How Joe DiMaggio Children's Hospital's focused on person-centered care and physician burnout to earn Planetree award

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With hospital turnover a pervasive issue in healthcare, affecting everything from patient care to an institution's bottom line, Joe DiMaggio Children's Hospital in Hollywood, Florida found a way to keep its staff happy and focused: Back massages.

And food. And a voice. And a whole lot of other things.

For years, the hospital has molded its philosophy around the concept of "person-centered care," a culture that promotes the inclusion of patients and staff in key decisions, and seeks to treat both contingents with the ultimate respect -- a personal approach that has reduced physician burnout, improved care and earned a coveted gold certification from their partners at Planetree.

Planetree is a nonprofit group that partners with healthcare organizations around the world to promote better care and better treatment of patients and staff; a gold certification is rarified air for any hospital. In Joe DiMaggio's case, the honor is extra special: They're the first children's hospital in the world to have achieved this designation.

The strides creating a positive workplace for staff comes at a time when more than half of U.S. physicians report feeling burned out. Earlier this year, a Medscape National Report on Physician Burnout and Depression found that nearly two-thirds of U.S. physicians report feeling burned-out, depressed or both, with one in three admitting that their feelings of depression have an impact on how they relate to patients and colleagues.

Physician burnout can hurt the bottom line. Research has shown, for instance, a consistent relationship between higher levels of physician burnout and lower levels of patient safety and quality of care. Quality of care is increasingly tied to reimbursement as the industry moves away from fee-for-service and toward value-based payment models, and a more consumer-oriented framework.

Joe DiMaggio has focused on things both large and small, shaping a workplace culture that seeks to reduce stress -- a philosophy that predates its involvement with Planetree. The back massages, offered to physicians, nurses and pharmacists no matter their shift, is a part of that. Recognizing the quality of their work, and involving them in key organizational decisions, contribute to the culture as well

"Our work is stressful, and even to decompress for a few minutes is very helpful," said Bella Cabrera, Joe DiMaggio's chief nursing officer. "If you're happy to come to work, then it's not going to be work."

Sara Guastello, Planetree's director of knowledge management, said this workplace culture has a direct impact on the quality of care the hospital's young patients receive.

"They're widely recognized as a great place to work," Guastello said. "I think that's really relevant here, because when it comes to what we hear from patients and family members in how well they're cared for, what they're also feeling is the fact that staff is deeply connected to the purpose of the work they do. It makes all the difference in terms of the workplace culture. Their voice matters, there are opportunities for them to share ideas, and they're encouraged to provide constructive criticism.

"Burnout compromises the patient experience in general," she said. "You've got to care for the caregiver. Staff can't give what they don't have."

When it comes to the patients themselves, including them in care decisions, no matter how young they are, has been an integral part of the approach. A council of former patients and their families was established, and along with a youth advisory group, has worked alongside hospital leadership on recommendations to create a more playful, healing environment.

"That included the menu kids needed to have," said Cabrera. "They're the ones who said, 'We need to have room service.' If a child wants chicken fingers at 7 in the morning, that is allowed. If they want chocolate mousse, they can have it. Over time, we really had to fine-tune the menu. We improve our care and processes pretty much on a daily basis."

Patient and family advisors are even part of the process when hiring new employees. While Cabrera said it's easy to hire people with the right head, it sometimes requires input from actual beneficiaries of care to find people with the right heart.

Even the youngest patients are engaged in meaningful ways. Nurses and physicians will ask them directly what they think will best help them understand their situation -- whether it's by reading or by having staff draw them a picture. If they're old enough to be engaged on any level, the staff will find a way.

Another big change: No more strict visitation hours.

"We had strict visitation, especially in the intensive care unit," said Cabrera. "Over time, we really have opened our visitation. We don't have visiting hours in the children's hospital. We even had to change the language. We realized the families are a part of the care of their children; we had to change the verbiage and realize they're not 'visitors.' They're there to spend time with their loved ones," she said. "What we have accomplished is trust."

To achieve Planetree's gold certification, two representatives from the nonprofit spent a few days observing and speaking with physicians, nurses, patients and families. Planetree's recommendations were limited to fine-tuning the processes, since so much of the person-centered philosophy had already been applied.

"Even for a high-performing organization, it can be really valuable just to have that fresh set of eyes and take note of how things are really going," said Guastello, "because when you're in a situation day in and day out, you can become sort of homeblind to what's going on, which could be a positive or a negative. You become hyper-focused on the task and then lose sight of the bigger picture of, 'Is this working for staff? Is this working for family members?'

"Also," she said, "when you're in that setting, you can become a little desensitized to your own strengths. You bring in a fresh set of eyes and they can highlight what you're already doing well."

Currently, Joe DiMaggio is working to expand its brand, not just in the tri-county area but internationally. The hospital is exploring the idea of selling the brand in the nearby Caribbean islands, banking on its burgeoning reputation as an institution that places a high premium on patient care.

"We chose to be in the healthcare field," said Cabrera. "Our patients did not choose to be sick. We owe it to them. Anything we can do to alleviate their suffering, let's do it."