Planetree 2013

Business As Usual is No Longer An Option Patient-Centered Care In a New Era of Health Care
KPJ Healthcare Conference and Exhibition 2013 Transforming Healthcare- Reaching New Heights

Tracy Walsh, LCSW Patient Experience Advisor, Planetree

There is nothing more powerful than an idea whose time has come. -Victor Hugo

An idea whose time has come

Planetree 2013

providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

Donald M. Berwick

The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to ones person, circumstances, and relationships in health care.

the essence of patient-centred healthcare is that the healthcare system is designed and delivered to address the healthcare needs and preferences of patients so that healthcare is appropriate and cost-effective.

Business as usual is no longer an option

Planetree 2013

Patient choice

PatientCentered Care
Levers of Change

Global health care reform efforts

International accreditation standards

Public reporting of quality outcomes

National healthcare policies

Payment reform

Medical tourism

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A new era of health care requires a cohesive approach centered on the patient.

As a patient I rebelled against being denied my humanity and that rebellion led to the beginnings of Planetree. We should all demand to be treated as competent adults, and take an active part in our healing. And we should insist on hospitals meeting our human need for respect, control, warm and supportive care, a harmonious environment and good, healthy food. A truly healing environment.

-Angelica Thieriot

A global catalyst
500 + healthcare sites

From small critical access hospitals to large academic centers

From rural to urban

Servicing the entire healthcare continuum

The core of the Planetree approach: the lived experience of patients, family and staff
Planetree 2013

Compassionate Human Interactions Access to Meaningful Information Support & Participation of Family, Friends

Healing Environment
Support for body, mind & spirit
Arts and Entertainment Spirituality Caring Touch Integrative Therapies Healthy Food and Nutrition

Healthy Communities

A growing evidence-base for the Planetree approach

Planetree 2012 2013

Human Interactions
The business case for compassion Empathy improves clinical outcomes

Access to Information
Shared decision making decreases costs

Family Involvement
Families in ICU decreases patient & family stress

Healing Environment
Post-hospital syndrome increases readmissions

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Business Case for Compassion

Cleveland Clinic
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Empathy The Human Connection to Patient Care

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Personalizing, Humanizing and Demystifying Compassion

Empathy + compassion = quality care

Planetree 2012 2013

..health benefits were greater for diabetes patients (better cholesterol and blood-sugar scores) who were under the care of empathetic doctors Hojat et al in Academic Medicine 2011

patients have better treatment adherence and suffer from fewer major medical errors while under the care of empathetic doctors Haslam in Medical Journal of Australia 2007

empathy in the therapeutic encounter resulted in faster recovery times of flu patients Rakel and Barrett et al in Patient Education and Counseling 2011

Compassion as a business imperative

When it comes to decisions about where to receive care and the selection of providers, evidence demonstrates that patient experience is a significant differentiator that drives consumer decisions. PWC Health Research Institute. Customer Experience in Healthcare: The
Moment of Truth. (July 2012); Grote KD. A better hospital experience. The McKinsey Quarterly. (2007).

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Staff attitudes and the quality of human interactions are consistently identified as factors that dictate whether a healthcare experience is positive or negative. PWC Health Research Institute. Customer
Experience in Healthcare: The Moment of Truth. (July 2012)

Patients perceptions of the quality of their relationships with their physicians were strong predictors of whether a patient would leave a physicians practice.
Safran et. al, Journal of Family Practice, 2011

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physicians who are able to understand and appropriately respond to the emotional needs of their patients (act empathetically) are less likely to be hit with malpractice lawsuits.
Virshup in American Journal of Medical Quality 1999

And yet, in the United States today

health professional did not treat them with dignity and respect or did not listen to your concerns

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21% of patients reported that a doctor, nurse or other

Source: NPR / Robert Wood Johnson Foundation / Harvard School of Public Health: Sick in America Poll, March 5-25, 2012.

53% of patients said the health care system generally

provides compassionate care

58% of physicians said the same.

Source: BA Lown, J Rosen, J Marttila. An agenda for Improving Compassionate Care. Health Affairs (2011).

