Transcript Issue Y2K The Great War for Talent!

Healthcare
Horrors &
Hope
Tom Peters/10.26.2004
1. Premise.
“If one didn’t know better, one
might think that hospitals set
out to design systems that
provide the most sophisticated
technical care but deliver the
worst possible experience to
sick people.” —Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
Golden American Age of Patient-centric,
Genetics-driven Healthcare Looms!
Current status: $1.3T+. 30M-70M uninsured. 100K killed
and 2M injured p.a. in hospitals. 85% treatments
unproven. Cure depends on locale in which treated.
50% prescriptions do not work. 2X docs. 2X hospitals.
IS primitive. Accountability & measurement nil.
And … EVERYBODY’S MAD-AS-HELL AND FEELS
POWERLESS: DOCS, PATIENTS, NURSES, INSURERS,
EMPLOYERS, PHARMA & DEVICE COS, HOSPITAL
ADMINISTRATORS AND STAFF.
2. Consumerism (Patientcentric Healthcare Arrives)
Anne Busquet/ American Express
Not: “Age of the Internet”
“Age of
Customer
Control”
Is:
Amen!
“The Age of the
Never Satisfied
Customer”
Regis McKenna
“We expect consumers to
move into a position of
dominance in the early
years of the new century.”
Dean Coddington, Elizabeth Fischer, Keith
Moore & Richard Clarke, Beyond Managed Care
“Parents, doctors, stockbrokers, even
military leaders are starting to lose the
authority they once had. There are all
these roles premised on access to
privileged information. … What
we are
witnessing is a collapse of that
advantage, prestige and
authority.”
Michael Lewis, next
Today’s Healthcare “Consumer”:
“skeptical and
demanding”
Source: Ian Morrison, Health Care in the New Millennium
“He shook me up. He put his hand
on my shoulder, and simply said,
‘Old friend, you
have got to
take charge of your
own medical care.’ ”
Hamilton Jordan, No Such Thing as a Bad Day (on a conversation with a
doctor pal, following Jordan’s cancer diagnosis)
“A seismic shift is underway in
healthcare. The Internet is
delivering vast knowledge and new
choices to consumers—raising their
expectations and, in many cases,
handing them the controls.
[Healthcare] consumers are driving
radical, fundamental change.”
Deloitte Research, “Winning the Loyalty
of the eHealth Consumer”
“It may be the most far-reaching evolution
of them all: the metamorphosis of passive
patient into consumer – and well-informed,
assertive consumer at that. The defining
axiom of traditional medicine – ‘doctor’s
orders’ is being turned on its head. These
days it’s the patients who are armed, the
doctors who must get wired to keep
nimble.” “E-health is the new house call.”
Richard Firstman, “Heal Thyself,” On Magazine
“Savior for the Sick”
vs.
“Partner for Good
Health”
Source: NPR
Consumer Imperatives
Choice
Control (Self-care, Self-management)
Shared Medical Decision-making
Customer Service
Information
Branding
Source: Institute for the Future
“The ‘curative model’ narrowly
focuses on the goal of cure. …
From many quarters comes
evidence that the view of health
should be expanded to
encompass mental, social and
spiritual well-being.”
Institute for the Future
Determinants of Health
Access to care: 10%
Genetics: 20%
Environment: 20%
Health Behaviors: 50%
Source: Institute for the Future
“Consumerism”: HMO backlash
(e.g., plans with more choice). Alternative
Medicine, Wellness & Prevention
bias. Info availability (disease, health,
docs, support groups, outcomes). Boomers
(“I’m in charge!” Discretionary $$$$ to spend:
cosmetic surgery, vision improvement, fertility,
etc.). Self-care (chronic disease).
High
expectations (genetics, etc.) …
3. Demographics:
The BOOMERS
Reach 60 in ’05!
“NOT ACTING THEIR
AGE: As Baby Boomers
Zoom into Retirement,
Will America Ever Be the
Same?”
USN&WR Cover
Boomer World
“From jogging to plastic
surgery, from vegetarian diets
to Viagra, they are fighting to
preserve their youth and
defy the effects of gravity.”
