Blank A E, Horowitz S, Matza D
Grants Management and Research Support, Beth Israel Medical Center, New York, NY 10003, USA.
Jt Comm J Qual Improv. 1995 Jun;21(6):289-99. doi: 10.1016/s1070-3241(16)30149-3.
Hospitals across the country are seeking to restructure the delivery of care. Planetree, an international consumer health care organization, works with hospitals to cultivate educated health care consumers and to create caring inpatient environments. This article gives an overview of Planetree's philosophy, examines staff and patient satisfaction, and contrasts Planetree with total quality management (TQM)/continuous quality improvement (CQI) as practiced at one hospital. PLANETREE'S PHILOSOPHY: Planetree's model differs from other patient-centered or patient-focused care models because of its emphasis on educating patients and making them active partners in the care process. To help make the hospital environment less forbidding, more homelike, and more conducive to social interaction, Planetree physically redesigns the hospital space.
Planetree hopes to achieve many goals with its restructuring of patient care, two of which are staff and patient satisfaction. Preliminary surveys indicate that nurses and nursing assistants on Planetree are more satisfied than are staff on comparable units. The results of patient surveys, however, are more ambiguous. Planetree patients are no more, or no less, satisfied with their care than patients on comparable units.
Both Planetree and TQM/CQI have goals of improving the delivery of patient care, and there are times when these approaches work in concert. There are times, however, when the different vantage points of TQM/CQI and Planetree may raise different questions and foster different solutions. Questions are also raised regarding whether Planetree benefits all patients in the same way. Furthermore, since it is not clear if Planetree's vision of humanizing patient care brings the results it hopes for, a long-term multifaceted research program is called for.
全国各地的医院都在寻求重组医疗服务的提供方式。国际消费者医疗保健组织“普莱尼特瑞”（Planetree）与医院合作，培养有知识的医疗保健消费者，并营造充满关怀的住院环境。本文概述了普莱尼特瑞的理念，考察了员工和患者满意度，并将普莱尼特瑞与某一家医院实施的全面质量管理（TQM）/持续质量改进（CQI）进行了对比。
普莱尼特瑞的模式与其他以患者为中心的护理模式不同，因为它强调对患者进行教育，并使他们成为护理过程中的积极参与者。为了使医院环境不那么令人生畏、更像家且更有利于社交互动，普莱尼特瑞对医院空间进行了实体重新设计。
普莱尼特瑞希望通过重组患者护理实现多个目标，其中两个目标是员工和患者满意度。初步调查表明，普莱尼特瑞的护士和护理助理比可比科室的员工更满意。然而，患者调查的结果则更为模糊。普莱尼特瑞的患者对其护理的满意度与可比科室的患者并无差异。
普莱尼特瑞和TQM/CQI都有改善患者护理服务的目标，而且有时这些方法会协同发挥作用。然而，有时TQM/CQI和普莱尼特瑞的不同视角可能会引发不同的问题并促成不同的解决方案。还存在关于普莱尼特瑞是否以相同方式使所有患者受益的问题。此外，由于尚不清楚普莱尼特瑞使患者护理人性化的愿景是否能带来其所期望的结果，因此需要开展一项长期的多方面研究项目。
