Healthcare Horrors

1
Healthcare Horrors HopeTom Peters/10.26.2004
2
1. Premise.
3
If one didnt 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
4
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 EVERYBODYS MAD-AS-HELL
AND FEELS POWERLESS DOCS, PATIENTS, NURSES,
INSURERS, EMPLOYERS, PHARMA DEVICE COS,
HOSPITAL ADMINISTRATORS AND STAFF.
5
2. Consumerism (Patient-centric Healthcare
Arrives)
6
Anne Busquet/ American ExpressNot Age of the
InternetIs Age of Customer Control
7
Amen!The Age of the Never Satisfied
CustomerRegis McKenna
8
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
9
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
10
Todays Healthcare Consumer skeptical and
demandingSource Ian Morrison, Health Care in
the New Millennium
11
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
Jordans cancer diagnosis)
12
A seismic shift is underway in healthcare. The
Internet is delivering vast knowledge and new
choices to consumersraising 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
13
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 doctors orders is being
turned on its head. These days its 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
14
Savior for the Sickvs. Partner for Good
Health Source NPR
15
Consumer ImperativesChoiceControl (Self-care,
Self-management)Shared Medical
Decision-makingCustomer ServiceInformationBrand
ingSource Institute for the Future
16
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
17
Determinants of HealthAccess to care
10Genetics 20Environment 20Health
Behaviors 50Source Institute for the Future
18
Consumerism HMO backlash (e.g., plans with
more choice). Alternative Medicine, Wellness
Prevention bias. Info availability (disease,
health, docs, support groups, outcomes). Boomers
(Im in charge! Discretionary to spend
cosmetic surgery, vision improvement, fertility,
etc.). Self-care (chronic disease). High
expectations (genetics, etc.)
19
3. Demographics The BOOMERS Reach 60 in 05!
20
NOT ACTING THEIR AGE As Baby Boomers Zoom into
Retirement, Will America Ever Be the
Same?USNWR Cover
21
Boomer WorldFrom 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
22
Pick up any copy of Glamour or Mens Health, and
youll 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, acupunctureyou name it.Coddington,
Fischer, Moore Clarke, Beyond Managed Care
23
Sixty Is the New Thirty Cover/AARP/11.03
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4. Quality COULD IT TRULY BE THIS AWFUL?
25
Quality of care is the problem, not managed
care.Institute of Medicine
26
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
27
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
28
As unsettling as the prevalence of inappropriate
care is the enormous amount of what can only be
called ignorant care. A surprising 85 of
everyday medical treatments have never been
scientifically validated. For instance, when
family 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
29
CDC 1998 90,000 killed and 2,000,000 injured
from nosocomial hospital-caused drug errors
infections
30
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
31
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
32
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
Forum. There is little evidence that patient
safety has improved in the last five years. Dr.
Samantha CollierSource Boston Globe/07.27.04
33
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.
34
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.
35
Established state-of-the-art cancer careabout
which there is no longer any debateis
erratically applied.Source Institute of
Medicines National Cancer Policy Board
36
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
37
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,
medicines leading expert on error, points out
that many other industrieswhether the task is
manufacturing semiconductors or serving customers
at the Ritz Carltonsimply wouldnt countenance
error rates like those in hospitals.Complication
s, Atul Gawande
38
In health care, geography is destiny.Source
Dartmouth Medical School 1996 report
39
Geography Is DestinyOften all one must do to
acquire a disease is to enter a country where a
disease is recognizedleaving 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
40
Geography Is DestinyE.g. Ft. Myers 4X
Manhattanback surgery. Newark 2X New
Havenprostatectomy. Rapid City SD 34X Elyria
OHbreast-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)
41
PARADOX Many, many formal case reviews failure
to systematically/ systemically/ statistically
look at and act on evidence.C.f.,
Complications, Atul Gawande
42
Most physicians believe that diagnosis cant be
reduced to a set of generalizationsto 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 flawedit causes more mistakes than
it prevents. Atul Gawande, Complications
43
Deep Blue Redux 2,240 EKGs 1,120 heart
attacks. Hans Ohlin (50 yr old chief of coronary
care, Univ of Lund/SW) 620. Lars Edenbrandts
software 738.Only this time it matters!
