Consider, for a probably unpleasant moment, your previous hospital visits. And then imagine a health-care institution where:
--Patients stay in an area that looks more like a condo than a hospital ward.
--Nurses are trained to give patients therapeutic massages.
--Patients are not only taught how to read their own charts, they (or their family members) are invited to make entries on the charts so physicians and nurses can know exactly what the patients think of their progress, how they feel about the way they’re being treated or any other observations or suggestions the patients might want to communicate in writing.
Free Nutritional Counseling
--Patients are given free nutritional counseling if they desire; and if they find the standard hospital menu is not healthy enough for them (or not ethnic enough or junky enough), they’re permitted to have whatever food they want brought in for them. Healthful snacks are provided round-the-clock and there’s even a small but well-equipped kitchenette where patients or their family members can prepare food. It’s not uncommon there to see a patient, such as Neil Murphy, who suffers from bone cancer, making his lunch while attached to an i.v.
--Sony Walkman stereos are available to patients, as is a library of audiocassette tapes and books. In addition, a movie of the week is shown on a videocassette recorder in the nearby patients’ lounge, where there is also a library of video tapes for 24-hour viewing, should a patient not feel like sleeping or disturbing a fellow patient with TV sound.
--Even bedridden patients have access to outdoor air as patients’ rooms have windows that can be opened.
--Twenty-four-hour visiting hours prevail, and family members are permitted to spend the night in patients’ rooms or in the nearby patients’ lounge.
--On admission, patients fill out forms regarding such things as preferred sleep patterns. When at all possible, these individual sleeping schedules are not interrupted with meals, tests or administration of medications.
--Patients receive packets of information on such subjects as their medical conditions, what to expect from certain tests they will undergo, what their medication accomplishes and what its side effects may be. If they want to know more, patients have borrowing privileges at a nearby medical library that delivers.
--There is “primary care” nursing in which each patient has one primary nurse responsible for his or her care, a “patient advocate” nurse to whom both doctors and other nurses report. In conjunction with the primary-care nurse, a patient discusses and makes decisions about every aspect of a hospital stay.
--The noise is at such a low level the place sounds like a library.
--"Little” things mean a lot. Where possible, anything institutional-looking (chrome or Formica, for instance) has been removed and in its place are warm, home-style furnishings made of oak.
A counter/barrier between the nursing station and patients has been removed. Harsh lighting has been replaced with soft, indirect lighting, complete with dimmers.
Brash, cheery, “upbeat” color schemes and supergraphics have been cast out in favor of low-key neutral colors believed to be more soothing.
In patient rooms, plain sheets and bedspreads have been banished and replaced with gently-shaded florals. The art on the walls has been carefully chosen not to be offensive (nature themes predominate).
Patient rooms are outfitted with bulletin boards and plants to avoid the stark, antiseptic look of traditional hospital rooms. And patients are encouraged to bring a few of their own things from home--pillows or quilts perhaps--to further counteract feelings of displacement and alienation experienced in strange environments.
All this is clearly no dream. It is a working reality on the sixth floor of Pacific Presbyterian Medical Center in the Pacific Heights section of San Francisco. The floor has been dubbed the “Sheraton Bypass” but its guests pay no more than other patients elsewhere in the hospital.
Open since June 3, the Planetree Model Hospital Project is being billed by its creators as “the nation’s first consumer-oriented hospital unit.” And even though some of the 13-bed unit’s features are not yet in place and minor kinks are still being worked out, the project is already being hailed as a success by both outsiders and insiders at Pacific Presbyterian Medical Center.
And perhaps the unit’s greatest indication of success--beyond the comments and letters from an almost entirely satisfied cadre of patients, nurses and doctors--is the fact that other health-care institutions are already calling Planetree and asking for help in setting up similar units.
The genesis for the Planetree unit began 10 years ago after Planetree founder, layperson Angelica Thieriot was involved in a series of hospital adventures, most of which she found rather non-conducive to healing. In 1975, when she was hospitalized with a mysterious, life-threatening virus, she found herself at the mercy of a “bungling and constantly changing staff” and recalls that “at one point I was left slumped over in a wheelchair outside X-ray for 45 minutes with a fever of 107 degrees.”
In the same year, her son was hospitalized with osteomyelitis and her father-in-law died of cancer. After this crash course in coping with hospitals, Thieriot vowed her next hospitalization--for the birth of her second child--would be different. And because she prepared carefully and made it a point to educate the staff about her preferences, that hospital stay was a relative triumph compared to her previous experiences.
But, she continually wondered, what about all those other people who are still having hospital visits that amount to prolonged nightmares? As she explains: “I thought to myself, I’m basically young and strong. What happens to people who are less sturdy, less capable of making demands?”
At first, Thieriot, a former environmental activist who is married to Richard Thieriot, editor and publisher of the San Francisco Chronicle, wanted to build an entirely new, patient-centered hospital. But as she researched this possibility and began to realize the enormity of it, she decided to start smaller and founded a nonprofit organization to establish a base of operation.
First Project Surfaces
Named Planetree, after the tree under which Hippocrates taught, the organization’s first project surfaced in 1981: the Planetree Health Resource Center, a lending library and clearinghouse that provides the public with access to medical and health information and computer research services. The Resource Center, located in the basement of Pacific Presbyterian Medical Center’s Health Sciences Library, has delivered books to the hospital’s patients for several years and it now provides the Planetree unit patients with additional resource material as well.
All along, however, the model hospital project was in the mind of Thieriot and Planetree’s board of directors, which includes a number of prominent San Francisco health professionals as well as members such as retailer/philanthropist Cyril Magnin and the Whole Earth Catalog’s Stewart Brand.
