Embodying respect for individuals during healthcare treatment

1. Research Roots of Planetree Patient-
Centered Design:
Embodying Respect for Individuals

2. Presenter
• Marc studied with Roslyn Lindheim and designed 4
Planetree model sites, including San Jose Hospital,
Mid-Columbia, Delano Regional and Beth Israel
Medical Centers.
• Planetree design consultant for many additional
Affiliates translating Planetree design principles into a
variety of settings, including emergency departments
and critical care areas.
• Marc has always believed that hospitals are emotional
spaces and need to provide places to both celebrate
and grieve. Marc often stays overnight in the hospital
to more fully appreciate the patient’s perspective.
Marc Schweitzer
M.Arch., AIA, NCARB
Senior Healthcare Architect
Secretary Planetree VDN

3. Learning Objectives
At the end of this course, participants will be better
able to:
1. Explain and present the original research behind
Planetree patient centered design.
2. Understand how a physical plan and key spaces
are critical to the patient centered Planetree
operations.
3. Evaluate the differences between simply
attractive spaces and those that support
patients, families, and all users.

4. Contents
“A Bad Place to Heal”
The Planetree Model
Patient Centered Place
1st Model Hospital Project
A Forest of Plane Trees

5. “Death’s head continually shows in the
present-day hospital. Why is the hospital not
as humanely practical in aesthetic effect* as it
tries to be in physical support?”
• Frank Lloyd Wright
* And social support

12. Contents
“A Bad Place to Heal”
The Planetree Model
Patient Centered Place
1st Model Hospital Project
A Forest of Plane Trees

13. “…. 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

14. Planetree Components
• Human Interactions
• Education : Patient & Family
• Healing Partnerships: Family, Friends
• Nutrition : Nurturing Aspects of Food
• Spirituality : Inner Resources for Healing
• Human Touch
• Healing Arts : Nutrition for the Soul
• Integrating Complementary & Alternative Practice
• Healing Environments : Architecture & Design
2003

15. Patient Centered Components
Copyright Planetree 2012
Healing
Environments
Access to
Information
Social
Support
Arts &
Entertainment
Spirituality
Caring
Touch
Integrative
Therapies
Food &
Nutrition
Healthy
Communities
Human
Interactions

16. Design Matters
Copyright Planetree 2012
• Environment is significantly related to recovery rates
• Patients behave better in well designed rooms.
• Design of a hospital makes a difference to staff
morale.
– 2003 CABE/ICM Survey (Great Britain)
• Physical improvements may improve patient’s
perceptions of care.
– Swan JE, Richardson LD, Hutton JD Health Care Manage Rev. 2003
• Physical improvements may shorten length of patient
stay and reduce need for analgesics
– Lawson B, Phiri M. Health Serv Journal. 2000

17. Contents
“A Bad Place to Heal”
The Planetree Model
Patient Centered Place
1st Model Hospital Project
A Forest of Plane Trees

18. Patient Centered Place
“the artist must penetrate into the
world, feel the fate of human
beings, of peoples, with real love.
There is no art for art’s sake. One
must be interested in the entire
realm of life”
Mark Chagall
“Anyone who has a Passion for
design should also have a passion
for humanity.”
Earl S. Swensson, FAIA
Carnaval of Flowers from Nice and The Côte D’Azur - Marc Chagall 1967

19. Evidence Based Design
• Personal Space
• Quiet
• Complexity
• Ventilation
• Natural Daylight
• Circadian rhythms
• Viewing Nature
• Visual Art
• Music
• Positive Distractions
• Smell
• Sounds
• Temperature
• Fresh Air
• Color
• Experiencing Nature
• Beauty
Minimal ResearchStrong Research
“Healing Spaces: Elements of Environmental Design That Make an Impact on Health”; Schweitzer, et.al. 2004

20. Evidence Based Design

21. Planetree Research Roots
• Lindheim & Syme
“…..unless people can, in some way,
create, manage, change, or participate
in activities that affect their lives,
dissatisfaction, alienation, and even
illness are likely outcomes.”
S. Leonard Syme, UC Berkeley School of
Public Health
Lindheim’s revolutionary ideas
emanated from a deeply held conviction
that living environments should reflect a
respect for human beings and enhance
their quality of life.

