Discover why health care organizations became Planetree affiliates. What motivated them? What were the specific challenges they faced and how did Planetree’s pathway to culture change lead them to achieve success?
New York-Presbyterian: The First Planetree Designated® Behavioral Health Organization
Patient satisfaction has increased from 78 percent in 2005 to 85 percent in 2013 and employee satisfaction has jumped from 78 percent to 91 percent in that time frame.
New York-Presbyterian/Westchester Division’s (NYP/WD) focus never wavered from delivering excellence in care for patients, families and staff; however, becoming a Planetree designated site allotted meaningful and common language to describe our everyday framework of putting patients first. Weaving the Planetree philosophy into our culture created a pathway for understanding the purpose behind our current methods and systems in place.
Planetree not only renewed our commitment to delivering patient centered care, it also assisted in standardizing practices across departments and clinical units. This in turn brought life to a method for sharing best practices and communicating cross departmentally among multidisciplinary teams. Strengthening a culture of teamwork and open communication encouraged front line staff to introduce innovative ideas to leadership for enhancing current patient care practices. Furthermore, many of our practices and strategic efforts were disjointed, which created hurdles in delivering cohesive and unified care. Since implementation, departments are less disconnected and function as a collective group with a purposeful goal in mind.
The development of new practices has created the opportunity to reward and recognize staff for their diligence and dedication to patient-centered care. The recognition of staff efforts bolsters a culture of one and emphasizes leadership focus of putting patients first.
Describe the most meaningful changes you’ve seen due to implementation of Planetree model.
The shift in NYP/WD’s culture is a continuous journey in which all staff are encouraged and empowered to create a positive patient experience within our institution. This cultural transformation has resulted in a sense of pride within all of our staff. As a direct result of Planetree, staff delivers empathetic care and support to patients and colleagues. The organization strongly believes that since the implementation of the Planetree model, staff are more than ever actively engaged in creating a safe and healing environment for patients and families. All NYP/WD staff continue to act as strong advocates for our patients under the belief that we are all caregivers who can make an impact in patients’ road to recovery.
Describe how Planetree supports and coaches your implementation journey. What training and resources are most helpful?
Planetree consultants and representatives were actively engaged during our initial implementation stage, and continue to provide support to our Planetree Coordinator and Patient Care Specialist. Additionally, Planetree Annual and Re-designation Reports encourage leadership to continuously evaluate our methods to ensure we are providing the most innovative practices in patient care. The self-assessment and feedback provided by consultants is an opportunity to explore new methods and improve current practices. Additionally, changes to Planetree standards help our organization be more innovative and push our limits in delivering excellence in patient care.
The Planetree International Conference on Patient-Centered Care also creates an opportunity for staff to be recognized for their dedication and connect with other Planetree Designated organizations from across the world in order to exchange best practices. The mentioned support, resources and tools promote our organizational patient-centered practices.
If you had to identify the single most important driver of your culture change success, what would it be?
The key to NYP/WD’s success in implementation is largely due to the leadership support and buy-in of Planetree vision. Leadership assisted in strengthening our vision, communicating the practices and motivating our staff. Leadership first hand embodied and became primary models of creating an exemplary patient experience. Our leadership acted as a driving force in ensuring that we achieved our goal of creating a patient-centered environment, and continue to offer support to sustain our progress. Leadership was incredibly strategic in the design and development of public and outdoor spaces within our organization to support the Planetree vision and shift in culture. For instance, we incorporated a fish tank in the public lobby, allowed for creative design to let in soothing natural light in staff lounges and built a labyrinth in the outdoor courtyard to support spiritual and meditative healing for patients. The incorporation of Planetree values in the architecture acts as a visual reminder of our commitment.
Perhaps the most significant change that has occurred from incorporating Planetree into the NYP/WD culture has been the creation of Planetree Committees. These committees are composed of multidisciplinary staff, at all levels, who are engaged and passionate about creating a Planetree environment and building a path in which all staff can participate in the Planetree model of care. Both the Making It Better for Inpatients and Outpatient committees work to identify and implement programs and ideas that positively affect patient care and experience. Our Making it Better for Employees committee leads the effort in promoting work- life balance initiatives and improving overall work experience/satisfaction of hospital employees. The Cultural Diversity and Consumer and Family Advisory committees works to ensure culturally competent services in both clinical and non-clinical areas and identify needs and concerns from the point of view of patients and their families. Healing Arts committee is dedicated to promoting the incorporation of cultural arts as an integral component of healthcare, while the Healing Environment Committee reviews the condition of our public spaces with an eye to rendering them patient, family, visitor, and staff friendly. Lastly, our Communications Committee plays a direct role in sharing best practices and recognizing/celebrating employees’ hard work.