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Good Samaritan Hospitals Patient Story Board and Sacred Stories

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Compassion Cultivation Training at Sharp Healthcare System

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Stamford Hospitals Good Grief Program

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VA New Jersey Healthcare Systems Sleep Menu

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A growing evidence-base for the Planetree approach

Planetree 2012 2013

Human Interactions
Empathy improves clinical outcomes

Access to Information
Shared decision making decreases costs

Family Involvement
Families in ICU decreases patient & family stress

Healing Environment
Post-hospital syndrome increases readmissions

Shared decision making lowers cost, while improving quality of care

A 2013 study published in the February issue of Health Affairs found:
providing shared decision making-based health coaching for patients with conditions that frequently require major treatment decisions reduces the overall costs of care, hospitalizations and surgeries significantly. patients who received enhanced support had 5.3% lower overall medical costs than patients who received the usual level of support. patients receiving enhanced support had 12.5% fewer hospital admissions than the usual support group, and 9.9% fewer preference-sensitive surgeries, including 20.9% fewer preference-sensitive heart surgeries.

Planetree 2012 2013

The impact of understanding patient preferences

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Preference Diagnosis: An understanding of how a patient values the trade-offs of potential risks, benefits and side effects of various options for treatment.
Mulley, A.G., Trimble, C. and Elwyn, G. Stop the silent misdiagnosis: patients preferences matter. BMJ, 2012, 345

Doctors believe 71% of patients with breast cancer rate keeping their breast as top priority. The figure reported by patients is just 7%. Once patients are informed about the risks of sexual dysfunction after surgery for benign prostate disease, 40% fewer prefer surgery. Only 41% of Medicare patients believe that their treatment reflected their preference for palliative care over more aggressive interventions.
Lee CN, Hulsman CS, Sepucha K. Ann Plastic Surg2010;64:563-6 Wagner E, et al. Med Care1995;33:765-70 Covinsky KE, et al. J Am Geriatr Soc 2000;48:Suppl:S187-S193.

Patient partnership opportunities

Planetree 2012 2013

Health Information Rounds

Patient Pathways

Bedside shift report

Shared Medical Records

A growing evidence-base for the Planetree approach

Planetree 2012 2013

Human Interactions
Empathy improves clinical outcomes

Access to Information
Shared decision making decreases costs

Family Involvement
Families in ICU decreases patient & family stress

Healing Environment
Post-hospital syndrome increases readmissions

Evidence for unrestricted visitation

Planetree 2012 2013

80%
Fumagalli et al. 2011

of family members of ICU patients develop anxiety, depression and/or PTSD related to their experience

Unrestricted visiting in the ICU doesnt increase infection ratesits associated with lower rates of cardiovascular complications and mortality and lower stress hormone levels.

Family involvement in action

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Emergency Department Take A Break Volunteer Program

Patient satisfaction rises with formalized family involvement at Sharp Memorial Hospital

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1) Represents range of participation by unit. 2) According to Press Ganey database.

A growing evidence-base for the Planetree approach

Planetree 2012 2013

Human Interactions
Empathy improves clinical outcomes

Access to Information
Shared decision making decreases costs

Family Involvement
Families in ICU decreases patient & family stress

Healing Environment
Post-hospital syndrome increases readmissions

Readmissions: The boomerang effect

Planetree 2012 2013

Patients (%)

Does being sick make you sicker?

Planetree 2012 2013

CONTRIBUTING FACTORS TO POST-HOSPITAL SYNDROME: sleep deprivation disruption of normal circadian rhythms

poor nourishment
poorly controlled pain and discomfort medications that can alter cognition and physical function deconditioning due to bed rest or inactivity

Krumholz, HM. N Engl J Med 368:100 - 102 | January 10 , 2013

Assess your healing environment/reduce stressors

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EMOTIONAL SUPPORT Family overnight accommodations SLEEP SUPPORT Quiet Environment/Sleep Menus NOURISHMENT Family Kitchens/Access to Food CONNECTION TO NATURAL ENVIRONMENT Healing Gardens and Natural Light

Creating a healing environment by softening technology

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Lessons from Planetrees 35 Years

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Patients are partners, not outsiders

The real experts on patient experience

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Caregivers and patients co-creating a shared agenda for improvement

Planetree 2013

Planetree Strategies for scaling up consumer engagement in improvement efforts :

o Focus Groups with patients, families, staff, etc. o Patient and Family Advisory Councils o Patient engagement on safety, quality and other organizational committees o Patient participation in hiring and evaluation o Patients as faculty o Patients to develop/act in simulations for staff training

