morethan 320 volunteers. In the early 1990s, the hospitalembarked on a path to evolve from a good hospital to anexcellent health care facility. The decision was made tobecome a Planetree hospital affiliate and change the way

patients and families traditionally experience health care. Highline is now celebrating its10th anniversary as a Planetree affiliate.


Highline Community Hospital identified at every point ofpatient care a Planetree representative from groups of staffmembers. This representative continually works to improvepatients’ experiences in conjunction with his or hercolleagues. A Planetree committee, made up of all

In addition to the dramatic physical changes, the MCMCUniversity was created to educate new employees about howthey are expected to establish successful healing partner-ships with patients. This program is conducted for nine hourson four days, and it specifically highlights the elevated levelof employee participation that is expected. The values ofattitude, team building and customer service are all conveyed,and the responsibilities and expectations of every employeefrom the housekeepers to the physicians are outlined.

Steps have also been taken to demystify the delivery of healthcare, as patients receive open and honest communicationabout their condition from their health care clinicians.Patients are welcome to read their charts and even write in them. Clinicians encourage patients to express theirconcerns and questions so that they can make the mostinformed decisions possible.

MCMC believes that information is power. Therefore itmakes many health care information resources accessibleto patients as well as residents in the community. Thereis a MCMC library in the town where residents can receiveinformation on any health care topic. There is also a freelecture series in the spring and fall at the medical center’smedical office building.

MCMC listens carefully when it receives patient feedback.Patients have prompted the creation of the Cancer Center, theCenter for Mind and Body Medicine, and the Sleep Center.

O U T C O M E S

The MCMC University has been identified as a benchmarkfor new employee orientation by the Healthcare Forum.Patient experiences have been so positive that AARP’sModern Maturity magazine recognized the medical centeras one of the nation’s top 15 caring hospitals.


For more about the Planetree Program at Mid-ColumbiaMedical Center, please contact Dianne Storby, vice president of Human Resources, at [email protected]. Formore information about Mid-Columbia Medical Center,please visit www.mcmc.net.

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M I D - C O L U M B I A M E D I C A L C E N T E R

H I G H L I N E C O M M U N I T Y H O S P I T A L

“Understanding your health care goals and values….”– The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities

C O M M U N I T Y H O S P I T A L L A U N C H E S A N D R E F I N E S P A T I E N T - C E N T E R E D A P P R O A C H



representatives and a full-time Planetree employee, meetsregularly to discuss initiatives, plans and outcomes. Patient-focused topics to be improved, such as patientconfidentiality reducing ambient noise, and respectingsleep cycles, are selected and then each patient care areaworks out its own solutions.

By adopting the Planetree philosophy, Highline CommunityHospital has created an environment that empowers patientsand their families to make informed health care decisions.All patients and family members are welcomed to theircare area with a letter introducing the area and its associ-ated amenities and services. Each letter is tailored to theindividual patient, identifying the unique enhancementsin their area including small libraries with medical, healthand inspirational resources; family kitchen and diningareas; or closets containing linens or towels for overnightfamily member guests.

As part of the Patient Family Information program, hospitalstaff are trained to ask patients and their families (with thepatient’s permission) about the type of information they seekabout their health. More than 350 fact sheets are available inEnglish and other languages on a wide range of topics.The staff will secure information that is not even relatedto a patient’s stay if that type of information is desired.

A full-time librarian staffs the hospital’s health library. She works with patients, physicians, the staff and thepublic. For example, when a baby was born with a clubfoot,the librarian researched the pediatricians in the area withexperience in working with children with clubfeet. Theattending physician followed up on the information andwas able to give the family a name of an experienced pediatrician in this area before the family left the hospital.For personalized requests, a volunteer nurse reviews theliterature and assembles succinct packets of information.

If patients would like family members and/or close friendsinvolved in their treatment plan, the staff keep all inter-ested parties informed about the patient’s health conditionand treatment options. Initially, some staff members wereuncomfortable with family and friends participating on thetreatment team. However, over time, caregivers have cometo realize the importance of such involvement.

The hospital’s cross-cultural collaborative committeelearned that there were six cultural groups that frequentedthe health care system, but that many staff members did not understand the groups’ traditions and practices. The committee built liaisons in the community with keymembers of these groups. This effort has created abridge of understanding and dramatically improved thepatient-staff relationship.

Staff is continually working with their colleagues to figureout how to be even more responsive to patients’ needs anddesires. For example, caregivers have requested that bloodnot be drawn at night – even though it is a better use ofstaff’s down time – because it is important to respect thepatients’ sleep cycles. The ICU staff reviewed the noise levelin the evening and terminated the practice of runningthe paper shredder at night, recognizing that it could beannoying and patients in ICU were not in a condition tocommunicate this to staff.

