This document provides an overview of the Picker Institute's Always Events initiative. The initiative aims to promote patient-centered care by identifying aspects of the patient experience, called Always Events, that should always occur when patients interact with the healthcare system. Picker is providing grants to support demonstration projects that develop and implement strategies to achieve specific Always Events related to communication and care transitions. The projects will form a learning network, and Picker will produce a compendium of best practices and tools derived from the projects.

1. ADVANCING EXCELLENCE IN PATIENT-CENTERED CARE
THROUGH EDUCATION, RESEARCH AND THE
DISSEMINATION OF BEST PRACTICES STRATEGIES
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2. About us
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ABOUT PICKER INSTITUTE
Picker Institute is an independent nonprofit organization dedicated to promoting the advancement of patient-centered
care to improve the patient and family experience with the healthcare system, and to assuring that all aspects of the
patient experience will be Always EventsSM that happen for every patient every time.
Picker Institute furthers this goal through support to education, matching grant programs, research in acute and long-
term care, publications on patient-centered care, partnerships with other like-minded organizations and the annual
Picker Awards. Coupled with a strong commitment and an open mind, these have resulted in a diverse and deep range
of projects that have made major contributions to the challenge of making quality healthcare available to everyone at a
reasonable cost.
CoNtENts
About uS 2
ContEntS 2
A LEttEr froM thE ExECutIvE DIrECtor AnD 3
thE ChAIrMAn of thE boArD
thE PICkEr PrInCIPLES 4–5
thE PICkEr AwArDS for ExCELLEnCE ® 6–7
ALwAyS EvEntS SM 8–9
PICkEr rESEArCh AgEnDA 10–12
EDuCAtIon 13
ConvErSAtIonS wIth LEADErS In thE fIELD of 14–17
PAtIEnt-CEntErED CArE
fInAnCIAL hIghLIghtS 18
boArD of DIrECtorS 19
2 for more information, please visit us at

3. opEN LEttEr
2 0 0 9 - 2 010 Pic ker Report
to our friends—
the man who died of pneumonia after a long and misdiagnosed illness in a new
york hospital at the age of 74 in May 2008 was not just anyone. the scion of a
family that could trace its roots back to the founders of this country on both sides
of the tree, he was a broadly accomplished man in his own right. Educated at the
best schools in the united States and abroad, he made a very distinguished name
for himself in journalism, publishing and public television. nor did he rest on these
laurels. he went on to become the president of a well-known college and a very
active supporter of innovations in modern telecommunications.
the man whose dying wife asked him “why does it have to be this way?” when the
drug that could have eased her painful spasms of coughing was not forthcoming
was not just anyone either. the dean of the school of public health at a celebrated
university and a prominent researcher in the fields of AIDS and heart disease, he
was on a first-name basis with many of the first names in healthcare and a second-
name basis with most of the rest of the healthcare community.
nor was the 57-year-old woman who died of undetected kidney failure at a
J. MArk wAxMAn, ESQ.
medium-sized hospital in Chicago just anyone. Laid off as a teacher of at-risk
Chairman of the Board
children in elementary school, and consequently without health insurance and a
primary-care physician, she put off seeking medical attention for her escalating
abdominal pain for as long as she could. when she finally went to the emergency
room, it was too late. but she was a wife and a mother. She loved teaching. She
read avidly, and gardening in the small plot behind her house in one of the city’s
suburbs was her passion. there is no question that had she had insurance she
would have addressed her health issues much more quickly and lived to return to all
the things she loved instead of slipping through the cracks and dying.
how did these people become the accidental victims of a healthcare system
that loudly claims to be the best in the world? what does this say for our current
healthcare system? how is this challenge to be addressed?
At Picker Institute, we believe that everyone deserves an optimal healthcare system,
regardless of means or status. for us, the healthcare debate that is playing out all
over our media is irrelevant. healthcare does not belong to one or another political
party; it is in and of itself an end, a necessity of life every bit as important as food LuCILE o. hAnSCoM
and shelter. we don’t care if healthcare services are delivered by the state, the Executive Director
federal government or a private entity, as long as they at all times measure up
to a standard of excellence that is well within reach in this country but too often
overlooked in the polarized flurry of threats and accusations that, unfortunately,
have come to stand for dialogue in this vital realm of human activity.
the guiding principle at Picker
Institute is that the patient’s
perspective must be central
to the design and delivery of
the optimal healthcare system.
Quality healthcare without
patient-centeredness is not J. Mark waxman, Esq. Lucile o. hanscom
quality healthcare. Chairman of the board Executive Director
www.pickerinstitute.org 3

4. prINCIpLEs
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THE PICkER PRINCIPLES
we believe that all patients deserve high-quality
healthcare, and that patients’ views and experiences are
integral to reaching that goal. Quality care without patient-
centeredness is not quality care. The principles of
patient-centered care are:
Respect for patients’ values, preferences and
expressed needs
Patients want to be kept informed regarding their medical condition
and involved in decision-making. Patients indicate that they want
hospital staff to recognize and treat them in an atmosphere that is
focused on the patient as an individual with a presenting medical
condition.
• Illness and medical treatment may have an impact on quality of
life. Care should be provided in an atmosphere that is respectful
of the individual patient and focused on quality-of-life issues.
• Informed and shared decision-making is a central component of
patient-centered care.
• Provide the patient with dignity, respect and sensitivity to his/her
cultural values.
Coordination and integration of care
Patients, in focus groups, expressed feeling vulnerable and
powerless in the face of illness. Proper coordination of care can
ease those feelings. Patients identified three areas in which care
coordination can reduce feelings of vulnerability:
• Coordination and integration of clinical care
• Coordination and integration of ancillary and support services
• Coordination and integration of front-line patient care
Information, communication and education
Patients often express the fear that information is being withheld from them and
that they are not being completely informed about their condition or prognosis.
4 for more information, please visit us at

