Nov 3, 2011

Lessons from the Dana Farber Cancer Institute

I consider myself lucky. My experiences as a patient are limited and predictable. My sister, on the other hand, suffers from a combination of chronic conditions. Midnight trips to the ED due to extreme pain occur regularly – often times accompanied by needless harm.

About a week ago, my sister was admitted to the ED, doubled-over in excruciating pain. The medical staff called for a CT scan. As a nurse was administering an IV for contrast solution, my sister explained that the needle was not in a vein. Unfortunately, the nurse did not heed this plea. After administering the scan, two things happened:
1) The scan showed nothing
2) Ashlee’s arm ballooned to three-times its normal size, stiff with contrast that never made it into her veins

Despite the success stories and leaders of patient-centered care I learn about IHI, my sister’s experiences leave me in limbo – somewhere between skeptical and cynical – regarding the state of care.

This limbo changed last week.

I joined 20 IHI team members on October 27 on a site visit to the Dana Farber Cancer Institute. We had the unique opportunity to dive into the patient experience without bearing the burden of being a patient.

Aside from the familiar name, I was completely unfamiliar with what Dana Farber offers to patients. But it quickly became apparent that Dana Farber did something special. Our destination, the Yawkey Building, stood out as the new building on the block. Instead of the cold, industrial design of its neighbors, the Yawkey building welcomes with a glass facade, cut with naturally-colored, wood trim. The design feels like it could hold an art institute, and in a way, it does (more on this later).

Patients and visitors can self park or valet (for the same fee!) in the underground garage. We made our way seven stories underground – the first few stories were full and when we found open spaces, they were reserved for patients and families. Nearly 100 feet underground, it became clear what sets Dana Farber apart. Patients are afforded the luxury of valet parking to avoid the garage – a nice touch when they clearly have more important things on their minds.

Yawkey’s main lobby and information center feels open and welcoming. Art hangs on the walls and from the ceiling. Dick Tonachel, a DFCI volunteer and one of our hosts, warmly greeted us and took us to our luncheon. Dr. Benz, the President of Dana Farber, welcomed us to Dana Farber. Then, in true patient-centered fashion, the leaders of the Dana Farber Patient and Family Advisor Council took over the meeting.

PFAC consults DFCI management to improve operations. As former patients, they provide a valuable end-user perspective. We learned that their input was sought out from the beginning. Initial blueprints were changed as the PFAC explained that certain plans could be improved for the patient experience. Including this perspective is so natural, but is not the industry norm.

Our group of 20 IHIers split into small groups of 5-6 members for the tour. Anne Tonachel – our tour guide, Dick’s wife, a DFCI volunteer, and a cancer survivor – led us through the institute.

A piece of art hung just outside the luncheon room. Anne explained that the building committee placed a high value on displaying art throughout the facility. This particular piece was titled The Souper Dress – a 60’s mod-style dress printed with a series of Campbell’s soup cans – an Andy Warhol original. The piece was donated to DFCI and is proudly displayed. We saw more art throughout our tour, some which was created by patients. It is all approved by a patient-filled committee.

(Starting with a Warhol was incredibly fitting. His fascination with Campbell’s Soup revolved around how egalitarian the soup was. The President of the United States and a minimum wage worker have the same Campbell’s experience. I think this sends a great message for the aspirations of our healthcare system.)

We continued on to the patient examination rooms. Anne pointed out that there were no cracks or seams in the room. The counter tops were one, continuous material. The examination table had no sections held together with seams. Places for germs to hide were minimized. Anne then pointed out the floor. No one noticed it at first. Instead of the standard, monochromatic tile, this tile included two perpendicular columns of color. Studies show that nauseous patients have an easier time when a simple floor pattern gives their eyes something to focus on.

This is when it hit me. DFCI pays incredible attention to detail. If there is something that can make the patient experience slightly easier, it is implemented. These small details add up to an experience that may be unmatched in health care. To drive this point home, Anne showed how every examination table in the building is stocked with the exact same items, in the exact same places, so a medic can handle an emergency on any floor.

The building team sought the eco-friendly Silver LEED certification. Aside from using as many renewable materials as possible, outdoor gardens collect rain water which helps minimize the energy consumption of the air conditioning system. DFCI thought of everything – and received Gold LEED certification.

Our final stop was a two story, indoor healing garden. Fresh plants are rotated monthly. Soft music plays. No food, drinks, or electronics are allowed. The calm of the room is soothing, giving patients a great place to reflect and mentally heal.

Going into this site visit, my mind was preoccupied with the upsetting patient story of my sister. But knowing how bad things can get and then seeing how incredible things can be had a profound impact on my spirit. It was a delight to see the Dana Farber Cancer Institute at work. We can all hope that this level of intentional quality will spread throughout our entire system.

- Alex Anderson, Executive Assistant at IHI