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ROBERT SIEGEL, HOST:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

AUDIE CORNISH, HOST:

And I'm Audie Cornish.

And next we examine one of the most important institutions in American life, a place that everyone can agree we need, yet no one wants to visit - the hospital. Once there, one in six Americans now say they're dissatisfied with the quality of medical care they receive. That's according to a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. A chief concern among those who say they've spent a night or more in the hospital this year, poor communication among doctors and nurses.

Well, one hospital in Virginia is trying to change that, and NPR's Julie Rovner takes us there.

JULIE ROVNER, BYLINE: Roger Baker says he's known as far back at the early 1990s that something wasn't right with the way hospitals were treating patients. Baker is also a doctor and CEO of Fauquier Hospital, in Warrington, which is about 50 miles outside Washington, D.C.

DR. ROGER BAKER: What essentially America was saying is that we're fed up with the impersonalization of medical care. 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.

ROVNER: But Baker says it wasn't until he met the leader of a hospital from Oregon several years later that a plan began to take shape. That Oregon hospital belonged to a group called Planetree. It was founded by an unhappy patient in the late 1970s to make hospital care more attentive to patients' wants and needs.

BAKER: He talked about all the different things that they did. And for some reason it seemed to click with me, in terms of it was the right thing to do, it's really what patients want wanted. He talked about healing the whole person, you know, dealing with individuals in terms of not just doing the science but also healing the whole body, and in terms of the spirit as well.

ROVNER: At the time, Fauquier was just about to launch a $75 million project to rebuild the hospital. Baker decided to launch a cultural change, as well. Today, you just have to walk through the doors to see that change in action.

(SOUNDBITE OF PIANO MUSIC)

ROVNER: The cafeteria known as the Bistro on the Hill, features live music, including a piano player who once worked at a nearby Nordstrom's department store. Just outside, there's an organic garden.

ZACK ERICKSON: We have a whole bed here of beautiful herbs which have been featured in our cafeteria and patient meals today.

ROVNER: Patient meals that are cooked to order, not just delivered from a cart, says Zack Erickson, Fauquier's head of nutrition. Inside the hospital, there's art on the walls, carpets on the hallways to keep the noise level down, and soothing lighting rather than harsh fluorescents. Even in the emergency room, the care is, well, personal.

This afternoon, Doctor Matthew Rhames is tending to breast cancer patient Theresa Hale(ph). She's got some unexplained swelling in her arm.

THERESA HALE: So when I need to come back, tomorrow?

DR. MATTHEW RHAMES: Yeah, we'll have you back tomorrow.

HALE: OK.

RHAMES: And I'll find out who's - who the doctors are tomorrow. I'll give you their names so that when you show up, you'll recognize their name and then they'll be able to pull up your chart.

HALE: OK.

ROVNER: Hale, who lives nearby but actually travels to a university center for her cancer treatment, is the rare patient who doesn't rave about Fauquier's care.

HALE: No, just I would say smaller.

ROVNER: But other patients, like Gary Louden((ph) say they like the fact that Fauquier - at 97 beds - isn't what some staff members referred to derisively as a big-box hospital. He says he felt more than well taken care of when he had shoulder surgery a couple of years ago.

GARY LOUDEN: It just seems like it's a lot more family oriented and caring here than maybe some of the other bigger centers.

ROVNER: What the hospital is providing is what patients seem to want. Fauquier's market share has grown nine percent since it won certification from Planetree in 2007. And patient satisfaction scores have improved, too. Unlike many larger hospitals, Fauquier doesn't charge extra for fancy food or private rooms.

CEO Baker says that moving to more patient-centered care actually prevents problems that end up making care more expensive.

BAKER: If a patient falls and breaks something, that's costly for the organization. If the patient is upset about something and their pain isn't managed well, they're going to complain about that. I mean, they may be in the hospital a day longer, which is costly.

ROVNER: But what's most important about Planetree and patient-centered care aren't things like organic food or quieter hallways, says Don Berwick. It's the idea of involving the patient and their families more in their own care. Berwick is the former head of the Medicare program and an expert on health quality.

DR. DON BERWICK: The amenities are nice, of course. 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 gets better, costs fall and satisfaction increases.

ROVNER: Of course, making a hospital truly patient-centered requires a big change on the part of the people providing that care. That wasn't easy at Fauquier. Over in a cramped treatment room, interventional radiologist Adam Winick is finishing up with his last patient of the day. He's using a balloon to remove a blood clot from a man's leg, letting him walk without pain.

DR. ADAM WINICK: And this is the muscle group here that feeds the outside of the thigh. And that blood vessel is open...

ROVNER: Winick says that one of the things that bothered him when the hospital moved to patient-centered care was eliminating set visiting hours. Among other things, that allowed patients' families unlimited access to the ICU. He was worried about what would happen when a patient's heart stopped and the resuscitation team rushed in.

WINICK: And having the family members standing there watching, I felt would traumatize the patient's families because they don't understand what's going on.

ROVNER: But Winick says when that happens a staff member is always assigned to explain to the family what's happening. So it hasn't been a problem after all. Winick also says putting patients at the top of the pyramid has improved communication between members of the medical staff.

WINICK: It puts everybody in the mindset that I'm doing this for the patient. And the doctor doesn't mistreat a nurse out of anger because she's doing it or he's doing it, you know, asking a question for the patient's benefit.

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

Julie Rovner, NPR News.

CORNISH: For more on what people said about the quality of their care, go to NPR.org.

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