The Whole Pa­tient and Noth­ing but the PA­TIENT

In­te­grat­ing the Plan­e­tree method of holis­tic care

201 Health - - Health Care Philosophy - WRIT­TEN BY ME­GAN MANNI

In the health care sec­tor, a lot of fo­cus has been placed on pa­tient-cen­tered care. But the ques­tion is whether it’s just lip ser­vice.

Hack­en­sack Univer­sity Med­i­cal Cen­ter is an af­fil­i­ate of the Plan­e­tree method of care, and has been since 2001. The Plan­e­tree phi­los­o­phy, de­vel­oped by a pa­tient in 1978, posits that health care should be de­signed first and fore­most around pa­tients’ needs. Cur­rently, there are 500 health care provider mem­bers na­tion­wide, in­clud­ing The Depart­ment of Vet­er­ans Af­fairs, which com­prises more than 1,000 fa­cil­i­ties na­tion­wide.

Af­ter thou­sands of fo­cus groups over more than 30 years, Plan­e­tree has built an ar­chi­tec­ture of struc­tural guid­ance for part­ner­ing health care or­ga­ni­za­tions – like Hack­en­sack – to as­sist those

Plan­e­tree pro­motes the de­vel­op­ment and im­ple­men­ta­tion of in­no­va­tive mod­els of health care that fo­cus on heal­ing and nur­tur­ing body, mind and spirit.

PLAN­E­TREE.ORG

or­ga­ni­za­tions in re­design­ing their ser­vices to truly fo­cus on the per­spec­tive of the pa­tient when de­liv­er­ing health care. Do­ing so in­volves more than just text­book med­i­cal care of the body.

The Plan­e­tree method takes a more holis­tic ap­proach, mak­ing sure to ad­dress not only the prob­lem solv­ing of phys­i­cal ail­ments, but “heal­ing and nur­tur­ing of body, mind and spirit of pa­tients, their fam­i­lies and care­givers.” That not only in­cludes bed­side man­ner, but even the de­sign of hos­pi­tal wards, doc­tors’ of­fices and other treat­ment fa­cil­i­ties. As with any trans­for­ma­tional change, a cul­ture change – which be­yond su­per­fi­cial re­con­struc­tion of nurses’ sta­tions can be the hard­est to ac­com­plish and is the fo­cus of a dis­ci­pline en­tirely its own called change man­age­ment – must be suc­cess­fully en­gi­neered so the or­ga­ni­za­tion is com­fort­able with the new mod­els, the new look, the new feel and the change it­self. Plan­e­tree’s lead­ers and rep­re­sen­ta­tives also help health care or­ga­ni­za­tions achieve that crit­i­cal change in cul­ture to sup­port the im­mer­sion of a com­pletely new phi­los­o­phy into ev­ery­day prac­tices.

HUMC was the first Plan­e­tree mem­ber and par­tic­i­pant in New Jersey and has im­ple­mented all points of that phi­los­o­phy down to the de­sign of its fa­cil­i­ties to en­hance the pa­tient’s ex­pe­ri­ence from be­gin­ning to end.

“It is through this af­fil­i­a­tion and the col­lab­o­ra­tive pro­cesses es­tab­lished be­tween our col­leagues, our pa­tients and their fam­i­lies that we con­tinue to im­prove our qual­ity pa­tient-fam­ily-cen­tered model of care,” says Ariella Noveck, se­nior me­dia spe­cial­ist of mar­ket­ing and com­mu­ni­ca­tions at HUMC.

