A conversation with Sara Guastello, VP of Knowledge Management, Planetree International
The Partnership: EYP Architecture and Engineering and Planetree International, a not-for-profit organization that works with healthcare facilities to improve person-centered models of care. EYP has long been committed to the Planetree philosophy. EYP has designed a Planetree Person-Centered Care Gold Certified® Hospital for Stamford Health in Connecticut, and has employed Planetree principles across many projects, including Platte Valley Medical Center in Denver.
Three Ways to Support Person-Centered Health Care during COVID-19
1. The pandemic is constantly evolving, and policies should reflect that. Changes to policy and practice should be based on current factual evidence and an understanding of the impact on the human experience of care. We need to shift the conversation to how to create a safe environment and minimize risk in ways that preserve compassion. In the spring, we saw some backsliding into a more paternalistic “we know best” approach that did not necessarily consider the impact on patients and families, which has resulted in a number of unintended consequences.
2. Communicate with empathy. Making caring visible can be difficult when everyone is wearing a mask. In healthcare facilities, so many staff members are coming in and out of patient rooms that patients are constantly thinking: “Who are you again?” Every time, care team members should reintroduce themselves and state their role in the patient’s care. Some helpful ideas: Use larger photos on badges, with warm, smiling faces. Make sure communication boards listing the current care team are visible and updated. Have some clear masks on hand to use with patients who are hard of hearing. These small, inexpensive actions still build rapport. Here are Planetree tools and resources on person-centered care during the pandemic for healthcare facilities.
A Deeper Dive
Planetree International embraces the values of empathy, empowerment, equity, dignity, and compassion. But its methods for transforming healthcare are rooted in evidence-based practices.
“It’s one thing to say, ‘person-centered care,’ but we have established a common set of international standards to define what people can expect from a person-centered care center,” says Sara Guastello, vice president of knowledge management for Planetree International.
And so, Planetree experts go into the field, visiting the “best of the best”—healthcare facilities designed around the Planetree model that are putting its ideals into practice daily. Planetree gathers metrics on key performance indicators, mines the evidence, and shares findings with others.
“You have to try something to find out if it works, so we nurture innovation, determine the most promising practices, then push them out with the goal of making them the norm in health care,” Guastello says.
Pros of Family Involvement (even in a pandemic)
When COVID-19 began spreading globally and pandemic protocols were put into place in healthcare facilities, hospitals and clinics began backing away from some of the tenets of person-centered care, such as allowing family members and visitors in patient areas.
Patients, some on ventilators and unable to talk, felt isolated, alone, and afraid.
Hospital staff absorbed the stress of caring for these patients physically and emotionally, while protecting their own (and their family’s) health with personal protective equipment (PPE).
This is not, says Guastello, the ideal situation for providing empathetic, person-centered, compassionate care—although plenty of good, empathetic care was still taking place.
“I’m not being critical of healthcare facilities,” she says. “We didn’t know what we didn’t know. All these changes were implemented out of an abundance of caution. But this partnership with patients and family we’ve been cultivating for so long, well, there is considerable evidence that it creates higher quality care experiences and definitively better results. COVID-19 may present challenges, but it doesn’t invalidate that evidence.”
When a family member is part of the care team, readmission rates are lower, the patient experience is superior, preventable errors are averted, and the information provided to the medical team is more complete and accurate, Guastello says.
In an approach aligned with CDC and WHO guidelines, Planetree International strongly advocates that a care partner be treated as a member of the care team and be allowed to stay with their loved one. “That care partner could very well be serving as the voice for their loved one, picking up on subtle changes in how they look and how they act,” she says.
When they are left out of the process, it can have heart-rending results.
So, in May, Planetree convened a pop-up coalition made up of 60-plus organizations; family, patient and elder advocates; clinicians; infectious disease experts; and others. The coalition developed eight guidelines for preserving family presence in healthcare facilities during pandemics and other challenging times.
For sure, in some cases the risks to the patient or their loved ones may preclude in-person visitation. But in others, the risks of not having family present can exceed the risks from COVID. These guidelines encourage that healthcare organizations establish processes and structures to make these determinations in consideration of all of these factors.
Even during the pandemic, some hospitals have been allowing one visitor per patient per day, as long as they have not tested positive for COVID. Others have allowed humanitarian exceptions for end-of-life care, pediatrics, and mothers in labor, providing PPE to visitors for safety.
Some facilities do make exceptions upon request, but do patients and their families know about this? And who do they make the request to?
Once again, open and constant communication is key.
Open Communication, Practical Support
Something as subconscious as word choice can make a big difference in how concepts and instructions are perceived. While war analogies such as “under siege,” and “on the frontlines” have been used in “combatting” the virus, other word choices may be more comforting and reassuring. Here is more from Planetree on the words we choose.
Take, for example, the “terrible term, ‘non-essential worker,’ ” Guastello says. “If employees are furloughed or working from home, they are hardly ‘not essential.’ We must make sure everybody still feels valued and connected.”
Rather than shutting down communication during the pandemic, “this is exactly when we need to understand what our consumers are thinking,” she says.
Despite all the safety protocols, disinfecting, screenings, one-way flow, and PPE, healthcare facilities are hearing from customers that they still don’t feel safe. “They are telling us they want the precautions to be visible, to literally see the cleaning happening,” she says. Actions that, pre-pandemic, hospitals and clinics tried to keep invisible and to perform after hours are now a reassuring sight.
The COVID-19 crisis isn’t similar to a weather event or a natural disaster, which hits and then transitions straight to the aftermath, Guastello says. “As things change day to day, there is a trajectory to what happens, and a disillusionment phrase. There is going to be a prolonged period of post-traumatic stress.”
The parades and pot clanging have stopped, and staff who were operating on adrenaline are now frazzled, trying to balance stress at work with stress (such as their children’s schooling) at home.
Facilities need to consider logistical, practical support for staff during this time, from a volunteer bank to help staff’s children with homework to virtual break rooms where employees can debrief and talk about the emotional toll this is taking through peer-to-peer sharing. “Pay attention to the evolving needs of staff,” she says.
Examples of some practical things that can be done for patients and families: Use a “what matters to me” document, a patient-preference sheet. Have a “commit to sit” campaign and provide easily accessible stools for staff, “who agree to sit for a while by the side of every patient every single day, just chatting with them, ‘Oh, I see you have a cat!’ ” Being intentional about creating these moments of connection can be instrumental in combatting loneliness and isolation, Guastello says.
The best use we can make of the pandemic, she says, is to learn from it for future crises. “Look at how decisions were made, stakeholder groups we need to be considering. Document actions taken and how they worked out and put in place proactive plans to preserve partnerships with patients and families.”
Reflecting those lessons in the built environment, Guastello says, comes from the process of codesign.
“We don’t just want the experts and tech folks in the room, figuring out how to create environments that work for patients, families, and staff,” she says. “Everything needs testing with real people: ‘How does it feel, talking to an avatar about this? Did the discharge instructions feel credible to you? Are you going to do those things?’ We need to know how these changes are impacting the human experience. And the only way to know that is to ask humans about their experiences.”
Person-centered care isn’t just for when it’s business as usual and things going well, she says. “It should be able to be applied in any circumstance, in different cultures, in different care settings. These are important, versatile, fundamental principles. We need to figure out how to make them work in challenging times.”
Health Partner Insights is a continuing series where we tap the collective wisdom of our health care clients on current challenges, trends, and technologies.