In addition to the Planetree Committees, which help to improve the environment and experience for patients, families and staff, the organization ensures that all new employees are introduced to our commitment to Planetree through New Employee Retreats. This is an opportunity for new staff to learn of the numerous ways the NYP team is embodying Planetree values and also become an active agent by becoming members of the Planetree Committees. In 2013, we began Planetree Refresher Retreats, and these retreats act a reminder to staff to deliver empathetic care and work as a team to through respect and teamwork.
Sharp Coronado Hospital Paves the Way for System-Wide Success
Sharp Coronado Hospital and Healthcare Center is a 204-bed acute-care hospital in Coronado, California that provides medical and surgical care, intensive care, sub-acute and long-term care, rehabilitation therapies and emergency services. It is a part of the Sharp HealthCare system, an integrated regional health care delivery system based in San Diego that includes four acute-care hospitals, three specialty hospitals, two medical groups and a health plan, plus a full spectrum of other facilities and services. In 2007, the Sharp HealthCare System was awarded the prestigious Malcolm Baldrige National Quality Award. In keeping with a tradition of building upon its success and experiencing the transformation of Sharp Coronado Hospital during its first eight years of Planetree implementation, the entire Sharp HealthCare System adopted the Planetree model in 2010.
Several years ago, however, Sharp Coronado Hospital faced a combination of challenges, including eroding market share, negative operating margins, an aging medical staff and difficulty recruiting. Such was the platform on which the hospital launched its Planetree initiative in 2002 as a framework for a cultural and operational renaissance from the inside out. With limited resources, it was recognized at the time that neither construction nor significant renovation was a viable option. Rather, the focus of Planetree implementation was on engaging staff and physicians, changing attitudes, and amplifying the voice of patients and families. Using the Planetree methodology, a steering committee, a multi-disciplinary hospital-wide workgroup and a patient and family advisory council were convened to guide implementation efforts. Staff training was initiated and Physician Forums were established to ensure active engagement of the medical staff in prioritizing and implementing patient-centered initiatives. Within just a few years, this comprehensive infrastructure for culture change paved the way for offering patients unrestricted access to their medical records, development of a Care Partner program to facilitate patients’ family members’ involvement in their care, and introduction of a variety of healing modalities to convey care and compassion and to support optimal healing. When funding became available, opportunities arose to align the physical environment to the transformed culture of the organization.
Sharp HealthCare administers a third-party survey to measure awareness and perception of its brand among members of the San Diego County community. According to the 2010 Gallup Research study, Sharp enjoys 98% awareness among survey respondents – higher than any other health care provider in the community. Sharp was the number one choice for orthopedics (23%) and joint replacement (19%). The key attributes consumers associate with Sharp include excellent doctors, nurses and staff; excellent medical technologies and facilities; kind and compassionate caregivers; and a focus on patients’ needs.
In the years since entering into its affiliation with Planetree, Sharp Coronado Hospital has been recognized for exemplary service, quality and safety. It has been recognized by Press Ganey for sustaining the highest level of excellence in patient satisfaction for both inpatient care and its emergency department, was honored with the “Best Place to Practice” award by Press Ganey in 2009 for two consecutive years of physician satisfaction greater than the 95th percentile, and is ranked among the “Top Ten California Hospitals” for clinical quality outcomes. In 2007, the hospital was among the first five hospitals nationwide to be named a Designated Planetree Patient-Centered Hospital. This past year Sharp Coronado earned an “Outstanding Patient Experience” Award for HCAHPS scores and its physician satisfaction and engagement ranked at the 99th percentile.
During its first eight years of implementation, Sharp Coronado Hospital was the sole Planetree affiliate within this Sharp HealthCare System. This uniquely positioned the hospital to evaluate the impact of Planetree implementation on orthopedic surgery patient outcomes, comparing itself to a comparable non-Planetree site within the system. The results of the five-year study were conclusive. The Planetree unit consistently demonstrated a shorter length of stay, lower cost per case and fewer productive nursing hours per patient day than the non-Planetree unit. In addition, the Planetree unit’s mean patient satisfaction scores were higher in 9 of 11 composite areas. These compelling results helped drive the entire Sharp HealthCare system to adopt the Planetree model. A system-wide contract with Sharp HealthCare was signed in January 2010, and in 2011 Sharp Memorial Hospital was named a Designated Planetree Patient-Centered Hospital.
Northern Westchester Hospital: The Path to Earning Planetree Designation® with Distinction
Northern Westchester Hospital in Mount Kisco, New York, is a 233-bed acute care hospital that began its Planetree journey in (2009) and became one of the first Planetree Designated® Patient-Centered Hospitals in 2007 when the program was launched. The impetus for engaging with Planetree came from CEO Joel Seligman whose aim was to excel at staff support and empowerment knowing that the staff drives the overall quality of care and a compassionate patient experience. After reading that Griffin Hospital in Derby, Connecticut, was recognized as the only hospital on Fortune magazine’s “Best Places to Work” honor roll, and learning it was a community hospital similar in its size and demographic and located just an hour away, Seligman called Griffin Hospital hoping to learn more about the road to becoming an employer of choice.