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Staff is the most powerful lever for change

The patient experience and employee experience are intertwined

173 hospitals in the British National Health Service

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Examine effects of patient-centered care Patient-centered care is associated with lower turnover intentions, which are positively related to the quality of care (hospital error rates and perceptions of care)
Effectiveness of patient-centered care is enhanced when complemented by high involvement work practices
Avgar, A., Givan, R. K. and Liu, M. (2011). Patient centered but employee delivered: patient care innovation, turnover and organizational outcomes in hospitals. Industrial and Labor Relations Review, 64 (3)

Creating a healthy workplace is essential to being patient-centered

Planetree 2013

Nurses who directly care for patients in hospitals and nursing homes have higher job dissatisfaction and burnout versus nurses working in other jobs or settings (eg, pharm.) 95,499 nurses surveyed Patient satisfaction levels are lower in hospitals with more nurses who are dissatisfied or burned out
Improving nurses working conditions may improve both nurses and patients satisfaction as well as the quality of care
Health Affairs; 2010: Nurses' Widespread Job Dissatisfaction, Burnout, and Frustration With Health Benefits Signal Problems For Patient Care

Inspiring caregivers creates workplaces of choice

Planetree 2013

A Planetree member since 2005

Employee Satisfaction

Employee Retention

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Its about changing culture, not just changing practices

Culture MUST change

Planetree 2013

I felt like I was interrupting them when I asked a question.

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Its not what we do, but how we do it, treating patients with dignity and respect. - Jane Cummings, Chief Nursing Officer for England

Lessons Learned
Planetree 2013

1) Patients are partners, not outsiders

2) Staff is the most powerful lever for change

3) Mindsets need to shift from setting-centered to person-centered 4) Desire is not enough. A structured pathway enables good intentions to become sustained change 5) Its about changing culture, not just changing practices

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Reflections on the journey. What leaders need to know.

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It is harder to change the culture of a health care organization than it is to build a new facility.

Must Haves for Building a Positive Culture

Planetree 2013

A commitment to staff education & training. Systems and practices consistent with organizational values and that promote fairness, pride, mutual respect and camaraderie. Honest and frequent communication to staff.

Planetree implementation drives high quality, high value care

Shorter Lengths of Stay1 Lower Cost per Case1 Higher Overall Patient Satisfaction1 Revenue generated through implementation exceed costs of implementation2 PC Lean = $400,000 annual projected savings3

1 Stone S. (2008). A Retrospective Evaluation of the Impact of the Planetree Person Centered Model of Care Program on In Person Quality Outcomes. Health Environments Research and Design Journal, 1(4):55-69 2 Coulmont M, Roy C & Dumas L. (2013). Does the Planetree Patient-Centered Approach to Care Pay Off?: A CostBenefit Analysis. The health care manager, 32(1), 87-95. 3 Frampton SB, Charmel PA, Guastello S. (Forthcoming: Sept. 2013) The Putting Patients First Field Guide: Global Lessons in Designing and Implementing Patient-Centered Care. San Francisco, CA: Jossey Bass..

Planetree implementation drives measurable improvement in quality outcomes: Clinical Quality

CMS Core Measures Comparison of U.S. Planetree Designated Hospital Average and CMS National Average Reporting time period: 10/01/2011 - 09/30/2012 (Q411 Q312) Data Source: The Commonwealth Fund, www.whynotthebest.org 100.00%
99.21%

99.00%
98.19% 98.16% 97.67%97.63% 97.21% 97.15%

98.00%

97.85%

97.00%

96.00%

96.02%

95.85%

95.00%
Overall Recommended Care Overall Heart Attack Care Overall Heart Failure Care Overall Pneumonia Care Overall Surgical Care

CMS National Average

Designated Patient-Centered Hospital Average

What patients want is not rocket science, which is really unfortunate because if it were rocket science, we would be doing it. We are great at rocket science. We love rocket science. What were not good at are the things that are so simple and basic that we overlook them. Laura Gilpin

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Patient-centered care is not an isolated aim. It is a unifying one.

In summary
Planetree 2013

1) Business as usual is no longer an option. 2) It is harder to change the culture of a health care organization than it is to build a new facility.

3) Patients are our indispensable partners in this effort.

4) Staff is the most powerful lever for change.

5) Patient-centered care is not an isolated aim. It is a unifying one.

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Thank you!