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Griffin Hospital by VP8177

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									Intensive Care
Author:David H. Freedman
Source: Inc magazine - February 01, 1999


URL: http://www2.inc.com/app/Clickcount?type=normal&cntatt_id=726&url=http://inc.com/incmagazine




By asking its customers what they wanted and then giving it to them--giving it all
to them--Griffin Hospital radically reformed its culture in a change-allergic
industry

Looking spiffy in a white jacket, Charlie is getting ready to perform rounds at Griffin
Hospital. He's adhered to the basic standards expected of hospital staffers: he's freshly
bathed; his teeth have been brushed. But Griffin is a bit more demanding of its caregivers
than some hospitals are, so Charlie has also been carefully appraised by his supervisors for
both disposition and height. Height is a concern because if Charlie were too short, patients
would have to lean out of bed to reach him; too tall and he'd be frightening. But Charlie,
who happens to be a dog, is just tall enough to place his slightly moist muzzle on the edge
of a bed for convenient, nonthreatening petting.

A few obvious questions probably spring to mind. But let's just skip them for now, and
instead simply note that Charlie is by no means the oddest thing you'll see at Griffin
Hospital. In fact, it's hard to know where to begin or end, oddity-wise. The music in the
parking lot? The double beds? The magic act in the patient lounge? The banana muffins
baking in one of the cozy kitchens found on every wing of every floor?

Businesses routinely embark on grand campaigns to satisfy the customer, to please the
customer, and in the most recent escalation, to delight the customer. But delighting
customers is easier said than done, as will be revealed by a quick check of your own delight
level the next time you're in the middle of a business transaction. Imagine, then, what it
would be like if the customers you were supposed to be delighting were widely considered
the most inherently miserable ones around. Further imagine that you had to do all this
delighting while changes in your industry were sucking per-customer revenues down a black
hole--and while far bigger and better-heeled competitors were frantically merging with
similar companies to create far, far bigger and better-heeled competitors that were hell-
bent on stealing market share away from you.

In other words, imagine you were a community hospital.

How, then, to explain the fact that at Griffin, which serves a mix of the modestly white
collar and the working-class ethnic in south central Connecticut, patient satisfaction has
soared to 96%--an astounding level in any industry, and one that's almost unheard of in the
hospital business? Not coincidentally, Griffin has boosted admissions an average of 2% a
year over the past four years, with healthy revenues and cash flow--and all while being
within coughing distance of no fewer than seven fiercely competing hospitals, including the
world-renowned Yale-New Haven Hospital.

Griffin's secret? A clear, three-step recipe that any organization can follow to similar
success. First, cultivate a decade-long obsession with reconceptualizing every element of
the business around customers' desires. Second, implement the resulting insights with the
sort of thoroughness and attention to detail usually reserved for, say, manned space flight.
And finally, be really, really nice. All the time. To everyone.

But if Griffin's journey has proved just how basic the formula for real business
transformation is, it has also demonstrated why most companies attempting even a modest
metamorphosis usually fall short. Qualities that most managers would consider the building
blocks of a successful business--stability, reasonable compromise, moderation, careful
prioritization--are also the very qualities that forestall radical, lasting change. What Griffin's
homegrown, do-it-yourself makeover suggests is that it is extreme, uncompromising
behavior--in Griffin's case, extreme common sense--that makes real change possible.

For nearly 80 years, nonprofit Griffin Hospital had been able to count on the steady
patronage of the citizens of Derby, Conn., where it's located, and the surrounding towns. It
was a population bound by tradition and by its dependence on the gritty rubber and metal
mills that were the core of the community's economy. But in 1985 a new highway joining
two of the state's main commuter routes passed right through town, and suddenly Derby
was just a convenient commute away from New York City, Hartford, and other faster-paced,
more affluent locales. Factories closed, and companies like Tetley Tea and Pitney Bowes
moved in. Over a period of four years, housing prices tripled as many old-time residents
sold out to young corporate marrieds.

