We've had a tremendous discussion going on in the topic:
Genius in Action -- Creating a Model for a Community Wellness Center
One of the areas that's come up as fundamental to any wellness model is a designation that's been called, "The Empowered Patient." Others have discussed self-determination and a patient-first focus. This topic is so critical, it seems, to our ability to really contemplate a new model, that I would like to invite us to use this topic area to explore more deeply what this really means in terms of a wellness model.
What is an empowered patient? How might a system be created to truly accomodate and serve this notion? How is an empowered patient different from our current notion as patients or those who serve patients?
Please chime in... I have the feeling we're really getting down to the some of the real bare fundamentals now. Let's see what we can discover together!
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Also remember there's another active topic regarding utilizing our genius to solve social issues. You'll find this topic directly below or by clicking this link:
Global Genius -- Creative Solutions for a Crazy World
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Wednesday, August 8, 2007
Genius Out of the Box -- Creating the Empowered Patient
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In responding to this topic's challenge (and, as a result to some of the comments in the previous healthcare topic), I'd like to raise a point that I remember Christopher provided in a workshop that he presented to my team.
ReplyDeleteHe suggested that the empowerment process can only function effectively when a person has the genuine capacity to perform what we are expecting them to perform. By capacity (and I'm reading my notes from his workbook), he suggested that this includes a past history of demonstrated performance by the person, as well as the skills, attitude, support, ability, etc.).
If we apply that same definition to an "empowered patient" that means that each patient will be at a different place along the empowerment continuum (with some being very competent and capable of fully managing their own care and making well-informed choices; while others may still be accustomed to a more parental relationship with their medical practioners and thus will need additional facilitation, training, education, coaching, etc. in order to move along this continuum).
My concern, when we start addressing the idea of patient empowerment, is that we will think that people are empowered because we say they are. As Christopher said in our course, waving a magic wand and saying, "You are now empowered," does not mean that someone is. If we do not incorporate this understanding into our model, we'll be doing a huge disservice to our patients and to the our staff.
Hopefully I've not misrepresented Christopher's ideas regarding empowerment. If so, please feel free to correct me.
As you can see, I'm still focusing on my comments from the past topic, because as much as we have made some great strides by getting back to the patient, I am concerned that we not delve into area this naively.
It may be tacky to quote myself, but to refresh the point, I previously mentioned that...
"Bottom line: Any plan that intends to create a more self-deterministic approach to healthcare, which I have heard echoed here repeatedly, must also simultaneously create: (1) a patient education system and an accountability system that requires patients to attend to their own health and education – and that requires the medical establishment to provide such an education before requiring patients to make uniformed decisions; and (2) a means of solving the apparent dilemma that arises when the economic incentive for a patient is removed."
Thoughts anyone?
Hey TN, wondered if that was you in the last topic (since you seemed to be part of JJ's entourage). You're right on the money, though. What you've described is pretty much verbatim what we covered in our empowerment discussion (glad it left a favorable impression and that the workbook's still useful -- that's always nice to hear).
ReplyDeletePersonally, I found that this understanding has helped me immenseley when considering a variety of scenarios where we are wanting to partner with people and create solutions. Your suggestion of applying it to an empowered-patient model makes good sense to me.
Like you, I'd love to hear other people's take on the matter.
Since TN has led the way with quoting themselves, I'd like to do the same for the purposes of this discussion.
ReplyDeleteIn the previous wellness topic I raised the following points:
"How do we put the responsibility for healthcare in the hands of the consumer?
How do we determine when a person is ready to make a healthcare behavior change?
Bottom line: I would propose that people change when the benefits of changing a behavior exceed the resistance – it’s an economic model.
Accepting responsibility for one’s own healthcare and making the necessary behavior changes that can impact health are all part of this self-management."
The concept I put forward in those comments is not merely theoretical. Several of our client companies implement this model currently. For example, the company agrees to cover all of the healthcare costs for their employees except for a minimal amount (for example a full family only pays $200 per month for a $0 deductible policy).
The employees can further reduce that cost by demonstrating that they are proactive in terms of their wellness. They demonstrate this by maintaining the correct weight; following a proper diet (assistance and guidance is provided by an on-staff nutritionist); not smoking or taking drugs; keeping their glucose levels, cholesterol, etc. in check; taking appropriate vacation time; and by participating in any of a variety on-site exercise programs and relaxation programs offered for next to free by the company.
In other words, by taking ownership of their own health and thus receiving healthcare credits for each criteria they meet, the employees can reduce their healthcare premium down to $0 per month.
We have found that this type of incentive is very helpful and rewards responsible behavior and good health. In other words, if the person is doing everything in their power to remain healthy and utilizing the resources (educational, nutritional, exercise, etc.) that are available to them, they are a lower risk and therefore benefit by receiving wellness credits.
It should be noted that the company is an essential and key component in this equation, for it must commit to the employees’ well being and provide the education, coaching, and assistance to support the effort. Thus, I belive that this model precisely fits the description of empowerment that TN descrbied.
Not surprisingly, the companies who follow this model not only save substantially on their overall healthcare costs (even with all of the additional benefits added in), but also save tremendously by having far less absenteeism and unwanted attrition.
I think this same type of model could be adopted for a community wellness center as well... and I'm excited that we're discussing this because I've seen it work... and work well!
I have been very much moved by the letter from Skye in another topic. She speaks for the man Rizzin. What she says for him is most essential and we should hear it profoundly. This is what we must understand here. It is at the very heart of our journey together. Talk of empowered patients is without true merit unless we see to the very heart of this matter.
