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Introducing Optimal Healing Environment to AUBMC

by Talar Aynedjian

Mihran Aynedjian

on 4 February 2017

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Transcript of Introducing Optimal Healing Environment to AUBMC

Optimal Healing Environments, Serendipity and AUBMC

Presented to Dr. Micheal Clinton
and Dr. Huda Huijer

By Talar Aynedjian

April 2014
A project submitted as partial fullfilment for MSN NURS 528

Definition of an Optimal Healing Environment (OHE)
Background and Significance , Samueli Institute, OHE Model & Elements
Literature Review: Magnet Hospitals & OHE Models
Methodology : Evidence Based OHE checklist & Force Field Analysis for OHE at AUBMC

Defining Optimal Healing Environment
Optimal Healing Environment (OHE) is the science of healing the body the mind and the spirit

It is a holistic approach newly developed and adapted in hospitals in the United States for patients to guide them to perform healthy behaviors and thus provide them optimal healing environment to enhance and accelerate their recovery
Smith et al. 2009

OHE is composed of four main elements which are as follows:
Internal: developing healing intention and experiencing personal wholeness
Interpersonal: cultivating healing relationships and creating healing organizations
Behavioral: promoting healthy lifestyle and applying collaborative medicine
External: building healthy spaces, fostering ecological sustainability
Smith et al., 2009
Nightingale wrote “ People are multidimensional, composed of biological, psychological, social and spiritual components”

She focused on sanitation and ventilation of patients’, the body and mind connection and that the environment played a core role in a patient’s holistic healing process such as utilizing colors, adding natural light, and eliminating noise
Nightingale, 1969
Background and Significance
OHE is an integrative medicine which
focuses on the whole person

There is growing evidence which indicates a significant relationship between specific health care environments (green environments), improved patient care, satisfaction and healthcare outcomes
Horrowitz, 2008
SI is a Non-profit research organization
that explores the scientific foundations
of healing and applies its research
findings to health care.
Samueli Institute defines healing as the process of recovery, repair and return to wholeness
After multiple meetings and symposiums, conducted by SI, with distinguished scientists, clinicians, and patients nationwide a common belief was shared about OHE:

"Healing is a crucial aspect to managing chronic illness and the basis of sustainable approaches in health care"

Smith et al., 2009
SI added that there was a need to
identify nurses’ perceptions of healing environments in order to understand
and create optimal healing

Nurses need to be spiritually well
themselves in order to be positively
present to patients
Dunn, 2010
The Samueli Institute (SI) emphasized the essential role of nurses as the primary workforce in hospitals

Nurses’ professional role is to deliver holistic care and become key agents towards optimal change

In 2009, SI joined forces with nursing organizations to shift care delivery from curing towards healing

When comparing conventional biomedical interventions that emphasize cure with the holistic OHE healing model, Samueli Institute creators , cited the following challenges:
Depersonalization of persons by technology and specialization
Increasing need to treat chronic disease as the population ages
Patient dissatisfaction
Escalating costs
Professional burn out

Literature Review
A multidisciplinary approach is essential to improve healing and enhance healing process for patients, families, and health care providers
Rubert et al., 2003
Horrowitz, 2008
Nurses provide healing environments and achieve positive
patient outcomes when they combine OHE elements such as:
• Decreased environmental noise
• Increased air quality,
• Implementation of open/unrestricted family
• Physical comfort
• Decreased stress
• Effective communication and appropriate multi-
disciplinary approaches to patient care delivery

Magnet Hospitals & OHE Models
Although AUBMC has not adopted the OHE philosophy, the Nursing Department Services chose a Professional Practice Model (PPM) that supports OHE elements and principles.

The AUBMC PPM is based on Jean Watson’s Caring Model, which defines, supports and promotes the holistic patient care.
Watson, 1979
Therefore, the AUBMC PPM is entirely consistent with the four OHE elements.

