Hospitals Reinvent Themselves

THE DALLES, Ore. —  Battling a recent illness, Vicki Bennett endured the usual unpleasantness of a trip to the hospital: bouts of pain so bad she couldn’t sleep, a battery of awful tests and the fear of knowing she was sick enough to be there.

But Mid-Columbia Medical Center is no ordinary hospital. The only hospital in this Columbia River Gorge town may be a window into the future of medical care.

Instead of the secrecy that surrounds so much of what happens in health facilities, Mid-Columbia gave her personalized information packets about her illness--debilitating chronic immune disease--and nurses patiently described any tests she underwent. She was encouraged to look at her medical chart and to ask questions about her care. Guests were allowed to visit 24 hours a day: Her young children, upset at their mother’s illness, stayed overnight in pullout beds in her room.

What Bennett may remember most, though, is the afternoon the hospital sent a musician from Seattle to her room to serenade her. As he strummed his guitar, the lines of pain that had creased Bennett’s face softened. With eyes closed, she hummed along, then reopened them to reveal tears. Taking the musician’s hand, Bennett whispered: “Thank you. The music takes the pain away.”

Some leading health care experts say Mid-Columbia offers lessons for hospitals large and small, with its emphasis on patient education, preventive care and medical approaches that emphasize the emotional as well as the physical aspects of healing.

Hospitals across the country are undergoing profound changes that, in the next century, could transform patient care and the traditional role of the hospital in the community. These changes are coming as the nation’s hospitals attempt to cope with a rapidly evolving health care system--changes that would be accelerated by GOP-sponsored proposals to revamp the Medicare and Medicaid programs.

Health care experts say hospitals of the next century will be strikingly different from the large multipurpose hospitals with which most Americans have grown up. They’ll be smaller, employ far fewer people and treat primarily the sickest patients, with most medical care actually occurring in outpatient clinics or same-day surgery centers.

Many hospitals won’t even call themselves that anymore: They’ll be part of large “health system” networks that will include multiple hospitals, clinics, physician groups, home health care companies and related businesses. The increasingly tightfisted economics of health care will force many hospitals to give up their independence. Already, a growing number of money-losing hospitals run by nonprofit and religious organizations are being swallowed up by deep-pocketed, for-profit chains.

A major force behind these changes is the burgeoning managed-care industry, which is dramatically changing medical economics. Managed care’s emphasis on cost-cutting has sharply reduced the length of hospital stays in California and elsewhere, forcing hospitals to downsize to stay afloat.

Turmoil, Opportunity

To compete and survive in the future, however, health care executives are realizing they need to do more. Some are beginning to see the turmoil as a golden opportunity to steer medicine away from its preoccupation with disease treatment and technology toward a more patient-oriented, holistic approach that is more cost-effective.

“We have been in such a historic period of technology concentration that we have stopped looking at the way that human behavior affects you physically,” says Dr. Matthew Budd, medical director at the Harvard Community Health Plan, a health maintenance organization in Cambridge, Mass.

Adds Dr. David Simon, medical director of the Sharp Institute for Human Potential and Mind Body Medicine in San Diego: “Most of my medical colleagues see managed care as a real invasion of the way they practice medicine. But those of us embracing mind-body medicine see this as an opportunity to get people to maintain their health. It frees up the resources to do this.”

At Harvard Community, Sharp and at Mid-Columbia and other hospitals, this means a growing focus on prevention or “wellness,” nontraditional therapies, the use of architectural design to aid healing and patient education as a strategy of maintaining people’s health and controlling costs.

‘Whole-Person Care’

Examples of these efforts:

* As part of a futuristic planned community near Orlando, Fla., the Walt Disney Co. and a Florida hospital company are building a state-of-the-art medical center with an emphasis on “whole-person care.” Part of Disney’s Celebration development, it is touted as the first U.S. medical center built from scratch to emphasize preventive care. It will include a fitness center, a clinic for mind-body medicine and computer-communications links allowing Celebration residents to call up their medical records or interact with health professionals from home.