M.W.C. Howgill, “Healthcare Consumerism, the Information
Revolution and Branding”
“Pick up any copy of Glamour or
Men’s Health, and you’ll see pages of
advertisements encouraging readers
to enlarge their breasts, retard
baldness, correct their vision,
improve their smile, or relieve stress
through herbs, massage therapy,
acupuncture—you name it.”
Coddington, Fischer, Moore & Clarke, Beyond Managed Care
“Sixty Is the
New Thirty”
—Cover/AARP/11.03
4. “Quality”: COULD
IT
TRULY BE THIS AWFUL?
“Quality of care
is the problem, not
managed care.”
Institute of Medicine
“Without being disrespectful, I
consider the U.S. healthcare delivery
system the largest cottage industry in
the world. There
are virtually no
performance measurements
and no standards. Trying to
measure performance … is the next
revolution in healthcare.”
Richard Huber, former CEO, Aetna
“A healthcare delivery system
characterized by idiosyncratic
and often ill-informed
judgments must be restructured
according to evidence-
based medical practice.”
Demanding Medical Excellence: Doctors and Accountability in
the Information Age, Michael Millenson
“As unsettling as the prevalence of inappropriate care
is the enormous amount of what can only be called
A surprising 85% of
everyday medical treatments
have never been scientifically
validated. … For instance, when family
ignorant care.
practitioners in Washington were queried about
treating a simple urinary tract infection, 82 physicians
came up with an extraordinary 137 strategies.”
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
CDC 1998: 90,000 killed
and 2,000,000 injured
from nosocomial
[hospital-caused] drug
errors & infections
1,000,000
“serious
medication errors per year” …
“illegible handwriting, misplaced
decimal points, and missed drug
interactions and allergies.”
Source: Wall Street Journal / Institute of Medicine
Various studies: 1 in 3,
1 in 5, 1 in 7, 1 in 20
patients “harmed by
treatment”
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
HealthGrades/Denver:
195,000
hospital deaths per year in the U.S., 2000-2002 =
390 full jumbos/747s in the drink per year.
Comments: “This should give you pause when
you go to the hospital.” —Dr. Kenneth Kizer, National Quality
. “There
is little evidence that
patient safety has improved in the
last five years.” —Dr. Samantha Collier
Forum
Source: Boston Globe/07.27.04
“This should give you pause
when you go to the
hospital.”
“There is little evidence
that patient safety
has improved in the last
five years.”
RAND (1998): 50%,
appropriate
preventive care. 60%,
recommended treatment, per
medical studies, for chronic
conditions. 20%, chronic
care treatment that is wrong.
30% acute care treatment
that is wrong.
“Established state-of-theart cancer care—about
which there is no
longer any debate—is
erratically applied.”
Source: Institute of Medicine’s National Cancer Policy Board
“In a disturbing 1991 study, 110
nurses of varying experience levels
took a written test of their ability to
calculate medication doses. Eight out
of 10 made calculation mistakes at
least 10% of the time, while four out
of 10 made mistakes 30 % of
the time.”
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
YE GADS!
New England Journal of Medicine/
Harvard Medical Practice Study: 4% error rate (1 of 4
negligence). “Subsequent investigations around the
country have confirmed the ubiquity of error.” “In one
small study of how clinicians perform when patients
have a sudden cardiac arrest, 27 of 30 clinicians made
an error in using the defibrillator.” Mistakes in
administering drugs (1995 study) “average once every
hospital admission.” “Lucian Leape, medicine’s
leading expert on error, points out that many other
industries—whether the task is manufacturing
semiconductors or serving customers at the Ritz
Carlton—simply wouldn’t countenance error rates like
those in hospitals.”—Complications, Atul Gawande
“In health care,
geography is
destiny.”