44
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
45
Genius Required?
46
Leapfrog Group
CPOE/Computerized Physician Order
EntryICU staffing by trained
intensivistsEHR/Evidence-based Hospital
ReferralDuh 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
47
The Benefits of FOCUSED EXCELLENCE
Shouldice/Hernia Repair 30-45 min, 1
recurrence. Avg 90 min, 10-15
recurrence.Source Complications, Atul Gawande
48
5. The IS/Web REVOLUTION
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Some grocery stores have better technology than
our hospitals and clinics. Tommy Thompson, HHS
SecretarySource Special Report on technology
in healthcare, U.S. News World Report (07.04)
50
Were in the Internet age, and the average
patient cant email their doctor.Donald
Berwick, Harvard Med School
51
Computerized Physician Order Entry/CPOE 5 of
U.S. hospitalssource HealthLeaders/06.02
52
Want email consultation 90 patients, 15
docs. Evidence Patients do not pester docs.
Time is saved. No one has sued (shows care
connectionthe absence of which is the major
cause of suits).Source New York Times
53
Telemedicine Reduces days/1000 patients and
physician visits for the chronically
illDecreases costs of managing chronic
diseaseExpands service areas for
providersReduces travel costs to and from
medical ed seminarsDouglas Goldstein,
e-Healthcare
54
Our entire facility is digital. No paper, no
film, no medical records. Nothing. And its all
integratedfrom the lab to X-ray to records to
physician order entry. Patients dont have to
wait for anything. The information from the
physicians office is in registration and vice
versa. The referring physician is immediately
sent an email telling him his patient has shown
up. Its wireless in-house. We have 800
notebook computers that are wireless. Physicians
can walk around with a computer thats
pre-programmed. If the physician wants, well 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
)
55
Detroit Med Center 100M IS MakeoverExperiment
Surgical residents equipped with Palm IIIxe.
Med Director Its 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.
56
The VHA gets it! E.g. Laptop at bedside calls
up patient e-records from one of 1,300 hospitals.
Bar-coded wristband confirms meds. National
Center for Patient Safety in Ann Arbor. Docs
and researchers discuss optimal treatment
regimensresearch center in Durham NC. Doc
measures guidelines e.g., pneumonia
vaccinations from 50 to 84. Blame-free
system, modeled after airlines. Whats 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/SourceWSJ 12.10.2001
57
Patient by patient, problem by problemdrug
reactions, hospital caused infectionsSalt Lake
Citys LDS Hospital has attacked treatment-caused
injuries and deaths. One of the secrets of LDSs
success is a custom-built 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
58
Info RevolutionConsumerism (research,
consultation, B2C, etc.)Clinical Info Systems
(guidelines and outcome measurement, etc.)100
Web-based (internal) SystemsElectronic Medical
RecordsPatient-physician email-consultationTeleh
ealth-Remote Monitoring (biosensors, home
testing, etc.)Telemedicine (consultation,
invasive treatment, global medical village,
etc.)
59
6. Conclusion.
60
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 EVERYBODYS MAD-AS-HELL
AND FEELS POWERLESS DOCS, PATIENTS, NURSES,
INSURERS, EMPLOYERS, PHARMA DEVICE COS,
HOSPITAL ADMINISTRATORS AND STAFF.
61
7. HealthCare21
62
HealthCare21 21 Ideas for Century211.
Hospitals kill people. (And many of those they
dont kill, they wound.) (And they deny it.)
(ERRORS RULE!) And Hustling ambulances kill
pedestriansand dont save patients.2. Doctors
are spoiled bratswho dont like measurements.
Or any form of interference. Docs are also
cover-up artists. The REAL Hippocritic sic?