* In a Chicago mall, two suburban hospitals have opened a breast health and mammography center at a Nordstrom store. Hospital officials say it is an effort to take medical care into the community in locations that are more convenient and less threatening than a hospital.

* San Diego’s Sharp HealthCare, an HMO and network of hospitals and physicians, opened an institute for mind-body medicine two years ago and now offers programs in nutrition, meditation and other techniques to HMO members. Sharp researchers also will begin a study this spring of how massage, stress management techniques, support groups and yoga can be used to complement traditional medical treatment for breast cancer patients.

Such ideas as mind-body medicine and “healing” architecture have been promoted for years by a handful of medical researchers and others. But mainstream medicine largely scoffed at these ideas as scientifically unproven or “just too woo-woo-sounding,” as one researcher put it.

Some health care experts believe the changing economics of medicine will give hospitals no choice but to get serious about preventive care. Health care companies will have to focus attention not just on patients who come to their hospital and clinics, as they have traditionally done, but take responsibility for improving the health of everyone in the communities they serve.

“‘We have to get out to where the people are and we have to prevent diseases,” says Leland Kaiser, a health care consultant and futurist. “You’re going to see a tremendous effort to reach out to people and provide services in the community where they are really needed.”

Kaiser calls this idea a “hospital without walls,” where care is decentralized outside the hospital and delivered to the patient in homes, churches, schools and other settings. Technology, he and others believe, will play a crucial role in these changes. He envisions “community health information networks” in which patient information is accessible to the health care institutions, providers and patients.

He envisions a day when patients tap into the Internet to get second opinions and multimedia and when so-called virtual reality technologies are commonly used to help patients learn to care for themselves.

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Many of the innovations that health care experts are extolling these days can be seen at Mid-Columbia, from programs to improve the health of schoolchildren to efforts to electronically link residents to the hospital.

It wasn’t always that way.

Five years ago, Mid-Columbia was an unexceptional, 125-bed hospital that no one outside this part of Oregon had heard of. Although financially strong, the independent nonprofit hospital was having trouble filling beds as insurers pushed for shorter stays and imposed ever-stingier fees.

Mark Scott, the hospital’s blunt chief executive, was frustrated.

“Something was missing,” he says. “We had no philosophy of what we were doing. Our mission statement, like those of most hospitals, was to be the biggest, the toughest, to have the most market share and be the most high-tech.”

So focused was Mid-Columbia on institutional matters that patients seemed a second thought. “Most hospitals are cold, dehumanizing and intimidating places,” he says. “The way we treat people in this business is wrong.”

Scott’s epiphany came at a business seminar where he heard of a pioneering health care design concept known as Planetree. The idea appealed not only to Scott’s desire to recapture that missing human element he speaks of, but also to the need to adapt to the managed care revolution that was sweeping across Oregon.

Planetree is a San Francisco-based organization that promotes the use of architecture and patient care concepts to make health care facilities less sterile-looking and more humanistic--all in an attempt to aid the healing process. Founded in 1978, Planetree was the inspiration of an Argentina-born woman, Angele Thierot, who was frustrated by the lonely, impersonal experiences she had encountered in U.S. hospitals.

Twenty-three hospitals have adopted the Planetree concept--including Beth Israel Medical Center in New York, Kaweah Delta District Hospital in Visalia, Calif., and hospitals in locales as far-flung as Norway and England. But Mid-Columbia was the first to redesign an entire hospital in the Planetree concept. More than 400 hospital officials from the United States, Europe and Japan have come to see Mid-Columbia.

Scott, a longtime hospital administrator with an MBA, is a passionate advocate of Planetree and the need for change in the hospital industry. He gives exuberant 20-minute responses to seemingly simple questions, proclaiming: ‘We’re on fire here! We’re rock ‘n’ rolling!”

He talks about how art, architecture, music and family can be used to help sick people get better faster. Hospitals, he exhorts, should be “value-driven” organizations, known for customer service and quality standards like the Disneys and Ritz-Carltons of the corporate world. Hospitals should be “bone honest” with patients, empowering them with information about their illness.