Source: Dartmouth Medical School 1996 report
Geography Is Destiny
“Often all one must do to acquire a
disease is to enter a country where a
disease is recognized—leaving the
country will either cure the malady or turn
it into something else. … Blood pressure
considered treatably high in the United States might
be considered normal in England; and the low blood
pressure treated with 85 drugs as well as
hydrotherapy and spa treatments in Germany would
entitle its sufferer to lower life insurance rates in the
United States.” – Lynn Payer, Medicine & Culture
Geography Is Destiny
E.g.: Ft. Myers 4X Manhattan—back
surgery. Newark 2X New Haven—
prostatectomy. Rapid City SD 34X Elyria
OH—breast-conserving surgery. VT, ME,
IA: 3X differences in hysterectomy by age
70; 8X tonsillectomy; 4X prostatectomy
(10X Baton Rouge vs. Binghampton).
Breast cancer screening: 4X NE, FL, MI
vs. SE, SW. (Source: various)
PARADOX: Many, many
formal case reviews …
failure to systematically/
systemically/ statistically
look at and act on evidence.
C.f., Complications, Atul Gawande
“Most physicians believe that
diagnosis can’t be reduced to a set
of generalizations—to a ‘cookbook.’
… How often does my intuition lead
me astray? The radical implication of
the Swedish study is that the
individualized, intuitive approach that
lies at the center of modern medicine
is flawed—it causes more mistakes
than it prevents.” —Atul Gawande, Complications
Deep Blue Redux*: 2,240
EKGs
… 1,120 heart attacks.
Hans Ohlin
: 620.
Lars Edenbrandt’s
software: 738.
(50 yr old chief of coronary care, Univ of
Lund/SW)
*Only this time it matters!
“Practice variation is not caused by ‘bad’ or
‘ignorant’ doctors. Rather, it is a natural
consequence of a system that systematically
tracks neither its processes nor its outcomes,
preferring to presume that good facilities, good
intentions and good training lead automatically
to good results. Providers remain more
comfortable with the habits of a guild, where
each craftsman trusts his fellows, than with the
demands of the information age.”
Michael Millenson, Demanding Medical Excellence
Genius
Required?
Leapfrog Group:
CPOE/Computerized Physician
Order Entry*
ICU staffing by trained
intensivists**
EHR/Evidence-based Hospital
Referral***
*Duh I: Welcome to the computer age.
**Duh II: How about using experts?
***Duh III: If you do stuff a lotta times, you tend to get/be better.
Source: HealthLeaders
The Benefits of …
FOCUSED EXCELLENCE
Shouldice/Hernia Repair:
30-45 min, 1% recurrence.
Avg: 90 min, 10%-15%
recurrence.
Source: Complications, Atul Gawande
IS/Web
5. The
REVOLUTION
“Some grocery stores
have better
technology than our
hospitals and
clinics.” —Tommy Thompson, HHS
Secretary
Source: Special Report on technology in healthcare, U.S. News & World Report (07.04)
“We’re in the Internet
age, and the average
patient can’t email
their doctor.”
Donald Berwick, Harvard Med School
Computerized Physician Order
Entry/CPOE:
5%
hospitals
source: HealthLeaders/06.02
of U.S.
Want email consultation: 90%
patients, 15% docs.
Evidence: Patients do not
pester docs. Time is saved. No
one has sued (shows “care & connection”—
the absence of which is the major cause
of suits).
Source: New York Times
Telemedicine …
Reduces days/1000 patients and
physician visits for the chronically ill
Decreases costs of managing chronic
disease
Expands service areas for providers
Reduces travel costs to and from medical
ed seminars
Douglas Goldstein, e-Healthcare
“Our entire facility is digital. No paper, no film, no
medical records. Nothing. And it’s all integrated—from the lab to
X-ray to records to physician order entry. Patients don’t have to
wait for anything. The information from the physician’s office is
in registration and vice versa. The referring physician is
immediately sent an email telling him his patient has shown up.
… It’s wireless in-house. We have 800 notebook computers that
are wireless. Physicians can walk around with a computer that’s
pre-programmed. If the physician wants, we’ll go out and wire
their house so they can sit on the couch and connect to the
network. They can review a chart from 100 miles away.” —David
Veillette, CEO, Indiana Heart Hospital (HealthLeaders/12.2002)
Detroit Med Center:
$100M IS Makeover
Experiment: Surgical residents equipped with
Palm IIIxe. Med Director: “It’s not unusual to have
a team of 5 or 6 residents responsible for the
patients of 25 doctors. For each resident, that
could mean seeing 40 patients spread across 10
floors and 5 buildings.” Records work was
manual; but “Now you export the list of patients
to your Palm, with the room number for each
patient and with lab results from the last
72 hours.”
