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Modern medicine with a heart

August 17, 2011
by V. Tellis-Nayak, PhD
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V. Tellis-Nayak, PhD
V. Tellis-Nayak, PhD


It seems to be a variation on a familiar theme. Still, this remarkable story deserves to be told and re-told. Argentina-born Angelica Thieriot is laid low by an unknown virus and is feeling depressed by her first experience in an American hospital. Thieriot had delivered two sons in an Argentine hospital where medical technology lagged, but her nurse, doctor, family and friends all contributed to a caring environment. The San Francisco hospital, however, was a model of efficiency with strict visiting hours, with highly credentialed doctors who could not connect, with nurses who were intently busy but hardly smiled or spoke. Several weeks of such disengaged professional care left Thieriot staring at bare walls-bored, lonely and scared. It also gave her time to think and to imagine.

Upon discharge, she walked out of the hospital fired up by a novel vision of hospital care. Why can we not have a medical technology that integrates spirituality, one that is imbued with values of compassion, comfort, aesthetics, dignity, shared knowledge and partnership? She envisioned modern medicine with a heart; a healing environment that dignifies the person as it nourishes the soul, cheers the heart and mends the body. She called her idea Planetree-recalling the sycamore tree under which, 2,400 years ago, medical guru Hippocrates taught person-centered care.

A SPIRITUAL OASIS

In an age of impersonal medicine, the Planetree concept gives primacy to the patient. Since 1978, the year it all began, Planetree has incarnated into an alliance of more than 500 healthcare organizations committed to engaging the patient as a fully informed partner in one's own medical care. Planetree is firmly established in the United States, Canada, the Netherlands, Japan and Brazil, within diverse healthcare settings and in sizes ranging from 25 to 2,000-plus beds.

It is not a mere felicitous coincidence that Planetree's central operations are housed at its Affiliate, Griffin Hospital in Derby, Conn.-a modest 160-bed community hospital that stands like a colossus of quality. Every connoisseur and authority, from The Joint Commission to the AARP, has heaped highest honors on it as “Number 1 in Connecticut,” “one of the top ten Healing Hospitals in America,” “among the top 5% for patient satisfaction and an exceptional patient experience,” and “for its high degree of community value.”

Bold initiatives, it seems, are coded in Planetree's cultural DNA; Planetree has engendered not a few innovative leaders. Among these you should note Susan Frampton, president of Planetree (the same that topped the list of Tom Peters' Superstar/Top 41 Entrepreneurs). With Heidi Gil, her senior director, by her side, and the skills of a medical anthropologist under her belt, Frampton deftly steered the Planetree ship into long-term care waters. This massive initiative found early success. Since 2003, more than 100 continuing care communities have answered the call and now, as Affiliates, proudly march to the Planetree beat.

THREE ELUSIVE GOALS

Without pausing to savor the success, Gil was soon at the helm, again piloting the new Affiliates toward long-term care's three coveted but elusive goals: achieving person-centered care, initiating cultural transformation, and pursuing an evidence-based path to excellence.

On the first leg of this journey-or phase one-Gil and her team matched Planetree's person-centric philosophy to the daily demands of long-term care. They spelled out its 11 separate dimensions in 63 “Designation Criteria”-the Planetree standards that are meant both to guide LTC behavior and to assess its outcomes. These criteria are arguably the most comprehensive and the most demanding in the entire arena of person-centered approach. They affirm that care-recipients are not the only beneficiaries in a person-centered environment-the staff, managers and all other participants are persons as well. All persons share the same universal human need to be recognized, to belong, to give, to grow and to transcend. Thus, a caregiver is no less deserving of a quality of life, as is the resident.

These standards are distinctive in another telling way: They aim not so much to teach the mediocre how to comply with minimum standards, but they constantly remind Affiliates of Planetree's lofty mission that urges them to keep to the high road, to reach out for excellence and to strive to add quality to life, dignity to death, zip to the spirit and cheer to the heart.

PATH TO QUALITY

An evidence-based approach to quality was the principal agenda for phase two. The team worked with onsite caregivers and converted the Designation Criteria into precise measures. (Disclosure: I served on this team). These measures make it possible for Affiliates to track their progress toward set targets and goals vis-a-vis the Planetree mission, to benchmark their performance against the performance of peers, to identify their strengths and to diagnose the weak links in their systems.

This high-minded agenda, now in its testing phase, is by far the most ambitious data-driven quality improvement venture ever undertaken in long-term care. Its success calls for imaginative leaders who can marshal institutional support, institute cultural change and set up ongoing mentoring and monitoring systems. This is indeed a tall order! No one is better poised to pull off this feat than Planetree.

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