5. based on patient interviews, hospitals can focus on three • Accommodation, by clinicians and caregivers, of family and
kinds of communication to reduce these fears: friends on whom the patient relies for social and emotional
support
• Information on clinical status, progress and prognosis
• respect for and recognition of the patient “advocate’s” role
• Information on processes of care
in decision-making
• Information and education to facilitate autonomy, self-care
• Support for family members as caregivers
and health promotion
• recognition of the needs of family and friends
Physical comfort
Continuity and transition
the level of physical comfort patients report has a
Patients often express considerable anxiety about their ability
tremendous impact on their experience. from the patient’s
to care for themselves after discharge. Meeting patient needs
perspective, physical care that comforts patients, especially
in this area requires staff to:
when they are acutely ill, is one of the most elemental services
that caregivers can provide. three areas were reported as • Provide understandable, detailed information regarding
particularly important to patients: medications, physical limitations, dietary needs, etc.
• Coordinate and plan ongoing treatment and services after
• Pain management
discharge and ensure that patients and family understand
• Assistance with activities and daily living needs
this information
• hospital surroundings and environment kept in focus,
• Provide information regarding access to clinical, social,
including ensuring that the patient’s needs for privacy are
physical and financial support on a continuing basis
accommodated and that patient areas are kept clean and
comfortable, with appropriate accessibility for visits by
family and friends. Access to care
Patients must know they can access care when it is needed.
Emotional support and alleviation of fear Attention must also be given to time spent waiting for
and anxiety admission or time between admission and allocation to a bed
in a ward. Focusing mainly on ambulatory care, the following
fear and anxiety associated with illness can be as debilitating
areas were of importance to the patient:
as the physical effects. Caregivers should pay particular
attention to: • Access to the location of hospitals, clinics and physician
offices
• Anxiety over clinical status, treatment and prognosis
• Availability of transportation
• Anxiety over the impact of the illness on themselves and
• Ease of scheduling appointments
family
• Availability of appointments when needed
• Anxiety over the financial impact of illness
• Accessibility to specialists or specialty services when a
referral is made
Involvement of family and friends • Clear instructions provided on when and how to get
Patients continually addressed the role of family and friends referrals
in the patient experience, often expressing concern about the
impact illness has on family and friends. these principles of
patient-centered care were identified as follows:
www.pickerinstitute.org 5

6. pICkEr AwArds
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THE PICkER AwARDS FOR EXCELLENCE®
IN THE ADVANCEMENT OF
PATIENT-CENTERED CARE
the identification and promotion of “best practices” that lead to the
advancement of patient-centered care is an important element in Picker
Institute’s mission. one method of promoting best practices is the recognition
of professionals in the field whose work best exemplifies the Institute’s goals
and philosophy.
the Picker Awards for Excellence® and the Picker Awards and Education
Program were established in 2003 as an educational component of improving
patient-centered care. “our mission is to make the patient’s experience,
whether in a hospital or a doctor’s office, a better one,” said harvey Picker, the
founder of Picker Institute. “the Picker Awards are intended to honor people
and organizations who have made significant contributions to achieving this
goal, and to highlight them as role models for others in the healthcare field.”
“The very act of being nominated 2010 PICKER AWARDS
for an annual Picker Institute Paul D. Cleary, PhD
award demonstrates your Dean, yale School of Public health
commitment to improve the lives
of patients by making interaction Atul Gawande, MD, MPH
with the healthcare system less general surgeon and author
stressful and more comfortable. Arnold P. Gold, MD
The honor of winning will inspire founder, Arnold P. gold foundation
others to do the same.”
Karen C. Schoeneman, MPA
gail L. warden, MhA Deputy Director, nursing home Division, CMS
President Emeritus
henry ford health System
Picker Institute board of Directors
2010 Picker Award winner Dr. Atul
Gawande and Picker Institute board
member Dr. Stephen Schoenbaum 2010 Picker Award winners Paul Cleary, Ph.D., Dr. Arnold P. Gold and Dr. Atul Gawande
6 for more information, please visit us at

7. 2010 Picker Award Winner Paul Cleary, Ph.D., 2010 Picker Award winners Dr. Atul Gawande
and board member Gail Warden and Dr. Arnold Gold
PAST PICKER AWARD WINNERS
2009
Margaret E. O’Kane, President, national Committee for Quality Assurance
Institute for Patient- and Family-Centered Care
Dr. Bill Thomas
2008
James B. Conway, Senior vice President, Institute for healthcare Improvement
Cincinnati Children’s Hospital Medical Center
The MedCom Danish Health Data Network
2007
Edward H. Wagner, MD, MPh, Director, MacColl Institute for healthcare
Improvement
Pioneer Network
Agency for Healthcare Research and Quality Executive Director Lucile O. Hansom and 2010
Picker Award winner Karen Schoeneman
2006
Prof. Sir Liam Donaldson, Chief Medical officer, uk Department of health
Planetree
Karen Davis, President, the Commonwealth fund
2005
Albert G. Mulley, Jr., DMSc, MD, and John E. Wennberg, MD, MPh
Cofounders, foundation for Informed Medical Decision Making
Integrated Healthcare Association
Initiativkreis Ruhrgebeit
2004
Sir Donald Irvine, MD, frCgP, frCP, fMedSci, Chairman, Picker Europe
2003 Dr. Arnold P. Gold and Picker Institute board chairman
J. Mark Waxman
Margaret Mahoney, Past President, the Commonwealth fund
www.pickerinstitute.org 7

