Planetree Pioneers

Angelica Thieriot

As the founder of Planetree, a not-for-profit organization that works with hospitals to improve the patient experience, Angelica Thieriot has touched the lives of countless patients, their families, and the staff who care for them. Her notion of a patient-centered model of health care predated the advent of health care consumerism, the information explosion stimulated by the Internet, and the current financial and staffing challenges plaguing the hospital industry. And yet, by creating a model that speaks to our universal desire for comfort, nurturing, compassion and information when we are feeling at our most vulnerable, her foresight has equipped hospitals nationwide with an innovative model for delivering health care. Designed to ensure that patients’ well-being, comfort and dignity are the paramount concerns, the Planetree model is a viable and effective one because it helps hospitals to balance this sharpened focus on the patient experience with the day-to-day demands of budget deficits, regulatory pressures, staffing shortages and growing consumer and media interest in hospital performance data.

Angie’s contributions to improving health care services in the United States have been driven by her personal experiences as a patient nearly 30 years ago which found her hospitalized for several weeks with a fever of unknown origin. While she recognized she was receiving medically and technically first-rate care, the experience left her feeling detached, ill-informed and insignificant to her own healing process. Within a year of her own hospitalization, both her son and father-in-law entered the hospital and Angie received a “crash course” in the health care system from the family’s perspective. Relegated to distant family waiting areas and the unsettling uncertainty of not knowing what was happening to loved ones, she realized that her experience as a family member was as depersonalizing and terrifying as her experience as a patient.

When she shared these experiences with others, she discovered that hers were hardly the exception to the rule. In fact, many with whom she spoke — including hospital executives, nurses, physicians and other hospital staff — shared her frustration with the lack of simple human caring in hospitals.

Compelled to take action, Angie used her influence and contacts to do what so many patients and family members over the years have likely dreamt of doing: she set about to fundamentally change the way health care is delivered. To take on this tremendous charge, Angie founded Planetree as a not-for-profit organization in 1978, taking the name from the tree under which Hippocrates – the father of modern medicine – taught his students in Ancient Greece. This nod to the roots of medicine represented Planetree’s dedication to merging the best Western technology with age-old healing practices, many of which had been long abandoned. Over the centuries, medicine had lost its holistic, patient-centered focus, and Planetree, under Angie’s leadership, vowed to reclaim that for patients. Everything in the hospital setting was evaluated from the perspective of the patient. Every element of the organization’s culture was assessed based on whether it enhanced or detracted from personalizing, demystifying and humanizing the patient experience. A premium was placed on making information available to health care consumers, enabling them to be partners in their care.

Angie shared this vision with executives at a number of local hospitals. Not surprisingly, her radical ideas were not immediately embraced. Ultimately, however, San Francisco’s Pacific Presbyterian Medical Center (now California Pacific Medical Center) offered Angie the opportunity to realize her idea for a hospital that valued the “personal touch” just as much as medical technology.

Planetree’s first step was to establish a consumer health resource center in San Francisco. In 2006, the Center commemorates its twenty-fifth anniversary of providing patients with access to the information they need to understand their health conditions, ask questions and engage in meaningful dialogues with their health care providers. Open to the public free of charge, the Center was (and is) a place where the lay public had access to medical and health information, as well as in-depth research services. Twenty-five years ago, the depth and breadth of health information made available at the Resource Center was an unheard of luxury at a time when patients were still routinely barred from entering a hospital or medical school library.

The notion of a Consumer Health Library was somewhat ahead of its time. Long before the advent of the Internet ushered in an age of unlimited access to information, the Planetree model recognized that informed and educated patients were far better equipped to be active participants in their own care. Today, there are fifteen Planetree Health Resource Centers across the country dedicated to this mission.

In 1985, bolstered by the success of the Planetree Health Resource Center, Angie — along with the volunteer board of directors she recruited which included physicians, entrepreneurs and philanthropists — turned her attention to the site of her dreadful patient experience: the patient unit. Her memories of unfamiliar nurses hurrying in and out of her room at all hours of the night, of the blank walls she stared at for hours on end, and the seeming disinterest in her as an individual informed the renovation of a typical 13-bed medical/surgical unit into the first Planetree patient unit.