And Griffin started losing patients at an alarming rate. The newcomers all seemed willing to
travel 10 or even 30 miles to be cared for by Griffin's competitors. To find out why, Griffin
commissioned a survey of local residents. More than a quarter of the respondents labeled
Griffin a hospital "they would avoid." The reasons given: the medical staff was lacking, the
facilities were shabby, the parking was inadequate. Oddly enough, many of the people who
leveled the harshest criticisms also noted they had never so much as driven by the hospital.
"How did they know parking was a problem if they had never even been here?" asks Bill
Powanda, vice-president of support services. "We realized the sort of effect that word of
mouth was having." (Powanda's life has been so linked with Griffin's history that he can
actually say he was born in his office--the space he occupies was once part of the maternity
ward.)

In 1987, when Powanda was starting to ponder the question of how to counter the hospital's
bad rep, his father-in-law was admitted to Griffin with terminal stomach cancer and a
bleeding ulcer. Right at the unfortunate man's bedside, the doctor told Powanda and the
rest of the family that the ulcer was inoperable, and the appropriate thing to do was to stop
the blood transfusions that were barely keeping him alive and let him die. Powanda's father-
in-law suddenly spoke up. "Is it OK if I have something to say about this?" he asked.
Everyone looked at him. "I'd rather die on the operating table, if you don't mind." Suit
yourself, the doctor told him. The operation was surprisingly successful, and though the
man died 18 months later, he went home to his family that next week, feeling well.

At about the same time, another vice-president at Griffin was in a serious car accident and
was hospitalized for nearly three months in Hartford. Meanwhile, the wife of Griffin's then
CEO, John Bustelos, went into a diabetic coma and died at Griffin; a Griffin vice-president
lost a breast to cancer; and the father of then Griffin assistant administrator Patrick
Charmel--Charmel is now Griffin's CEO--suffered a heart attack and was hospitalized on
Long Island.

When the executive staff members were finally back mulling over Griffin's image problem,
they happened to compare notes on their personal run-ins with the medical establishment.
They reached an immediate consensus: hospital experiences were significantly more
unpleasant than they ought to be. To figure out how Griffin could do better, and maybe win
new patients out of it, they decided to go back to their potential customers for more
detailed research.

But which customers? Griffin's board wanted the executives to focus on geriatrics, noting
that the population was aging. But Charmel, then a rangy, softspoken but direct 27-year-old
who essentially ran the hospital's day-to-day operations while CEO Bustelos focused on
starting up a Griffin health-maintenance organization, had his eye on obstetrics and
maternity. "I figured we should catch them while they're young," says Charmel. "Then we'd
automatically get them later, when they're old." The board gave in.

Griffin passed out detailed questionnaires to its obstetrics patients, as well as to new and
expectant mothers who had chosen to use other hospitals, and ran focus groups. After a few
months the executives had assembled an impressive maternity wish list. For example, not
only did mothers want their husbands there during delivery, but many wanted their children
and their own parents in the birthing room, too. They wanted rooms that didn't look like
hospital rooms. They wanted double beds, so their husbands--or whoever--could sleep next
to them. They wanted Jacuzzis. They wanted big windows and skylights. They wanted fresh
flowers. They wanted big, comfortable lounges where the family could gather. They wanted
nurses who paid close attention to them and doctors who followed up on problems.

Now it was time to draw up plans. "We knew what our customers wanted," says Powanda.
"So we figured all we had to do was find a hospital that offered these things, and then just
imitate it." Charmel had one of the female managers stuff a pillow under her dress, and the
two of them visited every obstetrics and maternity ward within an hour's drive, posing as
expectant parents who wanted to tour the facilities. At the same time, other managers
searched through industry literature to identify the half dozen or so hospitals in the country
with the best delivery and maternity reputation, and then flew out to visit them. Then the
team members gathered again to compare notes and select the hospital that would serve as
their template for customer satisfaction. The winner was...nobody. "So we decided we'd
build it ourselves," says Powanda.