The VHA gets it!
E.g.: Laptop at bedside calls
up patient e-records from one of 1,300 hospitals. Barcoded wristband confirms meds. National Center for
Patient Safety in Ann Arbor. Docs and researchers
discuss optimal treatment regimens—research center
in Durham NC. Doc measures & guidelines; e.g.,
pneumonia vaccinations from 50% to 84%. Blamefree system, modeled after airlines. “What’s needed
in the U.S. is nothing short of a medical revolution and
the VHA has gone further than most any other
organization to revamp its culture and systems.”—
Rand/Source:WSJ 12.10.2001
“Patient by patient, problem by
problem—drug reactions, hospital
caused infections—Salt Lake City’s
LDS Hospital has attacked treatmentcaused injuries and deaths. One of the
secrets of LDS’s success is a custombuilt clinical computer system that
may serve as a national model for how
to save patient lives.”
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
Info Revolution
Consumerism (research, consultation, B2C, etc.)
Clinical Info Systems (guidelines and outcome
measurement, etc.)
100% Web-based (internal) Systems
Electronic Medical Records
Patient-physician email-consultation
Telehealth-Remote Monitoring
(biosensors, home testing, etc.)
Telemedicine (consultation, invasive treatment,
“global medical village,” etc.)
6. Conclusion.
Golden American Age of Patient-centric,
Genetics-driven Healthcare Looms!
Current status: $1.3T+. 30M-70M uninsured. 100K killed
and 2M injured p.a. in hospitals. 85% treatments
unproven. Cure depends on locale in which treated.
50% prescriptions do not work. 2X docs. 2X hospitals.
IS primitive. Accountability & measurement nil.
And … EVERYBODY’S MAD-AS-HELL AND FEELS
POWERLESS: DOCS, PATIENTS, NURSES, INSURERS,
EMPLOYERS, PHARMA & DEVICE COS, HOSPITAL
ADMINISTRATORS AND STAFF.
21
7. HealthCare
HealthCare21: 21 Ideas for Century21
1. Hospitals kill people. (And many of those they don’t kill, they
wound.) (And they deny it.) (ERRORS RULE!) And: Hustling
ambulances kill pedestrians—and don’t save patients.
2. Doctors are spoiled brats—who don’t like measurements.
Or any form of “interference.” Docs are also cover-up artists.
The REAL Hippocritic [sic?] Oath: “DON’T RAT ON A
FELLOW DOC”.
3. Most prescription drugs don’t work—for a PARTICULAR
patient. Current drugs = Blunderbusses.
4. Think … WELLNESS. Think … PREVENTION.
5. THERE IS LITTLE “SCIENCE” IN “MEDICINE.” (See state to
state variations … country to country variations … the general
lack of agreed-upon treatments.)
6. You could save thousands of lives (think Schindler)—if you
just outlawed handwritten prescriptions.
7. “Detailers” will disappear … when GenX docs arrive.
HealthCare21 (Cont.)
8. IS/IT in hospitals is primitive (despite smart people and
enormous expenditures—think Sears).
9. Systemic IS/IT is worse—links between docs, insurers,
providers, patients.
10. ELECTRONIC MEDICAL RECORDS …TO UNIFORM
STANDARDS. (NOW.) (PLEASE.)
11. THE WEB WILL LIBERATE. (Info = Power.)
12. 80M BOOMERS RULE. ($$$$$. Desire for c-o-m-p-l-e-t-e
CONTROL. NOW. “LEADERSHIP” OF AGING PROCESS.)
13. “Drug Discovery” processes at Big Pharma are … hopelessly
over-complicated.
(???: Bye Bye … Big Pharma.)
14. 90% of the “healthcare fix”: HARVEST THE LOW-HANGING
FRUIT. “They” are … NOT … the Enemy. “I have seen the
enemy … and it am me.” Damn it.
HealthCare21 (Cont.)