8. ALwAYs EVENts™
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OvERvIEW • Care transitions: Patients need an appropriate level of
Picker Institute is dedicated to enhancing the delivery of patient- communication when moving from one provider or healthcare setting
and family-centered care throughout the u.S. healthcare system. In to another (for example, from primary care doctor to specialist, from
furtherance of this mission, Picker Institute has adopted an organizing hospital to home, long-term care or rehabilitation facility and from
principle focused on the concept of Always EventsSM /Always emergency department to inpatient unit).
ExperiencesSM. Always Events are defined as “those aspects of the
patient and family experience that should always occur when patients COLLABORATIvE LEARNING NETWORK
interact with healthcare professionals and the healthcare delivery As the demonstration projects are developed, Picker will support a
system.” collaborative exchange of information among the project teams through
periodic conference calls, bimonthly webinars and e-mail blogs. this
Picker Institute’s Always EventsSM Challenge grant Program provides learning network will be a source of tools and strategies for achieving
matching grants of up to $50,000 each to support the development and the selected Always Events.
implementation of innovative projects that demonstrate how the Always
Events concept can be implemented in practice. the projects are Picker will also support the development of key messages and media
intended to produce strategies, programs and processes for achieving tools, including establishing a presence in online social media networks,
selected Always Events that can be replicated across a variety of to provide communications support for the demonstration projects.
healthcare delivery settings and thus contribute to widespread and
measurable improvements in patient- and family-centered care. BEST PRACTICES COMPENDIUM OF TOOLS & STRATEGIES
At the conclusion of the one-year program, Picker will produce a com-
GUIDING THEMES pendium of lessons learned and tools and strategies derived directly
based on input from patients, families and frontline caregivers, Picker from the research projects to promote and achieve the specific Always
has identified two key areas of focus for Always Events: Events selected for focus in the demonstration projects and to generate
replicable models for adoption and use by other on a national scale.
• Communication: the interactions and exchange of information
between patients and providers, as well as among the team of
providers responsible for a patient’s care, must involve the patient in an
appropriate, patient-centered way; and
ALWAyS EvENTS RESEARCH AGENDA SM
AMERICAN ACADEMy OF PEDIATRICS NORTHEAST vALLEy HEALTH CORPORATION
Project: “family feedback—Always! (ffA)” Project: “team up for health”
ANNE ARUNDEL HEALTH SySTEM PLANETREE/GRIFFIN HOSPITAL
Project: “the SMArt Discharge Protocol” Project: “Same Page transitional Care:
CLEvELAND CLINIC Creating a template for optimal transitions”
Project: “unmet Expectations regarding ICu QUALITy PARTNERS OF RHODE ISLAND
Patient outcomes: Identification and Project: “Enhancing Medication Safety
Management of At-risk families” through Picturerx”
DARTMOUTH-HITCHCOCK MEDICAL CENTER SAINT JOSEPH HOSPITAL FOUNDATION
Project: “Implementation of a Set of Project: “Comfort and Pain relief Menu”
Always Events that will Increase Communication” ST. JUDE CHILDREN’S RESEARCH HOSPITAL
HEALTH CARE FOR ALL Project: “Parent Mentor Program”
Project: “Patients and families UNIvERSITy OF CALIFORNIA–SAN FRANCISCO MEDICAL CENTER
Improving hospital Discharge” Project: “Improving Patient- and family-Centered
INOvA HEALTH SySTEM Care for hospitalized Persons with Dementia”
Project: “Developing a Patient-Centered UNIvERSITy OF MINNESOTA AMPLATz CHILDREN’S HOSPITAL
Approach to handoffs” Project: “MyStory”
IOWA HEALTH SySTEM UNIvERSITy OF PITTSBURGH MEDICAL CENTER
Project: “Always use teach-back!” Project: “Care team twittering and guardian Angels”
LAHEy CLINIC MEDICAL CENTER vANDERBILT UNIvERSITy MEDICAL CENTER
Project: “transitions of Care Partnership Project” Project: “Effective Communication and Collaboration
MARCH OF DIMES with Patients and families for falls Prevention”
Project: “Close to Me” yALE–NEW HAvEN CHILDREN’S HOSPITAL
MASSACHUSETTS GENERAL HOSPITAL Project: “Premature Life transitions: A Patient- and
Project: “Always know your Caregiver/ family-Centered End-of-Life Care Program for neonates”
Always responsive”
for full descriptions and updates on the Always EventsSM projects,
visit http://alwaysevents.pickerinstitute.org/.
8 for more information, please visit us at