It seemed obvious to everyone involved that the first step should be to prioritize the wish
list and winnow it down. After all, some of the ideas, like allowing children in delivery
rooms, seemed goofy. Some, like skylights, seemed frivolous. Some, like Jacuzzis, seemed
downright dangerous--since any obstetrician could tell you that bathing during labor carried
a risk of infection. As for double-size hospital beds--well, they didn't even exist. And how
was the hospital supposed to change the behavior of doctors and nurses, who tend to be
fiercely protective of their routines? The team had the various ideas written out on flip
charts around the room, and they were arguing and crossing out, then arguing some more
and crossing out some more. Suddenly, Charmel spoke up. "Why are we doing this?" he
said. "We asked them what they wanted, and they told us. Now let's just give it to them."

After a stunned pause, someone said, "You mean, all of it?"

"Yeah," said Charmel. "All of it."

The new obstetrics and maternity unit opened in 1987. It had rooms where families could
gather. It had fresh flowers. It had skylights. It had a Jacuzzi. (Research revealed that the
concern over infection was a myth.) It had custom-built double beds. It had birthing-helper
classes for children and grandparents. And it had "primary-care nursing"--each patient was
the responsibility of a single nurse who would make sure that all the patient's needs were
met and that the doctors were taking care of business.

Patient response was immediate and enthusiastic. But some of the nurses complained to
Charmel when a swarm of family and friends took over one of the communal rooms for
pizza parties or late-night card games. "Excellent," replied Charmel. "That's what the room
is there for." Some staffers complained when a husband got off the late shift at the factory,
headed over to the ward, and climbed into the double bed with his wife, waking up mother
and baby. "What's going to happen when we discharge her tomorrow?" replied Charmel.
"He's going to come home from the late shift and wake his wife and baby up. As long as
they're not complaining, we might as well let them get used to it here." Several of the
obstetricians, meanwhile, grumbled about having to be at the beck and call of patients.

Obstetrics admissions doubled over the next few years. And along the way, not only did
most of the nurses get used to the extra demands of the wing, but they started to like
them. Turnover among the nursing staff, always a problem at Griffin, started to drop. And
the nurses were even taking it upon themselves to find more ways to cater to the patients.
For example, they came up with a program that offers a free exam of mother and baby back
at the hospital three days after discharge--or at the mom's own home, should a hospital
return be inconvenient. Ninety-six percent of mothers were soon availing themselves of that
exam, and in one-third of the cases a nurse identified a problem that might have otherwise
gone untreated, such as jaundice or lactation difficulties. Perhaps most amazing of all, only
a small percentage of the patients asked to have a nurse come to their homes to conduct
the exam; they all seemed perfectly happy to drop back by the hospital.

Some of the obstetricians never did get used to the new order, however, and they moved
on. In the past, such doctor vacancies were crises for Griffin because of the difficulty in
attracting good physicians to a tired, old-fashioned facility. But now the hospital found that
top-notch obstetricians, including younger and female doctors often favored by expectant
mothers, were actively seeking Griffin out. What's more, because the new unit's philosophy
was clearly established, the doctors who signed on tended to be physicians who preferred
working in this new "patient driven" model. "Our environment was becoming a recruiting
tool," notes Lynn Werdal, vice-president of patient-care services.

None of which meant that Charmel's next suggestion didn't come as a surprise when he
threw it out to the executive team, in 1990.

"Can we build an entire hospital like this?" he asked.

Yes. They could.

As I stand at the edge of the Griffin Hospital parking lot, listening to the classical music
being piped through nearby loudspeakers, someone approaches and cheerily asks if I've
forgotten where I've parked. This is Phil Landona, an outgoing, middle-aged man who
serves as a parking-lot guard and, given that he's often the first Griffin staff person a
patient sees, as a general putter-at-ease. He often personally leads people into the hospital
and then back to their car when they leave. He strikes up an easy conversation before
wishing me a good day.