Funded by grants from the Henry J. Kaiser Family Foundation and the San Francisco Foundation as well as ongoing fundraising by Angie herself, Planetree worked with architects, interior designers, and health care providers to transform the traditional hospital unit into a nurturing environment that promoted healing, learning and patient participation. Barriers that typically physically blocked patients and/or family members from interacting with nurses were removed. Natural light was abundant, paint colors were soothing, and the furnishings and use of natural woods were evocative of the comforts of home. Family lounge areas and a kitchenette encouraged the presence of loved ones. “Care Partners,” or those who would continue to care for the patient after he or she was discharged, worked closely with nurses in a supportive, supervised environment to learn whatever skills might be needed. Customized information packets, a unit-based medical library and opportunities for direct communication with physicians all promoted Planetree’s commitment to patient education. While drawing on the latest technology in Western medicine, the model unit attempted also to nurture the healing resources within each patient. Although medicine traditionally draws on the body’s resources to heal, Angie – and Planetree – believed that by incorporating the mind and spirit into this process, healing could take place faster and more completely. In an effort to meet the needs of the whole person (body, mind and spirit), the Planetree Unit incorporated the arts, massage, and a number of complementary therapies into its healing environment at no charge to patients.

Angie’s brainchild — the Planetree unit — was the culmination of years of grassroots efforts to realize a completely re-oriented model of care in the hospital setting. Its creation launched one of the most far-reaching experiments in the realm of consumer-responsive, patient-centered care ever attempted in this country. The unit was a pioneering effort to change the way that patients experienced hospitals; from impersonal and intimidating institutions to nurturing, healing and educational environments. The successes achieved and lessons learned on the first model unit set the stage to replicate the model at other model sites across the country. Within five years, five Planetree model units had been established from coast to coast.

The seeds of innovation and change that Angie planted nearly 30 years ago have had a far-reaching effect. Today, Planetree is an internationally recognized leader in patient-centered care. The core principles of the Planetree model are essentially that same as those reflected in the model unit. Working alongside over 100 hospitals, long-term care facilities, rehabilitation centers and psychiatric facilities in the United States, Canada and Europe, Planetree is fulfilling Angie’s vision of personalizing, humanizing and demystifying health care. Some of the ideas Angie introduced nearly three decades ago – such as giving patients access to their medical records and unrestricted visiting hours – seemed radical at the time. In the years since, however, these radical ideas have become much more widely accepted and practiced. By introducing these concepts and persistently challenging health care providers to re-consider the typical provider-focused mentality and to broaden the concept of what it means to be “healing,” Angie Thieriot truly transformed the patient experience for countless patients, loved ones, and care givers.

Thirty years ago, Angie was alarmed and spurred to action after hearing how so many others’ hospital experiences mirrored her own cold, frightening stay. Today, Planetree continues to be rooted in the experiences of the patient. Every year, the organization conducts scores of focus groups, hearing first-hand from hundreds of patients, employees, and care givers, many of whom share experiences not unlike Angie’s. Unlike thirty years ago, however, today, thanks to Angie’s vision, Planetree is able to offer these frustrated and disillusioned patients and employees a model for change. Angie knew that the 13-bed Planetree unit was the kind of environment she would have liked to have experienced during her previous hospitalization. To more formally study the effectiveness of the unit, the University of Washington conducted a four-year randomized evaluation that ultimately demonstrated both patient and employee satisfaction were significantly higher in the Planetree unit. A second study focusing on twelve Planetree hospitals pre- and post-implementation of the model also demonstrated significant increases in patient satisfaction with their hospital stay within a 12 to 24 month period. Those results continue to be demonstrated at Planetree hospitals across the country.

Today, the Planetree organization represents over 600,000 annual patient admissions; 10 million out-patient visits; 90,000 births; and over 80,000 health care professionals. It operates with an annual budget of $2 million, a professional staff of twelve, and a volunteer board of directors comprised of prominent leaders in the health care industry.

While Angie is no longer involved with Planetree’s day-to-day operations, her connection to the organization remains strong. An honorary member of the board of directors, she is an advocate and ambassador for patient-centered care, most recently contributing on a task force to adapt the Planetree model for long-term care facilities and assisting with the organization’s fundraising efforts. Still, her vision for how health care should be delivered – and her tenacity to see her vision realized – continue to inspire the thousands of health care workers who every day are putting the Planetree model into practice.

The very first Planetree model hospital site opened in San Francisco in 1985. The 13-bed medical-surgical unit was planned and implemented with the input of patients, families, and employees. One of those employees, a night nurse captivated by the spirit of a true patient-centered approach to the delivery of care, was Laura Gilpin.

Laura came to work for Planetree, where she served as an inspiration to affiliate members around the world. As a staff nurse who worked at Sloan-Kettering’s pediatric oncology unit prior to the Planetree Unit in San Francisco, Laura brought credibility, humor, and a practical approach to patient-centered innovation. Many of these innovations were documented in the book Laura co-edited, “Putting Patients First,” which won the 2004 ACHE Book of the Year Award. As Planetree has developed both as an internationally recognized philosophy of care and a growing membership organization, Laura was the common thread.