ReplyDeleteI copy her words and hope this is permissible. I sense, she will understand and trust in my efforts.
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Skye said...
Rizzin's been real sick lately... but he still reads this blog every day. After I read him what had been written the last two days, he told me something that I thought you would all enjoy. So I asked him if I could write it down for you. The words as I'll share them aren't as wonderful as if he'd written it himself... but if you know him, you'll be able to understand what he said to me:
"If one day you awoke... and realized that I was you... you were me... that we were each a very real part of each other... how could we not take care of one another?
"If one day we awoke to discover that we are IT... and IT is we, me, you... all of life in every form... how could we not take care of this planet... and ensure that this rare and amazing thing called life... which creates... and feels... and sees... and contemplates... and is enraptured with awe... how could we not ensure that we protect it in every way possible."
He's so happy that you are all talking about these things and that some of you understand what he's been trying to say.
I send you his love and mine tonight.
Sincerely,
Skye
----
Please read and seek to grasp this humble message. I cannot think of a better way to say it. We must be able to transmit this message in our every action. This most assuredly must be our path.
Peace to each of you,
Trinh
Trinh, I don’t' know you, but I've always been inspired by your words. This time, though, I'm a little confused.
ReplyDeleteIt's not that I don't find the words of this young woman touching, for they are very moving indeed. However, you then said in response that, "Talk of empowered patients is without true merit unless we see to the very heart of this matter."
Now perhaps I'm too sensitive and am taking this personally, but it seems that with regard to the organizations I referred to, their talk has turned into very positive action. They've chosen to do what they've done out of a genuine desire to do the right thing for their people. I'm not sure that they share the precise spiritual values that you describe and yet I'd say that their talk of empowered patients is of real value and genuine merit.
To discredit their actions simply because they share a different philosophy (or maybe even a different degree of the same philosophy) seems counterproductive.
Can you clarify my thinking or help me understand what you mean by your words?
Sincerely,
Michelle
I don't mean to be ganging up on you, but I too am curious as to where your remarks are leading, Trinh.
ReplyDeleteMichelle called me this morning uncharacteristically upset (largely on our behalf) after having read your comments. She was asking me for input regarding her commentary, since she did not want her words to come across too defensively. I admire her desire to seek balance and her willingness to provide me with some feedback in regard to this response as well.
To our point, my friend Trinh, you and several others have kept driving your position home with the incessancy of a dripping faucet -- and perhaps not incorrectly. I think, however, that for we who are more oriented toward the western mind, we may feel like we've been inspired and we get the point. What follows is our national desire for something actionable.
In a previous topic I wrote the following:
"We should constantly ask, “How do we take care to the individual?” Not, “How do we bring the patient into an institution?”
“We should also think radically about the relationship between the individual and their own healthcare. The 20th century relied upon a hierarchical relationship between a physician and a highly dependent, passive patient.
“If we are to avoid an ever-increasing epidemic of late disease, individuals will have to take more accountability for their own health -- something that has been shown to be extraordinarily difficult to do."
In reference to Michelle's comments, since we are one of the organizations to which she referred, we have spent the last five years creating a wellness program within our organization. All of us have worked consistently to ensure that this program and the other humane ethos we have put in place within our organization have become institutionalized as simply our way of being.
We have watched the transformation of our organizational culture and of the mindsets of our people. They now, with some exceptions that we continually seek to assist, have become empowered patients who are accountable for their own health and well being and who feel a genuine responsibility toward one another as well. We firmly believe that the actions we have taken are the responsible steps that we must take in our role.
To provide further context as to our mindset in this regard, I also previously entered the following commentary in this blog:
“So, can we contemplate a society where the upcoming generation has a better understanding of their health in a practical, objective, and jargon-free manner? Can we dare to hope for a system that meets the needs of all people as opposed to an increasingly select few?
“We must. It is that simple. Though the task may be monumental at first, we must marshal all of our technological innovation, capacity, and ability and combine these with a level of committed compassion that may surpass our current reach. Nonetheless, it is our duty and our call as members of the human race.”
You seem to suggest, however, that we are still missing a vital component. I am all ears and have my heart wide open, my friend. What more are we missing about this point that you and others seem so ardently dedicated to?
If you are going to keep playing the same hand, perhaps you need to be more willing to be fully open about your concern. Your subtly seems to be lost on many of us and is beginning to seem almost patronizing. I am sure this is not your intent and so I am inviting more full disclosure.
Trinh, others --- please don't hold back.
WC, Michelle, I get your frustration... but I trust there is a reason behind these comments made by Trinh and others. And it's totally cool that you're asking the big "why, what's up" questions.
ReplyDeleteThis scene kind of reminds me of a story that one of my teachers used to tell me when I'd get frustrated with my practice. It goes like this...
"There is no East or West, North or South," said the master. "These are merely names given to the sky by one to another who is seeking their way home."
"But if there are no directions, how does one know which way to go?" queried his student.
"Ah, but more importantly," said the master. "How does one know there is somewhere to go? Perhaps we are already there."
Now that still tweaks my reptilian brain... and my college educated, multi-degreed mind as well. And I readily admit that I'm guessing... cause that's the kind of girl I am... but that's what I think the point is. Are you catching my drift?
We're all in such a hurry... that the meditation crowd have twised our old motto into a clever little saying to get us to stop for a half a second. They say, "Don't just do something. Sit there!"