Challenges to Progressing OHE at AUBMC
Creating a supportive self-healing system rather than perpetuating a medically oriented system of health care

Extending the meaning of evidence-based practice, to encompass when appropriate CAM

Establishing collaboration and open communication among all health care providers

Empowering patients to participate in facility and service planning

OHE is a guiding framework for improving health care and has been identified as a core element of the healthcare of the future.

An evidence-based checklist has been developed and found useful in assessing progress towards OHE at Lebanon's leading medical center, AUBMC.

Thank You

Changing awareness of OHE at AUBMC.

Creating the intention to adopt OHE elements in accordance with the AUBMC PPM for nursing.

Capitalizing on the helping factors and overcoming the hindering factors identified in the Force field analysis
(Lewin, 1979) conducted as part of this study.

The checklist can be used by other organizations to assess their progress towards OHE and to identify the further actions required to achieve an environmentally sustainable healthcare facility.
The checklist will be particularly useful to organizations applying for Magnet designation.
Rubert et al., 2003
Today’s healing environment requires a
patient centered care which includes a pleasing physical setting and a supportive organizational culture
Malkin, 2003
OHE Initiatives noted by SI included :
Common values of health as the basis of
body-mind-spirit interrelationships
Patient-centered relationships
Organizational cultures that support
personal growth and mastery
Availability of
and alternative medicine (CAM)
Physical environments that supports healing

OHE Evidence-Based Checklist

An evidence-based checklist was developed to assess progress towards OHE in acute hospitals.

The checklist was used to conduct a gap analysis that recognizes AUBMC accomplishments in OHE and identifies areas for improvement should AUBMC choose to embrace OHE.

Again it is important to emphasize that AUBMC has not adopted the OHE philosophy.

Therefore, what follows
must not
be interpreted as criticism of AUBMC

Prospects for OHE at AUBMC
Promoting OHE in healthcare facility would assist the organization to optimize patient, nursing and organizational outcomes.

Consistent with Magnet designation, official adoption of OHE at AUBMC would contribute to patient safety and quality improvements and capitalize on the potential of nurses and others to involve patients and families as stakeholders in planning for the future.

It is important to note that OHE elements are interrelated and to improvement today will allow further progress to follow tomorrow.

AUBMC‘s 2020 vision is exemplary, but it lacks an explicit healing dimensions. Should OHE be an objective for the organization to achieve, much will be gained if change starts today.
Magnet Hospitals
Magnet designation recognizes excellence in patient care delivery
Kramer et al., 1991
Magnet hospitals invest in nurse staffing levels, continuing professional education and work environments that achieve better patient outcomes and lower mortality rates
Bird, J., 2013
Magnet Hospitals are successful in attracting and retaining nurses by providing a quality work environment
Smith et al., 2009
Magnet Hospitals
8% of U.S. hospitals are magnet designated

Magnet recognition stimulates positive organizational behaviour that improves patient outcomes
Bird, J., 2013
NCCAM defines Complementary and alternative medicine as a group of diverse medical and health care interventions and practices that are not generally considered part of conventional medicine
CAM reduces stress, enhances healing, decreases infection rates, increases staff and patient satisfaction and lowers hospital operating costs
Geimer-Flanders, J., 2009
Recommendations based on OHE elements in AUBMC
Provide sessions to AUBMC staff and administration on OHE and the positive outcomes of OHE.

Integrate OHE with the AUBMC 2020 vision.

Educate undergraduate and graduate AUB medical, nursing, and public health students OHE and their application to hospital and community healthcare. (France et al., 2011).

Promote Magnet environment and AUB and AUBMC events and activities that enhances OHE

Encourage all AUB and AUBMC staff and members and clients to practice healthy behaviors to create healthy environments and foster OHE in AUBMC.

Promote CAM at AUBMC since based on literature it helps at creating healing intentions and healing environments such as music-therapy, aromatherapy, acupuncture, massage therapy, yoga, hypnosis…

Provide CAM which is believed to be integrated significantly in the future of medical practice (Masson, 2005)

Foster and market the AUBMC 2020 vision since it constitutes a significant part of further establishing AUBMC as the preferred referral medical center in the region.

