Patient-Centered Care:

A Strategic Imperative

Susan Frampton, Ph.D.

Dr. Frampton is the President of Planetree, a not-for-profit
organization, working with a growing network of hospitals and
continuing care communities around the world to implement
Planetree’s comprehensive patient-/resident-centered model of care,
resulting in improvements in both clinical and operational outcomes.
Frampton has authored numerous publications, the most recent
including a series in the American Journal of Nursing, the International
Health Federation Journal, Patient-Centered Care Improvement Guide,
a web-based document that has been downloaded over 30,000 times,
and the edited collection Putting Patients First, Second Edition
(Jossey-Bass Publishing, 2008). Frampton has served as a member of
the NQFs National Priorities Partnership since 2009, participated on
The Joint Commission’s Expert Advisory Panel on culturally competent
patient-centered care standards, and the Institute of Medicine’s review
panel for their 2009 publication on integrative medicine. In addition to
speaking internationally on culture change, quality and safety, and the
patient experience, she has presented keynotes on designing patient-
centered practices in acute care, continuing care, and ambulatory
medicine settings for the Healthcare Design Symposium, Veterans
Health Administration and the WHO. Additionally, Dr. Frampton was
honored in 2009, when she was named one of “20 People who Make
Healthcare Better” by Health Leaders Magazine.

[email protected]

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Agenda
• The Business Case for Patient-Centered
Care
• A Best Practice Example of Patient
Centered Care Implementation
• The Stairway to Patient-Centered Care
Excellence

Learning Objectives
• Review the definition of "patient-centered
care" and why patient centeredness is an
important dimension of overall care quality
• Gain practical ideas for implementing field-
tested patient-centered approaches for
meeting a broad range of patient, family
and caregiver needs

2
 Defining Patient‐Centered Care
“…providing care that is respectful of and
responsive to individual patient preferences,
needs, and values and ensuring that patient
values guide all clinical decisions…”

“ ‘Patient-centeredness’ is a dimension of health care quality in

its own right…its proper incorporation into new health care
designs will involve some radical, unfamiliar, and disruptive
shifts in control and power, out of the hands of those who give
care and into the hands of those who receive it.” – Donald
Berwick

“Providers partner with patients to anticipate and satisfy

the full range of patient needs and preferences.
Providers support staff in achieving their professional
aspirations and personal goals.”

Business as Usual Will No Longer Suffice
• Institute of Medicine
• Identifies patient-centeredness as one of six national aims of health care
quality
• “…providing care that is respectful of and responsive to individual patient
preferences, needs, and values and ensuring that patient values guide all
clinical decisions…”

• Centers for Medicare and Medicaid Services

• Public reporting of HCAHPS scores
• Value-Based Purchasing (VBP)

• Healthcare Reform
• Accountable Care Organizations
• Patient-Centered Medical Home
• Bundled Payments

3
 Reducing Costs through Patient-
Centered Care in VBP & ACO
Environments
Patient/Family
Patient- involvement & Engaged
centered care Shared decision- patients
making

Better Engaged Potential

diagnosis of patients reduction in
patient consume less health care
preferences health care* costs
*Stacey, D., and others. “ Decision aides for people facing health treatment or screening decisions.” Cochrane Database Syst Rev, 2011; 10: 
CD001431
Wennberg, D. and Marr, A. “A randomized trial of a telephone care‐management strategy.” New England Journal of Medicine. 2010; 363:1245‐
55.

Planetree’s Roots: Patient Activation 
“…the ideal hospital would
combine the best of modern
medicine, with the best
possible patient care
experience to become a truly
healing environment, where
just being there is healing .”
Angelica
Thieriot
Planetree founder

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 Guiding Principles of Patient‐Centered Care
Activation of Patient &
Caregiver
Access to Information

Involvement of Family

Humanized Care

Healing Environment

Personalization of Care

What is important to patients?

Patient‐Centered Approaches    
are Gaining Traction!
• 24 hour, patient-directed
visitation

• Care partners

• Patient and Family Partnership

Patient and Family Partnership Councils
Councils
• Shared decision making

• Family-initiated rapid response

team

• Bedside shift report

• Family rounding
Care Partners • Empathy training for staff

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Framework for Putting Concepts Into Practice
Activation of patient & caregiver
 24-hour, patient-directed visitation
 Care partner programs
 Patient and family advisory councils

Access to Information
 Open medical records
 Health resource centers
 Bedside rounding

Healing Environment
 Quiet at night
 Decentralized nursing stations
 Home-like aesthetics
 Family spaces