The Path to Planetree
The inquiry swiftly led to an invitation for Seligman and his colleagues to tour Griffin and meet with leadership and frontline staff. During this visit the Northern Westchester team discovered Planetree’s patient-centered care philosophy and how it served as both a foundation and a beacon, enhancing Griffin’s staff and patient satisfaction rankings and shaping it to be a truly special organization. The Northern Westchester team felt a great deal of synergy with their Griffin peers and decided to join the Planetree Membership Network. As a Planetree Affiliate, NWH used the Planetree components as a guide to analyze their patient centered strengths and areas of opportunity. Planetree informational sessions, consultative services, patient focus group facilitations, and the Planetree Designation process, all provided NWH with a comprehensive understanding of what it truly means and what it truly takes to be a Patient and Family Centered institution.
A Roadmap to Patient-Centered Care
“Planetree provides the roadmap to creating an experience for patients and families that is centered on the right thing – the needs and expectations of patients and families. Because of Planetree’s expertise in conducting focus groups with healthcare consumers, an arsenal of data is available to affiliates to identify what is most important to patients in their healthcare experience. Additionally, Planetree assists organizations to strategize on how to achieve those goals by connecting us with other organizations that are doing great work and are willing to share their best practices.” says Seligman. “We are part of an international, collaborative community and it’s easy to connect directly with peers around the world and learn from their success and failures. Because of this learning network, we have access to policy and procedures, powerpoints, research and dialogue from other like-minded, patient-centered organizations.”
By listening to the voices of staff, patients and families, Northern Westchester has created a culture in which staff realizes their vital roles in living the mission and they feel empowered to break down barriers that may impede patient care. Their creativity is encouraged and their opinions count. This open communication with leadership extends to all relationships with care teams working seamlessly and communicating consistent messages to patients about their care and giving them opportunities to add to the conversations and plans of care. The culture at NWH is one of shared governance – where staff are directly involved in the design of systems and processes, quality outcomes and patient and staff safety, teamwork and work-flow, enhancing the patient experience and staff reward and recognition.
The Planetree philosophy of patient centered care is the underpinning of a number of patient experience initiative NWH has recently rolled out. To name a few, a newly re-designed inpatient experience, an Emergency Department facility and process redesign, implementation of an enhanced Patient-to-Nurse Call system for direct communication and enhanced responsiveness and the design and implementation of bedside tablets with real time patient access to aspects of their medical record. Being the industry leader in Patient-Centered care also inspired the Hospital’s new “Food is Care” initiative to bring a healthy,delicious menu to patients customized for their dietary guidelines and served at times they select to have their meals instead of a prescribed dining time. In addition to having choice and control over meal selections and delivery times, NWH also give patients the ability to choose the artwork that they would like to have in their room. “New initiatives are always being developed. Designation doesn’t mean you nailed it. Every day the world changes, regulations change and patient preferences and expectations change. NWH works with Planetree and the community of affiliate organizations to continue excelling in our patient experience journey. We want to create an environment where patients and their family caregivers feel truly involved and are active participants in their plan of care. Our goal is for patients to leave the Hospital feeling well and armed with the knowledge of how to stay well and out of the Hospital. The Planetree components help the staff appreciate how vital having meaningful patient and family interactions are to effective communication and quality outcomes, in addition to creating an efficient, comfortable and therapeutic care environment,” says Maria Hale, Vice President, Patient Advocacy and Patient Centered Support Services.
Sustaining the Gains
It’s important to measure initiatives and this is no different when considering adopting the Planetree components as part an organization’s cultural strategy, says Hale. NWH has metric score cards for its patient-centered process initiatives in order to gauge success. For example, prior to implementing the NWH Food is Care/Room Service Program the hospital ranked at the 48th percentile in food quality by Press Ganey). “We knew our food processes were not centered on the needs of the patient. After a robust redesign and implementation, NWH has sustained patient satisfaction for Food Quality at the 92nd percentile and maintains HCAHPS scores above the national average. Organizationally, we view our HCAHPS data as our patient-experience barometer. The domains measured by HCAHPS are also central to the components of Planetree – It’s so wonderful when things are aligned. Quality outcomes and patient experience is on the agenda of every hospital in the nation. We are all working on implementing initiatives that are perceived by our patients and families to be high quality and value-added. However, for NWH, the success is in fostering an environment that hardwires patient-centered process into the way we do our work and provide care and service. This is where the rubber meets the road. It requires a commitment to staff coaching resources, reinforcement and recognition and accountability. It’s one thing to implement – the real work is in the sustainability,” states Hale. The Hospital has also developed a structured implementation staff coaching model and a patient inquiry process to support staff during this period of change, analyze the process and to obtain real-time feedback from patients on the process improvements.