I think that's the point my network darlings.
Love you all intensely,
JJ
JJ is most kind, but I fear others have seen the truth. Trinh is old and foolish. One must always remember this. English is not the best language for my mind. Therefore, one may wish to disregard all of what this old man says.
ReplyDeleteOne question remains in mind, however, for which I seek an answer. Perhaps you may assist me in understanding. If we have grasped the deepest essence of what this man Rizzen has spoken, if it has permeated our hearts, why continue to make proof of the value of this path by saying it is good for our business?
Dollars and cents seem to have a strong power in this conversation. Might they have the final word? What if they say, no? Will the plan be set to one side? Everyone will most certainly understand if we could not afford to care.
But I am still not sure. I could be very naïve to ask. If one does a thing that is right by its very nature, must it also be justified by what is right for business? There are other laws working as well perhaps? Could it be that life itself has its own laws? Are they so subtle, so profound that we often do not see?
I believe these questions are the restless dog that will not settle in my mind. I keep raising this question and it has grown tiresome for some. Perhaps I might sit longer. Maybe the dog will grow tired of me and visit another house and all will be fine.
Thank you for being patient with me and hearing my thoughts.
Peace to all of you,
Trinh
My appreciation and respect to all for maintaining your honesty and civility even among the thorns.
ReplyDeleteJJ and Trinh, you have said a few well-placed paragraphs what it would have taken me 10 pages to say much less potently.
I believe that we are in the process of identifying the biggest issue that divides this discussion, the issue whose presence keeps the great ideas proposed by folks like WC and Michelle from taking hold. I believe that what appears to some of us as a tiresome rehash of the same ideas might instead be an effort to encourage the discussion deeper, to a level it almost never goes and which, as Trinh is beautifully suggesting, it very much needs to. I think we would be very well served, after taking a few well-deserved breaths, by an honest, clear, and hopefully friendly dialog about the relationship, or perhaps the conflict, between healthcare-as-marketplace and healthcare as....well....healthcare. It seems to be the 800 lb. gorilla that everyone is trying to talk around. Instead, shall we invite him to the discussion? Do we have the stones and the patience for that?
I do not believe the keys to new understanding in this area are exclusively held in any one camp, but that some are held in all, and so I will echo JJ in suggesting that perhaps what is emerging here, rather than an argument, is merely a picture of the "East, West, North and South" of that same sky that all of us are ultimately living under.
For my part, I hope with all my heart that Trinh's "restless dog" will never grow tired of us.
And Rizzin....well, you already know.
BKO, I think you have some cards up your sleeve that you're not playing. If there's a gorilla in the room, it's time to flush it out into the open. Clearly there are some of you who are seeing this more clearly than I am.
ReplyDeleteI am sincerely requesting that we take this conversation to what ever level necessary to get to the bottom of this matter.
Please, let's not waste any more time dancing around the issue. As we say in Chicago, "Time to play ball!"
With respect,
WC
Hmmm... Play ball! Now that could take on a lot of meanings.
ReplyDeleteUsually when I've had an executive, who's up the ladder from me, tell me to play ball, it means that they'd like me to forsake my own values, please - - because they're getting in the way of the company's goals. (With the implication being -- or else they'll have to demote or fire me).
You don't mean that kind of play ball, do you WC?
DJ, no that's not what I meant by, "Time to play ball." It's an expression that the ballpark announcer used to say, when I was a kid, just as a game was about to get started. I was using it to elicit the same feeling since I'm hoping we're about to engage in a fun, action-packed round.
ReplyDeleteSounds like like you've worked for some real bastards before. Sorry to hear that. A little piece of advice -- don't carry the chip on your shoulder everywhere you go. It's like a magnet for bastards.
Yeah, sorry about that. I know I carry an attitude. Didn't mean to put it on you (well, I did, but it wasn't right).
ReplyDeleteThis ought to be the one place I can assume good intent...
Master Trinh, you are a real character, aren't you? I always find myself enjoying a delightful mixture of laughter and learning when you write. The day you become too old and truly foolish, I'll send you a memo advising you of such.
ReplyDeleteWC, I think there's a great point that Trinh raised that I'd like to re-interject here, before BKO or anyone else provides a genuine response to your challenge. I'll present it in the form of several questions:
Is your organization currently profitable?
Has it been profitable (or not below breakeven) throughout the years during which you have provided your wellness program?
If so, what would you do if you had a less fortunate year, where your profits evaporated and you fell into the red?
What if your board of directors asked you to diminish the program because it was eating into the profitability?
I am genuinely curious as to what your answers might be (realizing that asking anyone to respond to hypotheticals has lately been ruled unfair in the U.S. political debates -- How surprising, right?).
Are you "game" to play and contemplate some answers, my friend.
Respectfully,
Silvio
Michelle,
ReplyDeleteI am, like Silvio, also curious as to the answers you may supply to his questions, and I have a couple of additional questions:
What happens if an employee does not want to take advantage of these offers from the company? Is it a requirement that all employees participate in this program? And, where does the time come from to participate? Can employees take work time to see a nutritionist?
I am sure you can tell where I am heading. What I want to know is whether the company would offer said programs sans profitability (which, in essence, is just rehashing Silvio's questions, I realize).
Anonymous, Trinh, and others:
ReplyDeleteI appreciate the emphasis you are placing on the basic fundamentals here. And I recognize, as has been stated by WC, that we most assuredly have something to learn from your deeper understanding of this area.