15. The number of U.S. un-insured is the nation’s #1 disgrace.
That said, insured “consumers” are spoiled brats.
They/we/me act as if healthcare were a free good … and
believe that an incipient hangnail calls for at least a CAT scan
… or two. ANSWER: MAKE US FEEL THE PAIN.
16. Genetic engineering & biotech change … EVERYTHING.
(Within 15 years.)
17. New Medical Devices change … EVERYTHING. (Within 15
years.)
18. IS/IT changes … EVERYTHING. (Within 10 years.)
19. New Docs change … EVERYTHING. (Within 10 years.)
20. New Patients change … EVERYTHING. (Within 5 years.)
*
*
HealthCare21 (Cont.)
ALL THIS =
ENORMOUS
OPPORTUNITY.
21.
The
Opportunity of Several Lifetimes. (For the Bold & Brave.)
H’Care WILL be … TOTALLY … re-invented in the next two
decades. (And, hey, it is our largest “industry.”)
8. Doing It Right
Planetree: A Radical
Model for New
Healthcare/Healing/
Wellness Excellence
“It was the goal of the
Planetree Unit to help
patients not only get well
faster but also to stay well
longer.” —Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
“Much of our current
healthcare is about curing.
Curing is good. But healing
is spiritual, and healing is
better, because we can heal
many people we cannot
cure.” —Leland Kaiser, “Holistic Hospitals”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Determinants of Health
Access to care: 10%
Genetics: 20%
Environment: 20%
Health Behaviors: 50%
Source: Institute for the Future
The 9 Planetree Practices
1. The Importance of Human Interaction
2. Informing and Empowering Diverse Populations: Consumer
Health Libraries and Patient Information
3. Healing Partnerships: The importance of Including Friends
and Family
4. Nutrition: The Nurturing Aspect of Food
5. Spirituality: Inner Resources for Healing
6. Human Touch: The Essentials of Communicating
Caring Through Massage
7. Healing Arts: Nutrition for the Soul
8. Integrating Complementary and Alternative Practices
into Conventional Care
9. Healing Environments: Architecture and Design Conducive
to Health
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1. The Importance of
Human Interaction
“There is a misconception that supportive interactions require
more staff or more time and are therefore more costly. Although
labor costs are a substantial part of any hospital budget, the
interactions themselves add nothing to the budget.
Kindness is free.
Listening to
patients or answering their questions costs nothing. It can be
argued that negative interactions—alienating patients, being
non-responsive to their needs or limiting their sense of
control—can be very costly. … Angry, frustrated or frightened
patients may be combative, withdrawn and less cooperative—
requiring far more time than it would have taken to interact with
them initially in a positive way.” —Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
Press Ganey Assoc/1999: 139,380 former patients
from 225 hospitals
0 of top 15 factors determining Patient Satisfaction
referred to patient’s health outcome
PS directly related to Staff Interaction
PS directly correlated with ES (Employee Satisfaction)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Mgrs re staff: wages, security, promotion
opportunities
Staff re staff: interesting work (M:5 of 10),
appreciation (5 of 10), sense of being “in” about
what’s going on (10 of 10)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
The Customer Comes
Second: Put your People
First and Watch ’Em Kick
Butt, Hal Rosenbluth (and
Diane McFerrin Peters)
“100 Best Places to
Work”/RLevering/2001
Get straight answers
Appreciation
Collaboration
Interest in me as a person
Camaraderie (“Fun place to work”)
“Perhaps the simplest and most profound
of all human interactions is kindness. …
But if it is so simple, it is surprising how
frequently it is absent from our healthcare
environments. … Many staff members
report verbal ‘abuse’ by physicians,
managers and coworkers.” —Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
“Planetree is about
human beings caring
for other human
beings.” —Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel (“Ladies and
gentlemen serving ladies and gentlemen”—4S credo)
2. Informing and
Empowering Diverse
Populations: Consumer
Health Libraries and
Patient Information
Planetree Health Resources Center/1981
Planetree Classification System
Consumer Health Librarians
Volunteers
Classes, lectures (CR)
Health Fairs
Griffin’s Mobile Health Resource Center
Open Chart Policy
Patient Progress Notes
Care Coordination Conferences (Est goals, timetable,
etc.)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
3. Healing
Partnerships: The
importance of
Including Friends
and Family
“When hospital staff members are
asked to list the attributes of the
‘perfect patient and family,’ their
response is usually a passive
patient with no family.” —Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
The Patient-Family Experience
“Patients are stripped of control, their clothes
are taken away, they have little say over their
schedule, and they are deliberately separated
from their family and friends. Healthcare
professionals control all of the information
about their patients’ bodies and access to the
people who can answer questions and connect
them with helpful resources. Families are
treated more as intruders than loved ones.”