Tending to the Needs of Families
NWH has also embraced the Planetree component of family involvement with the creation of the Ken Hamilton Caregiver Center. The Center specializes in addressing the needs of the family caregiver, providing a physical oasis to replenish and recharge and meet with a dedicated social worker and over 30 volunteer caregiver coaches. The Caregiver Center has served over 7,000 family caregivers and the Center and Support Program has been replicated by a number of health care institutions. NWH has a comprehensive Replication Program available to interested organizations.
Learning and Sharing, Growing and Innovating
Today Northern Westchester Hospital is recognized with Planetree’s highest honor—Planetree Designation® with Distinction for not only serving as a standard bearer of a patient-centered culture but sharing expertise with health care organizations around the world through conference and webinar presentations and demonstrating that unwavering conviction and continuous process improvement can lead to a sustained patient-centered culture.
VA New Jersey Health Care System Receives Bronze Award for Patient-Centered Excellence
Building on a Strong Foundation
A tertiary health care system providing nearly 500,000 healthcare visits annually, VA New Jersey Healthcare System’s (VANJHCS) Planetree journey dates back to 2005. At the time, a committed team of leaders and caregivers were endeavoring to provide top quality compassionate, effective and efficient care. Despite the best of intentions, though, the realities of coordinating care and meeting individualized needs within an organization as complex as the VANJHCS proved challenging to overcome. The organization found itself at an impasse—with the will and desire to make change happen, but unsure of how to go about doing so. It was a deep conviction that nothing less than the best care was acceptable for their patients that led the VANJHCS to Planetree.
Redefining What it Means to be a Caregiver and Recasting the Role of Patients and Family Members
A Planetree Organizational Assessment revealed significant opportunities for re-casting the role patients would play as integral members of their own care team. The assessment also illuminated opportunities to enhance care coordination and to engage staff and patients in improvement efforts, so that those most affected by efforts to improve could be part of developing the solutions.
Most importantly, though, this early Planetree engagement celebrated the dedication, loyalty, creativity and passion of the VANJHCS staff. These were the individuals who would be the standard bearers for patient-centered care within the organization, and it was clear through speaking with staff—from top leadership to front-line staff to volunteers—that not only were they completely up to the job, they were anxious to get started! Early champions emerged and early successes—such as introducing the healing benefits of yoga and aromatherapy, enhancement of healing arts programming, and implementation of a Blessing of the Hands ritual for staff—demonstrated to skeptics that change was indeed possible — and what’s more, that everyone’s opinions and ideas mattered.
Patient-Centered Care Immersion, Education and Infrastructures to Support Success
During the first year of Planetree implementation, the traditional Planetree retreat curriculum was customized to address the unique culture of the organization. A Planetree Steering Team was established and an Idea Bank was created to tap into the wealth of insights percolating among staff, volunteers, patients and their loved ones. The model ‘s emphasis on caring for the caregiver set the Planetree approach apart from other quality improvement efforts. It provided staff with positive reinforcement about the work they were doing, and cultivated a workplace culture of collaboration, collegiality, fun, and a shared vision for what the future of the VANJHCS would hold. Indeed, an important priority in year two of Planetree implementation was revamping the organization’s reward and recognition program to honor staff members who embody the Planetree philosophy of care. As a result, the organization saw its scores on the Praise dimension of its employee survey increase.
More than a Philosophy, A Structured Framework for Patient-Centered Care Implementation
What the Planetree model provided for the team at VANJHCS was a structure and process for converting the team’s conviction that patient-centered care was the right thing to do into tangible and sustained change. By availing themselves of Planetree’s coaching offerings, attending the Planetree Annual Conference, participating in web education sessions, and accessing practical implementation resources through My Planetree, the team chartered a VANJ-specific course to patient-centered care—and in so doing, demonstrated not only that patient-centered cultural transformation is possible in even the largest and most complex healthcare organizations, but also what it takes to make it happen. Indeed, VANJ has not only availed itself of Planetree’s varied resources and services, they have also been among the most generous contributors to this rich knowledge base, frequently sharing their innovative and exemplary practices through tours, conference presentations and webinars.
In reflecting on how the VANJHCS of today differs from that of five years ago, leadership, front-line staff, physicians, patients and families alike consistently point to the myriad of ways the organization has truly embraced the patients and his/her support system as an integral member of the care team. Today:
- Patients are proactively encouraged to review their real-time personal health information, using a process that was co-developed by physicians, staff and patients themselves.
- An online portal enables patients to manage their personal health information
- Patients are engaged in a dialogue about their sleep preferencesand how staff can support them in getting the rest they need while hospitalized, which has resulted in a documented improvements in patients’ ability to get quality sleep.
- Family members are invited to care team meetings to assist with discharge planning.
- With the aim of providing a personalized care experience that meets each individualized patient’s needs, patients’ care plans may include a variety of healing modalities, including yoga, aromatherapy and mindfulness meditation.