O U T C O M E S

In 2001, AARP’s Modern Maturity magazine recognizedHighline Community Hospital as one of 15 “Hospitals WithHeart” in the country. The hospital also received the “Top10 Award for Innovations in Health Care” from the Centerfor Innovations in Health Facilities.


For more information about Highline Community Hospital,visit www.hchnet.org. For more about the Planetree Program at Highline Community Hospital, please contactDonna Taylor, program manager, at dtaylor @hchnet.org.

15


H I G H L I N E C O M M U N I T Y H O S P I T A L


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St. Joseph Hospital PeaceHealth is a 253-bed, two-campusmedical center and Level II Trauma Center in Bellingham,Washington, and Whatcom County’s only hospital. St. Joseph along with SeaMar Community Health Clinic,Family Care Network, North Cascade Cardiology, GroupHealth Cooperative and Community Health Plan ofWashington make up the Whatcom Community HealthImprovement Consortium (CHIC). CHIC’s goals: supportpatients in being full members of the care team, improveaccess to care, and enhance communication across healthcare organizations. In 2002, CHIC became one of sevenhealth care organizations nationwide to receive fundingfrom the Robert Wood Johnson Foundation for thepurpose of “Pursuing Perfection in Health Care.” Throughthese resources, changes aimed at supporting a patient-centered community-wide chronic care managementsystem are underway.


As highlighted in the Institute of Medicine report,Crossing the Quality Chasm, the nation’s current healthcare system does not adequately support the needs ofpatients with chronic illnesses and as a result, gaps in careoften occur. In the current system, patients do not have a central role in determining their care, one that fosters a sense of responsibility for their own health. Without an emphasis on facilitating patient self-management, theburden is placed on an overstressed health care systemnot aligned to manage such conditions.

The Pursuing Perfection project aims to reduce hospitaladmissions and re-admissions for adults with diabetes andcongestive heart failure by strengthening patients’ ability to manage their own care and creating a more responsivehealth care system. This includes an emphasis on improvingthe safety of medication management between providersand patients.

This particular case example focusesspecifically on the Pursuing Perfection project’s use of a health management tool called the “Shared Care Plan.”The Shared Care Plan is a HIPAA compliant, Web-based,patient-owned tool that allows patients to collaboratewith their care teams online to manage their chronicconditions. The Shared Care Plan is being piloted with a small group of patients and health care professionals.While it is not yet publicly available, the Web site,www.patientpowered.org, allows for a download of apaper-based version of the tool.

The objectives of the Shared Care Plan are to:

• Facilitate communication between patients and health careprofessionals to support planned care and to ensure “nothingabout me without me” from the patient perspective.

• Give patients a tool to learn about and practice the princi-ples of self-management, producing engaged patients.

• Offer health care professionals an additional communi-cation tool to provide timely information that supportsplanned care and patient self-management.

The features of the Shared Care Plan tool include:

• Personal Profile. This section is where the patientrecords important details about their health and life,which will help health care professionals give them thetype of care that works best for the individual patient.Information about the role of religion or spirituality inthe patient’s life, the existence of advance directives orpower of attorney documents and the patient’s primarylanguage and learning style are among details recorded.

• Goals. Patient goals are the key to success in managingtheir conditions. This area provides a place to capturethose goals, both clinical and personal.

C A S E S T U D Y : S T . J O S E P H H O S P I T A L P E A C E H E A L T H

“Your caregivers need complete and correct information about your health and coverage so that they can make

good decisions about your care.”– The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities




C A S E S T U D Y : S T . J O S E P H H O S P I T A L P E A C E H E A L T H

• Next Steps. This area focuses on both the barriers/concernsthat patients face as well as their short-term steps toachieve better health management. It is a section focusedon action: What are those actions that the patient willtake to improve health outcomes. The care team alsocan recommend steps for patients to take and list theactions the care team members will take to support thepatient’ goals.

• Care Team. This includes the people and organiza-tions that support the patient in managing his or herchronic condition. Certain people are fully registeredcare team members who have an active user name andpassword that allow them to log in and see the patient’sShared Care Plan.

• Medications. This list is an integrated view of medica-tions that are currently prescribed and how/what thepatient is actually taking. Patients are encouraged to keeptheir medication lists, including over-the-countermedications, accurate and up-to-date with the knowledgethat medication safety and effectiveness is the goal.

O U T C O M E S

It is too early to quantify results of the full initiative.However, many patient stories have emerged to emphasize the value of this tool. For instance, a patient

required transport to the emergency room due to dehydration that was exacerbated by his chronic illness.Because his wife provided the EMS with his shared careplan, his experience was “seamless”. The team of healthcare professionals reacted quickly to the situation withup-to-date information and effective interventions. Ashis specialty doctor later commented, “All of my patientsneed one of these. It would ensure safe, timely and effective care across the community.”