9. PICKER INSTITUTE ALWAyS EvENTS NATIONAL STEERING COMMITTEE SM
Cochairs: Katherine Browne, MBA, MHA Beverley Johnson Barbara Packer, MS
Gail L. Warden, MHA, Center for health Care Quality Institute for Patient- and the Arnold P. gold foundation
J. Mark Waxman, Esq. Joyce C. Clifford, PhD, RN, family-Centered Care John Santa, MD
Picker Institute board of FAAN Gregg S. Meyer, MD Consumers union
Directors the Institute for nursing Massachusetts general hospital Gerald M. Shea
Lucile O. Hanscom healthcare Leadership Ken Mizrach AfL-CIo
Picker Institute Eric A. Coleman, MD, MPH vA Medical Center East orange Liaison:
Karen Adams, PhD Practice Change fellows Debra Ness Carolyn Clancy, MD
national Quality forum Program national Partnership for Agency for healthcare
Barbara Balik, RN EdD Nancy Foster, PhD women & families Quality and research
Institute for healthcare American hospital Association Peggy O’Kane
Improvement Thomas James III, MD national Committee for
humana Inc. Quality Assurance
Nancy Foster, PhD
Always Events NSC Sir Donald Irvine, MD
“for me, the most Always Events NSC
important Always “how did we come to
Jennie Chin Hansen Event would be for the Always Events? out
American Geriatrics clinician to ask the of a concern that the
Society patient, ‘what do you scientific excellence
“to strip the dignity and hope to achieve, and of medicine wasn’t
humanity from patients how can we help you always matched by
is just wrong.” get there?’” good care.”
John Santa, MD Bev Johnson
Always Events NSC Always Events NSC Debra Ness
“It’s surprising to me “I like it that this Always Events NSC
how many hospitals concept is targeted to “the goal is to have
and patients are individuals and families it used continually by
reluctant to share their as well as to healthcare doctors to improve the
successes.” professionals.” care they give.”
Susan Frampton
Planetree
“we define Always
Mary Ann Peugeot Events as things
Peggy O’Kane vanderbilt Medical that are important to
Always Events NSC Center patients and families
“A list that’s not too “Always Events are and then we develop
long will enable us what you know is strategies to make sure
to focus on the right always going to they happen as often
things.” happen.” as possible.”
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10. rEsEArCH
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GRADUATE MEDICAL EDUCATION ~ RESEARCH AGENDA
Picker/Gold Foundation
Graduate Medical Education ~ Challenge Grant Program
the Picker/gold graduate Medical Education Challenge grant Program provides annual grants for the research and development
of innovative projects designed to integrate successful patient-centered care initiatives and best practices into the education of
our country’s future practicing physicians.
the Arnold P. gold foundation became a partner in the program in 2009. working together, Picker Institute and the gold
foundation seek to improve the quality of medical education and healthcare delivery by incorporating the patient’s point of view.
2010–2011
BETH ISRAEL DEACONESS MEDICAL CENTER/ PROJECT EvALUATION COMMITTEE
HEBREW SENIOR LIFE
Project: “how Do you have the Conversation? David Leach, MD, Chairman richard frankel, PhD
Picker Institute board of Directors Mary Joyce Johnston, MJ
A Curriculum for residents”
Lucile o. hanscom Adina kalet, MD, MPh
BRIGHAM & WOMEN’S AND BOSTON CHILDREN’S
hannah honor Carl A Patow, MD, MPh,
HOSPITALS/HARvARD MEDICAL SCHOOL
Mr. Max bassett MbA, fACS
Project: “transitioning from Pediatric- to Adult-
Mr. Jim Cichon v. Sreenath reddy, MD, MbA
Centered Medical Care (the Patients’ Perspective)” virginia Collier, MD richard wardrop III, MD
CHILDREN’S HOSPITAL OF ORANGE COUNTy Ms. nettie Engels Mitzi williams, MD
Project: “training Pediatric residents in the Delivery Susan frampton, PhD
of news and the Discussion of Issues related to
Death and Dying in a Pediatric Population”
DARTMOUTH-HITCHCOCK MEDICAL CENTER
Project: Integrating Patient- and family-Centered 2009–2010
Care Principles into a Simulation-based ALPERT SCHOOL OF MEDICINE/BROWN
Institutional Curriculum” UNIvERSITy/HASBRO HOSPITALS
THE JOHNS HOPKINS UNIvERSITy SCHOOL OF Project: “Developing health Care transitions:
MEDICINE/BAyvIEW MEDICAL CENTER A resident Learning Module on building bridges”
Project: “Developing and Implementing a AURORA HEALTH CARE INC.
Patient-Centered Discharge Curriculum” Project: “Screening/Managing Interpersonal violence
MOUNT SINAI SCHOOL OF MEDICINE During Pregnancy at an urban teaching hospital”
Project: “Project PArIS (Patients and residents in Session)” BETH ISRAEL DEACONESS MEDICAL CENTER
RIvERSIDE METHODIST HOSPITAL/OHIO HEALTH “Improving Patient Communication Skills
Project: “teaching Disclosure: A Patient-Centered Among Surgical residents”
Simulation training for the Crucial Conversation” CHILDREN’S MERCy HOSPITAL
UNIvERSITy OF CALIFORNIA–IRvINE Project: “Introducing a family-Centered Care
Project: “humanism in the Perioperative Environment” Curriculum to a Pediatric residency Program/Measuring
UNIvERSITy OF MASSACHUSETTS SCHOOL OF MEDICINE Its Effects on the Centeredness of Pediatric residents”
Project: “home Medication Education and Support DUKE CHILDREN’S HOSPITAL & HEALTH CENTER
(hoMES): A resident Module on home Care for Children” Project: “teaching family-Centeredness in the PICu:
UNIvERSITy OF MARyLAND A novel Approach using Medical Simulations”
Project: “Empowering Patients to optimize their UNIvERSITy OF CONNECTICUT HEALTH CENTER
Medication regimens: A Multidisciplinary Approach” Project: “Communication in family Meetings: Developing
UNIvERSITy MEDICAL CENTER FOUNDATION ARIzONA and Assessing a Curriculum for residents”
Project: “the native American Cardiology Cultural UNIvERSITy OF WASHINGTON FAMILy MEDICINE RESIDENCy
Competency Curriculum” Project: “Creating a Patient-Centered Care Plan (PCCP)
WAKE FOREST UNIvERSITy HEALTH SCIENCES within an Electronic Medical record; and Evaluating the
Project: “Improving transitions of Care for older Adults Impact of PCCP use on Patients and healthcare team
through Interdisciplinary Education for Medical residents” Members”
10 for more information, please visit us at