HUMC be­gan its Plan­e­tree jour­ney with its lead­er­ship and staff and, like the Plan­e­tree net­work it­self, in­cor­po­rated the views of pa­tients, their fam­i­lies and the com­mu­nity it serves. That feed­back re­sulted in in­no­va­tive new prac­tices, in­clud­ing: • The in­creased vis­i­bil­ity and ac­ces­si­bil­ity of the

ex­ec­u­tive lead­er­ship team with front-line staff • Specif­i­cally ad­dress­ing pain, po­si­tion and

per­sonal needs dur­ing nurses’ hourly rounds • Dis­charge phone calls to en­sure pa­tients

un­der­stand all in­struc­tions pro­vided • A “quiet cam­paign” high­lighted by quiet sig­nage in pa­tient care ar­eas, in­clud­ing re­duced over­head pag­ing • A re­newed fo­cus on ac­count­abil­ity for the

or­ga­ni­za­tion’s “Stan­dards of Be­hav­ior” • A re­vised visi­ta­tion pol­icy, pro­vid­ing fam­ily mem­bers more flex­i­ble times to visit their loved ones • Fam­ily-cen­tered lounges, med­i­ta­tion rooms and gar­dens strate­gi­cally lo­cated through­out the med­i­cal cen­ter • An in-room din­ing pro­gram af­ford­ing pa­tients the abil­ity to or­der freshly pre­pared food that is con­ve­nient to their eat­ing sched­ule • HUMC’s award-win­ning Take a Break pro­gram, an ex­pan­sion of their vol­un­teer pro­gram, pro­vid­ing fam­i­lies in the emer­gency room an op­por­tu­nity for so­lace while spe­cially trained vol­un­teers re­main with their loved ones • A Pas­toral Care Depart­ment ad­dress­ing all

cul­tures and re­li­gions to meet spir­i­tual needs • A Ser­vice Ex­cel­lence Depart­ment that proac­tively ad­dresses pa­tients’ and fam­ily mem­bers’ needs and con­cerns While there are other Plan­e­tree mem­ber or­ga­ni­za­tions in New Jersey, HUMC is the only one in Ber­gen County. How­ever, neigh­bor­ing hos­pi­tals such as En­gle­wood Hos­pi­tal and Med­i­cal Cen­ter and The Val­ley Hos­pi­tal in Ridge­wood main­tain sim­i­lar pa­tient-cen­tered care mod­els.

PA­TIENT-CEN­TERED CARE MOD­ELS

Made­lyn Pear­son, se­nior vice pres­i­dent of pa­tient care ser­vices and chief nurs­ing of­fi­cer at En­gle­wood Hos­pi­tal and Med­i­cal Cen­ter, de­scribes En­gle­wood’s care de­liv­ery as pa­tient- and fam­i­ly­cen­tered care.

“Our pro­cesses are de­vel­oped to keep the pa­tient and fam­ily at the core of care de­ci­sions,” Pear­son says.

On the other hand, she says, Plan­e­tree is a “par­a­digm shift” that takes place to put the pa­tient and fam­ily at the cen­ter of de­ci­sion mak­ing, and in­cludes “a com­plete trans­for­ma­tion to a dif­fer­ent model of care.”

To achieve that, Pear­son says, an or­ga­ni­za­tional as­sess­ment and then a struc­tured ap­proach to trans­form­ing the en­vi­ron­ment, care pro­to­cols and pro­cesses would need to take place. The en­vi­ron­men­tal change in­cludes re­mov­ing bar­ri­ers (par­ti­tions, walls, al­coves, nurses’ sta­tions) that would change the way hos­pi­tals feel by re­mov­ing feel­ings of iso­la­tion or ex­clu­sion.

Pear­son added that for Plan­e­tree to be im­ple­mented across the health care sec­tor, fun­da­men­tal changes would have to be made in “how hos­pi­tals are built, hir­ing prac­tices, com­mit­tee re-struc­ture, in­volve­ment and ac­cess to in­for­ma­tion, [and] com­plete in­volve­ment of pa­tient/fam­ily in process re­design. Pa­tients and fam­i­lies [will] need to be­come ac­tive par­tic­i­pants in their care and care de­ci­sions, which they are not al­ways com­fort­able with.”

Val­ley has in­te­grated many of the Plan­e­tree ideas into its prac­tices, de­spite not be­ing a full-fledged Plan­e­tree mem­ber.

A pure Plan­e­tree model that would re­design floors and re­move nurses’ sta­tions is not al­ways re­al­is­tic from a lo­gis­tics per­spec­tive, says Ann Marie Le­ich­man, R.N., vice pres­i­dent for pa­tient care ser­vices and chief nurs­ing of­fi­cer at Val­ley.