These partnerships between patients and caregivers have extended far beyond the bedside, the consultation room, and the clinic. Focus groups, listening sessions, an idea bank, a Consumer Satisfaction Council and involvement of patients on committees are just a sampling of the mechanisms in place to infuse the perspectives of patients into decision-making at the organizational level. This spirit of partnership has forever altered how organizational priorities are set and decisions are made at VANJHCS. Most recently, the medical center’s pharmacy underwent an extensive renovation, with the changes largely driven by feedback from users.
PARTNERING WITH PATIENTS
Reigniting the Passion of Caregivers
THE ROLE OF LEADERSHIP IN THE CULTURE CHANGE EFFORT
Today, the workplace culture at VANJHCS is more enriching, inclusive, collaborative and empowering. Compulsory Planetree retreats, the multi-disciplinary steering team, and initiative teams that draw on staff from throughout the organization reinforce that every single staff member is a caregiver, with a responsibility to be attuned to the needs and expectations of patients and families, as well as to be a colleague that works across department-lines to put patients first. Over the past five years, the VANJHCS has sustained the gains it has made on employee satisfaction surveys, consistently outperforming its peer group on employee satisfaction in the “group,” “entrepreneurial,” “bureaucracy,” “rational,” and “enabling” dimensions. At the same time, the organization’s turnover rate has steadily decreased.
A Breeding Ground for Patient-Centered Care Innovation
With a multitude of mechanisms for accessing stakeholder perspectives, a well-orchestrated process for capturing and prioritizing ideas and opportunities, and a well-established infrastructure of teams and committees to deploy, monitor and measure the improvement efforts, VANJHCS has all the essential ingredients for an organizational culture that continually evolves and improves, re-defining what is possible in patient-centered care.
At a time when health care organizations around the world are starting to test the waters of just what it takes to meaningfully engage patients in co-developing solutions for delivering high quality, high value care, the VA New Jersey Health Care System is an example of partnership in action. Veterans and family members administer point-of-care surveys to patients and report back their findings through the Veteran and Family Education Volunteer Committee. They also have been instrumental in the development of a new, state-of-the-art simulation center that will facilitate experiential and simulation-based learning. Patients and family members have served as consultants in the development of clinical scenarios for the simulations and will be among the actors enacting the various simulations with learners to strengthen caregivers’ competencies around such topics as patient-centered communication strategies and delivering bad news.
Since embarking on its Planetree journey, VANJHCS has utilized a variety of approaches for monitoring progress and measuring the impact of the changes implemented. Data collected through patient and employee experience surveys, safety measures and other performance measures demonstrate sustained gains that reflect the wide-ranging impact of the culture change effort.
Bronze Recognition: Cause for Celebration!
These sustained gains were recognized recently by Planetree when it awarded VA New Jersey Health Care System’s East Orange Campus with Bronze Recognition for Meaningful Progress in Patient-Centered Care. It is the first health care organization to be awarded Bronze-level recognition since Planetree introduced the recognition level. It is also the first VA Medical Center nationwide to achieve recognition for its patient-centeredness, further establishing itself as a national leader in delivering Veteran-centered care. This recognition has been cause for celebration for the medical center. It has shined a light on the hard work of the entire VANJHCS team and even further strengthened the sense that they are all working together toward a common aim. The award of Planetree Bronze Recognition has further galvanized the team to build on the success it has experienced to date, with an eye on becoming the first integrated medical center to achieve Planetree’s highest level of recognition for patient-centered excellence: Designation.
WHAT DOES BRONZE RECOGNITION MEAN TO YOU?
VANJHCS Then and Now
January 2006 VANJHCS East Orange Campus Planetree Organizational Assessment
September 2012 VANJHCS East Orange Campus Planetree Progress Assessment
“Bureaucracy keeps creativity from happening. You can’t move to do things. The processes are becoming more difficult.” – Staff Member
“I think there’s a big change from a few years ago. Now the style is a lot more collaborative. You still have the structure in place, but the top leadership informs staff constantly about measures and initiatives. – Staff Member
“I just had a colonoscopy and was looking for feedback which I didn’t get. I was hoping someone would say, ‘This is what you have going on…this is what you should do.’ I was really disappointed.” — Patient
“They prepare you to go home better than I remember the private sector. I had a serious situation and I was told what to expect. There were no surprises…they tell you everything.” – Patient
“The wait was long and after the procedure I had a lot of pain. My pain wasn’t taken care of and the nurse told them that I had already left the hospital so it took longer to get my meds.” — Patient
“They took me immediately and did an EKG before the paperwork was even done. They took me right in. They gave me pain medicine and antibiotics. This is not the first time I have come here and gotten excellent service…the nurses are excellent.” – Patient
“Adhering to the rules, whether or not it makes any sense…this lack of flexibility will keep us from getting there.” – Staff Member
“[Patients] have a choice with the daily blood draws. We have a phlebotomy service that will and do the scheduled draws around 5:30 a.m. or 6:00 a.m. on a regular basis, and then we have an on-call person that can come in and do it whenever the patient wants, so that gives us a lot of flexibility.” – Staff Member
“Patients get lost. We need more signs with body parts to show what is where.”