No matter how much you've been warned that Griffin doesn't look like an ordinary hospital,
or how carefully you've followed directions inside, or even if Landona has personally led you
by the elbow, you can't help wondering if you've made a mistake when you enter Griffin's
lobby. Think of the lobby of a high-powered law firm: expensive-looking wood; curving,
sophisticated structures; and an energetic, pleasant, and efficient-looking young
receptionist sitting alone behind a massive desk, smiling at you as if you were the moneyed,
tough-to-please client whose arrival the firm has been frantically preparing for over the
course of weeks.

Speaking up a little to be heard over the near-concert-quality player piano that's running
through a light jazz number off to the side, I tell the receptionist the name of the person I'm
there to see, and she enthusiastically suggests that I simply keep walking straight ahead
down the one corridor leading out of the lobby until I come to the central registration area.
As I walk along the handsomely appointed hallway, I notice there are no signs on the wall to
direct me to any of the various wings or specialties. At the central registration area, which
resembles a bank president's waiting room, I ask a man in a suit to direct me to an office.
"Sure, follow me," he says.

This is pretty much the experience any patient has when he or she shows up at Griffin. The
outer lobby and central registration area act as a pleasant funnel in which it is virtually
impossible to become lost or to avoid being greeted. Once you've registered, someone will
lead you to the appropriate wing--it's not good enough to merely give you directions.
Pointing is actually banned in hallways. All this, of course, is in place of the more common
experience of entering a crowded, noisy, disorienting lobby and trying to follow signs to a
particular ward. "No one's going to give you high marks for having good signage," explains
Powanda. "Being taken to your unit by a person is something you remember."

Throughout the hospital, corridors are generously trimmed in maple and nicely carpeted
(special wheel bearings were brought in to keep gurneys from bogging down in the thick
pile), and they feature warm, indirect lighting. There are no gurneys, wheelchairs, crash
carts, or food-tray dollies lining the corridors. There are no public-address-system pages or
announcements or gongs. "Pat hates noise and clutter," says one nurse, "Pat" being
Charmel. "He gets really annoyed if he sees a piece of equipment sitting outside a room."

The rooms are furnished at a level of taste and comfort roughly equal to that of a typical
upper-middle-class hotel. Some rooms are outsized, with couches that fold into double
beds. Those are the "care partner" rooms, in which family members who help provide care
are allowed to stay with the patient. None of the rooms is more than a dozen feet or so
from a nurses' station.

Nor are they more than 100 feet or so from a well-stocked, home-style kitchen open to all
patients and visitors 24 hours a day. Sometimes patients cook as a sort of therapy; one
patient who was a chef cooked dozens of complete Thanksgiving dinners while waiting for
his appointment with surgery. Some families gather in the kitchen, put on a pot of coffee,
and then make life-and-death decisions that somehow would be that much harder in a
hospital room or hallway or lounge.

Everywhere you turn at Griffin you see similar unhospital-like touches--touches that were
mostly inspired by ideas solicited from Griffin's customers. But remaking the hospital at
large to suit the needs and whims of its customers was a task on a different scale from that
of redoing the maternity wing.

In a way, Griffin had been cherry-picking when it focused on maternity--that is, it had
selected the easiest target, the one most likely to meet with success. After all, expectant
mothers tend to be young, robust, and upbeat. They generally aren't actually ill, are in the
hospital for only a few days, don't require extensive treatment, and tend to provide good
revenues, relative to what they cost the hospital.

Providing an emotionally satisfying, minimally inconvenient experience to a broad
population is a different story. Patients are typically senior citizens who can be hard to
please under the best of circumstances, let alone when they're suffering from heart attacks,
having parts of their bodies removed, or fighting for breath through failing lungs.
Nevertheless, the Griffin team again prepared community surveys and focus groups to
determine what it would take to make people in that age group like a hospital.

Again, the resulting wish list was staggering. They wanted nice furniture. They wanted
kitchens. They wanted carpeting. They wanted nurses by their beds essentially all the time--
it turned out that elderly patients often pressed the call button not because anything was
wrong but just to make sure someone was out there just in case. They wanted unlimited
visits at any time from anyone and everyone. They wanted their pets to visit. They wanted
spouses or family members to have beds to sleep in right there in the room with them and
help take care of them. And they wanted a better understanding of what was happening to
them, medically speaking.

