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Optimal healing environments.

A massage before surgery. Yoga classes for visiting family members. Soothing music piped into the patient room. Meaningful conversations with caregivers. These are among the techniques hospitals are adopting to develop what have become known as "optimal healing environments."

Regulatory, economic and workforce pressures too often have taken the healing out of health care, proponents of the concept assert. "For most hospitals, the primary focus is on diagnosis and treatment," says Wayne Jonas, M.D., president and CEO of Samueli Institute. "In the meantime, most hospitals would like to focus on healing the patient." Creating an optimal healing environment is a way for an organization to return to its roots as a healing enterprise and help achieve its mission and vision.

The optimal healing environment is one in which all aspects of the patient care experience are designed to support and stimulate healing.

"Establishing an optimal healing environment requires a radical change in how we think about health care delivery," says Patrick O'Malley, M.D., an internal medicine specialist for Walter Reed Army Medical Center, Washington, D.C. It requires a significant cultural change, he says. Jonas agrees. "Changing the physical environment is often the easy part. Changing the cultural environment can be difficult to do."

To begin, organizations should conduct a self-assessment of the environment to identify opportunities to promote and practice healing. Optimal healing environments are not created overnight. Staff education and training will be a significant component. Clinicians need to learn to integrate healing-oriented practices into their work and enhance their communication skills. "It's important to let patients tell their story," O'Malley says. Patient-centered interviewing is one way to accomplish that. And clinicians must learn to evoke empathy in their patient encounters. "It's not the quantity of time that clinicians spend with patients, but the quality of time that matters," he says.

The physical environment plays a central role in creating optimal healing environments. Evidence-based design provides numerous elements to improve care, enhance productivity and raise levels of employee and patient satisfaction. Lighting, sound and availability of family space are all important elements. "Optimal healing environments are better for everyone who encounters that environment," says Kimberly Montegue, director of design consultation services for Planetree.

Jonas recommends that health systems adopt one area of focus following the organizational assessment and build on that success. Demonstrating early success will win over skeptics and inspire support for future efforts. Promoting healing provides a sense of meaning to caregivers, Jonas says. It can improve morale and employee and patient satisfaction. "It's a differentiator," he says.

Most importantly, Jonas says. "It's the tight thing to do."

key components of the optimal healing environment

An optimal healing environment is one that supports and stimulates patient healing by addressing the social, psychological, physical, spiritual and behavioral components of health care and enabling the body's capacity to heal itself.




Enhance sensory input. The physical space must support healing through lighting, access to nature, music, color and architecture, among other things. The physical space can eliminate stress among patients and clinicians, improve efficiency and morale, reduce infections and falls and promote healing.


Enhance natural processes. Health care organizations should consider the chemical impact, energy use and ecological sustainability of their practices and processes. For example: reduce the volume of drugs and chemicals deposited into the environment; increase energy efficiency; replace, when possible, products and practices that are resource intensive, cruel to manufacture or add pressure on endangered species.



Enhance healthy habits. Practicing healthy lifestyles leads to a healthier, more satisfied workforce and facilitates the healing process.

Organizations should promote and provide instruction in healthy behaviors and lifestyle changes for patients and employees.


Enhance medical care. The appropriate application of integrative medicine can foster a healing environment. It includes the coordination of conventional medicine complementary and alternative medicine, and cultural practices.

The provision of comprehensive, personalized care can help improve outcomes and enhance patient satisfaction.



Enhance caring. Healing relationships are founded on compassion, empathy, social support and communication. Cultivating healing environments establishes trust among patients, families and caregivers. And it can improve patient outcomes as well as patient and employee satisfaction.


Enhance culture. Optimal healing environments derive from organizations that support teamwork and service. A healing culture is achieved through organizational values that promote and reward trust, compassion, service and commitment to active learning.



Enhance awareness. Optimal healing environments start with the conscious development of intention, awareness, expectation and belief in improvement and well-being.