“Everywhere you go here they tell you how to get where you are going. If you have more than one appointment, the next one will give you directions for the next. If you even look slightly confused, three people will ask you in you need help.”
Sustained HCAHPS Improvement at Loma Linda University Medical Center Rooted in Patient-Centered Values
“Our values should be at the heart of everything we do,” this was the vision that Jesse Mock, Vice President for Patient Engagement at Loma Linda University Medical Center, had in mind when LLUMC joined Planetree in 2007. “I see partnering with Planetree as an opportunity to return to our roots and affirm our core values: compassion, integrity, excellence, teamwork and wholeness. Planetree’s 10 components of patient-centered care are in direct alignment with Loma Linda’s motto “to make man whole.”
For more than a century, LLUMC’s pioneering leaders have developed faithful, innovative approaches to health care for the whole person. Pure air, sunlight, moderation in lifestyle, rest, exercise, proper diet, the use of water, and trust in divine power were foundational to Loma Linda’s first foray into providing health care and education. The success of the past provided a base for expanding the vision of integrated health care to include an experience that supports and enhances healing. The deep roots of LLUMC’s patient-centered values have created a strong foundation from which LLUMC continues to thrive.
The strategy of engraining a culture of patient-centered values within LLUMC takes constant and deliberate attention. At LLUMC it is part of the strategic plan. Part of that plan takes shape over time through the practice of “SOARing”; which means, Selection of staff for values alignment, Orienting to the values, Appraising on the values, and Recognizing for living the values. Planetree affirms and reinforces the strategy during Planetree implementation and assists to drive meaningful and sustainable culture change. This type of sustained improvement is evident in the LLUMC HCAHPS scores since joining Planetree. Increasing emphasis on achievement, improvement, and consistency in the eight HCAHPS composite areas, which impact 30% of a hospital’s Value-Based Purchasing (VBP) score has improved over the outcomes reporting period.
This pay-for-performance approach, established as part of the Affordable Care Act, incentivizes hospitals based on how well they perform or improve on Process of Care, HCAHPS, and Outcome measures. For some hospitals this increased emphasis on scores, tied to financial incentives, creates pressure for quality improvement teams to become score chasers, where the focus is on targeting a better score, rather than a deep dive into systemic culture change. Planetree’s central tenet to be person-centered is lost when the focus is solely on a number as a goal. Human interactions are at the core of most measures, including HCAHPS – “We are human beings, caring for other human beings.”
Caring for patients and each other is a century-old value and practice at LLUMC and, is a continued focus as a key component of its quality improvement efforts. Since joining Planetree in 2007, LLUMC has seen an increase in every HCAHPS domain. While the increase in scores may appear linear on the surface, LLUMC acknowledges that there was a learning curve as patient-centered processes became engrained in our culture; something that other healthcare organizations working on the deep systemic culture change needed to develop and implement patient-centered care can relate to. The increase is important and something to celebrate, however, this is just a milestone on the never-ending journey. LLUMC’s goal is to continue to improve the patient experience in every domain. Pausing to celebrate incremental changes is an important aspect of caring for the caregiver. Human relationships are at the heart of the changes in patient satisfaction scores over time and LLUMC credits staff for making it happen.
LLUMC leaders are encouraged by these outcome measurements of the patient experience and are pleased with the partnership and support of Planetree. “Our goal for Planetree in the future at LLUMC is to Personalize, Humanize, and De-mystify the patient experience through a focused and deliberate enhancing of our model of care design with Planetree guidance, which will drive the planning process for new facilities and the delivery of services in the organization,” says Mr. Mock.
Patient-Centered Lean® Leads Bethel Health Care to Greater Employee Satisfaction and Significant Cost Savings
Bethel Health Care (BHC) in Bethel, Connecticut has embarked on an enterprise wide value stream analysis utilizing the distinct Patient-Centered Lean℠ methodology to achieve greater efficiency and financial savings while enhancing the resident, family and caregiver experience. The first in a series of scheduled Patient-Centered Lean events at BHC focused on the area of greatest opportunity, the inventory and purchasing systems. Beginning in December, a team consisting of staff from purchasing, housekeeping, maintenance, nursing, and administration completely overhauled the inventory systems at BHC and The Cascades Assisted Living. Significant accomplishments included:
•Cleaning, organization, and consolidation of all storage rooms.
•Implementation of a new inventory tracking system.
•Providing greater access to supplies to clinical staff.
•Creation of a new file storage area with greater accessibility.
•Development of new standards for the ordering, delivery and distribution of supplies.
•Improved caregiver satisfaction
•$58,500 worth of square footage
Lean Approach to Nursing overtime
In June, a Planetree coach and BHC staff came back together with the aim of minimizing nursing overtime. The current state provided much opportunity for improvement.
