Jamic Journal
June 2000
by Chihiro Wada

The Embodiment of an Ideal Hospital - Visiting to the PLANETREE Hospital

Nowadays, hospitals cannot survive the time unless they switch their objectives from a staff-based hospital to patient-based, patient-friendly, patient-satisfying hospital. In 1975, when Shinonoi General Hospital (Nagano prefecture) started serving dinner at 6:00 p.m. instead of 5:00, it was a sensation as people called this hospital “patient-based.” 20 some years later, 60% of Japanese citizens say, “ medical treatment is a service industry” and expect more to national medical service. In 1998, a hospital was chosen as the consumer-based excellent company for the first time in history. This indicates that people no longer have to give up on hospital services. Now, medical institutions are considered to be patient-based, service-providing organization, and are regarded as equally as regular corporations. Through this article, we want to consider the realization of patient-based hospitals by introducing a PLANETREE hospital. What is your goal as a hospital for the 21st century?

Nine pillars of PLANETREE

A woman named Angelica Chariot was once hospitalized in the United States. During her stay, she felt an enormous resent towards a hospital being too cold and inhumane. After leaving, she constructed a hospital model, not convenient for the service provider but from a patient's viewpoint. This occurred in 1978. From then on to the present, NPO (nonprofit organization) named “PLANETREE” has contributed greatly to improve medical service from patients' point of view. PLANETREE refers to a shade of a tree where legend says that Hypocrites, a father of medicine, taught his pupils under. A model of PLANETREE is made up of following nine items:

Human interaction
Giving care by respecting the patients' and their families' individuality is essential. PLANETREE supports staffs to enable them to give these kind of service by coordinating the environment and hospital culture. The “healing partnership” between patient, family, and staff is realized by a positive participation of a patient.

Encourage patients through information and education:
Medical records are always placed on the sideboard of hospital beds for the patients to see. They are also free to fill them out. Patient and family education are performed by illness information files, critical path, participating conferences, among others. Resource centers are located in the district or inside the hospital, where books, magazines, videos and computers are available to collect information on illness.

Importance of a family, a friend, and a social support network
PLANETREE believes love and warmth is essential to healing, and encourages families or a close person to participate in the care. During a “care partner program,” education and training are performed so that a family can participate in care during hospitalization and afterwards as well. When families are not available, a volunteer stays by their side and becomes a mental supportive by doing things such as holding their hands during operation. There are no restrictions in visiting hours and people may come and go even in ICU.

Vitality: importance of soul nature
A chapel, gardens, and meditation rooms are available in the hospital, and the environment is set so that each individual can pull out their inner vitality.

Importance of physical contact
Everyone patient, family, or staff can receive massage services. They are done by trained volunteers and student massagers to reduce costs. Massage is taught to the patients' families as a part of the “care partner program”.

Healing art: nutrition to the heart
Through visits by storytellers and clowns, music and comedies, a relaxing, pleasant atmosphere is made. Volunteers help by decorating bedrooms, and lend patients a hand when they want to create something by themselves.

Alternative treatments increase patients' choice
Patients are beginning to appreciate holistic treatments, which are not only western medicine but are natural, harmless, and not aggressive. Aromatherapies, pet therapies, image treatments, Reiki, touch therapies, yoga, etc. are adopted.

Construction designs leading to health and healing
Water and natural light inside the hospital create homey and warm atmosphere. Libraries, kitchens, lounges, activity rooms, chapels, gardens, and family accommodation facilities are available.

Importance of a meal
A low fat menus are prepared at a cafeteria and the vending machine has healthy treats in stock. Since kitchens and dining rooms are located on each floor, a family can cook and eat together. Dietitians guide methods for delicious and healthy cooking.