“We’re trying to personalize what it is we do in this crazy business, to humanize and demystify the information,” Scott says. “We know how positive emotion helps people heal. . . . I just want to enliven this place with positive emotion. . . . We have an inquisitive environment here that is radically different from any hospital in the country.”

A Homey Hospital

A stroll through the hallways, patient rooms and medical laboratories of Mid-Columbia reveals a starkly different look from the sterile, institutional image of the average American hospital.

Patient rooms have a homey feel and are equipped with VCRs, Walkmans and bulletin boards, where patients tack up family photos and other personal items.

To ease the fear and isolation that some patients feel, family and other guests are encouraged to visit at any hour, spend the night in sleeper chairs and serve as “care partners” for patients. In living-room-like “activity” rooms, visitors can chat, watch movies, play games or seek solace in stunning views of the Columbia River, cherry orchards and wheat fields.

The hospital’s hallways are filled with artwork. Workers are instructed to keep intravenous stands and other medical gear out of sight. Patients are routinely treated to performances by harpists, banjo players and barbershop quartets. There’s even been a dog show.

Every floor has a small kitchen and dining area where families can prepare meals for patients--with a nurse’s supervision--as an alternative to plastic-wrapped hospital grub. Staffers tell of a dying woman’s family that used the kitchen a few years back to prepare a full Thanksgiving meal. Although the woman was too ill to eat anything, she was comforted by the familiar cooking smells. Her family, instead of sitting helplessly by her bedside, took some solace in performing a last act of love.

“We don’t just tolerate family members spending the night or cooking meals here, we encourage it,” Scott says. “We’re healing the family, not just the patient. We’re healing the spirit.”

But it’s more than just the physical environment that makes Mid-Columbia different.

Another tenet of the Planetree organization is educating patients to be more knowledgeable and involved in their own care. Upon admission, patients are given information packets about their illness, including if they want information about nontraditional treatments such as acupuncture.

At many hospitals, patients would feel intimidated or would be discouraged from looking at their medical charts. Mid-Columbia patients are encouraged to review their charts and to ask questions about their care.

“You’re more in charge of your treatment and care here,” says Bennett, 35, who suffers from severely painful ailments known as fibromyalgia and chronic fatigue and immune dysfunction syndrome. “If I feel that my painkillers aren’t working or I don’t particularly care for a physical therapy, I can write that in my chart. . . . It makes you feel like you’re more in control. Before, everything was a big secret.”

Bennett, whose illnesses have put her in and out of hospitals over the years, says Mid-Columbia’s staff is always careful to explain medical procedures--why it is necessary or how long a test will take. “These things can be very scary for the average person.”

As part of its efforts to help people take responsibility for their own health, the hospital established a medical resources library in a cozy, Victorian-style house that is open to the public. People drive an hour or more to look at books, magazines or clipping files or to tap into the Internet.

Utopian Experiment?

Indeed, all these efforts raise the question of whether Mid-Columbia’s effort is a wistful, Utopian experiment doomed to failure by a health care system in which cost-cutting and bottom-line considerations are increasingly prevalent.

While the efforts of Mid-Columbia and hospitals exploring similar programs win plaudits from health care policy types, some say that financial and institutional barriers make the model impractical for urban hospitals in Los Angeles or New York City. With hospitals under financial pressure, many lack the resources to completely remake themselves like Mid-Columbia or pay for training and other costs.

But others say that many of Mid-Columbia’s programs are applicable to other hospitals. “There’s a lot of skepticism, and cost is an issue that people put up there as an excuse for not doing some of these things,” says Robin Orr, a health care consultant in Dana Point and former executive director of Planetree. “But it doesn’t cost more money to treat patients with dignity and respect.”

Scott concedes that he doesn’t yet have data to show that Mid-Columbia’s new programs are getting patients better faster or shortening hospital stays. But he notes that the hospital’s rates and average length of stay--yardsticks of a hospital’s efficiency--are competitive with other hospitals in Oregon.

“I measure the effectiveness of what we’re doing,” he says, “by the stories that the nurses and patients tell me.”