Newsweek Japan
July 2000
by Laura Silverman

PUTTING THE PATIENT FIRST

A hospital stay is no picnic--especially when you're 91. But it could be much worse than what Sarah Dayton, in for gallbladder surgery, is experiencing. (Like the other patients and family members in this story, Dayton requested that her real name not be used.) Her private room at Griffin Hospital in Derby, Connecticut, called a “care-partner room,” is a veritable grande suite, with a sleeper sofa, a coffee table, dual bathrooms, televisions and closets, a VCR, wall -to-wall carpeting and a large window overlooking a garden--all for the fee of an ordinary room. Her two daughters are leased with the comforts the room provides. But what they really appreciate is being allowed to stay in it, and participate fully in their mother's care. “We're able to continue what we do at home,” says daughter Joan. “It's very comforting.”

The concept of patient-centered care is nothing new. It's been gathering momentum in the United States for two decades, driven by an increasingly consumerist patient population. Yet in the typical hospital--an entrenched institution if ever there was one--it remains little more than a buzzword. Not at Griffin, which proves its commitment to patients by its affiliation with a non-profit consultancy called Planetree. Founded by a patient in 1978 after a particularly unpleasant hospital stay (and recently taken over by non-profit Griffin Health Services Corporation, which runs Griffin Hospital), Planetree offers its affiliate hospitals a model of care that discards every notion we take for granted about hospital--from what one should look like to how the people inside should interact--and envisions a radically new environment in which every decision turns on one concern: what would patients want. It sounds implausible at best. And yet 33 Planetree hospitals in the United States are proving that it can be done.

The first thing most people notice about a Planetree hospital is how unlike a hospital it looks. At Griffin, lighting is incandescent; floors are carpeted; original artwork lines the walls; fresh flowers grace the tabletops; patient rooms, all private, are set back from the hallway; lounges boast fish tanks or baby grand pianos; and equipment is hidden, kept in a separate corridor when not in use. Music drifts through the hallways and the smell of baked goods emanates every morning from homey kitchens installed in every unit. “You go [to other hospitals], and you're in an institution,” says Dr. Kenneth Schwartz, a cardiologist who works mostly out of Griffin. “You come here, and you're in a healing environment.”

Creating a healing environment from scratch cost Griffin $24 million. It sounds pricey, but says CEO Patrick Charmel, a traditional facility is no cheaper. In fact, in some ways, a patient-centered approach can be more economical; the mahogany finishes that soften interiors at Griffin, for example, cost less than the stainless steel used in most hospitals. Mark Scott, the CEO of Mid-Columbia Medical Center in The Dalles, Oregon--another Planetree hospital noted for its architectural beauty--explains that it's just a matter of where a hospital chooses to put its money. “In most hospitals, you see it in the lobbies,” says Scott. “We start with the patients, so we can create kitchen areas and lounges and activity rooms and atriums.”

Moreover, says Charmel, it's a good investment. Griffin Hospital is 15 minutes by car from seven larger hospitals, and before it implemented Planetree in 1994, it was in danger of going out of business. Now, while most hospitals in the state face stagnant or declining admission rates, Griffin's are up four percent over last year, and patient satisfaction stands at 98 percent. And while Charmel believes that Griffin's favorable work environment has attracted better doctors over the years, he thinks it's the attention to patients' needs that has turned the hospital's fortunes around. “Quality in the minds of most patients has to do with service,” he explains. “They expect the clinical outcomes. So if you're going to stay in this business, you're going to have to be consumer responsive.”

This doesn't mean hospitals must make expensive renovations to keep up. The core of Planetree is a philosophy; it's about empowering patients and treating them like human beings. Thus, depending on the hospital, Planetree can mean anything from allowing 24-hour visiting hours, letting patients read their charts and providing them with educational materials on their illness to recruiting volunteer “hand-holders” for patients undergoing surgery, arranging volunteer massage, entertainment and pet therapy programs, or simply training staff to be kinder. Encouraged to be creative with the philosophy, many Planetree hospitals have come up with their own humanistic touches. At Bergan Mercy Medical Center in Omaha, Nebraska, the ER nurses make handmade quilts for babies who die of SIDS.

Whether Planetree's focus on patients improves their health is a matter of debate. The single study looking at patient outcomes, in which a Planetree unit was compared to traditional units at California Pacific Medical Center in San Francisco, showed no significant differences. On the other hand, there is no shortage of research indicating that elements of the Planetree approach have a positive effect--from one study showing that music played in an intensive coronary care unit decreased patients' heart rates, to another in which patients assigned to a room with a scenic view needed fewer potent painkillers, to dozens proving the therapeutic effects of touch. But with or without data, it seems obvious to practitioners of Planetree that what they're doing helps. “Let's face it, happy patients get b better,” says Bonnie Swendson, a nurse at Griffin.

So if Planetree is so wonderful, why have only 33 of America's roughly 6,000 hospitals adopted it? Largely, say observers, because hospitals are conservative institutions with staffs that are deeply resistant to change. “You're changing somebody's whole way of life, saying what you've done for 20 years is no longer good,” explains Luanne Miller, a nurse at Griffin. Moreover, many hospitals think they're doing patient-centered care already, without really understanding what that means. “Everybody's convinced they know what the right thing is for patients,” says Dr. Steven Horowitz, medical director of two Planetree units at Beth Israel Medical Center in New York City. “And often they make big decisions without ever talking to patients.”

The first thing Planetree does is talk to patients--and staff and community and everyone else with a vested interest in the hospital--through focus groups and questionnaires. This is part of Planetree's “Readiness Assessment,” which helps a hospital figure out what it needs to do to become genuinely patient-centered. For an annual fee of $15,000 ($20,000 the first year), Planetree affiliates also receive a box full of manuals, $5,000 worth of consulting, the ability to network with other affiliates and numerous other benefits.

But most of all, they get an opportunity to make a difference in the lives of people at their most vulnerable. Two years ago, Ann Hummel's husband died of cancer while at Griffin, and she still brims over with emotion talking abut the care he received. “They knew Frank, they talked to Frank. They knew he liked only one room for chemotherapy and they always saved that room for him,” she recalls. Recently, Hummel had the opportunity to purchase a cheaper insurance plan that didn't include Griffin, But quickly decided against it. “I'll pay that extra money to go to Griffin,” she says. “I wouldn't go anyplace else.”