Weekly OT in nursing = 504 hours ≈ $15,445
OT is built into the schedule process
All employees do not get OT. 0-199 hrs. = 80% of nursing staff, 200-400 hrs.= 15%, 400-500 hrs. = 5%
Human resource availability impacts staff vacancies.
••Move charting to nursing office
••Establish flexible schedules
••Develop a call list
••Ensure competencies through skill building
••Create rewards and incentives
•The Bottom Line Projected Savings: $12,381 weekly, $643,812 annualized
Additional LEAN Kaizen events are scheduled to focus on facility repairs, dining, marketing and staff education.
Patient satisfaction is a top priority at Danbury Hospital (DH). DH is a 371-bed teaching hospital in Connecticut and a level II trauma center with multiple Centers of Excellence in partnership with a number of office practices in the region. Recognizing that opportunities existed to improve communication around treatment plans and medication, two units were targeted for Patient-Centered Lean℠ Kaizen events.
The first unit, 8W, is a 25-bed cardiac telemetry unit. With the help of Planetree our staff set out to improve the communication of the plan of care amongst the team of providers and to our patients and their families. Our team included unit nurses, a physician’s assistant, a quality management staff member and champions from the medical staff, nursing and administration. Using the tools of Patient-Centered Lean℠ (value stream and process maps, cause and effect diagrams, PIC and SIPOC charts) we drilled deep into the problem and identified several opportunities for improvement. We “went to the Gemba” where we observed, first hand, how the Planetree components were demonstrated in the work that we do caring for our patients. Again, we discovered areas where we could do better.
Based on this analysis, we were able to put together a number of counter measures, some of which we started implementing right away; others are a work in progress. A multidisciplinary patient review team, including cardiologist, hospitalists, residents and nurses, meets daily to coordinate the plan of care. New phone technology enhances nurse to nurse reporting at change of shift. Expanded use of white boards in patient rooms includes displaying goals for the day, medication schedules and staff/provider names. With these improvements in place, we have already seen upward trends in patient satisfaction that consistency of practice brings.
Encouraged by our success, we moved on to 9W, a 26-bed medical unit, to focus on improving communications around new medications and their side effects. This time our team included nurses, physicians and pharmacists. We used the same set of tools, and more. A decision matrix was useful in helping us prioritize our improvements while emotional mapping served to identify the parts of the process where patients have the most anxiety. Nurses are now printing a brief drug summary at the bedside for all newly prescribed medications while physicians are focusing on discussing new medications and their side effects. House-wide, all employees were asked to complete an awareness-raising educational model regarding the importance of patient-centered communication. Again, results have been very positive. Interviews with patients, before and after the Kaizen event, show impressive gains in patients’ understanding of their medication regimen as observed through a series of qualitative bedside interviews. Patients felt as though both nursing and physician staff answered all related questions satisfactorily. Here is a snapshot of our results:
• Name of new medications – 64% to 92%
• Explanations of side effects – 18% to 58%
• Receipt of education materials – 9% to 50%
We now have a set of tools in our quality toolbox and experience using them in rapid cycle improvement. Reducing waste and streamlining our procedures gives us the opportunity to reinvest recovered resources directly back into the patient experience.
Hospital Israelita Albert Einstein: Humanizing Healthcare in Sao Paulo, Brazil
The first healthcare organization in Latin American to implement the Planetree model of patient-centered care, Hospital Israelita Albert Einstein (HIAE) is located in Sao Paulo, Brazil. A large hospital with more than five thousand employees, including 500 full-time physicians, HIAE also is the world’s first hospital to receive Joint Commission International accreditation.
HIAE provides an extensive range of services for patients from Brazil and from visiting patients from around the world, with numerous specialties including integrated cardiology, neurology, and oncology diagnosis and treatment, as well as organ transplantation, orthopedics, dermatology, gastroenterology, hematology, ophthalmology, plastic surgery, and urology. Einstein also has a Diagnostic and Preventive Medicine Center that offers numerous tests. HIAE is Latin America’s largest liver transplant center, performing some 200 transplants annually, and achieves a consistent liver transplant success rate of 90 percent, on par with the best US and European hospitals.
In 2009 HIAE joined Planetree to advance the humanized and personalized qualities of its services for all of its clients, including patients, family members, and employees. Since its first assessment by Planetree in Spring 2009, HIAE has achieved substantial advances in patient-centeredness.
Though Brazilian hospitals are not required to use patient experience measurement tools such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), HIAE has begun implementing HCAHPS both as a strategy for evaluating internal performance and identifying priority areas for improvement, but also for benchmarking with US hospitals. Since 2009, when the hospital starting working with Planetree, HIAE has achieved substantial improvements in patient experience scores across the hospital. For example, increasing percentages of patients report that they are satisfied or very satisfied with their experiences and that they would definitely or probably recommend the hospital to family and friends. HIAE also consistently collects feedback from patients through the widespread utilization of comment cards throughout the hospital. Utilizing this feedback HIAE has calculated an indicator of humanization [# of compliments - # of complaints / 100] with very impressive results.