I would like to invite you, as well, to set aside some of your skepticism and open yourselves to the possibility that there is good work being done already. Could it be better? Yes. Is it miles ahead of the status quo? Yes.
To answer your questions, Anonymous, I'll refer to information that does not represent WC's company, as I am sure he will answer for his own organization.
First, to your question as to employees being required to participate in the wellness program, the answer is, no. While they are certainly encouraged to do so, and we make every reasonable accommodation to make it possible for all, we also recognize that due to certain cultural, religious, and personal reasons participation in our wellness programs is sometimes not appropriate or best for everyone.
The time for participating in our programs, in all of the companies with whom we work, is company-paid time. Employees are given several break times throughout the day (which they often did not have prior to our program) and their supervisors are required to help them figure out ways to attend the various programs, if the employees so desire (this could include a visit with a nutritionist, medical advisor, an exercise or yoga class, a meditation class, etc.). They also may use the break to do whatever other company approved activity in which they choose to engage.
Employees are also offered healthcare insurance for any doctor or practitioner they choose (no networks) and are often able to have $0 dollar deductible coverage for their entire family for an average price of $200 per month (dramatically less than the national average). The employees, however, do not have to enroll in the healthcare insurance program. As mentioned in my other commentary, the employees are also able to earn wellness credits that can reduce their health insurance costs down to $0 per month by meeting certain wellness goals (they can meet these goals on their own or with the assistance of the company provided programs). The goals include areas like weight, cholesterol levels, glucose levels, walking, muscle tone, body fat ratios, etc.
Now, as to profitability, we are in the U.S. and that means that companies are profit-driven and that they answer to stockholders. Regardless of one’s views on American capitalism, however, we view those facts as conditions precedent and we deal them in the way we must to ensure that the wellness of employees is protected as much as we possibly can.
How do we do that? We so by making a business case for wellness. The facts are that companies who enroll in or create their own effective wellness programs experience increase productivity, decreased absenteeism, increased retention, and an easier time recruiting top talent.
To that end, we also encourage work-life balance programs and help organizations establish flexible work schedules wherever possible, work-from-home programs, and encourage organizations to grant employees 15 hours of vacation from day one (with employees eventually being able to garner up to 30 hours of vacation over time). This is virtually unheard of in most U.S. companies who grant their employees 0 hours upon starting (they typically must earn their first week’s vacation over their first year as they put in hours). And, since all of the areas covered by our programs have dramatic positive impact on the bottom line for companies, the cost-to-benefit ratio is high for these types of wellness programs.
This type of business case, which we help them measure by tracking the various components just listed, helps ensure, though not guarantee, that in times of declining profits and other industry stresses, companies stay with the programs. Now I won't pretend that they do so because they are benevolent angels. They do so because they know it will cost them if they don't (and we've helped them develop that education regarding the consequences by showing them anonymous case studies of organizations that elected to do otherwise).
In summary, the critical element that many of you are raising is a deep beautiful truth, I believe. Meanwhile, we are making a major shift in terms of how organizations view wellness by appealing to their greedier, more capitalistic nature. Someday we hope that the paradigm will shift substantially enough to where companies do these type of programs because they are the right thing to do. In the meantime, we are witness the wonderful impact that wellness cultures are having on people, families, and organizations. We may only be succeeding one company at a time -- and we may be accomplishing what we do through traditional business case means -- but we are helping create a new paradigm nonetheless.
Please don't be naysayers to those who are making dedicated efforts in the right direction just because we haven't been able to sell what we do (yes, it still must be sold) using the philosophical underpinnings that you espouse (and we strongly support). That would be missing a real opportunity to celebrate the small wins that are occurring each day of the week. You may be jaded about the current healthcare dilemma in the U.S. The bigger question is, are you willing to be hopeful and envision the possibilities that can occur even amidst what many believe is an amoral system?
Sincerely,
Michelle
P.S. And may I mention one other business case factor that continues to delight us. The companies who participate in our program have continued to save on their actual annual healthcare insurance premiums, in spite of the fact that they subsidize a much larger percentage of this cost than normal, because we a) they have a far healthier employee base; and b) we have helped them become more effecitively self-insured.
ReplyDeleteI hear you, WC and Michelle. I don't have any unplayed cards. If it seems like it, it's just that I've been in this particular discussion so many times before, and this time around I want so much for it to go somewhere ELSE. In my past, the subject has always been so inflammatory that even gentle excursions into it end up provoking responses that I simply don’t want to absorb anymore. Pardon me for being personal, but I’m very tired of all of it, and long ago resigned myself to working my little corner of things with my own clients and a small group of like-minded colleagues (who BTW, are from every conceivable area of healthcare, including the mainstream) and letting that be enough. The fact that I’m participating in this exercise as actively as I am, given my naturally reclusive tendencies, is an indicator of the level of my trust in Chris, and of the fact that you have all so clearly committed yourselves to a radically different kind of dialogue. And for the record WC, I didn’t read your “play ball” comment any differently than you meant it. I’m actually grateful for the opportunity to join you at this particular table under these particular circumstances.
