Therapist Stephanie Kleba uses music therapy, among other things, to help patients relax during their stay at Delnor Hospital.

Transforming Patient Care Through The Planetree Approach

Delnor hospital is one of just seven nationwide, and the first in Illinois, to receive the Patient-Centered Hospital designation from Planetree.

Therapist Stephanie Kleba uses music therapy, among other things, to help patients relax during their stay at Delnor Hospital.

Delnor Hospital has long been recognized as an outstanding provider of quality health care for the greater Geneva community. With the adoption of a unique patient-centered program called Planetree, Delnor has both broadened and deepened its commitment to ensuring that patients receive not only the finest medical care, but also the level of personal treatment they deserve.

Delnor is proud to be one of only seven hospitals in the United States, and the first in Illinois, to be Planetree-designated. Registered Nurse Diane Ball, staff trainer, is among those who advocated for the Planetree approach.

“We’ve always appreciated that service was an important part of what we do,” she says. “But we wanted to do more, so we went on a journey, starting in 2000, to better understand excellence in patient care. The Institute of Medicine published a landmark paper, ‘Crossing the Quality Chasm,’ which stressed that, to provide effective care, it must be safe, efficient, well-timed, quality-oriented and patient-centered. And then we discovered Planetree.”

Volunteers deliver chocolate chip cookies to patients and family members.

Founded in 1978, Planetree is a nonprofit organization comprised of health care providers who focus on patient-centered care. Named for the sycamore (also called planetree) under which Hippocrates sat to teach medicine, Planetree pioneered the concept that patients come first. Its philosophy is to personalize, humanize and demystify the health care experience for patients and their families, while giving them full access to medical charts, test results and educational materials.

Planetree is not intended to be a one-size-fits-all solution, so Ball and her staff adapted it to fit Delnor’s specific needs.
“We liked it immediately,” Ball says. “Planetree gave us a model of patient-centered care that we felt we could wrap our arms around.”

Jennifer Peterson, a staff telemetry unit cardio monitor, worked with Ball to develop a Planetree protocol for Delnor.

“Diane came to me with the program, and I said, ‘Absolutely,’” Peterson says. “Although Planetree was entirely new to me, I saw how its philosophies touched patients and their families. We actually derived several different paths from Planetree to embrace a hands-on healing environment. We’re incorporating a lot of new ideas that we didn’t offer before, which focus on strong social support, anxiety resolution, serenity and open communication.”

Planetree is founded on 10 guidelines, or care concepts, beginning with close personal interaction between patient and family and Delnor’s professional staff, explains Ball, who is Delnor’s Planetree coordinator. The second Planetree guideline emphasizes social support, through family members and friends, which is vital to healing.

Diane Ball

“We may not be able to cure every patient, but we can help them heal,” Ball says. “That’s why we eliminated the old visiting hour rules and instead allow 24-hour access, with no restrictions. Our Care Partner program helps patients while they’re hospitalized, by training designated family members and friends to change dressings, act as liaisons between patient and doctor, find food and water for patients, and more.” Visitors can take advantage of dedicated sleepover space, if they wish to spend the night.

Empowering patients through education and information is another major emphasis in the Planetree concept. “We now have a policy that gives patients access to their charts and records in the hospital, and we go over the information with them,” Ball says. “This helps them to make informed decisions about their care. Delnor has libraries for patients, covering all aspects of disease and medicine, as well as a Web site link called Health A-Z.”

Providing an environment conducive to healing is the fourth focus. Delnor’s newer additions incorporate more single-patient rooms; bigger windows; softer lighting; warmer building materials; balconies for getting fresh air; more family gathering spaces; and removal of barriers, such as chest-high dividers around nurse stations. The overall result is a more spacious and gracious environment.

“Food is another important part of quality patient care,” Ball says. “Delnor has volunteer cookie ladies who visit patients and families, armed with chocolate chip cookies. Meals at Delnor are designed to be wholesome, nutritious and appealing.”

Both patients and visitors enjoy playing the piano in Delnor’s lobby.

Finding positive ways to distract patients from pain, worry and anxiety is another way Delnor implements Planetree concepts. A grand piano in Delnor’s lobby offers patients, visitors and staff the opportunity to play and listen. Volunteer musicians perform live music on a regular basis, using guitars, violins and dulcimers. A clown occasionally strolls the hallways, lightening the mood by keeping patients’ minds on happier things.

“We take a team approach to the spiritual needs of patients and staff,” Ball says. “Delnor has an interdenominational chaplain available.”

Human touch is central to Planetree’s philosophy. Simple hand, foot and shoulder massage, provided free, helps patients to relax. On a limited basis, Delnor offers therapy pet greeters in the hospital lobby, where patients can arrange to drop in and visit with the gentle, trained dogs. Staff needs also are taken into account. Three times each year, Delnor hosts a Staff Spa Day, transforming an area into a spa with soft lights, music and massage to refresh and recharge staff members.
“Delnor also offers complementary therapies to relieve anxiety, insomnia and pain,” Ball says. “These are comfort measures that ease the distress that hospitalization can cause.”

Fewer errors are made when patients stay in private rooms like this one.

Among the most popular is music therapy. Stephanie Kleba, MT-BC, is on staff in Delnor’s music and medicine department. An Ohio native, she graduated from Florida State University, the home of much music therapy research. She sat for her boards in Dallas, and practiced there before moving to the Chicago area in 1996. She stays informed about clinical outcomes and research that focus on the effect music has on patients who are autistic, physically disabled, in pain, emotionally stressed or living with diseases such as Parkinson’s.