11. LONG-TERM CARE PROGRAM
Consistent with Picker Institute’s credo that quality of life is as Services for the Aging, American College of health Care
important as quality of clinical care in all healthcare settings, Administrators, American health Care Association, American
the institute inaugurated its long-term care program in March Medical Directors Association, the Coalition of geriatric
2008, taking the mission to promote patient-centered care to nursing organizations and national Consumer voice for Quality
the nursing home and long-term care arena. Long-term Care.
under one aspect of the program, Picker awards grants to “vIvE: DEvELOPMENT OF TOOLS TO IMPROvE NURSING HOME
support initiatives aimed at improving the quality of life in all PROvIDERS’ ASSESSMENT SKILLS”
LtC settings, with the goal of making patient-centered care a
VIVE: the video on Interviewing vulnerable Elders, which was
reality in many more nursing homes throughout the country.
released in July 2010, is a tool to teach care managers how
to interview nursing home residents using the MDS (Minimum
PICKER LTC RESEARCH AGENDA Data Set) 3.0 implemented by CMS in october 2010. As of the
end of March 2011, it had been viewed on the Picker Institute
“ACHIEvING STAFF STABILITy AND IMPROvING and other web sites more than 13,000 times.
PERFORMANCE: A NURSING HOME LEADER’S
GUIDE” “NURSING HOMES AS CLINICAL TRAINING SITES:
the American College of health Care Adminis- RECOMMENDATIONS TO THE FIELD”
trators received a long-term care grant to pro- the goal of this project is to develop and disseminate a module
duce a book on achieving staff stability and to be used as a core training tool in presentations on how to
improving performance. the book, now titled maximize the use of nursing homes as clinical training sites.
Meeting the Leadership Challenge in Long- Recommendations will seek to improve the number, quality
Term Care: What You Do Matters, written by and preparedness of nursing and other academic healthcare
barbara frank, David farrell and Cathy brady, was published programs using nursing homes as clinical training sites, and to
in early April2011. AChCA plans to work with the authors and improve readiness to serve as clinical training sites.
other long-term care colleagues to distribute the book widely
among practitioner and academic networks. “LONG-TERM CARE IMPROvEMENT GUIDE”
following the model of the highly successful
“CREATING HOME: ADvOCATING FOR CHANGE Patient-Centered Care Improvement Guide,
IN HOW AND WHERE WE AGE” published in october 2008, the Long-
In collaboration with its partners, Pioneer network developed Term Care Improvement Guide serves as
this consumer education pilot in response to the growing a practical resource for long-term care
realization that consumer awareness of and advocacy for organizations that are working to become
culture change are critical to its widespread dissemination. more patient-centered.
Partners included the American Association of homes &
Lucile O. Hanscom, Picker Institute, Anne Basting, TimeSlips Dr. Bill Thomas, The Picker Report Christa Holjo, PhD, vA
and Bonnie Kantor-Burman, Ohio on Aging
Health Dept.
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12. rEsEArCH
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A compendium of best-practices tools and strategies, it Shot on location in a retirement community in Milwaukee,
explores the experiences of residents, their families and their wisc., it chronicled the daily life of residents and staff as they
caregivers in long-term care settings across the country and struggled with understanding and implementing revolutionary
highlights practices that have been developed to meet the adjustments in the way the community operated—a process
needs of this population in an environment where expectations, that has come to be known as “culture change.” Lichtenstein’s
preferences and priorities may be different from those in a production company, 371 Productions, will work with rose
hospital setting. Marie fagan of Lifespan of greater rochester, new york, to
convey the film’s lessons about aging, caregiving, end of life
“TIMESLIPS” and culture changes to more than 300 employees through
the mission of timeSlips, by replacing memory with programs conducted in eight rochester-area workplaces. A
imagination, is to bring meaningful, creative engagement consumer engagement project, the program seeks to enlist
into the lives of people dealing with dementia resulting from consumers as catalysts for change.
conditions such as Alzheimer’s disease and stroke, and to
help create person-centered care environments for people “THE PICKER REPORT ON AGING WITH DR. BILL THOMAS”
with dementia. timeSlips envisions a society where people the goal of this partnership, which began in May 2010, is to
with dementia and memory loss and their caregivers have the raise public awareness of and build support for making long-
highest possible quality of life and a society free of the stigma term care person-centered. to that end, the project has taken
so often associated with dementia and memory loss. advantage of the tremendous scope and delivery of the social
media network. bill thomas is known throughout the world for
“THE PICKER PAPERS: A SyMPOSIUM ON his passionate advocacy of elders and elderhood, which he
CULTURE CHANGE AND DINING” believes do not receive the attention or respect they deserve.
the Picker Papers are a dynamic learning using videos, blogs, commentary and news updates on
experience featuring a comprehensive facebook, youtube, twitter and the other social media, Picker
THE PICKER PAPERS background paper and webinars of Institute and Dr. thomas are building a strong connection
A Symposium on
Culture Change presentations by nine of the most sought-after among people who share his and Picker Institute’s vision of
and Dining
minds in culture change and dining. how person-centeredness enhances variety of life and quality
of care in long-term care settings.
“‘ALMOST HOME’ OUTREACH: EDUCATING EMPLOyEES ABOUT
ELDERCARE AND CULTURE CHANGE” In 2009, Dr. thomas was the first winner of the Picker Award
In february 2006, filmmakers brad Lichtenstein and Lisa for Excellence in the Advancement of Patient-Centered Care in
gildehaus made a documentary film called Almost Home. a Long-term Care Setting.
Jim Conway, IHI, and Sir Donald Irvine, J. Mark Waxman, Picker Institute, Lucile O. Hanscom, Executive Director,
Picker Institute and Bev Johnson, IPFCC Picker Institute
12 for more information, please visit us at

