Picker Perspectives

One of the ways Picker Institute supports patient-centered care is by recognizing people in healthcare who have made significant contributions to achieving patient-centered care worldwide.
Picker Perspectives is a monthly feature that highlights people who have promoted patient-centered care in their work or through their organization.

This month the Picker Perspective is on Susan Frampton, the president of Planetree, a nonprofit organization that provides education and information in a collaborative community of healthcare organizations, facilitating efforts to create patient-centered care in healing environments.

Susan Frampton is the president of Planetree, a nonprofit organization that provides education and information in a collaborative community of healthcare organizations, facilitating efforts to create patient-centered care in healing environments. Planetree and Picker Institute are collaborating on the production and broad dissemination of a patient-centered-care guide to help healthcare organizations improve the patient experience by implementing patient-centered care. For more information on Planetree, visit www.planetree.org.

What was the genesis of Planetree’s mission?

Planetree was founded 30 years ago by a patient, Angie Thieriot, following several traumatic interactions with the healthcare system as both patient and family member. Angie focused attention on the human versus the clinical experience of care, which she felt was so lacking.

In talking with other patients, family members and frontline staff, Angie and a group of early pioneers identified ten key aspects of the patient experience that needed to be examined in order to provide a truly healing experience that addressed not only the physical needs of patients but the emotional, social, spiritual and intellectual needs as well.

These key components became the Planetree model of patient-centered care, and in the 1980s several innovative hospitals developed sites based on these models. Striving to personalize, humanize and demystify the patient experience, these model sites were radical departures from “business as usual” in healthcare environments. Every aspect of care and the way it was delivered was evaluated from the patient perspective, and significant changes were made to better support the control and involvement of patients in their own care experience. Hundreds of leadership teams from hospitals all over the world visited these model sites, incorporating many of the ideas they saw in practice.

Planetree’s mission continues to focus on its role as a global catalyst in moving healthcare systems from a provider to a patient focus, using the patient’s perspective to shape everything that we do in hospital, clinic and long-term-care settings. Over time, a learning community of forward-thinking organizations has adopted the Planetree model to help guide their efforts in establishing a patient- and family-centered culture. This network of affiliates now comprises more than 140 sites in the United States, Canada, Europe, Latin America and Japan.

Why has it taken medicine so long to understand and integrate an appreciation of the influence of the physical environment on the patient experience?

The physical environment, or what we refer to as a healing environment, is one of the ten Planetree model components, and in many ways the easiest to understand and address. Other components of the model, such as compassionate human interactions and access to meaningful information, tend to be more challenging.

I think that medical culture is beginning to understand and appreciate the importance of the built environment in shaping not only the patient’s experience but the experience of the staff having to “live” in that environment day in and day out. There is a well-known phenomenon in medicine regarding the lag time between the identification of an innovation, or “best practice,” and its widespread adoption of between 15 and 20 years, so we’re more or less on schedule. A great deal of research has been conducted over the past 20 years on the impact of the physical environment on health and safety, and this is now being incorporated into the design of many healthcare facilities. For example, major renovations or construction of acute-care hospitals in many states now require that all of the rooms be single-bed rooms. This is a departure from the past, where multi-bedded rooms were the rule. This is a change based on the evidence now available about the health and safety benefits of single-patient rooms.

What piqued your interest in the work of Planetree? What is your healthcare background?

I am a medical anthropologist by training and have spent my career working in hospital and clinic settings. Before I joined Planetree, most of my work focused on patient advocacy, community health education and holistic approaches to care. Planetree’s approach to enhancing the patient experience is very much a culture-change model, so it made perfect sense to me. In anthropology, we’re trained in the participant-observation approach to data collection, and that is essentially what we do for hospitals interested in implementing patient-centered changes. We participate and observe patients, families and staff in the healthcare environment, engaging them in meaningful dialogue in order to identify their preferences, ideas and priorities. We use this information to shape the work within the institution.

The CAHPS survey has made it clear that ambiance is important in the patient experience. Have you seen increased interest in the need for Planetree’s expertise since the survey results were released? Any major institutions initiating this work?

The CAHPS survey has helped to focus attention on the patient experience, and the human side of the care equation. This has in turn increased interest on the part of hospital leadership teams in patient satisfaction and the opportunities for improving the way we define, implement and measure patient-centered care. The Planetree model, and in particular our Patient-Centered Hospital Designation program, are useful tools for organizations wanting to improve the patient experience. A number of health systems have begun to use the model and set designation as a goal, as one avenue for addressing H-CAHPS. These include several VA systems, the Cleveland Clinic and Sharp Healthcare.

Do you have a global network? How do you see healthcare systems in other countries addressing this issue? Where does the United States stand in the degree to which it has embraced the concept?

Global interest in both patient-centered approaches to care and the Planetree model have continued to grow over the last decade. I’m actually sitting in a hotel room in Osaka, Japan, today, responding to your questions, invited here by a large healthcare system interested in becoming the first Planetree hospital in Japan. We’ve just begun similar work with one of the largest hospitals in South America, and we have responded to new inquiries from organizations in India, Dubai, Qatar, Australia, South Africa and Malaysia during the last year alone.

We have a thriving partnership with Planetree Nederlands, where a member network has been growing steadily over the past four or five years, and we plan to enter into a similar venture with the Ministry of Health in Quebec to begin network development there. The entire Calgary Health Region is implementing the Planetree model. We’ve also worked with hospital partners in Iceland, Norway, Ireland and England in the past. I see this international work continuing to expand as consumer demand for a different healthcare experience increases worldwide.

The United States was one of the earliest adopter of patient-centered care, in part because our consumer health movement has been relatively strong and vocal. But we have a long way to go, and a lot of work to do, both here and abroad