ReplyDeleteIn that spirit, I've been trying to find new language and new ways of thinking and dialoguing that might contribute to a less divisive outcome than this discussion usually produces (at least in my life!). I have no wish to slow things down unnecessarily, but it appears to me that some of what we’re suffering from, in healthcare and in society generally, is our tendency to act without bringing all of ourselves along for the ride. I think that’s much of what Trinh is pointing out to us. I value his contributions deeply for that very reason. I am VERY interested in opening these subjects robustly, but I am also sure that some of the others in this discussion can echo me related to the fact that there is an awful lot of fatigue and scar tissue on our end of things based on past experience, and we tend to be very careful when entering this territory. Sorry if it felt at all duplicitous. Nothing could be further from the intent. By now, I'm even tired of my OWN position, so you can only imagine how I feel about everybody else's!:):)
I have read your points with great interest and I think about them as clear-minded, pragmatic and innovative and really have no quarrel whatever with the approach. I agree with you both that they are excellent procedural steps that would be assets in our wellness center environment. Maybe what you're feeling from some of us really has more to do with a deeper issue that we keep stumbling on. I don’t know if what I’m about to say reflects the thinking and feeling of others, but I suspect it might, at least partially.
THE 800 LB. GORILLA
I don't trust profit-oriented systems to be guardians of the human services. And the bigger they get, the less trustworthy they become.
I don’t trust our government to do it either, and ditto on the bigness. After reading Skye on the other string this morning, I was reminded again of why I feel that way. I realize it has the capacity to sound silly and naïve to some, but I think it really does start with love, just like Skye describes. And I don’t think the current system supports that much. I don’t think the resistance you’ve felt has anything to do with the fact that your ideas aren’t great or won’t work or that they’re not needed in the running of any patient-empowering facility. Instead, I think it’s because some of us have a great suspicion of the effect that profit has on healthcare and of the motives that even good initiatives proposed by good people such as yourselves are serving when they arise in profit-oriented environments. I’m not an anarchist who wants to smash the structure and try to build something new from the ashes. I do, however, strongly advocate replacing the foundation. How would the system look if that foundation were changed from profit and power to love and life force? I think patient empowerment starts with creating systems that are human scaled. Systems that are too large and administered too far away from the people they serve unavoidably become SELF-serving, whether for profit or otherwise. While that may empower organizations and bottom lines, it DIS-empowers patients. It’s one thing for participants in the system to derive livings from the care and services they provide. It’s another for illness and food and shelter to become profit sources for third parties. For me, that’s a (maybe THE) ethical issue. I think it gets particularly important at the point where stockholders and share prices enter the picture, a fact that has already been brought up by others in this discussion.
Although I now work completely outside mainstream healthcare, I served my corporate sentence. Capital serves itself first, and always will, because that is its nature, and I don’t think we’ll get where we’ve talked about going until profit is out of the picture. I think some of SB’s and JD’s ideas related to the credit union model might have some utility here in beginning to take some of your ideas and deploying them in a different context.
By way of saving some time, and in the hope they will help us go deeper with this stuff, I will recount some of the arguments I’ve been presented with in the past (pre this blog) in response to my introduction of these ideas. They fall into a few basic categories, some of which make no sense given the subject matter but which frequently come up anyway, much to my puzzlement. Also in the interest of saving time, I’ve included my stock answers to go with the stock arguments. Some of you may have some others to add to the list. My most common ones take form something like the following:
- Long lists of examples of the accomplishments of modern healthcare (very few of which I dispute, so it always seems like they’re preaching to the choir.)
- Indignant rants about the importance of “objectivity” (which I don’t believe is really possible. Indignant rants are certainly possible, but objectivity, I think is much less so)
- Accusations that I am anti-scientific (which I absolutely am not and which always makes me wonder why people on that side of the argument so often start defending science during a discussion related to money????)
- Apologies for the “right” to profit (which is written where? For those of you who are movie geeks, I call it the Gordon Gecko speech)
- Statements about profit being essential to innovation (No one innovates because they want to help?)
- Uncomplementary suggestions related to the speculation that I am
a damn Commie (That is emphatically not the case. I find all forms
of politics equally repugnant).
I am being a tad snarky here, and purposely so, because while I am very willing to engage these and all other relevant issues, I really, really, really want not to have to wade through the same old songs and dances in the same old way again, and I took WC’s challenge to me this morning to mean that we were ready to do that. HOORAY!
PS.
ReplyDeleteMichelle, I posted my previous comment before I had read your latest. Thanks. I think this has already started things into a very productive area, because on the one hand, your comments point out the need to remain pragmatic and solution-oriented within existing conditions, while Trinh, et al are pointing out the necessity of constantly working with reference to our fundamentals. A balance between those two principles makes for a potentially hearty, heady brew, and might illuminate our way forward. Thanks all, this is good stuff. Keep it coming!
Michelle,
ReplyDeleteThank you much for your extensive response to my questions; I appreciate it. And I recognize the efforts made (and victories won) by corporate wellness programs. I harbor neither condemnation nor disregard for the programs being promoted, nor am I discounting the resulting benefits for the employees. I applaud the efforts and would, in fact, like to take it a step further…How can we extend the “good work being done already,” and make it available to all?
I am passionately promoting the notion that wellness and health are human rights, and that the life force we have so carefully contemplated recently on this blog may be honored better by recognizing that we are in this life together, come sickness or health. What happens to one of us ostensibly affects us all. How can we make health promoting benefits and medical care accessible to our citizens regardless of employment status?
I believe that empowerment is (at least partially) the result of having choices available as opposed to it being just the mere absence of limitations…An empowered patient is therefore, in my view, a patient with personal choice and options to choose from.
