Enloe Medical Center’s journey to Gold Certification with Distinction for Leadership and Innovation in Person-Centered Care is nothing short of remarkable. This Level II trauma center in rural northern California is now an internationally recognized leader in quality and safety and a hospital of choice within its local community. Given these monumental achievements, it is hard to believe it’s tumultuous history.
IN 2007, Enloe Medical Center ranked in the bottom 2nd percentile of hospitals nationwide for patient experience. A devastating series of patient safety incidents fueled the perception that it was a hospital to avoid. Strained personal relationships jeopardized effective professional collaboration and the organizational culture was polarized. This state of upheaval, though, ultimately gave way to a pivotal time of reflection: Who do we want to be? The groundwork was laid for a comprehensive cultural transformation. Instead of focusing on minimizing harm and losses, the team rallied around an inspirational vision of person-centered care. The vision was so much more than a way to rebound from the turbulence of the previous era. It was a way to restore a sense of pride and purpose to the healthcare workforce and to redefine how Enloe would live out its mission.
A Culture Reset That Emphasized Principles Before Programs
Enloe selected Planetree International to help navigate this transformation. Planetree brought a clear direction and a credible set of principles and practices. What Planetree did not bring was an off-the-shelf, one-size-fits-all action plan. But that suited the Enloe team just fine:
“We weren’t bringing Planetree in to give us a bunch of Planetree programs that would transform culture. We brought Planetree in for the values. We then took those values and translated them into something that is meaningful for us.”
- Dr. Marcia Nelson, MD, MMM, CPE, FAAFP, FAAPL, Chief Medical Officer.
This new values-driven mission and person-centered care strategy established the direction. A collaborative leadership team set the pace. They recognized the need to look beyond the C-Suite and tap into the wisdom and experience of every member of the workforce. For this, the Planetree Leadership Team was formed. Led by the Board of Trustees’ Vice Chair along with staff and community members, the team spearheaded more compassionate care for patients at the end of life, sponsored animal assisted activities and created the “Caring for You” cart to take diversions and light refreshments to patients, families and friends in waiting areas. A Patient and Family Advisory Council (PFAC) was formed to better access the perspectives. This group has worked collaboratively to improve guidelines for visitation, enhance the communication processes for families waiting for a patient in surgery, and create an easier-to-understand patient menu. The PFAC also partnered with the human resources department to enhance the interview process for prospective employees to include questions that focus on what patients most value in their caregivers. Instead of focusing on minimizing harm and losses, the team rallied around an inspirational vision of person-centered care. The vision was so much more than a way to rebound from the turbulence of the previous era. It was a way to restore a sense of pride and purpose to the healthcare workforce and to redefine how Enloe would live out its mission. The impact of these partnerships has been so profound that once approval was granted to open a new cancer center, one of the very first planning groups convened was a PFAC.
Putting Relationships First
Investments made to create an environment where staff would feel valued and professionally fulfilled yielded enormous dividends. What was once described by staff as an “authoritative,” “oppressive” and “tumultuous” culture is now characterized by them as “empowering,” “rewarding,” “safe” and “calm.” Planetree retreats were instrumental this shift. These experiential workshops focused on the vital role each staff member plays in delivering an exceptional patient experience.
In a period of two years, 93% of staff participated in a full day Planetree retreat. This created a pervasive understanding of how person-centered care principles would shape the Enloe experience into the future. At the same time, a special emphasis was placed on restoring connections within the medical staff, relieving professional burdens, supporting their involvement in nonclinical activities and creating more inclusive decision-making processes. “Regardless if they are staff or physicians or volunteers, all our caregivers feel like they are making a difference.”
– Judy Sitton, Board Member
A New Building Reflects the New Culture
A new patient care tower became a physical expression of partnership, respect, service and person-centeredness. The five story building features welcoming family lounges and family zones in patient rooms and nurse stations designed to promote open communication. A meditation room provides a space for reflection, and healing is promoted through artwork and interior design elements that foster a connection to nature.
It is what happens within these spaces, though, that is most transformative. Processes like bedside shift report, patient family care conferences, and communication boards with space for family notes and patient goals all invite patients and care partners to actively participate in care. The What Matters to Me tool enables caregivers to get to know their patients more fully. Patient preferences are further honored through a Sleep Menu devised to help patients get the rest they need to heal. A “Poke Plan” for pediatric patients prompts them to share their preferences for needle sticks.
The Results
Enloe’s Planetree journey coincided with public reporting of HCAHPS patient experience scores. Being in the bottom 2nd percentile of all hospitals in the county for likelihood to recommend was a huge wake up call. But it also became a goal post and a concrete way of measuring progress. A steady increase in HCAHPS scores reflected healthier relationships among colleagues, adequate capital investment to support improved care processes, and values effectively translated to changed behaviors and attitudes. This improvement trajectory was mirrored with employee and medical staff engagement as well. Today, Enloe scores in the 82nd percentile for physician engagement and the 58th percentile for staff engagement.
Having targets to work toward proved important for organizing the all-encompassing transformation. Planetree’s Person-Centered Care Certification™ Program offered up a credible and actionable framework. The comprehensive criteria demystified preconceptions about person-centered care and provided meaningful milestones. Each successive level of recognition earned became an important – and motivating – mark of progress toward becoming the culture all had envisioned.
Today, this one-time Planetree Bronze Certified hospital is a Planetree Gold Certified Hospital with Distinction, a level of recognition reserved for organizations that are moving the model of person-centered care. For Enloe, this entailed spearheading a person-centered approach for treating some of society’s most disregarded patients – those with substance abuse disorder – and truly changing lives through empathy, respect and a holistic approach to care.
The Moment(s) of Truth: Testing the Culture
Enloe Medical Center’s impressive transformation is made all the more extraordinary by the fact that the hospital has maintained these gains amidst a series of catastrophic natural disasters, a cyber attack, a tragic mass opioid overdose in the community, and a global pandemic. Any one of these crises would have been a serious stress test of the durability of the hospital’s change effort. But Enloe’s person-centered culture has persisted. In fact, according to hospital leaders, it was less a matter of the hospital sustaining the culture, but rather the culture sustaining the hospital:
“I don’t think Enloe would have gotten through the challenges we have had since 2018 if we hadn’t set on our course of person-centered care. Our Planetree journey helps us define and then live by our values. We became more resilient. We had more solid relationships. We weren’t fighting each other; we were working together. We knew how to communicate with our community and with our patients, and that helped us become a trusted resource in these times of difficulty.”
- Dr. Marcia Nelson, MD, MMM, CPE, FAAFP, FAAPL, Chief Medical Officer.