—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“Family members, close friends and
‘significant others’ can have a far
greater impact on patients’ experience
of illness, and on their long-term
health and happiness, than any
healthcare professional.” —Through the
Patient’s Eyes
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“A 7-year follow-up of women
diagnosed with breast cancer
showed that those who confided
in at least one person in the 3
months after surgery had a 7-year
survival rate of 72.4%, as
compared to 56.3% for those who
didn’t have a confidant.”
Institute for the Future
Institute of Medicine/ “Crossing the Quality Chasm”
Respect for preferences
Involvement in Decision Making
Access to care
Coordination of care
Information and education
Physical comfort
Emotional support
Involvement of Friends and Family
Continuity of care
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Care Partner Programs (IDs, discount meals, etc.)
Unrestricted visits (“Most Planetree hospitals have eliminated
visiting restrictions altogether.”) (ER at one hospital “has a policy of never
separating the patient from the family, and there is no limitation on how many
family members may be present.”)
Collaborative Care Conferences
Clinical Guidelines Discussions
Family Spaces
Pet Visits (POP: Patients’ Own Pets)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
4. Nutrition: The
Nurturing Aspect
of Food
Meals are central events
vs
“There, you’re fed.”*
*Irony: Focus on “nutrition” has reduced focus on “food” and “service”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Kitchen
Beautiful cutlery, plates, etc
Chef rep
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Aroma therapy (eg “smell
of baking cookies”)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
5. Spirituality: Inner
Resources for Healing
Spirituality: Meaning and Connectedness in Life
1. Connected to supportive and caring group
2. Sense of mastery and control
3. Make meaning out of disease/find meaning in
suffering
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Griffin: redesign chapel (waterfall, quiet
music, open prayer book)
Other: music, flowers, portable labyrinth
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
6. Human Touch:
The Essentials of
Communicating
Caring Through
Massage
“Massage is a powerful way to
communicate caring.” —Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick Charmel
Mid-Columbia Medical Center/Center for Mind and Body
Massage for every patient scheduled for ambulatory
surgery (“Go into surgery with a good attitude”)
Infant massage
Staff massage (“caring for the caregivers”)
Healing environments: chemo!
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
7. Healing Arts:
Nutrition for the Soul
Planetree: “Environment conducive to healing”
Color!
Light!
Brilliance!
Form!
Art!
Music!
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Florence Nightingale/Notes on
Nursing/patient’s need for beauty,
windows, flowers: “People say the
effect is only on the mind. It is no such
thing. The effect is on the body, too”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Griffin: Music in the parking lot;
professional musicians in the lobby
(7/week, 3-4hrs/day) ; 5 pianos;
volunteers (120-140 hrs arts & entertainment
per month).
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
8. Integrating
Complementary and
Alternative Practices
into Conventional Care
CAM (Complementary & Alternative Medicine):
83M in US (42%)
CAM visits 243M greater than to PCP (Primary Care
Physician) (With min insurance coverage)
W-F-Educated-Hi inc
Don’t tell PCP (40%)
OTA: <30% procedures used in conv med have
undergone RCTs (randomized clinical trials)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Griffin IMC/Integrative Medicine Center
Massage
Acupuncture
Meditation
Chiropractic
Nutritional supplements
Aroma therapy
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
9. Healing Environments:
Architecture and
Design Conducive
to Health
“Planetree Look”
Woods and natural materials
Indirect lighting
Homelike settings
Goals: Welcome patients, friends and family … Value
humans over technology .. Enable patients to
participate in their care … Provide flexibility to
personalize the care of each patient … Encourage
caregivers to be responsive to patients … Foster a
connection to nature and beauty
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Sound
Texture
Lighting
Color
Smell
Taste
Sacred space
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Access to nurses station:
“Happen to”
vs
“Happen with”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
The Eden
Alternative
The Ten Principals of the Eden Alternative
1. The three plagues of loneliness, helplessness, and boredom
account for the bulk of suffering among Elders.
