April 2006

Person-Centered Care Meets Mind, Body and Spirit Needs

04-06dailey Photo

As a member of the admitting staff at Central Kansas Medical Center, Great Bend, Kan., Eleanor Dailey is committed to putting patients at ease.

In keeping with its tradition of care for the body, mind and spirit, Catholic Health Initiatives continues to sharpen its focus on person-centered care. “Person-centered care is distinct from patient-centered care,” said Milt Hammerly, MD, vice president of medical operations and integrative medicine for Catholic Health Initiatives. “Both approaches customize care to meet an individual patient’s needs, but they differ as to who is in control. Person-centered care places the focus of control with the individual being served, versus patient-centered care, in which providers of care have the locus of control. Person-centered care brings all of an individual’s richness and complexity as a person — his or her preferences, values and relationships — into the picture.” John Anderson, MD, chief medical officer for Catholic Health Initiatives, said person-centered care represents an enrichment of patient-centered care. “Person-centered care takes into account all dimensions of a person,” he said. “It resonates deeply with who we are as an organization and why many of us entered the health care field.” Patients or Persons? While the people who come to Catholic Health Initiatives’ facilities for care are often referred to as “patients” or “residents,” that probably isn’t how they would choose to define themselves. “If you meet someone and ask her to tell you about herself, she may talk about her work, family or hobbies: ‘I’m an accountant,’ ‘I’m a mother of three,’ or ‘I’m a skydiver,’” said Hammerly. “‘I’m Dr. Miller’s patient’ is probably much further down the list of ways she defines herself. Any individual in our care is much more than a patient: he or she is a person who deserves respect and an understanding of his or her values and priorities.” Person-centered care is a philosophy of care that emphasizes involving patients and their loved ones in care decisions and giving them a feeling of control over the care received. “When individuals and their family members feel in control, they often share more information, more freely, with caregivers,” said Hammerly. “With more information, we can do a better job of meeting the individual’s needs.” Persons who feel more in control of their care may also be more confident about requesting and accepting help from a variety of caregivers, including chaplains, therapists and social workers. “When the focus is on meeting the needs of the whole person in mind, body and spirit, care is naturally more comprehensive and collaborative,” said Hammerly. “We find that when care is comprehensive and collaborative, other important issues — such as safety and quality — tend to fall into place. It’s difficult to deliver person-centered care that isn’t safe, because the care is truly customized for an individual. However, it’s very possible to deliver safe care that isn’t person-centered.” Person-Centered Palliative Care A person-centered approach to care is evident in the Palliative Care Program at Saint Joseph HealthCare in Lexington, Ky. “Our goal is to improve the quality of life for patients with life-limiting illnesses,” said Billie May, RN, clinical nurse specialist in palliative care. “That means addressing whatever interferes with their quality of life, whether it involves the mind, body or spirit. No one caregiver can address all of those needs, so we use a multidisciplinary team to provide palliative care for these patients.” As a consulting team brought in by a patient’s attending physician, Saint Joseph’s Palliative Care Team works to identify and address all causes of a patient’s pain and suffering. “We recently provided care to a woman in her 40s, newly diagnosed with cancer, who was in excruciating pain,” said May. “The cancer had spread to her bones, so there was certainly physical pain. But, we found that she also had overwhelming psychosocial stress. She was an independent, single, self-employed woman with no health insurance, so she worried about paying her medical bills. She worried that she might not be able to return to work. Because of some unresolved family issues, she was afraid that she would not be able to rely on her family for help when she left the hospital. As we worked to control her physical pain, we also worked to resolve her insurance status, involve her family in her care, ease her emotional stress and introduce her to community resources that could help and support her after she left the hospital.” Saint Joseph’s Palliative Care Team provides this type of comprehensive, person-centered care to hundreds of patients and families each year. Saint Joseph’s program is affiliated with the Palliative Care Center of the Bluegrass, one of just six organizations in the country designated as Palliative Care Leadership Centers by the Robert Wood Johnson Foundation. “As a consulting team, we have the luxury of spending enough time with patients to discover the true sources of their pain and suffering,” said May. “We can have a positive effect not only on their symptoms while they are hospitalized, but on the care they may require in the future. And, we are able to educate our nursing staff in palliative care interventions, which raises the quality of nursing care for all of our patients.”