Anonymous, BKO, et al,
ReplyDeleteMichelle did a splendid job of describing our organization's program as well, so I shall not be redundant.
Michelle and I also spoke last night by phone and I think we're both of the same opinion that, as BKO stated, we've been describing what we've found to be possible within the current, less-than-perfect system; while many of you have been looking at modeling a more ideal system, and thus the focus on key fundamentals before moving forward.
With that in mind, I would also like to suggest that in addition to the freedom of choice that Anonymous mentioned, there are several other key conditions to patient empowerment (and each of these components has a patient aspect and an organizational aspect -- be it company, community, etc.):
1) Competency and capability to make choices (this implies that an education opportunity is made available and is able to be accessed);
2) Clearly defined goals or vision that is inclusive of multiple needs (this implies that there is an on-going participation in the process of defining the goals);
3) Menu of choices as to how to meet the goals (and the freedom to choose not to meet the goals or participate at all);
3) Responsibility for choices (a mind set going into the process by both parties that they are responsible for how they show up in the process)
4) Accountability (willingness to own the consequences good or bad of choices).
We have found that without all of these aspects in place, that "empowerment" ends up falling short.
Choice is essential, yes. But so are the rest of the elements. We believe patient empowered is one of those fundamental elements along with the deep respect for life force and the human right for care (and the choice to not receive care).
Any thoughts?
A quick note to all:
ReplyDeleteI will be out of the office for the next ten days and accessing my computer only during the evenings. Please excuse any delay this may have regarding your comments.
Comments made before 8pm Pacific, should, in all liklihood, be posted that night.
Thanks for your patience,
Christopher
WC, couldn't agree more. While I certainly also side with Anonymous in that choice is critical, my experience hss shown me that a choice is not really a choice without the knowledge to make an informed choice, the capability and sometime support to carry it out, and the willingness to step up and own the outcome of the choice.
ReplyDeleteThat said, I am also noticing that I simply assumed that because Anonymous did not include those elements that they were excluding them. I sit here now, realizing that Anonymous may have simply assumed that of course these elements are a natural part of free choice, every bit as much as a leaf is part of tree.
Hmmm, interesting process I just walked myself through.
TN, you made me laugh. Sounds all too familiar, and your last comment kicked my mind a bit. I wonder if your your aha might help us further make use of what I see as a possibly constructive polarity that's developing in this latest version of the discussion. I realize it's dangerous to categorize too quickly, and I don't want to slap anyone exclusively into one or the other, but it looks at least on the surface like we have one group that starts into a problem by breaking it down into its components, and another that starts at the opposite end, by trying to find the larger context that will help them put it back together.
ReplyDeleteA wise person in my life once asked me which I thought was better, breathing in or breathing out. At the time, it formed a somewhat devastating critique of my youthful stupidity, but I have since learned to appreciate it as the kind and wonderful teaching metaphor that it was. To continue along the path of TN's insight, might that idea be helpful to us as we try to find a way to join our forces here?
Thoughts?
Yes, BKO. I laughed too.
ReplyDeleteThe other thing that I think we could all be aware of (me included, of course) is the human tendency to unconsciously form biases about people (you know the little stories we make up in our head that assign valuable characteristics to one, and dubious qualities to another).
I've learned to start questioning myself on that all the time because, quite simiply, I form those unconscious biases without even thinking about it (that's why they're called unconscious, I suppose).
But yes, we of the content mind, must learn to think more context-oriented, and vice versa. If we can all be more flexible in that regard, we'll actually be breathing both in and out (what a concept)!
I've been commenting in the other topic, but became interested in this conversation as well. I've looked back through some of your previous topics on wellness (I like that notion so much more than healthcare) and perceive that there's a perception, at least, that the only way to pay for healthcare, other than an individual's contribution, is increasing everyone's tax.
ReplyDeleteWell, in Canada we've been more creative (at least I think so... and that, in and of itself... is bold for a Canadian). The Canadian healthcare system is paid for in large part by an allocation of the natural resources of the country.
In other words, prior to any money going anywhere else, when something is mined, drilled, cut down, etc., there is a national levy (quite a small, percentage actually -- but it's cumulative effect is very ample) which is put into a public health account. It is from this account that all public healthcare costs are paid.
No tax need be assessed an individual in such a scenario. And the small slice taken from the resource is miniscule compared to what companies would have to pay if they were paying for healthcare insurance for their employees like in the U.S.
So here's a thought toward patient empowerment -- ensure that everyone has the choices available from which they may choose. Then, yes, let's educate as to the choices... and most certainly I agree with the other wonderful ideas raised by this group.
Interestingly, the descriptions given by Michelle and WC, while absoultely stunning in the U.S. are somewhat commonplace in Europe and even in many organizations in Canada.
Somewhat shocking, isn't it? But quite simply -- and here's the real point -- one's wellness, in many countries, is viewed as a basic human right from which organization's should not profit (at least not excessively). But then, that's a fundamental difference between the U.S. and the rest of the world, isn't it? Profit, ultimately, is at the foundation of the American value system. I don't say that as a criticism, merely as an observation.
Hope these remarks have been beneficial to the discussion.
Kindly,
Sarah
C'mon now, Sarah. Not criticism -- just an observation? It's okay to criticize, if the intent is positive and it's not launched as a personal attack.
ReplyDeleteI read your comment to one of my girlfriends, who's also Canadian. She laughed and said, "Now that's Canadian. We always like to come off as "nice." But underneath it all we're passive agressive -- especially toward Americans."
