Pushing Beyond Patient-Centered Design
These days, Susan B. Frampton, president of Planetree Inc. (Derby, Conn.), finds herself packing a suitcase a lot. Her 2015 calendar is booked with business trips, including a nine-day stay in China to visit a group of hospitals interested in the nonprofit’s educational services and methodology for creating better healing environments.
The increased travel—especially to locales outside North America—illustrates Planetree’s evolution as a catalyst for change and the growing global interest in patient-centered care.
“We have members now in 15 different countries and partner offices in four different countries,” she says, including Holland, Canada, Brazil, Germany, and Latin America.
This global effort in support of patient-centered care, she says, has been fueled in part by open access to information on the Internet, a social movement toward patient advocacy and patient rights, and emerging evidence connecting patient-centered approaches, empathy, and compassion to better medical outcomes.
That puts the 30-plus-year-old organization in a sweet spot. This past October, when the World Health Organization convened an expert panel of 30 consulting firms to advise on a person-centered platform, Planetree was the sole representative from the U.S.
Frampton’s also busy working with the National Quality Forum to pilot a Patient Passport program, which allows patients to share information with caregivers, such as the people in their support system and any barriers to health. “It becomes a document that can encourage a different kind of conversation between a doctor and patient,” she says.
It’s one of several tools that Frampton wants to use to help change the conversation about healthcare and close the gap in designing better healing environments. In this interview with Healthcare Design, Frampton talks about the evolution of design, the challenges of moving to a value-based system, and the importance of moving beyond patient-centric care.
Healthcare Design: Angelica Thieriot launched Planetree in 1978 in response to a series of traumatic personal healthcare experiences. The idea was to create a holistic, patient-centered approach to medicine. Today, Planetree’s efforts reach around the globe. Was the original intention to become an international organization?
Susan B. Frampton: No, when it was launched, it was more this grand experiment to try out new and different patient-centered practices in hospital environments in the U.S. The first 20 years of Planetree’s existence were focused on developing a holistic patient-centered model, testing it out in the original model site, and then spreading it around the country.
We did that very effectively and many of the aspects of patient centeredness that Planetree pioneered, like open medical records and open visitations, have been adopted as mainstream approaches to improving the quality, safety, and personalization of care.
As a natural outgrowth of that success, we started to look at how we could apply this beyond the U.S. There was a corresponding interest on the part of many different countries looking for some of these same solutions. Over the last 10 years or so, we’ve updated our mission to include wanting to be a global catalyst for change in healthcare—not just a catalyst in the U.S.
What are some of the key elements in a patient-centric healing environment?
We look at environments and the extent to which they help to facilitate compassionate and dignified human interactions. For instance, when the door of the treatment room opens, where is the patient situated in that room? Are they right there on full display for anybody who is walking by in the corridor or has there been thought given to the way that the room is set up so that their privacy is ensured?
There’s been a huge amount of progress made in creating family spaces within both inpatient and outpatient facilities. We [also] think of this in terms of how can we support transparency and access to information in clinical settings, which might include looking at how computers are used in treatment spaces. Are they set up so that they’re easily accessible not only to clinicians but to the patients and family members?
Is this approach mainstream?
Although many enlightened organizations have made great progress, it’s by no means the majority. A family member of mine recently had inpatient surgery and one of her children wanted stay there at her bedside, which is a very good safety practice today. But this community hospital had no accommodation for that.
They ended up pulling in a recliner chair that was uncomfortable, and it hit home to me. Here’s a community hospital in an affluent suburb of Washington, D.C., and they still don’t get it. They still have not considered the comfort of family and what it takes to be welcoming in the physical environment. That’s not unusual; we still have progress we need to make.
Do you attribute that to lack of understanding or do you think it’s a budgetary decision that keeps a facility from addressing things like that?
In this case, I think it was illustrative of [the fact] that the staff has not yet been truly sensitized to the patient experience. It’s not that they’re purposely ignoring the comfort of the family member; they just don’t think about it. Nobody has sat them down and said, “What do you think it feels like to be the family member of a patient in our facility? Let’s try to design an environment and an experience that’s supportive and welcoming.”
It just hasn’t risen to the top of the priority list, which is unfortunate because there’s so much focus on HCAHPS scores and how we’re going to improve them. You would think that people at this point would have explored all avenues of how you might address those. There’s still a bit of a lag.
What does that mean to Planetree’s work and how you address that gap?
Today, particularly in the U.S., everybody is on the “patient-centric-care” boat. Where we’re at right now at Planetree is trying to push beyond that. We don’t talk about embracing the concept anymore, we talk about creating excellence in patient-centered care. That was the whole reason behind developing our patient-centered designation process. We’ve taken all of the best practices that patients have been talking about for years and put them into a framework. Organizations can use that as a pathway to guide their patient-centered efforts.
Looking to 2015, what is the biggest challenge that your organization faces?
We’re a relatively small not-for-profit with a really huge mission. We want to change the world and there are so many opportunities out there to do that. Trying to prioritize where we can be most effective and most helpful in the work that we do is our biggest challenge.
Are there any issues or areas that you put at the top of that list?
Trying to change a system [in the U.S.] that has so many challenges. Given the realities that we can’t just wipe the slate clean, it’s a huge challenge as we try to move from a fee-for-service system to a fee-for-value system. We’re beginning to realize how important patient engagement and the relationships between patients and their caregivers are, and yet we have a s
ystem that doesn’t really reimburse for meaningful discussion and education. We’ve still got more of that “seven-minute visit” mentality that we’re trying to deal with.
How can the built environment help overcome some of those challenges?
I’d love to see us do away with the whole notion of a waiting room. If we’re going to have anything there, it should be a “learning lounge” with opportunities for people to be engaged in learning about their own health and wellness and what they can do to support that.
People don’t live in vacuums, and if we’re talking about trying to improve lifestyle habits and behaviors that impact health, we’ve also got to involve not just the individual but their social support systems and families. We need to take more of a family-centered approach to care and then make sure that our physical environments support that. It needs to become the norm that when you’re trying to manage a chronic disease and you’re going in to see your doctor that your partner or family members come, too.