2. Life in an Elder-centered community revolves around close
and continuing contact with children, plants, and animals.
These ancient relationships provide young and old alike with a
pathway to a life worth living.
3. Companionship is the antidote to loneliness. In an Eldercentered community we must provide easy access to human
and animal companionship.
4. A healthy Elder-centered community seeks to balance the
care that is being given with the care that is being received.
Elders need opportunities to give care and caregivers need
opportunities to receive care.
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“The Eden paradigm allows
elders to care for animals,
birds, and children as well
as each other.” —Susan Eaton, Harvard/JFK school
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
The Ten Principals of the Eden Alternative
5. Variety and Spontaneity are the antidotes to
boredom. The Elder-centered community is rich in
opportunities to sample these ancient pleasures.
6. An Elder-centered community understands that
passive entertainment cannot fill a human life.
7. The Elder-centered community takes medical
treatment down from its pedestal and and places it into
the service of genuine human caring.
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
The Ten Principals of the Eden Alternative
8. In an Elder-centered community, decisions should
be made by the Elders or those as close to the Elders
as possible.
9. An Elder-centered community understands human
growth cannot be separated from human life.
10. Wise leadership is the lifeblood of any struggle
against the Three Plagues. For it, there can be no
substitute.
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“The most basic
question we need to
pose in caring for
others is this: Is this a
loving act?” —Leland Kaiser, “Holistic
Hospitals”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Conclusion:
Caring/Growth
“Experience”
Care!
Control!
Connect!
Engage!
Grow!
De-stress!
“An estimated 60 to
90 percent of doctor
visits involve
stress-related
complaints.”
—Newsweek/
“Health for Life”/09.27.2004
Learn more about
Planetree/
The Planetree Alliance:
www.planetree.org
9. Tom’s
HealthCare
2
Healthcare’s 1-2 Punch
1.
Hospital “quality control,” at least in the U.S.A., is a bad, bad joke. Depending on
whose stats you believe, hospitals kill 100,000 or so of us a year—and wound many
times that number. Finally, “they” are “getting around to” dealing with the issue.
Well, thanks. And what is it we’ve been buying for our Trillion or so bucks a year?
The fix is eminently do-able … which makes the condition even more intolerable.
(“Disgrace” is far too kind a label for the “condition.” Who’s to blame? Just about
everybody, starting with the docs who consider oversight from anyone other than
fellow clan members to be unacceptable.)
2.
The “system”—training, docs, insurance incentives, “culture,” “patients”
themselves—is hopelessly-mindlessly-insanely (as I see it) skewed toward fixing
things (e.g. Me) that are broken—not preventing the problem in the first place and
providing the Maintenance Tools necessary for a healthy lifestyle. Sure, biomedicine will soon allow us to understand and deal with individual genetic predispositions. (And hooray!) But take it from this 61-year old, decades of physical
and psychological self-abuse can literally be reversed in relatively short order by
an encompassing approach to life that can only be described as a “Passion for
Wellness (and Well-being).” Patients—like me—are catching on in record numbers;
but “the system” is highly resistant. (Again, the doctors are among the biggest
sinners—no surprise, following years of acculturation as the “man-with-the-whitecoat-who-will-now-miraculously-dispense-fix it-pills-for-you-the-unwashed.” (Come
to think of it, maybe I’ll start wearing a White Coat to my doctor’s office—after all, I
am the Professional-in-Charge when it comes to my Body & Soul. Right?)
CR
07.03: 60/264/180/145-85/140
10.04: 61/195/092/097-60/058
Off …
Univasc (<1/2)
Bextra
Lipitor
Toprol
Propranolol