Can't say if that's true -- it's her comment, not mine. (<:
But the main thing I actually wanted to convey was that I love the creative solution you proffered and the whole thought behind it. Thinking out of the normal box, into which we unconsciously place ourselves, presents solutions we would have never otherwise considered.
Thank you for jarring us into a new way of looking at the whole notion of funding. I wonder where else we can find hidden sources of income within our system that could provide the means to such a wonderful end.
Sincerely,
Michelle
Michelle,
ReplyDeleteWhat was it about Sarah's message that made you feel like she attacked anyone? Am I missing something?
Hi Michelle,
ReplyDeleteYou were right. My comment was meant as a little dig at the U.S. system (good naturedly, or at least that's what I am telling myself). And you're Canadian friend? Remind her that she's supposed to keep our little Canadian secret about being "nice" amongst the maple leaf clan (smile).
Seriously, my apologies and thank you for appreciating my comments, in spite of my little bit of attitude. I love what you're doing and the fact that it's being done in the U.S. is actually quite wonderful, especially because it's not the status quo.
Love,
Sarah
Sarah, Anonymous,
ReplyDeleteI didn't mean that Sarah's comment was personal, but rather that her comment was fine since it was constructive and not personal. Sorry for the confusion.
As for thinking outside the box though, I would like to get down to some creative thinking in terms of new forms of funding beyond the notion of a direct tax -- whenever the time is appropriate for that discussion.
Good evening, to all,
Michelle
There is a very essential piece in this discussion that I am going to re-visit at the risk of being seen as hyper-redundant. Furthermore, I don't mean these comments to come off as an affront to anyone either. I believe, however, that Sarah's initial comments about Canada's method of funding their healthcare system is a very telling statement as to priorities. In other words, because people's wellness is of prime importance and considered to be a basic human right, it logically follows that the money will be found and set aside to fund such a program.
ReplyDeleteIn the U.S. (governmentally speaking), those same priorities do not exist substantially enough to create such a solution. Whether it be from natural resources or other means, if the care of human life and health were of prime importance, the U.S. system would find a way to fund it.
But let's take this a level deeper. I believe that the U.S. public has been so mislead on this whole issue and that the mantra of rugged individualism has been so drummed into our collective consciousness that we have convinced ourselves that not only do we not have the right to expect healthcare protection, but that the concept itself is not right and is somehow a violation of the American way.
I fully understand the emphasis made by Trinh, BKO and others upon the very fundamental understanding as to the importance of life force; patient first; and of not allowing profits (or at the bare minimum -- excessive profits) to be made from such services.
My friends, there is a very, very key understanding that I'm hoping we're getting here... and I'm afraid we're not. As JJ said earlier, let's not be so quick to rush off this subject. Anyone else sharing my concern?
What Michelle, WC, and others are doing within the current system is marevlous and I hope they continue and make even further strides. And it is possible that within the foreseeable future that their approach (working within the existing system) is the best current apporach.
We still need to get to the root of the real issue, though (one which filters through much of U.S. and other societies and goes right to the heart of our world's most challenging issues).
What is the value of human life -- and of life itself (in all of its forms)? My father would say that this understanding is most crucial to the future of the entire planet. More and more each day, I agree with him.
With great sincerity,
Ellio
I don't know words strong enough to express how completely I agree with everything Ellio has said. And he has asked the unavoidable question:
ReplyDelete"What is the value of human life -- and of life itself (in all of its forms)?"
I know many of you are impatient about the need many of us have to fully explore this issue before moving forward, and we have been rightly reminded that much can by gained by employing a certain pragmatism in dealing with current conditions, but I don't think we will ever get to a valid definition of what an empowered patient is, or to a workable wellness center model, until we confront Ellio's question head on. And as he correctly points out, we will have to face down a very strong societal taboo to do it. I believe it's actually THE question on which everything that comes afterward must rest. And then further, will it be possible to create a model in which people who disagree about the answer can still work together productively?
I want to make sure we're all following the same fundamental understandings as we take baby steps forward.
ReplyDeleteTherefore, for the sake of clarity, what we are saying, if I'm in sync with all of you, is:
1. That the foundational principle upon which we will continue this discussion is that human life and all forms of life are of unique and special significance (sacred, beyond calculable value, and the other terms one might use to describe this understanding).
2. Operating from this most fundamental premise, we have said that it is of utmost importance that all people be provided the opportunity to support their wellness regardless of their ability to pay and that this opportunity is a basic human right (which concept transcends a notion of total individualism and embraces the idea that their is collective responsibility that we share together for our communal well being).
3. Along with these fundamental understandings is the concept that enriching ourselves as companies or individuals (and by this we mean making profit or excessive profit) is inconsistent with the previous two principles.
4. Further, I hear us acknowledging that the paired principles of freedom of choice and accountability (both on the part of the individual and the "system" or community to support and provide the tools needed are essential to patient choice or freedom and accountability).
5. And last of all, on my list at least, is the notion that we work preventively or from the standpoint of the early model and the idea that we are supporting wellness first; and then treating illness or wellness breakdowns from a systemic or whole perspective and then moving from the least invasive process first and then moving forward in accord with the patient's wishes.
Have I covered the points for we have come to some level of agreement or general consensus?
I realize that some of these certainly may merit more conversation, but am seeking, for my own understanding, if this group has come to some form of common understanding in the aforementioned areas.
