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Va. Hospital Treats the Whole Person

By M.J. McAteer
Special to The Washington Post
Tuesday, March 24, 2009

At Fauquier Hospital in Warrenton, a patient doesn't have to worry about getting stuck with a chatty roommate: All 86 of the hospital's rooms are private. Restricted visiting hours are a thing of the past, too: Family and friends can drop by any time, day or middle of the night.

Fauquier patients can order decidedly non-institutional dishes such as breakfast burritos, brick-oven pizza, Mongolian stir fry and desserts that are to die for, although the hospital probably wouldn't care to put it that way. And if a patient is accustomed to dinner at 8 or likes to sleep until 10, the concierge will take note and try to oblige.

Because of those and other features, Fauquier has been given "designated" status by Planetree, a nonprofit that promotes a more humanistic approach to health care. Planetree, which takes its name from the type of tree under which Hippocrates sat to teach his medical students, was founded in 1978 and now has 140 hospital affiliates, mostly in the United States; of those, eight have the "designated" label.

Other organizations serve as similar resources for health-care institutions, but Planetree was "the pioneer," says Rick Wade, a spokesman for the American Hospital Association. "The public doesn't know about Planetree," he says, "but health-care people know it means a commitment to a certain kind of internal culture. Before Planetree, hospitals were all about getting patients well, but not about what the patient was experiencing. Now 80 percent of the nation's hospitals are making some effort at patient-centered care."

Planetree addresses topics as diverse as patient education, social support, nutrition, spirituality and building design. Changing the culture of a very large hospital can be extremely difficult, Wade says, so most Planetree affiliates tend to be small- to medium-size facilities looking for a way to stand out. "Planetree doesn't market itself to hospitals," Wade says. "Hospitals come to Planetree."

Fauquier Hospital chief executive Rodger Baker was first impressed with Planetree when he attended a talk about the organization's philosophy and its vision of hospitals as "sacred healing places."

In the late '90s, when Fauquier was planning a $60-million-plus expansion and renovation, Baker sought advice from the organization, made site visits with staff to facilities using the patient-centered approach and, in 2000, paid the $15,000 fee for his hospital to become an affiliate. That gave him access to the organization's educational and professional resources as the hospital worked on implementing Planetree's 10 core components of patient-centered care. Planetree tracked Fauquier's progress; in October 2007, it judged the hospital to have met 45 specific standards for patient care and support staff, and gave it the "designated" label.

Baker estimates that such architectural features as private rooms with built-in sleeping accommodations for family members, carpeted corridors and additional windows added 10 to 20 percent to the cost of the construction project. Those extra expenses were worth it, he says, because the Planetree approach as a whole has resulted in improved market share and higher patient and employee satisfaction; as a result, no additional fees have been levied on patients or insurers.

The design differences at Fauquier are obvious. In waiting areas, lamps have replaced overhead lighting; halls have been carpeted to keep down noise or are finished in faux wood for a warmer feel. Community artwork hangs on the walls. "We try to look more like a hotel," Baker says.

Barriers between patients and staff, such as those sliding-glass windows that close nurses off from patients and the public, have been removed. Elevators for patients and the public are separate: No one really wants to be seen in a hospital johnny. No constant paging over the intercom system, either; instead, unobtrusive music plays all the time.

"Planetree," Wade says, "has had a tremendous impact on how hospitals are being designed and built, even if they aren't Planetree."

Family-Friendly Features

Changes extend beyond the physical structure to the human factor.

Consider one of the most common patient complaints: being asked the same question over and over by different staff members. That could be exhausting and infuriating for the patient.

Now, Baker says, computerized records have helped eliminate redundant questions, and the hospital strives to maintain a continuity of caregivers.

Elizabeth Mullen, who goes to Fauquier's infusion center for weekly chemotherapy treatment for breast cancer, volunteered about a year ago to serve on a patient advisory council for the hospital.

The first issue she broached was the infusion center's "ridiculous" and "redundant" process for registration. "It's a real burden when you aren't feeling well to have to register twice," she says. Within about a month, the hospital responded to her complaint, and now chemo patients register just once.

As for patient meals, the attitude used to be, "This is what you're going to eat, and this is when you're going to eat it," says Vernon Rhea, Fauquier's director of nutrition. Now, "within dietary constrictions," patients can pick from about 50 items or order from the Bistro on the Hill, the hospital's cafeteria -- and get a meal any time the kitchen is open.

Patients at Fauquier are urged to educate themselves about their condition and become partners in their treatment. The hospital has a clinician sit with patients to go over their medical charts, explaining such notations as "SOB": med-speak for "shortness of breath."

Some changes mean that patients aren't separated from family and friends, unless they want to be. In the emergency department, the near and/or dear can accompany the patient to one of 33 private treatment rooms. If the patient is admitted, a companion can sleep over on the fold-out couch provided in every room. "They make it very easy for families to stay," Mullen says.

Courtesies extend to outpatients, too. When Stanley Orr needed medical attention for a kidney stone in January, he told the hospital's concierge, Lisa M. Spitzer, that his wife was worried about driving them home in snowy conditions. Spitzer arranged for someone to chauffeur them -- at no charge.

It's not yet clear how the Plane-tree sensibility will affect either the hospital's medical outcomes or its bottom line, but Wade says he believes that patient-centered care leads to "fewer complications, fewer readmissions, improved outcomes and greater productivity."

Measures of Success

On the federal government's Hospital Compare Web site (http://www.hospitalcompare.hhs.gov), 76 percent of patients who had stayed overnight at Fauquier said "yes" when asked whether they would definitely recommend using the hospital. (The national average was 68 percent.)

Of 75 hospitals within a 100-mile radius of downtown Washington, only four scored higher than Fauquier: Johns Hopkins in Baltimore (80 percent), Anne Arundel Medical Center in Annapolis (79 percent), Winchester Medical Center in Virginia (79 percent) and Inova Fair Oaks in Fairfax (78 percent); Virginia Hospital Center in Arlington tied Fauquier at 76 percent.

Planetree's principles extend to better treatment of staff. Fauquier holds regular retreats for all staff to build teamwork. Employee benefits include a $10-a-month health club membership and a 20 percent discount at the Bistro.

Fauquier hopes to duplicate the success of Griffin Hospital in Derby, Conn., Planetree's flagship facility. The once-struggling hospital has posted growth in both inpatient and outpatient volumes far outstripping that of other hospitals in the state. At the same time, it has made Fortune magazine's list of 100 Best Places to Work for seven years.

If the experience at Griffin is prescriptive, the prognosis for Fauquier Hospital's future health should be promising.

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