Patient‐Centered Hospital Designation = 
Comprehensive PCC Implementation
 Structures and Functions Necessary for Culture
Change
 Human Interactions/Independence, Dignity and
Choice
 Patient Education & Responsibility
 Family Involvement
 Food, Dining & Nutrition
 Healing Environment: Architecture and Design
 Arts Program/Meaningful Activities & Entertainment
 Spirituality & Diversity
 Integrative Therapies/Paths to Well-Being
 Healthy Communities
 Measurement

11 Domains; 66 Criteria

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 Patients who would Definitely Recommend the
Hospital 2008 - 2011
80.00

78.00 Planetree Designated

Hospital Average
Patients recommend Planetree Designated hospitals (change: 2.56)
76.00
significantly more than peers (9%)
74.00
Planetree Non-Designated
Affiliates (change: 2.12)
72.00

70.00
National Hospital
68.00 Average (change: 1.85)

66.00

% of Patients Highly Satisfied (Scored a 9 or 10) 2008 - 2011

76.00

Planetree
74.00 Designated Hospital
Patients at Planetree Designated Average (change:
hospitals are significantly more 3.37)
72.00 satisfied than at other hospitals (5%)

Planetree Non-
70.00 Designated Affiliates
(change: 4.34)

68.00
National Hospital
66.00 Average (change:
3.87)

64.00

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 A Retrospective Evaluation of the Planetree
Patient-Centered Model of Care Program’s
Impact on Inpatient Quality Outcomes
Stone, S. in Health Environments Research & Design 2008

•What is the impact of the Planetree patient-centered

model of care on clinical outcomes?
• Length of stay
• Readmission

•What is the impact of the Planetree patient-

centered model of care on the cost of providing
care?
• Cost per case
• Productive nursing hours per patient day

What is the impact of the Planetree patient-centered

model of care on patient satisfaction?
•Planetree unit mean scores were higher in 9 out of 11 composite areas
(admission, meals, nurses, tests and treatment, visitors and family, discharge,
overall assessment, overall mean score and room).
•The Planetree unit demonstrated statistically higher mean scores in the meals
and nurses composite (p=<.05 with Eta squared = >.01).

Meals Nurses

• The Comparative unit demonstrated significance in the physicians composite

(p=<.05 with Eta squared = >.01).

Physicians

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What is the impact of the Planetree patient-centered
model of care on clinical outcomes?
•Length of Stay -
•The Planetree unit consistently maintained a lower length of stay.
•Significance was demonstrated in the lower Planetree unit’s mean length
of stay (2003 & 2006).

Length of Stay

•Cost per Case

•The Planetree unit maintained significantly lower cost per case in every
year.
Cost per Case

•Productive Nursing Hours per Patient Day

LVN & Aide
RN HPPD HPPD

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 A Structured Journey to Culture
Change - Patient-Centered Designation
- Renewal Retreat/ Activities
- Progress Assessment
- Learning Journey Site Visits
- Patient-Centered Program
Sustaining Development
- Merit Award Planning
- Work Teams
- Physician Engagement
Implementation - Initial Staff Retreats
- Leadership Retreats

- Report/ Recommendations
Staff Engagement - Infrastructure Building
- Organizational Assessment
- Informational Activities and Mapping
- Leadership Team Commitment
Leadership Readiness - Individual Commitment
- Patient-Centered Champions
Selection
PLANETREE PROCESS - Executive Leadership Readiness:
Observational & Exploratory
Learning

Non-prescriptive but Systematic

Process

Executive Staff Organizatio Leadership

Readiness Informatio Staff
nal Engageme
Sessions n Sessions Assessment Retreats
nt

Personalized Approach for Each Unique Organization

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Setting the Standard for Patient-
Centered Excellence

Actionable
Philosophy Practices that
drive outcomes

Differentiates Excellent Patient-centered Hospitals

Accelerates innovation and differentiation
Endorsed by the Joint Commission

Recognition for Progress Along the Way

“It is better to take many small steps in the

right direction than to make a great leap
forward only to stumble backward.”
~Proverb

Gold
Silver Designation
Recognition Excellence
Bronze Significant
Recognitio Advancement
Affiliate n Meaningful
The
Journey Progress
Begins

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 Resources for your journey

www.planetree.org

Bibliography
• Stacey, D., and others. “ Decision aides for people facing 
health treatment or screening decisions.” Cochrane Database 
Syst Rev, 2011; 10: CD001431
• Stone, S. “A retrospective evaluation of the Planetree patient‐
centered model of care program’s impact on inpatient quality 
outcomes.” Health Environments Research and Design, 
Summer 2008
• Wennberg, D. and Marr, A. “A randomized trial of a telephone 
care‐management strategy.” New England Journal of 
Medicine. 2010; 363:1245‐55.
*

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