04-06JeanineandKarstens Photo

Employees provide essential components of the focus on care for the mind, body and spirit. From left are Jeanine Fagerholm, unit secretary, Penrose-St. Francis Health Services, Colorado Springs, Colo.; Diane Karstens, coordinator of the “Make a Memory” program at Alegent Health, Omaha, Neb.; and Kelli Rudder, RN, director of Tri-County Hospice, Marymount Medical Center, London, Ky.

Through the Eyes of Residents Introducing or enhancing a person-centered approach can be challenging when caregivers believe they already provide the best possible care. “It can take extra effort to go to the next level of person-centered care,” said Hammerly. “Sometimes, it can be accomplished by looking at everything that happens in a health care facility through the eyes of a patient or resident.” That approach was taken by a team of leaders from Centura Health’s long-term care facilities in Colorado. For example, when team members observed meal times, they noted a lot of “hurry up and wait.” Employees would hurry to get residents up and dressed: then, the residents would wait for their meals, often while lined up in the hall outside the dining area. “Waking and feeding residents who don’t want to be woken and aren’t hungry, and then making them wait, can be traumatic for the residents and their caregivers,” said Hammerly. Some of the facilities are now trying an open dining concept. Meals are served for longer periods of time, giving residents more choice about when to get up and go to the dining room for breakfast, lunch and dinner. There is also a wider choice of food at each meal to appeal to residents’ differing tastes. “One of the Centura facilities, Villas at Sunny Acres, reported increased resident satisfaction, less wasted food and significantly improved employee satisfaction over a one-year period,” said Hammerly. “This is consistent with the results of open dining at other long-term care facilities.” Person-Centered Structures Person-centered care also has implications for the way health care facilities are designed. “Currently, most facility designs are based on industrial concepts that are convenient for providers, but not necessarily for patients,” said Hammerly. For help in designing new facilities or remodeling the old, some market-based organizations are drawing on the philosophy of Planetree, a nonprofit organization that advocates for the patient perspective in all aspects of health care, including facility design. Believing that the physical environment is vital to the healing process, Planetree advocates for warm, home-like design and decor that provide patients and family members with a sense of “safe shelter” while accommodating medical technology. Facilities that use the Planetree model provide patients and families with space for both solitude and social activities, such as libraries where families can read together and kitchens where they can cook favorite meals. Healing gardens, fountains, fish tanks and waterfalls may be used to connect patients and their families with the relaxing aspects of nature. Architectural barriers that can inhibit patient mobility or interfere with family participation are removed. “This type of environment can be very nurturing for caregivers as well,” said Hammerly. “They also benefit from working in a warm, comfortable environment.” Business Sense While facility design contributes to person-centered care, the most important element is the culture of the organization. “The good news is that when person-centered care is part of the culture of an organization, it contributes to good business outcomes,” said Hammerly. “Person-centered care leads to improved patient satisfaction and helps create a healthy work environment, which is a definite advantage in competitive markets.” Catholic Health Initiatives market-based organizations that want to develop or enhance a person-centered approach to care can begin with an assessment tool developed by the national Clinical Services Group. “We developed a questionnaire that is customizable for different care settings,” said Hammerly. “The results provide a baseline assessment of an organization’s person-centered care status according to criteria established by the Institute of Medicine and the Institute for Family-Centered Care. With identified opportunities to develop a more person-centered approach to care, an organization can begin to create changes that will benefit patients and caregivers.” Principles of Person-Centered Care
  • Dignity and respect, which entails identifying the unique needs and honoring the preferences of those we serve.
  • Transparent sharing of information to allow informed decision-making by those we serve.
  • Encouraging and enabling the active participation of those we serve to the extent that they are willing and able.
  • Collaboration between the persons cared for, their families, communities and care providers in developing programs, services and policies.
To request a copy of the person-centered care questionnaire, contact Milt Hammerly at milthammerly@catholichealth.net, or Marita Schifalacqua, director of professional practice innovation, at maritaschifalacqua@catholichealth.net.