The Whole Patient and Nothing but the PATIENT
Integrating the Planetree method of holistic care
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.
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.”
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.”