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Douglas S. Brown

Providing quality care, and a human touch

By Douglas S. Brown
January 11, 2010

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DONNA GAIEWISKI is a patient transporter at UMass Memorial Medical Center, where I work. One day last summer, she let me watch her do her job. Of many remarkable things I witnessed, one simple act stood out.

I was talking to a stroke patient in the hallway and Gaiewiski tip-toed behind her to tie the back of her gown. Gaiewiski had noticed it was open and did not want this woman to suffer any further loss of dignity.

This patient probably knew very little about the quality of the clinical care she received. But like most patients, she will always remember the quality of the human care. And these experiences are becoming a key factor in how patients perceive the overall value of a hospital.

In 2008, the federal government began to publicly report on patient experiences in hospitals. Through a standardized survey, patients are asked a series of questions: How well nurses and physicians communicate with them, how often they receive help quickly when they need it, and how often their room is kept clean, to name a few. The results are made available online at hospitalcompare.hhs.gov.

I recently did a little comparison shopping. What I learned surprised me. Clinton Hospital, the smallest of five within the UMass Memorial system, dramatically outperforms UMass Memorial’s flagship academic medical center (where Gaiewiski works), and most other preeminent teaching hospitals in the nation.

Why aren’t teaching hospitals satisfying patients as well as Clinton? The standard response is based on size and complexity. In our case, the medical center is more than 10 times the size of Clinton and treats patients with complex conditions. Its care teams include residents, interns, and medical students. It simply cannot be measured against a small community hospital. Or can it? Is academic medicine - known for outstanding advanced care - incapable of consistently providing the kind of experience that Gaiewiski embraces, or that Clinton provides?

In 1977, Angelica Thieriot was sick with a rare viral infection. She sought care at a prominent teaching hospital in California. While the clinical care was excellent, she had one of the worst experiences of her life. She was treated more like a specimen than a person. The inattention to her basic human needs left her feeling lonely and afraid.

Thieriot left that hospital on a mission: hospitals should be able to provide great clinical care and still treat patients like human beings. So in 1978 she started an organization called Planetree (named after the tree under which Hippocrates taught his medical students). That organization has grown to become an international leader in helping hospitals promote patient-centered care.

The Planetree model seeks to humanize the hospital experience. It promotes caring and compassionate connections between caregivers and patients. It encourages family involvement in care and urges full patient access to meaningful information. It supports nutritious food, an inviting physical environment, and the use of arts, entertainment, and spirituality to promote healing of the whole person. It values a touch almost as much as a test.

More than 150 US hospitals have embraced Planetree. Many of these consistently outperform other hospitals on patient satisfaction measures. But very few are academic medical centers.

Last year, UMass Memorial Medical Center became the first major academic medical center in Massachusetts to adopt the Planetree model. We have no illusions - this will be a long journey. Such broad cultural change does not happen overnight.

Our nation’s teaching hospitals are leading the world in research, education, and clinical care. But we lag in providing a great experience to patients. This was excused as a necessary evil of state-of-the-art medicine. That excuse is no longer valid. For patients, quality care is about more than good clinical outcomes. It is also about comforting them, treating them with dignity, and providing them a healing environment. It is about quietly tying their gown.

In the dawn of health reform, if our nation’s most preeminent hospitals are to maintain their perch of leadership and credibility, they will be wise to start focusing as much on the whole person as they do on the diseased body part.

Douglas S. Brown is senior vice president and general counsel of UMass Memorial Health Care in Worcester.

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