DESIGNING HEALTHCARE THAT HEALS Leland R. Kaiser, Ph.D. Kaiser Institute
Our Challenge• We have to go beyond the redesign of our medical care delivery system.• We have to go beyond the issues of access, cost and quality, as important as they are.
Our Challenge• We have to go further upstream.• We must begin designing out disease.• We must begin designing for health.
Our Challenge• Much of what we have to do is go outside what is normally considered to be a legitimate interest of the healthcare system.• We will be working in everyone else’s backyard to accomplish total environmental design.• This means overcoming immense social, political and economic resistance to this kind of approach.
Challenge• We have to do nothing less than change the way people live.• The challenge is total design.
My Belief• Design is the ultimate human science and art.• Design is the end stage of human evolution• To promote health and longevity, any race of sentient creatures anywhere in the universe will eventually have to re-design both their genes and their habitat.
The Five Most Important Design Dimensions• Designing for health• Designing out disease• Redesigning the human genome• Redesigning the human habitat
Our Preferred Future• Redesign requires us to envision our preferred health future.• I suggest this is the highest level of heath and wellbeing attainable for our population.• This definition takes us well beyond where we currently are in health planning and health services delivery in our country.
Basic Concepts of the Future• Our future is not fixed.• Our future may be invented or prevented.• Our future is not something that happens to us – it is something we happen to.
Basic Concepts of the Future• Imagination is our most powerful tool for redesign.• We must imagine what we want to see happen in our country.• Then, we must act to make our imagination a reality.
The Futures Mindset• To achieve a better design we will need to adopt a new mindset that takes us from treatment to prevention, potentiation and design.• This is the futures design mindset.
The Design Mindset• Good health happens when everything else works.• The best design goes the furthest upstream so disease can be designed out rather than treated.• This requires genetic design and environmental design.
The Design Mindset• This is the design century.• As healthcare professionals we should view ourselves as designers of America’s health
A New Perspective• When we talk about health we are usually referring to something we do to the person.• We now are beginning to realize the importance of also working on the person’s environment as well.• This is called habitat design.
The Design Formula• Health is a function of the transaction of the person and the environment.• H=f (P.E)• In other words you can change a person’s health by changing his/her habitat.• Healthy environments create healthy people.
Simple Examples• Start removing toxins from the air, water and food.• Improve the health of selected neighborhoods in our urban areas• Create model tribal villages• Design out work stressors• Help people exit damaging personal relationships• Design out hazards in the home
Simple Examples• Design homes you can live in for an entire lifetime• Re-design dangerous traffic intersections
Healthy Human Habitats• Good nutrition• Physical exercise• Clean air and water• Adequate housing• Adequate clothing• Good medical care• Convenient transportation
Healthy Human Habitats• Diverse recreational experiences• A safe physical environment• An empowering educational system• Opportunity for employment• Presence of a nurturing mentor• Opportunity for spiritual development
Healthy Human Habitats• Opportunity for self expression• Opportunity for ego enhancement• Meaningful activity to fill the hours• Incentives for continued self development• A feeling of begin needed• A sense of accomplishment
Healthy Human Habitats• Opportunity for membership in social groups• Opportunity to make friends• Acquisition of life goals and a sense of direction• A measure of control over one’s destiny• Development of skills and abilities
Healthy Human Habitats• Development of an interest in other people• Opportunity to give and receive love• Support and reassurance• Variety and change• Stable and predictable life situation
Healthy Human Habitats• Development of confidence and ego strength• Opportunity to redefine one’s self• Freedom to try on new life styles• Reinforcement of desirable social behavior• Abundance of cognitive sensory stimulation• Opportunity to be depended upon by others
Healthy Human Habitats• Opportunity for further education• Opportunity for leisure• Opportunity for healthy physical development• Competence models for emulation• Exploration of the world
What We Must Do• We have all the pieces we need to build a healthy people, but we do not know how to put them together.• We need to build bridges among the many contributing disciplines.• We need someone responsible for the finished product.
What We Must Do• Convene – involve an array of habitat specialists• Converge – bring these specialties together in an overall community design structure.• Test the design on demonstration villages and urban neighborhoods
Questions We Should Be Asking• Who are the underserved in our nation?• What health needs are going unmet?• What can we do to best improve the health status of our communities?• What is special and unique about our nation?
Questions We Should Be Asking• How can we be a better partner with our health care providers?• What can we do to reduce waste and better conserve our limited resources?• What new resources should we seek to develop in our nation?
America’s New Healthcare• Development of a coherent national health policy• Increasing the healthcare GNP• Movement toward universal health insurance coverage• Adoption of a holistic health model with CAM modalities
America’s New Healthcare• Tremendous expansion of primary care capability• Healthcare becomes innovation driven• Race to become world class in all that we do
Summary• What kind of a future do we want to precipitate?• What can we do today to begin moving toward that future?• Who can help us along the way?