Laura’s colleagues referred to her as the “conscience of Planetree,” never allowing us to stray from the organization’s mission to transform healthcare from the patient’s perspective, and to approach this work in a caring, kind and respectful manner. Laura’s book of poems, “The Hocus Pocus of the Universe” won the Walt Whitman Award in 1976. She also completed a second manuscript of poems shortly before her death in February 2007.

Planetree Pioneer Laura Gilpin from Planetree on Vimeo.

The Laura Gilpin Spirit of Kindness Grant Award

True to her characteristic generosity and concern for others, Laura asked that in lieu of flowers, charitable contributions be made to Planetree. It was her express wish that these gifts be used to support caregivers. Faithful to her intentions, Planetree has created the Laura Gilpin Spirit of Kindness Grant Award Program. Gifts in Laura’s memory will be used to support affiliates’ innovation in providing health care professionals with the care, kindness and support they need to be caring, kind and supportive caregivers to their patients.

A small grant award will be made annually to an affiliate doing extraordinary work in supporting its staff. The financial award is to be used to disseminate the selected program/initiative throughout the membership network to enhance care for the caregiver efforts throughout the Planetree community.

Applications and grant guidelines will be made available later in the year for those affiliates interested in submitting a specific program or initiative for consideration.

To make a gift to the Laura Gilpin Kindness Fund:

You can mail your gift to Planetree, 130 Division Street, Derby, CT 06418, Attn: Development Office. Please make checks out to Planetree with a note indicating your gift is in Laura’s memory.

Please call Planetree’s Development Office at 203.732.7171 or email with any questions.

Marc Schweitzer

Marc Schweitzer has always been passionate about the architectural and interior design of healing spaces. While working on his Masters of Architecture at the University of California, Berkeley, Marc studied with the renowned professor, Roslyn Lindheim. Roz served as advisor for his master’s thesis on creating healing environments. Roz later became a founding board member of Planetree and architect of the first Planetree model unit. Following her death, shortly after the first unit opened, Marc volunteered to carry on her work, designing Planetree’s four additional model sites, including San Jose Hospital, Mid-Columbia, Delano Regional and Beth Israel Medical Centers.

Through his work he developed, defined and expanded the Planetree design principles, translating them into a variety of settings, including emergency departments and critical care areas. He worked with Candace Ford to design the second Planetree Health Library in a restored Victorian house in San Jose. His work can also be seen at Bergan Mercy of Alegent Health and at Highline Medical Center. Marc has also served as a Planetree consultant for many additional sites, including Longmont and Fauquier, inspiring and educating other architects and design teams in Planetree’s principles.

 In the tradition of Roz Lindheim, Marc often stayed overnight on the hospital units he designed to more fully appreciate the patient’s perspective. Marc has always believed that hospitals are emotional spaces and need to provide places to both celebrate and grieve.

Marc is a senior architect with The Design Partnership, specializing in staff participation and consensus building, as well as the human interface with design. He remains at the forefront of standards of evidence-based design and current research.

In addition to his outstanding work in healthcare, Marc is accomplished in the area of historic restoration. He served as a director for the non-profit Foundation for San Francisco’s Architectural Heritage and has won numerous awards for his work. He also brings his expertise in healing environments into workplace settings and has designed Charles Schwab Headquarters in Denver, San Jose International Airport Corporate Offices and the Chancery Offices of the Catholic Archdiocese of San Francisco.

He has published many articles, including co-authoring the white-paper, “Healing Spaces: Elements of Environmental Design that Impact Health,” published as a supplement to the Journal of Alternative and Complementary Medicine in October, 2004. He is an international speaker on Planetree design. Marc brings passion and compassion to his work, as well as wisdom and dedication.

Candace Ford, MLIS

Candace Ford, MLIS Candace Ford grew up across the street from a library and has been at home in libraries ever since. She is committed to the idea that knowledge is power and health is our greatest asset. Her passion is giving people the information they need to get well and stay healthy.

Candace has been a medical librarian for 25 years and has been with Planetree since 1987. She was instrumental in creating the second oldest Planetree Health Resource Center, which opened in San Jose, California, in 1989. Since then, in partnership with other agencies, she also created five satellite health libraries throughout Silicon Valley, targeting underserved populations. These specialized libraries offer collections and services to reach people who are not traditional library users, but are hungry for health and medical information.

As one of Planetree’s resource specialists for the past 19 years, Candace has helped in the development of numerous health libraries across the county, from large hospital-based sites that combine their medical libraries with community access to stand-alone affiliate resource centers, set up for consumers. She also played a vital role in the revision of the Planetree Classification Scheme, now in use in hundreds of consumer health libraries around the globe.