“Pa­tients are your part­ners in care,” she says. “We fol­low the tenets, four core com­pe­ten­cies: re­spect and dig­nity, in­for­ma­tion shar­ing, par­tic­i­pa­tion and col­lab­o­ra­tion.

“We en­cour­age pa­tients and fam­i­lies to par­tic­i­pate in their care and de­ci­sion mak­ing at what­ever level they choose,” Le­ich­man says. “Some­times they feel de­ci­sions are made for them with­out con­sult­ing them – for ex­am­ple, a doc­tor ad­vis­ing a pa­tient to stay an­other day for an MRI.”

Pa­tients now can openly feel they have a choice to de­cline and sug­gest hav­ing the MRI done on an out­pa­tient ba­sis. Le­ich­man also men­tions diet con­sult­ing to help a pa­tient with new diet re­stric­tions tran­si­tion to life at home. When pro­vid­ing that guid­ance, she says, “We al­low them to pick off a menu and see what they pick. It’s very help­ful.”

MORE CHANGES MADE

Tra­di­tion­ally at shift changes, nurses dis­cuss pa­tients among them­selves at the nurses’ sta­tion.

“Now we do that re­port at the bed­side,” Le­ich­man says. “They are in­tro­duced [to the nurses], and the pa­tient can chime in and cor­rect them” dur­ing the re­lay­ing of in­for­ma­tion.

A pa­tient and fam­ily ad­vi­sory coun­cil was also cre­ated.

“We asked the pa­tients and their fam­ily mem­bers if they would come in and give us ad­vice about how we could be more pa­tient and fam­ily cen­tered,” Le­ich­man says. “One of the ad­just­ments was to re­view pa­tient ed­u­ca­tion ma­te­rial to make sure it was writ­ten in a style, man­ner and vo­cab­u­lary that was un­der­stand­able.”

More than 25 pa­tients and fam­ily mem­bers sit on var­i­ous com­mit­tees. Par­tic­i­pants have the op­por­tu­nity, Le­ich­man says, to counter sug­ges­tions.

“Now they can tell us, ‘That could be true from your point of view, but from a pa­tient point of view that’s not a good idea,’” she says.

Fam­ily mem­bers are wel­come to stay in the room in an emer­gency, as op­posed to feel­ing in the way.

“When some­one goes into car­diac ar­rest, the first thing they’d do is es­cort the fam­ily out, but some fam­i­lies want to be there,” Le­ich­man says. “So now we let them stay by the bed­side. This en­ables the fam­ily, if the worst should hap­pen, to know that ev­ery­thing pos­si­ble was done to save the pa­tient. They could see that a lot of peo­ple worked very hard to save that per­son.”

AL­TER­NA­TIVE MEDICINE

Plan­e­tree en­cour­ages holis­tic care – care that takes into ac­count not just the phys­i­cal but the men­tal and emo­tional needs of the pa­tient and their loved ones.

Val­ley im­ple­mented a Cen­ter for Holis­tic Prac­tice and has had more than 200 staff mem­bers go through a year­long train­ing pro­gram. In­deed, it has the high­est num­ber of na­tion­ally cer­ti­fied nurses, ac­cord­ing to the Amer­i­can Holis­tic Nurs­ing As­so­ci­a­tion.

“It’s re­ally in­ter­wo­ven into the daily prac­tice here,” Le­ich­man says. “And in ad­di­tion to the nurses them­selves un­der­stand­ing re­ally what it means to prac­tice holis­ti­cally and see the pa­tient holis­ti­cally, we also have two holis­tic nurse prac­ti­tion­ers here whose full-time job it is to prac­tice holis­tic medicine.”

To Le­ich­man, holis­tic care em­bod­ies the Plan­e­tree model.

“It goes hand in hand with pa­tient- and fam­ily-cen­tered care,” she says, “to see the per­son as a whole be­ing, not just treat the ill­ness, but you see all of their needs.”

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