Tuesday, June 7, 2005

Neal Peirce / Syndicated columnist

Patient-based health care: What a revolutionary idea

DERBY, Conn. — From Main Street merchants to U.S. senators, health care and its ballooning costs qualify as the new century's worst fiscal migraine. Now the problem is hitting not just government and employer budgets, but millions of people forced into big co-payments or unable to get coverage at all.

Many say the system can't be fixed — that too many entrenched interests stand in the way.

But check around America and some islands of intriguing innovation show up.

Take the nonprofit, 160-bed Griffin Hospital in a middle-class neighborhood 12 miles west of New Haven. The culture shock starts when you drive up and note there's free valet parking for patients.

But walk in the door and your amazement just keeps growing. In place of the familiar white plaster or steel that marks most hospitals, one immediately encounters lots of warm wood colors and carpeted floors — which continue throughout the building. Lighting is indirect — no cold fluorescents. Art is visible almost everywhere. Conciergelike volunteers greet patients in the lobby and escort them to service departments.

In the wards, pianists often provide soothing concerts. Rooms are the opposite of institutional: more like a bedroom at home. Instead of the standard nurses' fortresslike areas at the center of long corridors, there's a decentralized nursing station for every four to six beds. And every hospital bed has a line of sight to the responsible nurse. Scary medical equipment is kept in back corridors.

The central philosophy is strikingly simple. This hospital isn't run for the convenience of its doctors — however technically proficient or diagnostically brilliant they may be. Nor is it run to simplify the tasks of nurses, technicians, clerks or cooks, or to make life easy for management. Instead, it's all about the patient — to provide each with a personalized, humanized, demystified hospital experience.

Where's Raspberry?

William Raspberry is on vacation. His column will resume on his return.
Accordingly, there are no set visiting hours — family and friends are welcome 24 hours a day, with several hotel-quality rooms in which families can sleep over, even prepare meals. Several "care partner" rooms have space for family members to stay with the patient, using couches that fold out to double beds. The smell of muffins baked by volunteers wafts through the hallways.

Equally important, Griffin's patients are empowered. They take part in the conference on their diagnosis and treatment that is held shortly after admittance with attending physicians, their primary-care nurse (who's assigned them for their entire stay) and their family. Patients are kept in the loop on their treatment; a sign in each room urges them to read their medical chart.

Doesn't all this drive costs through the roof? No, I heard from Patrick Charmel, Griffin's president/CEO, and Bill Powanda, its vice president and a former Connecticut state senator. Designing a hospital for an informed healing experience rather than a treatment factory, they asserted, reduces error rates, avoids unnecessary treatments and medications, and minimizes peril of malpractice suits.

One result: Griffin is the only hospital that Fortune magazine has recognized as one of the "100 Best Companies to Work for in America" for six consecutive years.

Another result: More than 500 U.S. hospitals have sent teams to see the Griffin model firsthand. So many come that there is now a $3,000 fee for each tour and briefing.

Indeed, an actual mechanism now exists for hospitals to become co-enablers of Griffin's approach. It's called the Planetree Alliance, a collaborative for patient-centered care, which Griffin took over in 1998. Close to 100 hospitals have qualified, coached along by Griffin. Most are smaller in size. With the exception of New York Presbyterian Hospital, the nation's large teaching hospitals have resisted — precisely, one would guess, because it's so tough for institutions of their size and fame to break loose of the doctors-know-best, hierarchical model.

But the future may be different — a flowering of Griffinlike, consumer-oriented approaches. As management consultants Ernst & Young define it:

"The trillion-dollar American health-care market is on the brink of the biggest transformation yet. The primary force behind this change is not technology or managed care but the growing mass of educated and empowered consumers. 'Health care consumerism' will alter how health-care organizations will operate, how they compete and, perhaps, why they exist."

Neal Peirce's column appears regularly on editorial pages of The Times. His e-mail address is nrp@citistates.com

For more information, please contact Lisa Donnarumma at ldonnarumma@planetree.org or 203-732-1377.