Trevor Hancock: Can our hospitals be healing environments?

In my previous column, I mentioned two key questions that — sadly — always elicit giggles, if not outright laughter: Can I get a good night’s sleep in your hospital, and do you have the healthiest food in the community?

There are many more questions we could ask about the health of the hospital environment that would, for the most part, also elicit giggles. But it should not be this way. Hospitals should be healing environments for patients and their families.

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Twenty years ago, I worked with two U.S. hospitals that are leading members of the 550-member Planetree Alliance — Mid-Columbia Medical Centre in The Dalles, Oregon, and Griffin Hospital in Derby, Connecticut — and visited several others.

Mid-Columbia was the first hospital in the world to complete a facility-wide Planetree transformation, while the Griffin — which also did a facility-wide transformation — actually became the headquarters of the Alliance. Both are community non-profit hospitals.

Mid-Columbia is a 50-bed hospital in a small community in eastern Oregon. Among the highlights I recall were the waterfall and the grand piano in the main lobby, which set a wonderful tone coming in. There was art on the walls, colour everywhere and every floor had a small kitchenette where family members could cook a meal or snack for their loved ones. In the mornings, volunteers came in to bake muffins and cookies, and the smell wafted around the hospital — not your usual hospital smell.

The Griffin Hospital is a 160-bed urban hospital. It became a Planetree facility because the senior management, while planning a birthing centre that would be home-like, realized they or their families had all had bad health-care experiences in the past year or so. Why would we only do this in the birthing centre, they wondered — why not for the whole hospital?

So they did — and within the constraints of state budget rules. They said it cost them no more than a “normal” renovation and upgrade, because it was about spending smarter, not spending more.

Design is all-important. Nursing stations do not have a high partition for staff to shelter behind; staff work at decentralized open desks on the floor, closer and more accessible for patients and family. Often there were pull-out couches so family members can sleep in the room, carpets wherever possible, storage cupboards and a no-clutter policy that keeps the corridors clear.

Even the oxygen in the rooms was concealed behind pictures that could be easily slid aside when needed. And everyone from the CEO down is responsible for keeping the hospital clean and tidy.

Above all else, Planetree emphasizes being patient-centred. They take this seriously and go to great lengths to live that belief. For example, not only do patients have the right to read their medical chart, but to write in it. One physician said he had written: “Doing better,” the nurse had written: “Having a good day,” and the patient had written: “The hell I am!”

In one hospital, there were no overhead pagers, just overhead soft music — the staff carried wireless buzzers instead.

One nurse spoke movingly about feeling free to spend time holding a patient’s hand, because that was OK with management, while in another hospital, cleaning staff were also encouraged to hold someone’s hand or help them in small ways.

Many Planetree hospitals have health information centres, which take the traditional medical library and turn it into a public information centre, where doctors, nurses, patients and family members can all do their own research.

Planetree has not been widely adopted yet in Canada, with the first hospital to join (in 2005) being the Centre de réadaptation Estrie in Quebec; in 2008 a Quebec network was established. As CRE discovered, Planetree does not just benefit patients, it benefits the hospital too.

Since implementing Planetree, the number of complaints and the number of staff vacancies have decreased (this, despite a health-care worker shortage in Canada), while the employee retention rate has improved: from 94 per cent in 2005 to 98.7 per cent in 2010. Employee satisfaction at CRE consistently exceeds that of comparable establishments.

So yes, hospitals can be healing environments.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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