13. EduCAtIoN
Picker Institute sponsors educational workshops, summit LONG-TERM CARE LEADERSHIP SUMMIT
meetings, the Picker Lectures and the Picker Awards to further the 2010 Long-term Care Leadership Summit on oct. 5,
its mission of advancing and implementing patient-centered 2010, brought together leaders in the field of long-term
care. care to talk about implementing and advancing culture
change. Speakers included Dr. bill thomas (“the Picker
THE PICKER PLENARy LECTURES
report on Aging in America with Dr. bill thomas”), David
the Picker Plenary Lecture is delivered annually by a Picker farrell and barbara frank (“Meeting the Leadership
Award winner at one or more of the conferences at which Challenge in Long-term Care: what you Do Matters”) and
Picker Institute is present. others. the highlight of the summit was the release of the
Long-Term Care Improvement Guide, a compendium of
2010
best-practices innovations and approaches for initiating
Dr. Atul Gawande and sustaining a resident-centered culture change in
2010 Picker Award for Excellence long-term care and a partner to the very successful
Dr. Carolyn Clancy, Director, AhrQ Patient-Centered Care Improvement Guide published by
2007 organizational Picker Award for Excellence
Picker and Planetree in 2008.
Karen Schoeneman, CMS
2010 Picker Award for Excellence in Long-term Care
2009
Dr. Bill Thomas
2009 Picker Award for Excellence in Long-term Care
2008
Jim Conway, IhI
2008 Picker Award for Excellence
2007
Dr. Karen Davis, President, The Commonwealth Fund
2007 Picker Award for Excellence
THE PICKER PATIENT ExPERIENCE SERIES
Picker’s educational workshops are an essential component
of the institute’s mission to educate the healthcare industry
and the general public to the benefits of patient-centered
care. Picker sponsors workshops at national and international
conferences convened by healthcare organizations like
Planetree, Pioneer network, the Institute for healthcare
Improvement, ISQua and others.
Panel members at the LTC Leadership Summit
Dr. Carolyn Clancy, AHRQ Dr. Elliott Fisher and Dr. Atul Gawande Gail Warden, Picker Institute
www.pickerinstitute.org 13

14. CoNVErsAtIoNs
2 011- 2 01 2 Ann ual Report
CoNVErsAtIoNs I don’t understand abstractions, as a surgeon or as a writer.
In both modes, I need to understand a situation through
wItH LEAdErs knowing what happens to a particular individual. Let me give
you an example: not too long ago I attended a parent-teacher
IN tHE FIELd oF conference at my son’s school. I was interested in meeting
the new school superintendent and asking him what he was
pAtIENt-CENtErEd CArE working on. I thought he’d say educational reform, how to
restructure the educational system. but what he spends his
one of the ways Picker Institute supports patient- time on, he said, is healthcare. As a result of property tax
reform in Massachusetts, his budget for teachers has been
centered care is by recognizing people in healthcare
slashed. At the same time, the cost of medical benefits for
who have made significant contributions to teachers has risen by 9 percent. what is he to do?
achieving patient-centered care worldwide.
A little later I was talking to my son’s math teacher. he couldn’t
Conversations with Leaders in the Field of Patient- quite remember where my son was. with 35 students in the
class and one teacher, my son was disappearing somewhere
Centered Care is a regular feature that highlights
in the middle.
people who have promoted patient-centered care in
their work or through their organization. As I left the classroom, I ran across a teacher whom I’d
operated on for lymphoma. She was tough—she’d survived.
but 5 percent of teachers account for 60 percent of teachers’
total healthcare costs, and I suddenly realized that I was part
A Conversation with Dr. Atul Gawande of the reason my child was being neglected.
Dr. Atul Gawande is a general Seeing these issues in terms of the community where they
surgeon in Boston, Mass., were happening, I could understand the problem: Does great
and the author of several healthcare for this teacher have to bankrupt my son’s future?
internationally best-selling
books on modern medicine, Do you have an answer for that question?
including, most recently,
the Checklist Manifesto, I think hope lies in the bell curve for healthcare costs. there’s a
which reached the New York very wide variation, with most people grouped in the mediocre
Times’s nonfiction bestseller middle. the same is true of quality outcomes: Most people
list in 2010. He has also are in the middle. where I see hope in those facts is that the
been a staff writer at the best results often come at the least expense, and the least
new yorker magazine since expensive care often achieves the best results.
1998, and many of the pieces Dr. Atul Gawande you’re mentioned “community” several times. How
published there about his life important is community, as a concept and as a fact, in
as a surgical resident have achieving the triple goal?
played a larger role in clinical
and political developments in Community matters. there’s always a tension between
the healthcare industry. maximizing revenues and meeting the needs of the
community. In the end, all medicine—like all politics—is local.
At the Institute for Healthcare Improvement’s 22nd Annual the communities that have healthcare systems rather than
National Forum on Quality Improvement in Health Care, fragments of care are getting better results at lower costs.
you participated in a discussion of the “triple aim”: lower
costs and higher quality resulting in better healthcare. As a Central to achieving the triple aim is improving results divided
surgeon and a writer, how do you approach this issue? by lowering costs: reducing emergency room visits, eliminating
14 for more information, please visit us at