Again, Charmel said, Let's do it. The hospital was operating in a 60-year-old building that
hadn't been renovated since 1969; it was due for a new building. Why not design it to meet
all these newly identified needs?

Extensive community-hospital building projects need approval from a state commission, and
the commission literally laughed in Charmel's face when he told its members how he wanted
to spend some of the money. But the commission finally agreed to let Griffin do what it
wanted, as long as it did it for no more than the average cost of adding on a similar-sized
conventional hospital building--about $145 a square foot. "To do this right, we had to go
first-class on everything," recalls Powanda. "We just had to find a way to go first-class really
cheaply."

It threatened to be slow going. Simply coming up with a basic layout for the new rooms,
normally a boilerplate sort of process, turned out to be a painstaking experience. The design
not only had to meet patient demands for a homey, nonthreatening feel but also had to
accommodate medical equipment and extensive gas and plumbing fixtures, and provide
convenient access and movement to nurses, technicians, and the housekeeping staff, along
with their equipment. The management team and the project architects sketched ideas,
then employed a computer-aided-design system, then played around with cardboard
models, and finally built a full-scale mock-up of a hospital room in a warehouse across the
street from the hospital. Hundreds of patients, staff members, technicians, builders, and
board members paraded through the room, each one carrying a "ticket" with which to
submit ideas for modifications. "We must have moved the sink six times," recalls Charmel.

Charmel personally picked out furniture, favoring warm, semicontemporary wooden designs.
He even selected the hospital's trash cans. "I'm usually pretty hands-off with my staff," he
says. "I feel I'm just here to listen to their problems and help get obstacles out of their way.
But sometimes I do get obsessed with certain details." And with bargain hunting, too: after
he had found the designs he liked and purchased one of each from area stores, he had them
all stuffed into vans and brought to furniture manufacturers in Pennsylvania to get them
knocked off at about a third of the retail price.
No detail seemed too unimportant to fuss over. Handrails were tried out in a bewildering
variety of materials, shapes, and heights. "You'd be amazed at the difference a slight
adjustment could make in a patient's impression," says Charmel. Hospitals almost always
go with stainless steel, but Charmel insisted on wood for its added warmth--not to mention
the fact that it cost less. Fluorescent lighting was banned. "It makes people look sick,"
explains Powanda. "Patients already look sick."

When executives told focus groups they were planning on going with all private rooms, they
expected nothing short of applause. But senior citizens sometimes frowned at the news.
Under closer questioning, some of them--especially those who lived alone--confessed that
for them, having a roommate was one of the few perks of a hospital stay. OK, asked the
team, what if we had some double rooms for those who wanted them? More frowns--they
didn't like the lack of privacy in double rooms. But didn't they just say they didn't want
privacy? No, replied the senior citizens; they said they wanted the companionship of a
roommate, not a lack of privacy. And while you're at it, they said, make sure nurses don't
have to walk by our beds to get to our roommates' beds, and that we don't have to cross by
our roommates to get to the bathroom, and that we don't end up staring at a wall while our
roommates get a nice window view. "The politics of double rooms can get kind of
complicated," notes Charmel.