Clinicians need to develop awareness and compassion for the patient; an emotional connection facilitates the healing process.


Enhance integration. Self-care integrates patients with the care experience and fosters a sense of wholeness and well-being. Self-care also encompasses the caregiver experience and how the organization can support clinicians in the attainment of personal goals.

It's important for both patients and clinicians to have a sense of who they are and who they should be.

CAM in hospitals

Despite a slight drop in 2009, acceptance seems to be building steadily that complementary and alternative medicine therapies contribute to healing environments in hospitals. Hospitals are adopting CAM therapies to address patient demand and need.

who are the
CAM boosters?

In hospitals, administrators
are the most enthusiastic
supporters of complementary
and alternative medicine.

Board             3%
Administration   53%
Nursing          23%
Physicians       22%

Source: Health Forum: Complementary and
Alternative Medicine Survey of Hospitals, 2007

Note: Table made from pie chart.

why do hospitals offer CAM?

Hospitals say the main reason they offer complementary and alternative
services is because patients ask for it.

Patient demand                   84%
Clinically effective             67%
Reflects mission                 57%
Attracts new patients            40%
Physicians request               40%
Differentiate from competitors   33%
Potential cost savings           21%
Other                            14%

Source: Health Forum: Complementary and Alternative Medicine
Survey of Hospitals, 2007

Note: Table made from bar graph.


case studies

Grinnell (Iowa) Regional Medical Center

Grinnell began incorporating integrative health into its practice about 10 years ago and now offers a host of therapies including aromatherapy, massage, acupuncture and music. Creating an optimal healing environment is about creating the best environment for patients and employees, says President and CEO Todd Linden. "Integrative therapies complement the traditional medicine that we offer and help us improve our care," he says. A big component is focusing on the clinician-patient relationship. A "Compassion in Action" program helps foster interpersonal relationships between clinicians and patients. A focus on personal wellness has improved morale among employees, as well as patients and families. Family members of inpatients are provided free use of the organization's fitness center. "There is a business case to be made here," says Linden. "The optimal healing environment is definitely part of our reform response. Providing high-quality, low-cost care will be critical."

Abbott Northwestern Hospital, Minneapolis

Integrative health is fundamental to the care provided at Abbott Northwestern Hospital. "We are embedded in the optimal healing environment concept," says Lori Knutson, R.N., executive director of the Penny George Institute for Health and Healing. The Institute seeks to combine conventional medicine with evidence-based complementary and integrative therapies. "Optimal healing environments aren't just about physical space. It's more about the people in the space," says Knutson. To that end, Abbott is working with its nursing staff to enable nurses to be more present as providers. The "Transformative Nurse Training" educates nurses on holistic health and integrative nursing. Nurses learn skills to promote and enhance healing, including massage, meditation and physiologic relaxation response. "Nurses are the instrument in healing," says Knutson. More than 66,000 inpatients have received some form of integrative therapy to date.


the business case

Samueli Institute is working to develop and validate a business case for OHE to promote widespread adoption within the hospital field. Research on healing initiatives have shown:

* An increase in morale and productivity because of workplace wellness programs;

* A reduction in length of stay through access to natural light;

* A reduction in patient falls because of patient-centered room design;

* A decrease in risk-adjusted mortality among cardiac surgery patients because of the introduction of an interdisciplinary care team model;

* An increase in patient satisfaction through the provision of complementary and alternative medicine therapies;

* A reduction in nurse turnover through implementation of a nurse integrative healing arts program

Source: The Samueli institute, 2010

the built environment

The Institute of Healthcare Improvement has developed a checklist of design elements to promote an optimal healing environment. The IHI recommends that organizations use the checklist to assess whether the physical environment supports optimal healing.

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Title Annotation:Optimal healing environments technique provides many benefits for good health
Author:Jarousse, Lee Ann
Publication:H&HN Hospitals & Health Networks
Geographic Code:1USA
Date:Dec 1, 2010
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