Thieriot and her group persisted with their ideas that a hospital could have an environment that is more conducive to healing and a place where patients could learn how to best care for themselves (or be cared for). As one of the Planetree unit’s brochures describes the philosophy to new patients: “We believe that a peaceful, comfortable and attractive physical environment, warm and supportive care givers and a daily schedule of activities that reflects your needs and desires are major factors toward your rapid recovery.”
Eventually, the idea of a whole new hospital was scrapped in favor of establishing a small, model unit inside a typical, mainstream, high-tech hospital. That way, if the project is deemed successful, it could serve as a demonstration to other hospitals--proof that such a patient-centered unit is not only desirable but entirely possible in any hospital.
So meetings were held with most San Francisco hospitals and negotiations were begun with one other hospital before the unit was finally accepted at Pacific Presbyterian Medical Center.
Dr. John Gamble, the center’s chief of medicine and a long-term Planetree board member, says that the bureaucratic obstacles to the establishment of the unit have been considerable. But he adds that the persistence and the persuasiveness of Thieriot and her team resulted in Planetree gaining such major concessions from the hospital administrators as the right of refusal to use certain nurses on the Planetree unit and the right to remove those who don’t work out. (Planetree nurses, chosen from the hospital’s staff nurses, undergo additional training since the unit is run quite differently from others in the hospital.)
Fusses Over Medical Chart
The biggest “hang-up,” Gamble notes, came in Planetree’s insistence that patients be encouraged to read their own medical charts, which they are entitled to do by law . “It was really horrifying to doctors to begin with and to many nurses too,” he says. “But they’ve gotten used to it and nobody fusses about it now.”
Gamble is most eager for the project’s two-year evaluation, which is to begin in 1986 and be conducted by the University of Washington in cooperation with the Rand Corp. But the physician is already delighted at the reactions he and others have received. “I’ve heard from a lot of people on other units--both nurses and physicians,” he says, “They’re saying, ‘When are they going to make our unit like Planetree?’ ”
He’s also heard, however, that “there’s still some feeling among the nurses in the hospital that the nurses on Planetree are an elite group and getting more attention.”
As for reaction of physicians, Planetree’s hospital project administrator Robin Orr points out that the unit began with 15 admitting physicians placing their patients on the Planetree unit, which is a general adult medical ward serving patients with anything from AIDS to emphysema. The unit now has more than 60 physicians eager to place their patients there, she says.
Patient reaction has been similarly high. A visitor can even spot notes tacked on the kitchenette’s bulletin board, like the one from Lorraine O’Malley that says, “I’ll pleasantly remember this experience.” According to Thieriot, only one patient was dissatisfied of the more than 130 served since June. She suspects it was the result of overly high expectations on the patient’s part and a mistake by a nurse who challenged the amount of medication the patient was taking, only to find the patient backed up by his physician.
These and other minor problems have yet to be worked out of the system, she emphasizes, which makes it hard to start helping all the institutions that are already asking for material on how to replicate Planetree. And while Thieriot is pleased that other units in the hospital want to start borrowing some of Planetree’s policies and procedures, she’s also concerned that the borrowing could also invalidate the evaluation study that will be conducted.
Compare to Other Units
That’s because the study, which is expected to be funded by the Henry J. Kaiser Family Foundation at somewhere between $300,000 and $400,000, will compare Planetree’s effectiveness to that of other units in the hospital. (Start-up costs for Planetree have been funded by the San Francisco Foundation and the Henry J. Kaiser Family Foundation, which contributed a grant of $247,000 for salaries, research and development of materials. In addition, the Pacific Presbyterian Medical Center contributed 40% of the unit’s remodeling costs. Patients at Planetree pay the same rates as patients elsewhere throughout the hospital.)
The hope, of course, is that if Planetree is shown to be effective, it can also be reproduced in hospitals at costs that are no more than those hospitals presently incur. Planetree architect Roslyn Lindheim, a professor of architecture at UC Berkeley, points out that a unit such as Planetree can be physically created at a cost similar to that of a traditional hospital. (Much of the expense involved in establishing Planetree went for taking things out or relocating that which already existed, she emphasizes.)
Like the others, Lindheim is also quick to note that Planetree is much more than its physical environment. It is not one single feature that makes the unit unique, she says, but rather that so many different approaches are being used in one place.
It remains to be seen if all this will make any measurable difference to the professionals who rate such things. Nor is it known whether such service will draw more patients to one hospital as opposed to another.
“There’s no question that the whole hospital industry is becoming very competitive,” observes Planetree administrator Robin Orr. “The bottom line has to be a hospital’s image and how you can draw patients and physicians into it.
“Planetree with its humanistic approach and patient-oriented programs is attractive to patients and to the physicians who admit those patients to the hospital. All the patients who’ve been readmitted to the hospital since their stay at Planetree have requested to be placed in Planetree.
“There are more hospital beds in the United States than we have patients. The hospital that has the competitive edge in the 1980s and 1990s is the hospital that’s going to make it.”
Such speculation has obviously not been lost on Dr. Bruce Spivey, president of Pacific Presbyterian Medical Center, who says he’s no longer giggling at notions proposed by the people from Planetree.
“While I didn’t laugh, I giggled a couple of times,” he admits, recalling his first reactions to the proposals for the model hospital project.
But Spivey has come full circle on Planetree. ‘It’s really just begun and there’s been very positive support by the medical staff and all areas of involvement,” he says now. “It’s not only being accepted, it’s being sought after.”