Impossible seemed more like it. No one could think of a way to design a double room that
met all those criteria. But one manager spotted a peculiar double room in a trade journal,
went to check it out while vacationing in Florida, and upon his return excitedly described the
room he'd seen: L-shaped, with the two beds arranged at right angles to each other, each
along one of the two limbs of the L. Because the room entrance and bathroom were located
at the bend of the L--the entrance on the outer bend and the bathroom on the inner--
caregivers could enter and walk directly to either bed, and neither patient would have to
walk by the other to get to the bathroom. The patients' views of one another were partially
blocked by the outside walls of the bathroom, which jut into the room somewhat. Fiddling
around with the layout, the team hit on the idea of placing cabinetry at the bend that
further blocked the patients' views of each other, as long as one or both beds were in the
flat position, offering privacy. But if both patients felt like a little companionship, they could
raise the heads of their beds, angling themselves forward enough to visually clear the
obstructions and see each other. Unfortunately, putting a window at both ends of the room
was out of the question; there would have to be a single window in only one patient's half of
the room. But the team figured out a compromise of sorts. If they placed the window
directly alongside one of the beds, then the patient in that bed would be close to the
window but would have to turn to the side to see it, while the patient in the other bed would
be farther from the window but would have a straight-ahead view of it. When the full-scale
mock-up was tested, it got a thumbs-up.

What to do about giving patients better access to nurses? In almost all hospitals, every wing
has a central nurses' station, which typically means that some patients are located the
hospital equivalent of a block away, which raises their anxiety. The solution: abolishing the
central station and instead creating individual nurse workstations around which four rooms
are arranged, fanlike. That way, each patient can look out along his or her bed and see the
primary-care nurse sitting some 15 feet away. Some of the nurses objected, insisting they
needed to be near other nurses to constantly share information and just to socialize to ease
the pressure of the job. But Lynn Werdal wasn't having any of it. "Hospitals had always
been arranged around the caregivers' needs," she says. "But this was all about the patients'
needs."
Still, Charmel and the team wondered, could the very nature of nursing and doctoring--that
is, the culture of medicine--be changed to suit patients?

When people say hospital environments can be highly infectious, they usually mean it in a
bad way. Not in the case of Griffin. Dropping by one of the kitchens is a good way to see
why.

Baking muffins in the oncology-unit kitchen today is Maureen Bolde, a senior citizen who
regularly volunteers to come by and do what she can for the patients. "When my husband
was alive, he was sick here, and the nurses were so wonderful to us, I could never pay
them back," she says. She tells the story of the time one of the nurses asked her if she
knew how to change her husband's dressing. She told the nurse she had done it several
times. Show me, the nurse said. At first, Bolde thought the nurse hadn't believed her and
wanted her to prove that she could do it correctly. But then she realized the nurse was
watching so she could learn and imitate Bolde's technique--the nurse felt that having
different styles of dressing might make the man uncomfortable.

Bolde is one of 400 regular volunteers, all of whom feel pretty much the same way she does
about Griffin. Some lead patients to rooms. Some hold their hands before and after surgery,
and in some cases during surgery. Some staff a "room service" program and run around
meeting requests for snacks, books, videos, slippers, and anything else a patient cares to
ask for. A volunteer once fielded a call from a patient who had been rushed to the hospital
on April 14: Would the volunteer mind getting the patient's tax forms from her car and
bringing them to her accountant across town? The forms were filed on time.

Patients, predictably, are high on Griffin. John DelPrete, a 28-year-old small-engine
mechanic and Derby resident who bears an extraordinary resemblance to the late comedian
Chris Farley, is sitting in a lounge, about to be discharged after battling back from a blood-
platelet disorder. "The last time I was in a hospital," he says, "I was five years old, and my
parents couldn't see me until they got off work, and then the nurses made them leave at 8.
This time my best friend got off work after midnight, and he was here until 3 a.m. It was
great."

DelPrete says he used to be uncomfortable thinking about illness, his or anyone else's. "I
was the biggest guy on the football team, but I passed out at the sight of a needle," he
says. But, like all Griffin patients, he was encouraged to look over his charts, was offered
literature about his illness, and took part in a detailed "case conference" the day after his
admission, in which nurses and doctors discussed where he stood now, what tests needed
to be performed, what was likely to happen based on the test results, when he could expect
to leave, and what might happen in the coming months and years. Now DelPrete matter-of-
factly quotes the rise and fall of his platelet count over each of the last few days as if he
were an intern. "My nurse, Jane, gave me a real positive attitude," he says. "Now I see the
light about taking care of myself." He nods with his chin at the corner of the lounge where
his three-year-old-daughter, Alexandra, is playing.