Establish AUBMC as the lead site for OHE in Lebanon and in the region.

Follow Lebanese Ministry of Environment and Ministry of Public Health requirements for fostering ecological sustainability.

Market and enhance the adoption of LEED at AUBMC which fosters green psychology and green environment as well as AUBMC 2020 vision.

Promote the AUB Nature Conservation Center activities and events as well as Faculty of Agriculture events at AUBMC and UHS activities, University for seniors, and EHSRM projects and activities.

Put more effort into creating green spaces and natural views around AUBMC due to their high importance for fostering healing (AUBMC 2020 vision).

Exceed the requirements of Lebanese Ministry of Environment laws which require assessment of the external environment

AUBMC Achievements based on OHE elements

Internal :
Developing Healing Intentions and experiencing

personal wholeness

Launch of enhanced Neuroscience and Cardiovascular services (including Holistic Headache Clinic and enhanced screening for Cardiovascular Disease)
Workshop on Integration of CAM in academical offerings at AUB (Master degree program) initiative taken by UHS and NCC
CME office conferences and educational offerings
Patient Affairs Office : patient satisfaction survey, patient advocacy, patient education , International case manager
AUB University for Seniors activities and events, Faculty of Public Health and community outreach services
Department of psychiatry at AUBMC, and Embrace fund activities and events
Research and publications, IRB
HR initiatives
Nursing department efforts : RN satisfaction surveys, Magnet, CPDC
HR : Award recognition, workshops on leadership , communication skills
Community services
Ongoing conferences, educational offerings : nursing rounds, medical rounds, mandatory sessions, exams
Magnet designation, shared governance and collaborative council, knowledge development and research
JCI accreditation
AUBMC 2020 vision : Centers of Excellence
MOH accreditation
AUBMC Patient affairs functions and efforts

Cultivating Healing Relationships
and Creating Healing Organizations
The AUBMC Professional Practice Model for Nursing
Green oval , green field at AUB, green spaces
Green Project Management course by CEC
Faculty of Engineering and institutional studies of traffic congestion and parking.
Green Mind Award EHSRM for Waste Management project
EHSRM efforts : REVA , First aid workshop for AUB safety warden, Stay safe Journal
AUBMC 2020 vision : LEED , advanced eco-friendly buildings
Nature Conservation Center (bee keeping, tree planting, awareness events)
Faculty of agriculture events and activities (organic food, AUB farms)
Practicing Healing Lifestyle and
Applying CAM

External :
Building Healing Spaces and
Fostering Ecological Sustainability
AUB University Health services, including the Wellness Program, acupuncture, smoking cessation, wellness fair...
Women's health program
Lebanese International Nutrition conference
AUB/AUBMC sports teams
Magnet Chain Committee activities (Run for Excellence, Board presentations.)
Beirut Marathon yearly participation: Medical, Nursing team
AUB student participation in the Olympics
Assembly Hall music concerts, including choir, dance festivals, AUB outdoors, West Hall events
Hostler Center Fitness Programs (with personal trainers)

OHE Evidence-Based Checklist
The purpose of this project is to examine how a gap analysis can be undertaken to determine priorities for the implementation of Optimum Healing Environments (OHE) in acute hospitals.

An evidence-based checklist was developed and used to identify OHE priorities for AUBMC to achieve should it formally commit to developing as an Optimal Healing Organization.

Force Field Analysis is then used to assess the feasibility of acting on the identified priorities.

The study concludes with recommendations that will be submitted for consideration by AUBMC administration.
Smith et al., 2009
Essentially a literature-based study, no systematic collection of primary empirical data.
Case study of one organization only
No formal commitment by AUBMC to OHE
Progress towards OHE at AUBMC has depended on serendipity
Champions for OHE have not yet made the voices fully heard

Force Field Analysis Diagram
American University of Beirut
Talar Aynedjian
Assistant Nurse Manager
Full transcript