Candace’s chapter “Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Education” appears in the book, Putting Patients First, which received the 2004 Hamilton book of the Year Award. She consulted with the editors of Consumer Health Information Source Book (7th edition, 2003) on the special section “12 Model Consumer Health Libraries” which includes the Planetree libraries in San Jose and The Dalles, Oregon.

After receiving her bachelor’s degree in journalism, she worked as a freelance writer and newspaper reporter, managed bookstores, and co-authored a book about pinball machines. She received her master’s in library science in 1981 from University of California at Berkeley. Candace frequently gives presentations on health literacy and information advocacy to local and national groups of medical librarians, health professionals, and literacy experts.

She is especially passionate about health literacy, trying to close the gap between the “haves” and “have-nots,” teaching classes to the elderly as well as underserved populations on how to use computers to access health and medical information. As a medical librarian, she brings together an astronomical amount of health and medical facts and data, from disparate sources, combined with consumer literature and support group information, to provide education and encouragement so that everyone has the opportunity to participate in their own care.

Dr. Steven Horowitz

As Director of Cardiology at The Stamford Hospital (a Planetree affiliate since 2003) and former Chief of the Division of Cardiology at Beth Israel Medical Center (one of the original five model Planetree sites), Dr. Steven Horowitz has been one of Planetree’s most staunch and influential Physician Champions, drawing on his stellar clinical reputation, his scientific background, and his powers of persuasion to demonstrate to fellow physicians, hospital administrators and hospital staff the clinical and operational merits of the Planetree model of care. Upon first hearing of Planetree more than 20 years ago, Steve himself did not need much convincing. According to those who have worked with him, for Steve, patient-centered care was inherently the way he had always practiced medicine. Nonetheless, Steve recognized that the model, while so simple and obvious to him, was also, at the time, a radical idea with the potential to effect profound change within the healthcare field. Thus began Steve’s journey as a consummate Planetree caregiver, advocate, ambassador, and pioneer.

Steve’s introduction to Planetree happened to coincide with his joining Beth Israel Medical Center as its Chief of the Division of Cardiology. In his earliest discussions with hospital leadership he used the opportunity to share his vision for how the Planetree model of care could transform the patient experience. His ideas were well-received, with one caveat: that he would have to figure out a way to pay for the capital improvements, staff retreats and other elements of the model that he had proposed. Steve hardly shied away from the challenge; on the contrary, he raised over $1 million to realize the vision he had for the Beth Israel cardiac unit, truly setting a new standard for physician involvement and engagement with Planetree!

In fact, Steve was intimately involved with virtually every aspect of implementing the model on the Samuels Planetree Model Unit at Beth Israel, including providing input on architecture and design, hiring staff, and actively participating in every staff retreat. He was on a first name basis with all staff and encouraged them to share with him their ideas and concerns. He complemented traditional physician rounding with “Planetree rounds,” convening staff to focus on specific aspects of patients’ experiences including family support, educational needs, their ability to participate in a self-medication program, and their interest in arts programming. It is not surprising, then, that those who were treated to a tour of the cardiac unit by Steve report that his pride at what had been accomplished was palpable.

When he joined The Stamford Hospital in 2003, he brought with him this enthusiasm and was instrumental in the hospital adopting the Planetree model. Just as at Beth Israel, Steve’s Stamford colleagues report that he is a visible and vocal Planetree champion, a steady influence on the hospital-wide efforts at cultural transformation, and a clinician who embodies the spirit of Planetree.

Steve can be described as a study in contrasts — intense, yet deeply warm, kind and sensitive; authoritative, yet open. It is precisely these qualities that have made him a valued friend to so many of his colleagues, as well as such an effective advocate on behalf of Planetree. Over the past two decades, Steve has not only successfully made the case for the model at both Stamford Hospital and Beth Israel, but he also routinely shares his personal experiences and gained knowledge to address physician concerns and (oftentimes) skepticism at Planetree member sites nationwide. He also speaks internationally on his experiences as a cardiologist working to personalize and demystify the healthcare experience. In addition, he authored the chapter “Creating Consensus: Partnering with your Medical Staff” in the book Putting Patients First, and he continues to sit on Planetree’s Board of Directors where he is one of the longest-serving members.

Steve’s skills and accomplishments as a physician only begin to capture the talents of this true Renaissance man. He is also a loving father, a talented artist, and a serious tournament ping pong player! In all that he does, Steve does them with skill and dexterity, with passion and enthusiasm, and with insight and dedication.