Issue link: https://beckershealthcare.uberflip.com/i/483154
6 Planetree President Susan Frampton, PhD, dis- cussed her philosophy of patient-centeredness, how far the healthcare industry has progressed regarding that mission and how it can progress even further. Note: Interview has been edited for length and clarity. Question: What does patient-centered care look like to you? Dr. Susan Frampton: In a nutshell, there are three words that characterize what patient-centered care is all about. The first is "personalize," how do we personalize the care experience of each patient so that they don't feel like a number or a disease or a part of the body, but a whole person? The sec- ond is "humanize," how do we make sure in a very high-tech world and industry that we put the hu- man being first and ensure we aren't doing things to people that dehumanizes them? We hear a lot of concerns from patients regarding the negative impacts technology has on the human experi- ence, where more attention is being paid to the computer screen than to the patient. And finally, "demystify" is the third characteristic. We need as a professional industry to demystify the experi- ence for patients so that they understand, in their own language, what is going on and how they can help themselves. As an industry, we've not done a good job of that; we have our own 'medical-ese' language that even educated people have a hard time understanding. Demystifying care means making it more transparent, not only in the way that things are described, but becoming more transparent in what we are willing to share with patients. Those to me are the foundational pieces of patient centeredness. Q: Why does patient-centered care matter? SF: I think it has become very clear over the last de- cade as new research has emerged that being kind to patients, open with information, involving them more in decision-making and being respectful of their input is simply better medicine. We can im- prove clinical outcomes when patients are a part of their own care experience and when we do things with them instead of doing things to them. There has been some pushback for many years about the softer side of medicine. For example, people question the importance of things like em- pathy, compassion and kindness because they feel as though they have surgeries and quality measures and other matters to attend to, so the human rela- tionship gets relegated to the back seat. What's fas- cinating now is the emerging literature demonstrat- ing a very powerful connection between empathetic physicians, who have good relationships with their patients and better clinical outcomes. Literally, peo- ple who have kind, empathic physicians heal more quickly, have better management of their diabetes or chronic condition and their course of contagious diseases like the flu are shorter. This fascinating literature supports the power of the relationship between healthcare provider and patient. Care is not just about the technolo- gy and the things we do to people; it's how we re- late to them and engage in a human relationship with them. My understanding is that healthcare is all about improving medical outcomes, so be- ing patient-centered and being kind and respect- ful should be as important as other quality and safety efforts. Q: Planetree clearly prides itself on hu- manizing healthcare. Can you give me some examples about how the organiza- tion's work does that? SF: At Planetree, we always begin with conduct- ing focus groups with the patients, the patients' families and the frontline staff of the organiza- tions that we are working with, be it a hospital, psychiatric facility, physician's office or nursing home. We ask those individuals to describe to us what is working in the healing experience in that organization and what can be improved upon to make the experience better. We always start this way, listening to the voices of the people closest to the care experience. Interestingly, there is of- tentimes a lot of coherence between what patients and families identify as being most important to what frontline staff do. Then, we use that infor- mation to develop transformation plans. We also do something that is unique with the training and education for the staff — we use a retreat process that is either a full-day experi- ence or a two-day overnight. During the retreat, we take the staff and put them in the shoes of the patients by having them participate in very in- teractive and engaging exercises. That way, they don't only think about the patient's experience, they get to actually feel it themselves. Planetree sees the retreat process as appealing to people's hearts as opposed to their heads. I'd say that many people working in healthcare have felt the mean- ing and the purpose and the mission of why they went into healthcare get drummed out of them over time. We try to help people reconnect and remember how profound their work is by giving them a little bit of the experience of walking in the shoes of the patient. One exercise in particular that we do seems very simple but can actually be very profound for the staff involved; it's a feeding exercise. In the middle of the retreat day, people are paired up as a patient and a care provider and we have them feed each other over a silent lunch. It sounds really simplistic but most of us have never been fed as adults and it is a very uncomfortable experience. One of the things that we first learn to do for ourselves as children is feed ourselves; it's part of being autonomous and it's part of being an adult. After the participants engage in that activity, we come together and de- brief it and draw the parallels with what happens to the patients when they are in a hospital or nursing home and their autonomy is taken away. Exercises like that help the staff realize how the patients feel disempowered and help us brainstorm ways that care providers can minimize that feeling as much as possible for patients. Many of the solutions cre- ated at Planetree over the decades have come out of those retreat exercises. Q: During your time working in healthcare, would you say the industry's attitude has changed toward patient-centeredness? How so? SF: I think we're in a time of great transition around patient-centered care in particular and I think there is a lot of great work being done to ad- dress some of the challenges. I think many, many organizations are finally beginning to get it but there is still a lot of work to do. I do believe the issue has now risen to a national level, thanks in part to the Patient Protection and Affordable Care Act. Threaded through that doc- ument are requirements for transparency and en- gagement as partners with patients and families, therefore it's talked about nationally. There is a whole research arm now that the govern- ment funds called Patient-Centered Outcomes Re- search Institute that asks patients to help them de- fine what a good medical outcome from the patient perspective is, and then they fund research around that. So I think this is a fantastic time for patient- centered care. The issue is really being looked at differently and taken seriously, and there is a lot of energy being directed toward improvement. Q: What can the industry — specifically, individual organizations — do to improve upon patient-centered care and make it more of a priority? SF: What I would suggest at the organizational level — be it for a hospital or a nursing home or a physician practice — is that they use a framework to guide their patient-centered improvement work. I say this because there are a zillion things going on in patient-centered care and everyone is saying that everything they do is patient-cen- tered. It has gotten to the point where it's easy to get lost in the weeds. I've also seen many shotgun approaches to different patient-centered projects that don't have any sustainability. How to Prioritize Patient-Centeredness: Q&A With Planetree's Dr. Susan Frampton (continued from cover)