PLANETREE affiliated hospital

Mid Columbia Medical Center (Oregon: 49 beds) is famous for being the first to introduce a PLANETREE MODEL to the hospital in the United States. The interior has a warm atmosphere with grained floors and walls, and the smell of muffins which volunteers bake drifts from the kitchen. Nurses carries and input terminal called handheld that free them from keeping records, which give them more time to spend with patients' bedsides. Nurse station is in a lounge style so those patients can always come in and talk. The “care partners” who participates in medical-treatment process attach the care partner batch, and always attends conferences and other meetings with a patient. It is reported that patients' solitaire and uneasiness are decreased by the support of care partners, and home care after leaving the hospital is performed very effectively. Each patient's medical records are put on their bedsides for them to see freely, and they are also free to fill in their current physical conditions. Providing a place to obtain illness information freely is indispensable for positive participation of such patients and families. PLANETREE model is also introduced to one ward of the California State University Hospital (UCSF), and PLANETREE health library is provided outside the hospital and is open to all patients as well as for people in the district. Exclusive medical librarians will not perform any medical treatments, but will thoroughly inform users how to obtain the needed information. Magazines and newspaper articles are filed according to the names of illness, and enables users to learn as much as they want. Moreover, the loans of books or videos, the Internet reference, etc. are of no charge. Each patient's independent study gives communication with staffs more density. Griffin Hospital (Connecticut: 161 beds) is in the center of attention as a PLANETREE hospital in recent years. Cheerful music heard from a parking lot makes you almost forget you are in a hospital. Upon entrance, a resource center can be found at left. It is a surprise that, for a town with a population of 20,000, as much as 1,400 people visit here annually. A satellite resource center is situated at every story of each ward, where patients can study. Although almost all rooms are single, for patients who feel they would like a company, some rooms are designed for two people in the shape of the letter “L”, to give them privacy. To give patients satisfying care, one nurse's workstation is located per every 2 to 3 rooms. Family beds are in every care partner room, and double beds are in obstetrics ward, and a family's positive participation is supported substantially. ICUs also come in single rooms, and families are free to come in without passing through a nurse's station. There are four waiting rooms for families per 14 beds. Most patients in this unit have serious illnesses whose families come in and out very frequently, and the number of rooms is still not enough to secure their privacy. Of course, ICU ward is also equipped with shower rooms for families. In this hospital, the paid personnel are in charge of massage therapies, and not only patients but also personnel and patients' families can receive massage service for free. Pet therapies are performed mostly by volunteers.

Ms. Lynn Werdal (RN), vice president and patient care services division of Griffin Hospital, says, “This is the right thing to do.” She declares “Although many people want to hear about the money, you do not need money to be kind.” At PLANETREE, volunteers mostly provide services in the hospital. At present, only Mid Columbia and Griffin are the only two which have adopted PLANETREE service for the entire hospital. Most hospitals have taken this to one unit, and plan to expand when they receive good results. Mr. Steven Horowitz (MD), a head doctor of the cardiac-vessel surgery ward (74 beds) of the Beth Israel Medical Center (New York State), who established PLANETREE ward in l992, is doubtful about the merits of introducing the system through single units. He indicates, “If it is introduced per unit, homeless patients or patients who needs a lot of looking after will be the only ones carried to PLANETREE ward, and makes effect measurement impossible. Therefore, we cannot expand It to other units.” However, comparing the patients after they've left the hospital, patients from a PLANETREE ward, who has received sufficient education, have a lower percentage of coming back to the hospital, probably because they are very aware of their illnesses.

Joining PLANETREE

PLANETREE affiliated hospitals count to 34 in the United States. When one joins PLANETREE, they can receive counseling, and can participate in an all-hospital meeting (once a year), or a video/telephone meeting any time. There are various merits, such as: a hospital can reach for advice from another hospital with a successful experience before trying any new programs, and if their original program is successful, they can spread it as the new PLANETREE method. Moreover, it may also become the motive of affiliation to achieve differentiation with a competing hospital by obtaining a PLANETREE. When we asked how could they compete when neighboring hospitals join PLANETREE, they informed us they couldn't unless they are 50 or more miles away from the previously registered hospital. The registration for the first year is $20,000.

PLANETREE is the forerunner as a patient intention model in the United States, and is greatly introduced in books such as “Patient Focused Healing (1993)” by Moore. In 1999, PLANETREE Canada was established, and is starting to expand