22. Key Planetree Research
ENVIRONMENTS, PEOPLE, AND HEALTH
Annual Review of Public Health 1983
◦ Focus in this paper is on those factors that affect
host resistance rather than on disease agents.
◦ All of the findings have as a common element the
importance to health of being "connected":
• with others (social relationships &
hierarchal status)
• with one’s biological heritage.
• with one’s cultural heritage
• with Place

23. Key Planetree Research
NEW DESIGN PARAMETERS FOR HEALTHY PLACES
Places, Vol 2, No. 4 1985
• Published after first Planetree Model Hospital completed.
• Explores implications for environmental design based on
new findings of importance of social factors.
• Social Connectedness
• Hierarchy, Self-Esteem, and Meaning
• Participation and Control
• Connection to the Natural Order
• Contact with Nature
• Connection to the Life Cycle
• Connection to Place

24. Patient Centered Process
• Putting Patients First
• Giving Patients a “Seat at the Table”
• Advocating for what patients want

25. Patient Centered Values
• Welcome the patient ’s family and friends
• Value human beings over technology
• Enable patients to fully participate as partners 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 beauty.
Arneill and Frasca-Beaulieu, 2003 in “Putting Patients First”

26. Patient Centered Specifics
• COMFORT & SAFETY
– Minimize environmental stressors
– Familiar materials and design
• DIGNITY & PERSONAL CONTROL
– Bedside controls
– Patient’s privacy
– Self medication
– 24hr access to food
– Barrier free
– Complementary therapies
– Personal expression

27. • EDUCATION &
PARTICIPATION
– On-unit Library
– Health Resource Center
– Open Nurses’ Station
– Satellite Support Services
• ACCESS TO SOCIAL SUPPORT
– Care Partner space
– Variety of Social,
Community space
– Dining rooms and kitchens
• POSITIVE DISTRACTIONS
– Entertainment
– Healing Touch
– Beauty
• CONNECTION TO NATURE
– Atrium, Skylights &
Gardens
– Fountains, Aquariums
– Patios & Balconies
– Indoor fresh air
Patient Centered Specifics

28. Contents
“A Bad Place to Heal”
The Planetree Model
Patient Centered Place
1st Model Hospital Project
A Forest of Plane Trees

29. Patient Centered Design - Places
Copyright Planetree 2012

30. Planetree Model at CPMC
• “Planetree, an organization
dedicated to humanize health
care, is restructuring a hospital
nursing unit physically, socially,
and organizationally to increase
the control patients have over
their own health and to reduce
the traditional hierarchical
attitudes of staff.”
– “nurses are no longer separated
from patients and families”
– “Families encouraged to
participate in patient care”

31. Planetree Model at CPMC
First Planetree Model

32. Planetree Model at CPMC

33. Planetree Model at CPMC
“To reinforce these changes the
physical form of the nursing
station was altered. The nurses
are no longer separated from
patients and families by a high
counter.
Instead the workspace is
opened up, making charts
available to patients and
families as well as to physicians
and nurses. To motivate
patients to greater mobility and
personal control, a lounge has
been located directly adjacent
to patients' beds.”

34. Planetree Model at CPMC
Families will be encouraged to
participate in patient care. There is
a place for them to stay overnight,
and even a small kitchen has been
constructed so that patients can
have their own favorite foods on
their own schedules.”

35. Planetree Model at CPMC
To personalize and
deinstitutionalize the
environment and create a more
familiar and relaxed atmosphere,
careful attention has been given
to the quality of light, the use of
natural woods, and the selection
of paintings, plants, and fabrics.

36. Planetree Model at CPMC

37. Planetree Model at CPMC

38. HCAHPS Comparison

39. HCAHPS Comparison

40. Assessment
• University of Washington conducted a four-year
randomized evaluation that ultimately
demonstrated both patient and employee
satisfaction were significantly higher in the
Planetree unit.
• A second study focusing on twelve Planetree
hospitals pre- and post-implementation of the
model also demonstrated significant increases in
patient satisfaction with their hospital stay within
a 12 to 24 month period.

41. Original Research Refs
• Lindheim R., Syme S. Leonard, Environments, People, and
Health, Ann. Rev. Public Health 1983; 4:335-59
• Lindheim R., New Design Parameters for Healthy Places,
Places 1985; Vol. 2, Number 4
• Lindheim, Roslyn and Helen H. Glaser and Christie Coffin.
Changing Hospital Environments for Children. Harvard
University Press, 1972
• Lindheim, Roslyn. Birthing centers and hospices: Reclaiming
birth and death. Ann. Rev. Public Health, 1981 2:1-29
• Lindheim, Roslyn. Factors Which Determine Hospital Design,
American Journal of Public Health Oct 1966;(56)10:1668-1675

42. Design Checklist

43. Design Checklist

44. Contents
“A Bad Place to Heal”
The Planetree Model
Patient Centered Place
1st Model Hospital Project
A Forest of Plane Trees