Oath DONT RAT ON A FELLOW DOC. 3. Most
prescription drugs dont workfor 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.
63
HealthCare21
(Cont.)8. IS/IT in hospitals is primitive
(despite smart people and enormous
expendituresthink Sears).9. Systemic IS/IT is
worselinks 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.
64
HealthCare21 (Cont.)15. The
number of U.S. un-insured is the nations 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.)


65
HealthCare21 (Cont.)21.
ALL THIS ENORMOUS OPPORTUNITY. The
Opportunity of Several Lifetimes. (For the Bold
Brave.) HCare WILL be TOTALLY re-invented
in the next two decades. (And, hey, it is our
largest industry.)
66
8. Doing It RightPlanetree A Radical Model
for New Healthcare/Healing/Wellness Excellence
67
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
68
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
HospitalsSource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
69
Determinants of HealthAccess to care
10Genetics 20Environment 20Health
Behaviors 50Source Institute for the Future
70
The 9 Planetree
Practices1. The Importance of Human
Interaction2. Informing and Empowering Diverse
Populations Consumer Health Libraries and
Patient Information3. Healing Partnerships The
importance of Including Friends and Family4.
Nutrition The Nurturing Aspect of Food5.
Spirituality Inner Resources for Healing6.
Human Touch The Essentials of Communicating
Caring Through Massage7. Healing Arts Nutrition
for the Soul8. Integrating Complementary and
Alternative Practices into Conventional
Care9. Healing Environments Architecture and
Design Conducive to HealthSource Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
71
1. The Importance of Human Interaction
72
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 interactionsalienatin
g patients, being non-responsive to their needs
or limiting their sense of controlcan be very
costly. Angry, frustrated or frightened
patients may be combative, withdrawn and less
cooperativerequiring 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
73
Press Ganey Assoc/1999 139,380 former patients
from 225 hospitals0 of top 15 factors
determining Patient Satisfaction referred to
patients health outcomePS directly related to
Staff InteractionPS directly correlated with ES
(Employee Satisfaction)Source Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
74
Mgrs re staff wages, security, promotion
opportunitiesStaff re staff interesting work
(M5 of 10), appreciation (5 of 10), sense of
being in about whats going on (10 of 10)
Source Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
75
The Customer Comes Second Put your People First
and Watch Em Kick Butt, Hal Rosenbluth (and
Diane McFerrin Peters)
76
100 Best Places to Work/RLevering/2001Get
straight answersAppreciationCollaborationInt
erest in me as a personCamaraderie (Fun place
to work)
77
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
78
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 gentlemen4S
credo)
79
2. Informing and Empowering Diverse Populations
Consumer Health Libraries and Patient
Information
80
Planetree Health Resources Center/1981Planetree
Classification SystemConsumer Health
LibrariansVolunteersClasses, lectures
(CR)Health FairsGriffins Mobile Health
Resource CenterOpen Chart PolicyPatient
Progress NotesCare Coordination Conferences (Est
goals, timetable, etc.)Source Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
81
3. Healing Partnerships The importance of
Including Friends and Family
82
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
83
The Patient-Family ExperiencePatients 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
84
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 Patients
EyesSource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
85
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 didnt have a
confidant.Institute for the Future
86
Institute of Medicine/ Crossing the Quality
ChasmRespect for preferencesInvolvement in
Decision MakingAccess to careCoordination of
careInformation and educationPhysical
comfortEmotional supportInvolvement of Friends
and FamilyContinuity of careSource Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
87
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
ConferencesClinical Guidelines
DiscussionsFamily SpacesPet Visits (POP
Patients Own Pets)Source Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
88
4. Nutrition The Nurturing Aspect of Food
89
Meals are central eventsvsThere, youre
fed.Irony Focus on nutrition has
reduced focus on food and serviceSource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
90
KitchenBeautiful cutlery, plates, etcChef
repSource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
91
Aroma therapy (eg smell of baking
cookies)Source Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
92
5. Spirituality Inner Resources for Healing
93
Spirituality Meaning and Connectedness in
Life1. Connected to supportive and caring
