Photo Credit: Courtesy Griffin Hospital
Griffin Hospital, in Derby, CT, has received national recognition and acclaim for creating a facility and approach to patient care responsive to the needs of patients.

The Patient as Partner

By Neal Peirce and Curtis Johnson

No one welcomes serious illness or injury, but when it happens, you’d be fortunate to be close to Griffin Hospital, set in a middle-class neighborhood of Derby, Conn., just 12 miles west of New Haven. Walk in the door and you meet culture shock -- not the familiar white plaster and steel sheathing of Medical America, but warm wood colors and carpeted floors. Quickly it’s clear the difference isn’t just cosmetic. This 160-bed community hospital focuses on a healing strategy made possible by medical professionals sharing responsibility with patients.

Most hospitals are designed around the presumed professional preferences of the doctors and nurses who do the work. Not Griffin. It’s a welcoming place, tastefully lit, with an open library full of medical information, and rooms that feel more like bedrooms than hospital wards. Scary medical equipment is confined to back corridors. Those large nursing station fortresses are dissolved into desks distributed so every patient sees a nurse through the door.

Visiting hours are 24/7. Even the family dog's welcome, if that lifts the spirits of the sick. There are overnight rooms for family and close friends that the Ritz-Carlton would be proud of; sleeper sofas added to lounges, and small kitchens where a family can cook a dinner.

Photo: Griffin Hospital Patients and their families can enjoy the talents of the various musicians who staff Griffin's daily Arts and Entertainment Program. Shown is musician Jim O’Mara.

All that is different enough. But here's the transformative turn that Griffin made in the road. Bill Powanda, vice president of the hospital and a former state senator, defines it as trust and responsibility. He enthusiastically describes how patients respond when their medical charts are written in plain English and kept within eyesight.

This kind of institutional behavior turns conventional medical practice on its head. Haven’t we heard for generations -- doctors know best?

Well, sometimes, but not always and not alone. In many cases, doctors make decisions about procedures or medications knowing less about the odds of success than major college football coaches know about the likely outcome of any play they run. The Griffin practice, by contrast, is to check first for proven best practices, applied for suitability with any given patient. There are small conference settings spread around the halls, where it's typical to see several doctors and nurses conferring on a case -- and as often as possible with the patient. The hospital provides patients and families with choices of different diagnostic tests, complete with the odds of getting a correct diagnosis and of experiencing bad side-effects.

This open, shared system works, says hospital CEO Patrick Charmel, adding: "We get very high ratings from patients. Our costs are lower because we don't do unnecessary tests and treatments, we don't make as many errors, so our malpractice insurance doesn't cost as much."

Photo: Griffin Hospital Griffin Hospital's Critical Care Unit was the first to be built using patient and family centered concepts that go beyond aesthetics.

The Griffin formula of collaborating rather than dictating, and putting the patient's experience first, is not every physician's preference. "Some docs left us," admits Powanda. But the staff is enthusiastically signed on; in fact, Fortune magazine has listed Griffin as one of the "100 Best Companies to Work for in America" for six years running, with a ranking of fourth in 2006. HealthGrades, the leading independent healthcare rating company, this year named Griffin in the top 5 percent of hospitals nationally for clinical excellence.

The Griffin way is spreading through a national Planetree Alliance of like-minded patient-centered hospitals that Griffin leads. Others in New England include Berkshire Medical Center (Pittsfield), Martha’s Vineyard (Oak Bluff, Mass.), Stamford (Connecticut) Hospital, Copley (Morrisville, Vt.), and the Bishop Wicke Health Center (Shelton, Connecticut).

Interestingly, none of New England’s famed big medical hospitals, known for their highly specialized faculties, have yet joined the alliance (though New York’s prestigious Presbyterian Hospital has). The omission is worrisome, since the Griffin/Planetree model could be part of the path to a better health care system. Like famed institutions, Planetree hospitals seek to respond and operate on proven best medical practices, and they’re on board with recent years’ push to avoid errors by creating, storing and then being able to access accurate, extensive electronic records on each patient. But they go the critical step further to involve patients early and consistently in decisions about their treatment options.

That’s not to say top-drawer institutions aren’t making some parallel moves. Take Dartmouth-Hitchcock. There, a patient with a back problem watches a 45-minute video in the Center for Shared Decision-Making. Often for the first time, he or she sees the significant odds that surgery is not likely to be more effective than a combination of physical therapy and medications. Decisions against surgery are then 30 percent higher than in traditional consultations with a physician. With spinal surgery costs ranging upwards of $70,000, the potential savings are immense.

Choosing surgery might be profitable for the medical center, but Dartmouth-Hitchcock sees value in changing the relationship between doctors and patients. One has to wonder: Couldn’t this become the New England norm, not the exception?

[Originally published March 2006]