15. unnecessary imaging and surgery. the teacher I treated—can 3. Collecting data: weather information, crop reporting,
we take care of her lymphoma by doing less, by making it grading systems.
easier for her to live her life and at the same time giving her the 4. Sharing information through broadcasts, mailers, meetings.
best chance of surviving?
this was not a case of the government taking control but of
What do you think of President Obama’s healthcare local farming communities trying to bend the bell curve of food
legislation? costs. And it worked. by 1930 food was down to 24 percent of
the family budget, and the workforce in food production was
I think it creates great opportunities for developing systems. down to 20 percent. by the 1950s, both proportions were less
however much it is attacked, it provides the tools we need, than 10 percent.
and the question for us is how do we want to use these tools?
Do we want to use them to drive up revenues—and there are a these results were beyond imagining. the abundance in our
lot of people saying that—or do we want to use them to create supermarkets became the best argument for the American
better healthcare systems in communities so healthcare for way of life and was critical to our becoming a superpower,
teachers doesn’t mean sacrificing our children’s future? how with the attendant responsibilities. there were some painful
do we lower costs without compromising the quality of care? dislocations, but no vast foreclosures and social unrest. the
system was created by trial and error, and by focusing on
we can set goals, but is it remotely possible that we can results rather than ideologies.
succeed? I’m a little skeptical that a community of 10,000
people can come together and develop a master plan, and I believe this is a road we can replicate. Like the food industry,
we’re a nation of more than 300 million. but if we start at the healthcare is comprised of hundreds of thousand s of local
local level, we may just succeed. entities. All of them want to provide great care, but they’re
measuring success by revenues.
How?
we’re at a time when hope and belief are sapped out of
At the turn of the last century, a major problem facing this society. there is a lack of belief in the collective possibility of
country was the cost of food. forty percent of a family’s where we can go. with the wrong incentives, the results have
budget went for food, and 50 percent of the workforce was been disastrous. Can it be fixed? no one knows.
involved in producing it. It was a fragmented system in which
the evidence of how to put better food on the table at a lower In order to transform the food system everywhere, we needed
cost was largely ignored. farmers for the most part repudiated to transform it somewhere. that is what we can do with
what they called “book farming.” healthcare, learning from it in the same way, through
In 1903 a man named Seamon knapp, whom we would deride 1. Experiments in financing
as a bureaucrat, defied this logic by making a very simple, 2. Collecting data. the scarcity of reliable healthcare data is
very small change: he persuaded a community of farmers a total embarrassment—we know more about cows than
to choose one of their number to try scientific farming, with we do about how many people died after surgery in the last
the proviso that if the experiment failed the farmer would four years.
be reimbursed for his losses. not only did the experiment 3. Innovation
not fail, but when the community was hit by the boll weevil, 4. Sharing what we learn
the experimental farm survived and thrived. guided by this
demonstrable success, farmers followed suit, and by 1930 I don’t know if the government will step up to the plate. but we
there were 750,000 demonstration farms. A hodge-podge had became the envy of the world with what we can do with food,
come together as a success. and we can do the same in healthcare. It does not seem like it
now, but all those small efforts we are making add up to being
there were four elements that made this possible: the accountable local community, the caring local community,
the organized local community.
1. Making it possible for farmers to own their own land.
2. Adding to the store of available knowledge with
experimental/research farms.
www.pickerinstitute.org 15

16. CoNVErsAtIoNs
2 011- 2 01 2 Ann ual Report
A Conversation with Dr. Arnold P. Gold
Dr. Arnold P. Gold, the winner of a 2010 Picker Award for Lifetime Achievement and Chairman Emeritus
of the board and co-founder in 1988 with his wife, Sandra O. Gold, of the Arnold P. Gold Foundation, was
honored for his lifelong dedication to the advancement of patient-centered care by preserving the tradition
of the caring physician and emphasizing the crucial need for humanism in medicine.
The mission of the Gold Foundation is to preserve the tradition of the caring doctor and advance humanism
in medicine through physician education. Students at more than 94 percent of the schools of medicine and
osteopathy in the United States participate in one or more of the foundation’s nearly two dozen programs.
Dr. Gold is professor of clinical neurology and clinical pediatrics at Columbia University’s College of
Physicians and Surgeons, with which he has been associated for more than 50 years. He received the
college’s Distinguished Service Award in 1998. The author of more than 80 published articles and several
books in the field of pediatric neurology, Dr. Gold has received numerous special awards, lectureships
and professorships and has been a visiting professor at many schools and colleges throughout the world,
Dr. Arnold P. Gold including Africa and Europe.
The Dr. Arnold P. Gold Child Neurology Center at the Morgan Stanley Children’s Hospital of New York-
Presbyterian Hospital, Columbia University Medical Center, was dedicated and opened in 2003.
Dr. Gold received the Lifetime Achievement Award from the Child Neurology Center in 2005 and an
Honorary Doctorate of Humane Letters degree from the Mount Sinai School of Medicine in 2008.
Dr. Gold, you have a stunning resume and a long, long list of more than civility. I maintain that with science alone, we cannot provide
publications, honors and awards. But what was it that piqued your the best healthcare possible, nor achieve the best healthcare outcomes,
interest in your foundation’s mission of preserving the tradition of or fulfill the social contract that medicine has with society. we can cite
the caring physician and advancing humanism in medicine? And all of the reasons—medicine as profit-driven rather than service-driven;
how long was it from the concept to the concrete? the marketing behavior of the pharmaceutical industry; the demands of
managed care with its limited time for communication and relationship-
So how did an academic and a clinician become an activist? In the building; the threats of litigation pitting the doctor and patient on
1980s I became concerned about certain trends in medicine. this was opposite sides, etc.—all forces of our contemporary healthcare system
an exciting time for science and technology, and it was apparent that that have weakened the pillar of humanism.
our fledgling physicians were becoming enamored with that aspect of
medicine. Additional pressures, including limited time for examining your work focuses on children and neurology. In fact, the Dr. Arnold
patients, plus the other stresses of medical economics, distanced P. Gold Child Neurology Center at the Morgan Stanley Children’s
doctors from their patients. because my patients had taught me so Hospital of New york-Presbyterian Hospital, Columbia University
much about the power of relationships and the importance of building Medical Center, was dedicated and opened in 2003. What drew you
trust and respect between doctor and patient, I could not accept a to these fields?
culture in which patients were referred to as “the tumor in room 202.”
though my parents were both lawyers, I set my heart and mind on
Do you feel that these two pillars of the medical profession—what becoming a doctor as a young boy. My family played an early role
one might even call the basic principles—have lost some of their in developing my professional persona. My mother taught me the
stature as medicine has advanced over the past 60 years? To what importance of perseverance and intellectual excellence. My father was
do you attribute this decline in civility? known for his humanism and sensitivity.
when I began my medical career, for many serious, life-threatening beginning with my parents, at each juncture of my journey, I found the
illnesses there simply were no cures. All we had in our black bags was essential mentor or friend who nourished and guided me.
the ability to care. today, with our burgeoning science and technology,
we have made great progress, but “cure” has overtaken “care” as the of my teachers, I especially remember Dr. Margaret Smith at Charity
primary objective in healthcare. I applaud the miraculous scientific hospital in new orleans. My internship at tulane under her guidance
advances of the past half-century. was pivotal in shaping my career. when I entered medicine, the formal
curriculum was rigorous, but not nearly as voluminous as it is now. At
but I agree that we have lost something important—vital, even—in our that time, caring for the sick and dying was often a primary objective,
modern medicine with its medical cures and medical perils. And it is since cures for many diseases were unattainable.
16 for more information, please visit us at