group2. Sense of mastery and control3. Make
meaning out of disease/find meaning in
sufferingSource Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
94
Griffin redesign chapel (waterfall, quiet music,
open prayer book)Other music, flowers,
portable labyrinthSource Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
95
6. Human Touch The Essentials of Communicating
Caring Through Massage
96
Massage is a powerful way to communicate
caring. Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
97
Mid-Columbia Medical Center/Center for Mind and
BodyMassage for every patient scheduled for
ambulatory surgery (Go into surgery with a good
attitude) Infant massageStaff massage (caring
for the caregivers)Healing environments
chemo!Source Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
98
7. Healing Arts Nutrition for the Soul
99
Planetree Environment conducive to
healingColor!Light!Brilliance!Form!Art!Mu
sic!Source Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
100
Florence Nightingale/Notes on Nursing/patients
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, tooSource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
101
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
102
8. Integrating Complementary and Alternative
Practices into Conventional Care
103
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 incDont tell PCP
(40)OTA lt30 procedures used in conv med have
undergone RCTs (randomized clinical trials)
Source Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
104
Griffin IMC/Integrative Medicine
CenterMassageAcupunctureMeditationChiropracti
cNutritional supplementsAroma therapySource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
105
9. Healing Environments Architecture and Design
Conducive to Health
106
Planetree LookWoods and natural
materialsIndirect lightingHomelike
settingsGoals 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
beautySource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
107
SoundTextureLightingColorSmellTasteSacred
spaceSource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
108
Access to nurses stationHappen
tovsHappen withSource Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
109
The Eden Alternative
110
The Ten Principals of the Eden
Alternative1. 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 Elder-centered 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
111
The Eden paradigm allows elders to care for
animals, birds, and children as well as each
other. Susan Eaton, Harvard/JFK schoolSource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
112
The Ten Principals of the Eden
Alternative5. 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
113
The Ten Principals of the Eden
Alternative8. 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
114
The most basic question we need to pose in
caring for others is this Is this a loving act?
Leland Kaiser, Holistic HospitalsSource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
115
Conclusion Caring/Growth Experience
116
Care!Control!Connect! Engage!Grow!
De-stress!
117
An estimated 60 to 90 percent of doctor visits
involve stress-related complaints.
Newsweek/Health for Life/09.27.2004
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Learn more about Planetree/ The Planetree
Alliance www.planetree.org
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9. Toms HealthCare2
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• 
  Healthcares 1-2 Punch
• 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 yearand wound many times that number.
  Finally, they are getting around to dealing
  with the issue. Well, thanks. And what is it
  weve 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.
  Whos to blame? Just about everybody, starting
  with the docs who consider oversight from anyone
  other than fellow clan members to be
  unacceptable.)
• 2. The systemtraining, docs, insurance
  incentives, culture, patients themselvesis
  hopelessly-mindlessly-insanely (as I see it)
  skewed toward fixing things (e.g. Me) that are
  brokennot preventing the problem in the first
  place and providing the Maintenance Tools
  necessary for a healthy lifestyle. Sure,
  bio-medicine will soon allow us to understand and
  deal with individual genetic pre-dispositions.
  (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). Patientslike meare catching
  on in record numbers but the system is highly
  resistant. (Again, the doctors are among the
  biggest sinnersno surprise, following years of
  acculturation as the man-with-the-white-coat-who-
  will-now-miraculously-dispense-fix
  it-pills-for-you-the-unwashed. (Come to think of
  it, maybe Ill start wearing a White Coat to my
  doctors officeafter all, I am the
  Professional-in-Charge when it comes to my Body
  Soul. Right?)

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CR07.03 60/264/180/145-85/14010.04
61/195/092/097-60/058
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Off Univasc (lt1/2)BextraLipitorToprolPropra
nolol