Simultaneous with these advances in patients’ experiences, HIAE also has evolved its culture to be more humanized, with the high quality technical skills of well-trained healthcare professionals becoming balanced with “high touch” interpersonal skills of all HIAE employees. In focus groups conducted with patients, family members, and staff from across the hospital, the care provided at HIAE was characterized as humanized in alignment with the hospital’s Planetree efforts. “Remembering the human part” of HIAE’s patients was repeatedly emphasized as an important achievement, and Planetree, it was succinctly explained, “is a way of humanizing.”
The Centre de réadaptation Estrie Honored as a “Best Employer”
The first Canadian institution to adopt the Planetree model, the Centre de réadaptation Estrie (CRE) is based in Sherbrooke, Quebec (Canada). CRE provides care for individuals with motor, hearing, visual, language or speech impairments in an outpatient setting with the exception of a 12-bed rehabilitation unit. A small organization, the CRE was challenged by a staffing shortage as well as waiting lists up to two years for services.
CRE joined Planetree in an effort to stand out from larger, more reputable healthcare organizations and improve staff engagement and retention. At the outset of CRE’s Planetree journey, they immediately identified a series of attitudes and behaviors to be promoted with a view to humanizing care. This, in turn, led to the development of quality improvement tools, notably satisfaction questionnaires for users and personnel, key competency profiles, as well as hiring and induction processes for new employees.
CRE’s management philosophy is to recognize each employee’s unique contribution, be open to differences, and see mistakes as a learning opportunity. Caregivers are not only encouraged to share their ideas and expertise but their artistic, musical and athletic talents to enhance physical and psychological health within the community.
In 2008, CRE was awarded first prize for the Quebec-based “Best Employer’s Challenge” in the 200-500 employees category. This achievement helps prove to healthcare professionals that it is still possible to feel empowered, fulfilled and happy when working within the healthcare network.
Planetree Quebec Network
Over the past years, a growing number of healthcare establishments have been observing the CRE journey with Planetree. Its many successes have led to the creation of a Quebec-based Planetree network, adapted to our specific context and cultural environment. It regroups organizations that are working together and supporting each other in developing a philosophy of person-centered healthcare, services and management. The mission of the new organization, created in the fall of 2008, is to become the standard bearer for the humanization of healthcare services and management throughout Quebec and French-speaking countries.
CMC-Mercy is a 180-bed, adult acute care facility in Charlotte, North Carolina, with 1,116 medical staff and 950 full time employees. The hospital is part of the Carolinas Healthcare System comprised of 33 affiliated hospitals in North and South Carolina. In 2007, CMC-Mercy experienced a leadership change and motivated by the opportunity to rebuild, CMC-Mercy partnered with Planetree to bring its vision of being a destination hospital to life. The team was committed to achieving Planetree Designation in three years.
In step with Planetree’s direction, a steering committee was developed in short order. Led by a Planetree coordinator as well as a physician, it included senior management and front line employees. A community advisory council with past patients was also established at this time. A selection process to identify high performers with desired characteristics was utilized for working group participation, retreat facilitators and “first attendees” at retreats. With a physician co-chairing the steering team in his newly identified role of “medical director of patient-centered care,” medical staff engagement received increased attention and a comprehensive approach including curricula for new physician orientation and Planetree updates at the Medical Executive Committee meetings were employed.
The committee focused on staff engagement and communication activities, and within the first two years more than 94 percent of staff attended phase one retreats, to be followed by phase two retreats in order to maintain momentum and enthusiasm. Planetree Department Certification was created requiring departmental projects to be submitted, along with an annual Patient-Centered Care Day celebration.
By engaging these high performing managers and caregivers, CMC-Mercy implemented numerous approaches to personalize care for patients and families. Care partner programs, bedside shift reporting and open medical records were introduced to improve communication and activation of patients in their care. A community advisory panel was launched to open lines of communication and identify needs of patients and families, and integrative therapies for patients as well as caregivers, such as aromatherapy, massage and tai-chi were introduced to promote additional paths to well-being.
Using the Mercy Experience Dashboard several outcomes are measured to gauge progress, which demonstrate that CMC-Mercy has significantly improved quality and safety measures along with patient satisfaction and employee engagement. The patient safety culture survey shows CMC-Mercy outperforming national averages in every domain, from hand offs and transitions, to staffing and overall perception of patient safety. Inpatient ‘excellent’ scores for nurse communication about treatment soared from 43.4 percent to 87.7 percent from 2007 to 2011 and during that same timeframe ‘likelihood to recommend’ increased from 61 percent to 80.8. By 2011, 90 percent of employees participated in the employee engagement survey, and the workforce commitment indicator score rose to the 89th percentile.
The team’s diligence and commitment led to the hospital achieving its goal in 2011 when it was named a Designated Planetree Patient-Centered Hospital.