17. In the hot new orleans summer of 1954, I was working literally around here’s what I tell medical students: while the textbook knowledge you
the clock at Charity hospital. It was at the height of the polio epidemic, have acquired over the years is certain to change, your raison d’être,
and we had 35 children in iron lungs requiring constant attention. wards if you will, will not. what will not change—what must not change—is
were not air-conditioned, and electricity was not dependable. Like my your conviction that good medical practice is, and should always be,
mentor, Dr. Margaret Smith, I slept, ate and stayed at the side of my relationship-centered and humanistic. the realities of illness, death and
patients. her behavior was my curricula; her values informed my own. dying require those skills so perfected by your predecessors—those
there were no mixed messages or competing values, as there are who had less to offer scientifically, but who knew how to communicate
today. Doctors did what their attendings modeled. Meeting the needs compassionately and effectively with patients.
of patients—whatever the personal cost—was the norm. Dr. Margaret
Smith, with dedication, inspiration and scientific excellence, led me into Seek to emulate those doctors who display technical competence,
the world of clinical pediatrics. compassion, empathy and trust. Mostly, you can choose the doctor you
want to be.
Serendipity plays such an important role in life. when I came to babies
hospital at Columbia in 1957, I had planned to go to Johns hopkins you and your wife, who founded the Arnold P. Gold Foundation with
to be a pediatric endocrinologist. At Columbia, I met my friend and a you, must have hope for the future of medicine, else you would not
founding trustee of the gold foundation, robert Mellins, who was then be working so hard to disseminate your own beliefs. Do you see
a pediatric resident. bob convinced me to experience a new field called progress? regress? no change in the status quo?
child neurology and led me to one of its founders, Dr. Sidney Carter. one
evening I attended rounds with Dr. Carter, and the rest is history. when we started the gold foundation, we felt a bit like the proverbial
wanderers in the desert in search of an oasis. “humanism in medicine”
Sid was the ultimate and consummate role model–mentor. A brilliant was an amorphous concept, one that few people could wrap their arms
clinician, Sid coupled scientific and diagnostic acumen with humanistic around. no one was talking about humanism, and we felt very much out
care at the bedside. under his influence, I decided to become a child there, on the fringe. but we were encouraged by a buddhist notion: “not
neurologist in spite of my uncle’s warning that “this new field will never all who wander are lost.”
give you a single patient.” throughout my more than 50 years as a
physician, I have tried to emulate this extraordinary man and to follow now here we are, more than two decades later, and the landscape has
his example. changed. humanism and professionalism are no longer an inspiring
indulgence. Certification requirements instituted by the u.S. medical
As I reflect on the experiences that have taught me the most about licensure agencies stipulate that in order to graduate, medical students
doctoring, I realized that my patient-centered practice was born from and residents will have to demonstrate humanistic and professional
those early and essential role-model mentors, the explicit and implicit behaviors as part of their core medical competencies. And we are
expectations that patients come first and foremost. beginning to see this same requirement for recertification of doctors in
practice.
What would you say to today’s medical students to remind them of
what medicine really is: caring for other people and trying to cure So we are optimistic ... and hopeful. there’s no denying that we’ve left
their ills? Can patient-centeredness be taught? the desert. but we must also remain vigilant to insure that relationships
and human beings remain at the center of any healthcare interaction.
My entrance into medical school held the promise of new discovery. but
from experience I learned that each discovery is replaced by the next,
that papers and books “age out” and that the single most important read the entire Conversation with Dr. gold at www.pickerinstitute.org,
aspect of my life has been the relationships I have enjoyed.
Paul Cleary, PhD, Dr. Arnold Gold, Dr. Atul Gawande and Mrs. Sandra Gold Lucile O. Hanscom and Dr. Arnold P. Go.d
www.pickerinstitute.org 17

18. FINANCIAL
2 011- 2 01 2 Ann ual Report
2010
STATEMENT OF FINANCIAL ACTIVITIES
totAL rEVENuE $1,770,403
totAL EXpENsEs $1,740,734
Programs 1,051,740
European offices 134,860
Meeting & Conferences 80,899
general & Administrative 367,215
Professional fees 106,021
NEt INCoME $29,669
EXPENSE PROGRAM EXPENSE
ALLOCATION
Professional fees
6% Programs
60% Awards
12%
general &
Administrative
21% Education
14%
Meetings &
Conferences
5%
European offices
8%
grants & Contracts
74%
18 for more information, please visit us at

19. boArd
Lucile o. hanscom,
left, executive director
of Picker Institute, with
board members, from
left, gail warden, Sam
fleming, David Leach,
J. Mark waxman,
Stephen Schoenbaum
and Sir Donald Irvine.
PICkER INSTITUTE
BOARD OF DIRECTORS
J. Mark waxman, Esq., Chairman
Samuel fleming, treasurer & Secretary
Stephen C. Schoenbaum, M.D., vice Chairman
Sir Donald Irvine, M.D., f.r.C.g.P., f.r.C.P., f.Med.Sci.
David C. Leach, M.D.
gail warden, M.h.A.
Lucile o. hanscom, Executive Director
11 Main St., 4th floor
P.o. box 777
Camden ME 04843-0777
tel 1.207.236.0157
1.888.680.7500
fax 1.207.236.3570
email info@pickerinstitute.org
web www.pickerinstitute.org
HARVEY PICkER
founder, Picker Institute
December 8, 1915–March 22, 2008
“understanding and respecting
patients’ values, preferences and
expressed needs is the foundation
of patient-centered care.”
www.pickerinstitute.org 19