Kindest regards,
TN
TN, while your comments seem to me to cover the general ideas that have been voiced by a number of our community here, I'm going to ask some of the rest of you, who originated these ideas, to provide feedback to TN. Do you feel he's on the mark with his summarization?
ReplyDeleteIn the interim – and perhaps afterward – I'd also suggest we spend some more time delving deeply into the following questions:
What does the idea of life being sacred in all of its forms (or whatever language is appropriate for you) conjure up for you in terms of wellness or healthcare?
What are your feelings and thoughts about the relevance of this fundamental notion in terms of creating a more effective relevant healthcare model and more empowered patients?
Why is this concept important for you (try to be as specific as possible)?
I think this level of discussion could be very helpful to all of us in really diving in deeply and thus absorbing more fully and bringing to our consciousness more completely the expressed importance of this principle. I am looking to surface some of our more deeply intuitive understandings and the knowledge that I know some of you have in this regard that may be helpful not only to those directly contributing in the conversation, but also to those who are reading along.
Please chime in, everyone.
Thank you!
I've been talking with Ellio and our crew a lot about this topic... and about TN's summary... and Christopher's invitation... and about the emphasis that Trinh, BKO, and others have placed on the "sanctity of life force" as Ellio and I began to refer to it.
ReplyDelete"Why are we soaking in this question so much?" was my question to Ellio in one of our group email sessions. "I think we get it."
His response to us was this (and Ellio, I know you're traveling, so I've copied your email to me verbatim):
**************
Understanding the sanctity of the life force is not merely a wellness issue. It is a fundamental and foundational principle regarding how we choose to live together on this planet. I do not mean to become even more granular about our discussion, but I think we must if we are to truly create a more workable holistic answer to the wellness opportunity (and countless other social opportunities that are presented to us every day).
Long ago a pope and a scientist made a deal with the devil. This negotiation led to the artificial and specious separation of science and religion. In essence, it removed the logical thought process from religion (and thus required "true believers" to accept everything on faith alone); and extracted the search for the divine out of science (thus eliminating any notion or acceptable curiosity about a Universal Ground of Being from "scientific matters").
This was a colossal mistake that has impacted our world in ways that could have never been anticipated at the time this deal was crafted. It is time to mend this rift and to re-join what should have never been torn asunder.
Though we who are biologists, chemists, and geneticists would like to simplify our task by eliminating the glaringly obvious issue of life force from our work, we are arriving at point in our research and our understanding of the nature of organisms where this artificiality no longer serves us. I think we all know this on some level. To admit it, however, is akin to heresy -- it is a blow to our overblown egos.
Now, to be clear, I am not talking about "God" which I believe is a term that has taken on so much cultural baggage as to be not only useless, but indeed dangerous. I am talking about the underlying essence that has motivated the creation of such concepts.
Let us assume, for just one moment, that there is an underlying force of life which expresses itself uniquely in each biological form and in each atomic structure. If we took the time to truly "be" with that understanding and to sit with the various forms of life that surround us and truly experience the life in each such form and structure, how would this inform us differently?
This was the work of my father and of his people and of peoples throughout eons of time before us, my friends. We may choose to write their deep knowing off to superstition, naiveté, or "child-like innocence." Or we may choose to grasp that there is something there for us to explore and understand.
I am not suggesting that we adopt blind faith in regard to this "life force" of which we speak. Instead, I am inviting us to adopt the open-minded, ferocious curiosity that has led to so many of our other scientific breakthroughs. Let us not forget that the word "science" implies a knowing. Therefore let us not close our eyes, hearts, and minds to the possibility that there is a deeper power at play in all of our science.
And, in the meantime -- based on the even remote possibility that this life force is indeed sacred -- let us contemplate every action as if it were so. For in so doing, I do not believe we will suffer, but will instead make far wiser choices at each step along our collective path. And who knows -- if we are finally humble enough to acknowledge that such a force exists -- we may even begin to find some of the deeper answers to the inner workings of science that have evaded us so well until now.
*********
Let's face it -- Ellio rocks! I would love to hear your comments and to see where this leads our discussion.
Love you all intensely,
JJ
Ellio, you DO rock. You're on it. 100%. Hearing this kind of thinking from a scientist eases my heart greatly. I've been asking why no one wants to talk about that particular "deal with the devil" for my entire career, and no one on that side of the discussion would. You're right, it's tantamount to heresy, even now. We as a society are so invested in "progress" and looking forward, that we have blinded ourselves to the truths of our own history, and that has the potential for undoing us. All of us, scientists and alternative weirdos alike. Thank you for stating the case so beautifully, Ellio.
ReplyDeleteThe life force was kicked out of the discussion long ago, much to our detriment, and I think what many people are having a problem dealing with is that if we TRULY bring it back, the contextual shift it creates is so deeply radical. If we really do it, it doesn't just change the way we administer healthcare. It changes how we DEFINE healthcare, and for that matter, it changes how we define what life is FOR.
Suddenly, as Ellio points out, we can't separate any part of healthcare from anything else. It also means that from day one of the shift, an awful lot of what we have always done, we can't do anymore and and still face ourselves.
Talk about an inconvenient truth!
I think we have arrived at the perfect transition point to evolve the topic forward. I'm therefore going to invite everyone to contribute to the next topic entitled, "Incomparable Genius -- Treating an Irreplaceable Being."
ReplyDeleteI am personally quite enthused to see where this topic will lead and invite you, as always, to dive in whole heartedly.
Thank you!
Christopher