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By Putting Patients First, Hospital Tries To Make Care More Personal

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    Patient Bob Berquist with Gregory Wagner, a doctor in the emergency department. Berquist, who volunteers at Fauquier Hospital, was admitted for low blood sugar when another nurse noticed he seemed dizzy.
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    Fauquier Hospital was among the first five hospitals in the nation — and the only one in Virginia — to meet a specific list of criteria that qualifies it as providing truly patient-centered care.
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    Lisa Spitzer, a registered nurse, is a Planetree program manager and concierge at Fauquier Hospital. She visits patients and offers a friendly ear and a helping hand.
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    The organic garden outside the hospital supplies the kitchen with fresh vegetables and herbs. Even the wood used for the trellises is untreated so that chemicals don't leach into the garden soil.
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    The chefs in the cafeteria try to buy whatever food they can't grow in the garden from farms as close to home as possible.
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    Twice a week, local seniors in Warrenton, Va., flock to the hospital's cafeteria, called The Bistro, for a meal, a great view and musical accompaniment by a retired piano player from a nearby Nordstrom's.
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    Family and friends are welcome at the hospital anytime, day or night, and each of the 97 patient rooms is designed as a single-occupancy room with a bed for caregivers to spend the night.
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    Each birthing suite is designed for the newborn to remain in the room with the mother, and there is an additional bed in the room for dad, or other care partner.
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No one likes to go to the hospital.

But some hospitals around the nation are trying to make their patients' stays a little less unpleasant.

They're members of an organization called Planetree, which was founded by a patient named Angelica Thieriot, who had a not-so-good hospital experience back in the 1970s.

"She herself became very ill and was hospitalized," says Planetree President Susan Frampton. "And while she felt she got good clinical quality care, she was really horrified by the human experience that she had. So she founded Planetree with a very lofty goal: to change the health care system to be more patient- and family-centered. And that has been our mission ... for the last three and a half decades."

Today Planetree has certified, or "designated," 30 hospitals and nursing homes in the U.S. and four countries as meeting a specific list of criteria that qualify them as providing truly patient-centered care.

Among the 14 Planetree hospitals in the U.S. is Fauquier Hospital, a 97-bed facility in Warrenton, Va., on the outskirts of Washington, D.C.

CEO Rodger Baker says there was an element of business to his decision to transform his hospital into a more patient-centered place. "We felt it could differentiate us in a market with giants around us," he says.

But mostly he wanted to make the change because he was convinced that something was wrong with the way hospitals were treating patients.

"We put patients in rooms with gowns that don't have backs on them; we strip them of their dignity; we don't explain things to them. And that's really not what they want," he says.

Baker says he first heard of Planetree in the early 1990s. But he had his epiphany while listening to the head of a Planetree hospital in Oregon, Mid-Columbia Medical Center, several years later.

"He talked about all the things they did in that hospital," Baker remembers. "And for some reason it seemed to click with me in terms of it was the right thing to do ... He talked about healing the whole person, dealing with individuals in terms of not just doing the science, but also healing the whole body, in terms of the spirit as well."

Indeed, Fauquier, which achieved its Planetree designation in 2007, offers a wide array of services not usually found in your average hospital.

Not only is every one of its patient rooms a private one, it has food cooked and delivered to order, some from its own organic garden.

The walls are decorated with local art, which is sold monthly to raise funds for the hospital's foundation. And the hallways are carpeted, to keep the noise level down.

"We have massage therapy; we do hand massages," says Lisa Spitzer, the hospital's concierge. "We bake cookies; every week we have volunteers come in once a week for this wonderful vanilla aromatherapy."

Spitzer — whose job is essentially to make sure that patients, staff and families have whatever they need, whenever they need it — describes Fauquier as "having a different energy about it" since it adopted the Planetree model.

Doctors and patients seem to agree.

Interventional radiologist Adam Winick admits he was a skeptic at first.

Winick says he was particularly concerned about doing away with set visiting hours, which among other things gave patients' families open access to the intensive care unit.

"My own little area that I was most worried about was in a code setting when the patient's heart stops. And having the family members standing there watching I felt would traumatize the patients' families, because they don't understand what's going on," he says.

But that hasn't turned out to be a problem after all: The hospital always makes sure a staff member is on hand to explain to the family what's going on in those situations.

Winick also says that communication has improved between patients and staff, and between doctors and nurses as a result of the changes. Poor communication in the hospital was a key complaint in the poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

"It puts everybody in the mindset that I'm doing this for the patient," he says. "A doctor doesn't mistreat a nurse out of anger because he's doing it or she's doing it — asking a question for the patient's benefit."

Patients also seem to appreciate what they see as more personal care.

"It's friendly, it's more like home," says Marianna Traczuk, who's been in and out of Fauquier several times being treated for ovarian cancer. She says she prefers Fauquier to the hospital where she used to get care in Maryland. "It's nice to have someone walk in and say, 'Hi, how are you today?' instead of walking by and acting as if you're invisible."

And how much more does all this pampering cost?

Actually, unlike many hospitals, Fauquier doesn't charge extra for private rooms or fancy food.

And Planetree President Susan Frampton says that providing the kind of care that involves patients and their families, and that patients actually want, can cut costs. She says that one hospital system that has some hospitals in the Planetree system and some that aren't compared its orthopedic patients.

"And they found that the length of stay was actually shorter" in the Planetree hospitals, she says. "People healed quicker, they were discharged more quickly, and so the cost of care came down. So [it was] interesting to counter that misbelief that care has to be more expensive if it's done in a patient-centered context, or in a place that's more pleasant to be in."

But health quality experts like Don Berwick, the former head of Medicare, warn that the most important part of places that are designated by Planetree aren't the fancy extras like alternative therapies or fancy food — it's the actual involvement of patients and families in their own care.

"The amenities are nice, of course," he says. "But what really counts in patient-centered care is that the more patients and families and their loved ones participate in their own care, really play an active role in the care itself, the better the care gets. Outcomes get better, costs fall, and satisfaction increases. So this isn't about the amenities; this is about the core of health care."

Berwick and other quality experts also warn that being a patient-centered facility doesn't itself guarantee high-quality care. Patients still have to make sure the medical staff is following proper guidelines for care and getting those good outcomes. But they say that keeping the patient and family highly involved in their care is one important indicator of a good hospital.



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