A philosophy in PHD: in ancient Greece, Hippocrates taught medicine to his students in the spreading shade of a great planetree. He taught that patients should be the focus of care and that the environment was an important factor in healing

Healthcare Financial Management, April, 2005

The tree's association with the father of medicine is the source of the name of the Planetree Alliance, an organization of hospitals dedicated to personalizing, humanizing, and demystifying ("PHD") the healthcare experience. The Planetree philosophy is patient-centered rather than provider-focused, committed to improving medical care from the patient's perspective. Patients are encouraged to read their own medical records. Their pets are allowed to visit. Families are encouraged to participate in the patient's care, and can even prepare the patient's favorite dishes in special kitchens on each floor. In addition to modern Western medical treatments, alternative options such as acupuncture and massage are offered.

Aurora Health Care, a not-for-profit system based in Milwaukee, Wis., has four Planetree hospitals among its facilities. Aurora BayCare Medical Center in Green Bay and Aurora Medical Center Manitowoc County in Two Rivers are two of those four. Sandra Ewald, CPA, is vice president of finance for those two facilities and has been in her role for the past four years. In a recent conversation with hfm, she talked about the senior financial executive's role in patient-centered care.

I think there are a couple of roles: to provide budgetary support and to educate. At our hospitals, we provide budgetary support for initiatives and practices that reinforce the patient-centered model, such as our annual all-day staff retreats. Staff action committees come up with initiatives that they think will support the tenets of Planetree. These committees are integral to driving the initiatives, so we have to make sure that we set aside funds to support their initiatives, such as hospitality baskets and so on.

Also, Planetree conducts an annual national conference to which we send several employees each year. We believe this is an integral part of keeping employees excited about the concept, and it encourages them to interface with other people and get a lot of good ideas to bring back to our facilities.

There's also the educational piece--promoting the philosophy in the departments that fall within finance. It's important to encourage employees to participate in committees and to help them understand how they can support and contribute to the patient-centered experience so they feel as if they're a part of it. I think otherwise it's too easy for employees to feel like "that's them, not us."

There are definitely differences between a Planetree and a non-Planetree facility. With Planetree, there's much more focus on the individual patient's needs and comfort. For instance, there are no set visitation hours; there is 24-hour visitation. People's pets come to visit. Room service is available for the families so they can stay with their loved one and eat with them if they want to. Our facility in Green Bay has onsite family accommodations similar to hotel rooms, which cater to the many patients and families who come from outlying communities for their care. Our Green Bay facility is a tertiary center for the surrounding area, and one of the things they've focused on was reducing the amount of lead time a patient needed prior to surgery. The facility implemented a 60-minute pre-op arrival time to accommodate patients who were coming from two, three, four hours away so they don't have to leave home at 2:00 in the morning.

Patient-centered care is definitely cost-effective. An important reason is that it can result in lower average length of stay. One of the Planetree tenets is to include the family in care where possible. I think that helps, not only with the length of stay and helping people heal more quickly, but also in reducing or eliminating repeated hospitalizations. Creating an environment of wellness and comfort helps people to heal faster. Philosophically, that's what Planetree is about.

Aurora BayCare Medical Center has a favorable average length of stay compared with our other hospitals within the system, and the Manitowoc County facility last year saw a decrease in its average length of stay. In 2003, average length of stay was 4.03 days; in 2004, itwas 3.76. Now, can I say that's all because of Planetree? No, but I think it's a contributor. There were a number of initiatives that contributed, such as better case management.

The patient-centered philosophy does have an impact on the bottom line. I think it's evident in the increases in market share due to increased patient and employee satisfaction. For instance, since the Manitowoc County facility became a Planetree affiliate, both their employee engage ment and patient satisfaction scores have gone up. And we've seen an improvement in the financials of that facility beyond what we expected.

Every month we measure patient satisfaction through surveys in all the different departments--inpatient as well as outpatient. We can see that we're making progress. I think a number of things play into that, but I strongly believe our affiliation with Planetree is part of it. Some examples of Planetree-type initiatives we've implemented include patients' families' participation in codes, pre-operative massage, "get well" cards signed by staff and physicians, and patient biographies focused on the long-term patients. The biographies, attached to the patient charts, provide a therapeutic exercise for the patient and have a humanizing effect on interaction between staff and patients.