Putting Patients First, Patrick A Charmel

“I've never really accepted the status quo and as long as I have the ability to influence change, I find that sustaining, fulfilling and self-actualizing” Patrick A. Charmel.


Patrick Charmel, is the chairman of the board at Planetree International and the president of Griffin Health Planetree’s parent company.

Patient Centered Approach

As president of Griffin Health and chairman of the board PlaneTree, I've been advocating for a patient centered approach to care for more than 30 years. As an acute care hospital, Griffin recognized many years ago that what we've done in the hospital industry is really focused on the needs of the provider, the physician and other caregivers like nurses, the technology that we use to deliver care.

The principle focus was on that and the patient was almost secondary and we recognized that was wrong and we needed to shift that focus. Planetree actually gave us a set of principles and a philosophy that helped us change our frame of reference to how we viewed care delivery.

The Journey to Improving Care

Over the last 30 years, we've been on the journey to use those principles to reinvent care from the patient's perspective. So early on we asked caregivers what they want from the patient experience, if they were a patient or a member of their family, what would they want from in hospital experience. We really focused primarily on the hospital experience and we had people articulate that and then we ask them to contrast what they described as the ideal experience to how we were then delivering care.

That was 30 years ago and there was a pretty big gap between the ideal that they described and how they viewed us delivering care at the time and frankly before we had asked that question and they had created that contrast between what they want from there for themselves in their family and the way we're delivering care now.

Shifting Dynamic Tension

They actually didn't see it. They didn't know that they weren't meeting the needs of patients because they had no frame of reference, but they were creating that gap. What that did was created what we call dynamic tension. So people saw the ideal and current reality and once they realized current reality wasn't the ideal, they wanted to move from where we were to where collectively we said we want to be.

That tension kind of drove us or propelled us toward the ideal and everybody wanted to be part of that because again, it was consistent with their personal values. It wasn't something that we impose on the organization. We said, what do you want as a caregiver? How would you want to meet the needs of your patients? And then as an institution, how can we remove all the barriers that prevent that from happening?

Some of it was policy and procedure, some of, is it conventional wisdom, some of is the rules and some of it is just the way we think. Some of it was physical barriers, the way the facility was designed because then we had a very traditional facility design. We changed all of that.

Designing for Patient Centered Care

I think in this work, when you talk about patient center, we definitely want to personalize care. We want to humanize care. But if you're running a large facility based organization, you're only going to be able to tailor care to a certain extent. It would be unrealistic or disingenuous for me to say that we can personalize everything we do we customize it down to the individual. I call it mass customization. There's this standard approach that we've adopted that is more patient centered that focuses more on the needs of patients in general.

Again, everything from the rules that we established and how we design the facility and then we do what we can to assess the individual's personal or special needs and make sure that we built in flexibility so that we can respond to that. Part of it is just educating empowering consumers so they can be actively involved in decisions affecting their care.

It's nice to say that we respond to people's needs, but how did they articulate their needs if we don't give them the information and the insight to be able to do that, and that's really been the foundation of the Plantree model. Planetree started as a library 40 years ago in downtown San Francisco. We're celebrating the 40th anniversary of

Planetree, but Planetree wasn't a care model until 10 years into its existence. It was a library in downtown San Francisco because its founder,  Angelica Thieriot had said, look, the only way that the healthcare system would be more responsive to healthcare consumers if we empower consumers and the way you do that is through access to information.

Well, there was no internet. People couldn't google it. So they went and they created a medical library that was staffed by trained medical librarians that was open to the community and created this groundswell of informed consumers. That's what motivated the healthcare delivery system to change, once we empowered consumers to be more involved, to play a more active role in their own wellbeing.

Maintaining a Standard of Excellence

It really resonated with me personally and like most caregivers, I was drawn into healthcare because I wanted to make a difference in people's lives. Frankly I want to do important and meaningful work. And when I started to see-- and I wasn't at the beginning of my career, but fairly early on in my career that the way care was being delivered, the way hospitals operated was doing a disservice not only to patients but caregivers, I felt sort of a responsibility to change it.

Then when you begin to make changes and you see the impact that's having, it motivates you to do more. As Planetree grew on, we were the first affiliate of the Planetree network, there were five models sites. Griffin was the first affiliate, we helped start the affiliate network and then it grew from there. When you create a community of like minded organizations who are trying to change the world, it's very energizing.

So learning from others who are also on the same journey, even if you lost your enthusiasm, we're all very competitive. If the community is moving and you're lagging, even though you might have started this movement, that motivates you or they kind of pull you along.

Because we believe in this, we're kind of evangelists for patient centered care, the individuals that are attracted to our organization, the caregivers that want to work there, come with a certain expectation on how we're going to perform and if we're not delivering on that promise, they don't mind slapping me in the side of the head and say, wait a minute, you're supposed to be patient centered and what you just did is inconsistent with that. So they keep you honest.

Remaining Energized & Driven in  Healthcare

Between community and our caregivers and patients saying, hey, this is supposed to be the Disneyland of hospitals, and Space Mountains not working today. You gotta fix that. Those things together I think really provide the impetus and the energy to continue this work. When I got into healthcare, I remember telling people that I was going to be a hospital administrator and people thought that was pretty boring.

Not very exciting, pretty mundane and I guess it could be if you approach it that way, if you didn't look for opportunities to really change. I like being a disruptor. I've never really accepted the status quo and as long as I have the ability to influence change, I find that sustaining, fulfilling and self-actualizing. And again, being part of an organization like this, that's what all of these people are. They're kind of change agents. So I think that's what, that's what keeps me going.