45. Planetree Components 2014
• Compassionate Human Interactions
• Access to Meaningful Information
• Support & Participation of Family, Friends
• Healing Environment
• Support for body, mind & spirit
– Arts and Entertainment
– Spirituality
– Caring Touch
– Integrative Therapies
– Healthy Food and Nutrition
• Healthy Communities

46. History &
Future
Source: DNV GL / Sustainia

47. Samueli Institute

48. Duke Integrative Medicine

49. VA Patient Aligned Care Team
1. Honor the veteran’s expectations of safe, high-quality, accessible care.
2. Enhance the quality of human interactions and therapeutic alliances.
3. Solicit and respect the veteran’s values, preferences and needs.
4. Systemise the co-ordination, continuity and integration of care.
5. Empower veterans through information and education.
6. Incorporate nutritional, cultural and nurturing aspects of food.
7. Provide for physical comfort and pain management.
8. Ensure emotional and spiritual support.
9. Encourage involvement of family and friends.
10. Ensure that architectural layout and design are conductive to health and healing.
11. Introduce creative arts into the healing environment.
12. Support and sustain an engaged workforce as key to providing patient-centered
care.
12 principles of patient-centered care

50. Great Britain
IMPROVES
• Patient satisfaction by improving patient
experience and effectiveness of treatment
• Patient experience by involving patients
in the delivery of their care
• Work satisfaction among healthcare
professionals
• Treatment compliance as patients co–
design and self–manage
• Health outcomes for patients as they are
better able to manage their long-term
condition
• Social capital by building networks of
support around the patient
• Use of primary care by improving
patients’ ability to self–manage
REDUCES
• Rate of medication errors
• Number of hospital admissions and
• Re-admissions
• Length of stay at hospitals
• Need for primary and secondary care
• Cost of healthcare

51. Design References
• Stone, S. A Retrospective Evaluation of the Planetree Patient-
Centered Model of Care Program’s Impact on Inpatient Quality
Outcomes. Health Enviroments Research and Design Journal
2008;1(4): 55-69.
• Nesta. People Powered Health: Health For People, By People And
With People, 2013
• Nesta: The Business Case for People Powered Health. 2013.
• Golembiewski, Jan. Salutogenic Design: The neurological basis of
health-promoting environments. World Health Design, October
2012
• Ulrich, Roger et.al. A Review of the Research Literature on Evidence-
Based Healthcare Design. Healthcare Leadership White Paper Series
5 of 5, September 2008
• Ulrich, Roger S. Evidence Based Environmental Design for Improving
Medical Outcomes. Texas A&M University,
• Huelat, Barbara J. Healing Environments: What’s the Proof?.
Medezyn, 2007

52. Design References
• Schweitzer, M, Gilpin L., Frampton S., Healing Spaces: Elements of
Environmental Design That Make an Impact on Health The Journal
of Alternative and Complementary Medicine 2004; Vol. 10,
Supplement 1: S71-S83
• Ulrich R., Zimring C., et.al. The Role of the Physical Environment in
the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity.
Report to The Center for Health Design; Sept 2004;
• Evans Gary W. The Built Environment and Mental Health. Journal of
Urban Health: Bulletin of the New York Academy of Medicine; 2003;
80(4): 536-555
• Karlin, Bradley E and Robert A. Zeiss. Best Practices: Environmental
and therapeutic issues in psychiatric hospital design: Toward best
practices. Psychiatric Services, 57, October 2006
• Erik Rasmussen, Kalle Jørgensen, Stephen Leyshon. PERSON-
CENTRED CARE – Co-creating a Healthcare Sector for the Future.
DN V GL and Monday Morning / Sustainia; March 2014
• Putting Patients First, 1st 2nd and 3rd Editions

53. Design Research Resources
• MyPlanetree
Planetree Visionary Design Network (PVDN)
http://community.planetree.org/communities/viewcommunities/groupdetails/?CommunityKey=e31e6
966-0097-476d-b9a2-9f960b1c4cb1
• PubMed
• The Center for Health Design
Knowledge Repository
http://www.healthdesign.org/search/articles

54. Visionary Design Network
VDN firms are specialists in
evidence-based health care
design following the
Planetree philosophy
and its core components of
healing design.
Members are leaders in the
practice of healing design.
Planetree’s philosophy of
building and designing
healing environments
that provide the greatest
opportunity for caring of
thebody, mind and spirit is
the basis of their designs
Through the integration of
evidence-based design
principles into their design
projects each firm has excelled
in their implementation of
Planetree philosophy.
Certification establishes these
firms as specialists in Planetree
patient-centered healing
design. Members of the
Network are working to further
educate the public about the
connection between culture
and the environment.

55. Virtual Education Presented by Planetree
The global leader in advancing patient-centered care solutions
www.planetree.org
Thank You!