In Whatcom County, this tool and other changes comprise achronic care management infrastructure being built to allowexpansion for other chronic conditions. Overall, hospitaliza-tion, re-hospitalization, and inpatient mortality rates areexpected to significantly decrease. More important, bycreating programs that effectively ensure that patients andproviders are working together using the latest evidence tomanage patients’ conditions, community members will behealthier, more productive and more secure.


For more about the grant and activities related to PursuingPerfection in Health Care, please contact Mary Minniti,project manager at (360) 756-6885. For more information about St. Joseph Hospital PeaceHealth, visit www.peacehealth.org.

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B A C K G R O U N D

Greenwich Hospital, a 160-bed community hospital, serveslower Fairfield County, Connecticut and WestchesterCounty, New York, and is a member of the Yale New HavenHealth System.

Following some negative publicity about patients’ billinggrievances, Greenwich completely redesigned its patientbilling system to dramatically improve the way patients receiveand access information relating to their hospital bills.


Greenwich Hospital’s CEO charged a continuous qualityimprovement (CQI) team to redesign the hospital’s billingsystem. The CQI team included representatives frompatient financial services, registration, informationsystems, human resources, credit and collection, public and guest relations, laboratory, emergency services, andoutpatient clinics. Three patients also were part of theteam. Eventually, a vendor joined the CQI team to helpdesign the invoice, the explanatory guide printed on the back of the invoice sheet, and the “detail of services.”

The team began by developing flowcharts of the existingsystem. Next, the team set out to understand what patientsrequired and expected from a hospital’s billing system. Forthis task, a phone log was crafted to capture the types ofproblems, complaints, and questions that were directed tothe billing department. Complaints included:

• Inaccurate charges

• Difficult-to-understand bills

• Poor customer service

• Incomplete and incorrect insurance information andineffective insurance payment collection

• Poor follow-up instructions for making a payment

When the team compared the existingprocesses to customer expectations, it noted the following:

• Insufficient customer service and support

• Difficult retrieval of details about charges, especially inpharmacy and medical/surgical supplies

• A lack of a standard format or language used in commu-nicating with patients

• Confusion related to statement transactions and adjustments

• No clear definition of steps in billings available to patients

• An inability to handle the majority of calls fromMedicare patients

The Patient Billing CQI team moved forward to implementa billing process that completely satisfied GreenwichHospital patients. The team conducted educationalsessions to help all hospital billers become more familiarwith clinical terms and medical procedures (e.g., whythere might be three different charges for a lab culture).Billers also were taught how to clarify frequently askedconsumer questions and learned about resource staff from other departments who could help answer patients’ questions.

The billing office now provides clearly printed itemizedcharges, and the financial office waits for secondary insurerremittances before it bills patients for the balance. Thebilling cycles were changed from 21 to 30 days to corre-spond with consumers’ typical expectations of a billingcycle. Greenwich eliminated sending detailed bills to alloutpatients. In addition, the director of patient financesends a personal letter of thanks to patients and asks themto check for accuracy of their insurance information.Patients also are provided with names, telephone numbers,and office hours when they can reach a hospital repre-sentative to discuss their bill.

The billing department’s voice mail was dismantled in favorof a Billing Help Line with specific hours of availability sothat patients could talk to a live person. A 24-hour message

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“Help with your bill and filing insurance claims.”– The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities

C A S E S T U D Y : G R E E N W I C H H O S P I T A L

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line was created to allow patients requesting an itemized billto receive it, with the understanding that the request wouldbe filled within one week.

O U T C O M E S

Changes to the billing system have reduced complaintslogged by frontline billing personnel from 30 per week to five per week. In addition, bad debt decreased toapproximately $500,000 under budget, and accountsreceivable declined significantly.

The billing office continues to log patients’ questions andcomplaints in order to improve their service, and patients’concerns are regular topics at weekly departmental meetings.

Connecticut’s Attorney General commended GreenwichHospital for its commitment to patients through hisrecognition of the hospital’s new customer-friendlybilling system. Public opinion changed with positive mediacoverage, and patients now receive the same excellence inservice upon discharge as they do in the hospital.


For more about the customer-friendly billing system,please contact Christine Beechner, director of patient andguest relations, Greenwich Hospital, at (203)863-4746,or Cheryl Farrey, director patient financial services,(203) 863-3029. For more information about GreenwichHospital, visit www.greenhosp.org.

C A S E S T U D Y : G R E E N W I C H H O S P I T A L



American Hospital AssociationLiberty Place, Suite 700

325 7th Street, NW

Washington, DC 20004

One North Franklin

Chicago, Illinois 60606

www.aha.org


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