“I started in Delnor’s Planetree program with Diane Ball in August 2007,” Kleba says. “Prior to that, I spent about two years discussing the benefits of music therapy and making presentations to demonstrate how music therapy would fit into the hospital’s patient care model. Delnor created a position for me when Planetree became the model here.”

With its holistic approach to mind, body and spirit, Planetree’s values align perfectly with music therapy objectives, says Kleba. “Many people come into the hospital with pain, or experience pain because of the treatments they undergo. It’s always an issue to offer comfort in whatever way possible. I work with the nurses, who let me know when a patient might be open to my help.”

Jennifer Peterson

Music therapy might involve offering access to recordings from a library of music and other soothing sounds, such as ocean waves. Patients can play the music whenever they wish, to ease pain and anxiety, and to relax and sleep.

“I develop a rapport with patients, which can lead to live sessions,” Kleba says. “I play guitar at their bedsides, usually starting with a slow beat that matches their heartbeat. We also try imagery, with music as the background, focusing on peaceful scenes that calm and refresh, such as deserts, mountains or oceans. I take them on a verbal journey that helps them to breathe through their pain. Of every 10 patients, I’d say eight or nine fall asleep during the session. Some tell me later they slept for hours.” Most sessions last 20 to 30 minutes. Kleba also teaches bone and muscle relaxation techniques to relieve stress.

Pet greeters do their part to welcome visitors and cheer up patients.

“We sing together, too – this is definitely not ‘American Idol,’” she jokes. “But singing old hymns, country favorites and Christmas carols allows patients to loosen up and promotes healing. Sometimes, the family is there and sings along. This is especially comforting during end-of-life situations. We can also go on a spiritual journey, taking a light with us to find the way.”

Music therapy has its roots in the aftermath of World War II, explains Kleba. After war-weary veterans returned stateside, they experienced extreme physical and mental stress. Musicians were called into the hospitals, to supply comfort and support. By 1950, the American Music Therapy Association had been formed.

“It’s my goal to assess each patient’s needs and to provide musical assistance,” says Kleba, who also studied psychology and anatomy. “It’s not for everyone. Some patients prefer talk radio, but I find it very rare that a patient fails to respond to music. I also work with stroke patients, who may have trouble speaking but can often sing.”

Dick Hankey

Delnor’s staff reaps the benefit of Planetree’s guiding philosophies, too. To promote a health-conscious community and expand the hospital’s boundaries, staff members grow vegetables in a garden on nearby land and donate the fresh produce to local pantries, says Ball. Recently, Delnor opened the garden to the community as an interactive group project.

“Adapting Planetree’s components to our already high level of patient care helped us to look at our services through the eyes of the patients,” Ball says. “Planetree worked with thousands of patients to develop these guidelines, as well as important factors like patient and staff safety. For example, providing private rooms for patients helps to ensure fewer errors. And it encourages all of us to be more open to patient questions and concerns, such as why we need to screen for MRSA [a type of staph infection] and other health care initiatives.”

The changes have made a significant difference in how patients are treated, above and beyond the excellent medical care they receive.

“While we always worked hard to help patients to heal and feel better, the traditional approach focused on their diseases or traumas more than on their humanity,” Peterson says. “Visiting hours were restricted. They had no access to charts and records, no access to food when tests or x-rays were scheduled at meal times, no opportunity to seek distraction or stress relief. Planetree provides a totally different perspective on providing nursing and physician care.”

Delnor Hospital now schedules tests around the patient’s needs, personalizing care to coordinate with family visits, regular meals and other considerations.

“Planetree emphasizes the patients’ points of view,” says Peterson. “What’s nice is that patients recognize the difference and tell us so.”

Dick Hankey, who has had several patient experiences with Delnor Hospital, now co-chairs its Patient Partnership Council.

“I’ve always enjoyed my relationship with Delnor Hospital, even though the reasons for being there are seldom good,” Hankey says. “I became involved in Planetree because I had some questions, after one hospital experience in which I asked the administration to look more closely at a few things. They got back to me and told me what they had done in response. The next time I needed to go to Delnor, the issues I’d brought up had been addressed.”

Not only were his suggestions implemented, but the entire exchange was handled in an open and honest manner, says Hankey. Shortly afterward, he was invited to join the Patient Partnership Council.

“The Council is comprised of two patient chairs and two staff chairs, plus former and current patients and nine staff members, who are encouraged to voice their concerns loud and strong,” Hankey explains. “I think it’s terrific that these 28 people can take the time and effort to commit to meetings. Delnor continues to improve the program in many new ways.”

Hankey believes that Delnor has done a phenomenal job of implementing Planetree, and doesn’t understand why more medical centers and hospitals don’t adopt the program.

“Delnor puts the patient first and doesn’t allow anything to stand in the way,” Hankey says. “Delnor was already doing a great job, but with Planetree, they’ve taken patient-centered care to a whole new level. They’ve ratcheted up the whole healing process.”

Another aspect that Hankey deeply appreciates is the transparency with which Delnor deals with patient concerns. Despite being a large, complex entity, Delnor leaders continue to be open and willing to make things better.
“They don’t just ask for advice – they also follow it through,” Hankey says. “They keep us very busy.” ❚