Praise also goes to the large health-resource center, open to the public, which has medical
books aimed at laypeople and computers linked to health-related Web sites. The medical
library where doctors do their research is adjacent to the resource center and is open to the
public, so it's possible to find patients and visitors sitting next to doctors, leafing through
medical journals. And though state regulations require too many shots and grooming
procedures to make it feasible for patients to receive visits from their pets, Griffin has
brought a half dozen or so dogs like Charlie up to code to soak up patients' surplus
affection.

Patients point out that they are constantly being bombarded by unexpected acts of
kindness. "I ran into someone from our environmental [housekeeping] staff today wheeling
a patient down the hall," says Werdal. "She had seen him sitting there, so she just left her
work, took over, and brought him to where he needed to go. Every employee of this
hospital is considered a caregiver, whether they're processing bills in accounting or cleaning
labs."

Most of the resistance to Griffin's openness with information has long since faded among the
medical staff. "A lot of doctors thought that letting patients see their charts would lead to
lawsuits," says Dr. Kenneth Schwartz, Griffin's medical director. "But we haven't had a
single bad experience that's come out of it." Werdal recalls the time a patient was due in
one of the labs for an echocardiogram but didn't feel well enough to be moved. "The nurse
in the lab just decided to wheel the machine down to his room and do it there, even though
no one had ever done that before," she says. "She didn't feel she had to ask my or anyone's
permission, and I like that."

Charmel and the rest of his team refuse to stand still. Though its reputation for sheer
pleasantness is attracting a growing number of patients from outside the immediate
community, Griffin is aiming for a national market by establishing niche services within the
hospital. One of those is a comprehensive pain- and headache-treatment center, in which,
among other things, tiny pumps are surgically implanted next to patients' spines to provide
a steady, measured flow of narcotics. Another is a hyperbaric wound-treatment center,
where patients are placed in high-pressure, high-oxygen tanks that speed the healing of
difficult wounds. Perhaps most remarkably, Griffin has even managed to construct an
intensive-care unit that provides virtually all the same patient-wish-list items, including
private rooms that are only slightly less hotel-like than the ordinary ones. To keep patients
accessible to visitors without restricting doctors' ability to rush in for emergencies, for
example, each room provides a door at opposite ends: one that opens onto a nurses' station
and the other opening into a lounge area from which family and friends can enter anytime
they wish, day or night.

In the view of Charmel and his team, such relentlessness in continuing to drive change
through every aspect of Griffin's world is not overkill. It's a fundamental requirement, the
alternative being an inevitable backsliding into compromise and convention. In Charmel's
eyes, there is no middle ground to transformation: you either take it to a wild extreme and
never stop pushing the envelope, or you fail altogether.

Griffin's managers are also looking to boost revenues by turning some of the hospital's
practices into products. Last year Griffin formally absorbed Planetree--a seminal-but-failing
consultancy that promoted health-care ideas like those developed at Griffin--by acquiring its
debts, and the hospital now plans to quickly implement Planetree's agenda. Michael Gaeta,
a former alternative-health-care consultant whom Charmel has put in charge of Planetree,
says he's already begun aggressively promoting the organization's services to other
hospitals in the United States and even around the world. With a $100,000 marketing
budget--up from Planetree's previous allocation of a few hundred dollars for photocopying--
Gaeta has produced slick brochures and videos and is constantly leading delegations of
visiting hospital staffers around Griffin. In the first six months after the acquisition, Gaeta
signed up four new hospitals as Planetree affiliates, each of which paid $20,000 for the first
year of membership and then $15,000 a year thereafter. Griffin has also started selling
how-to videos to other hospitals, such as one on how to set up a volunteer-based room-
service program, which sells for $300.

What's next? Charmel won't speculate on more distant plans, but one Planetree consultant
notes that when she travels with some of the Griffin crew, they often end up noting, in a
half-joking way, that airports sure could use some humanizing. "But," she quickly adds,
"there's still a lot of work left to do in health care."

								
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