"Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

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  • Harvey Fineberg’s mentioning the WHO definition of health.
  • The designs ought to return to the needs of the patient (person) as the first priority. Habits of practice do not matter. Needs matter.
  • Ralph Snyderman showed how much possibility there is for individualization. This is, by the way, if we take full advantage of the knowledge, the death knell of insurance – actuarial financing – of care. What generates “moral hazard” in an insurance system is a key lever for efficiency and effectiveness in a science-based, individually focused system of care and healing.
  • Normalize experience. Never, never, never separate a person from the loving community from which that person draws energy, self-esteem, solace, and wisdom.
  • Nutrition, air, noise.For my knee – weight, shoes, cement.
  • For my knee – I can use an elliptical exerciser, but not a treadmill. My choice of shoe is crucial, and a properly build orthotic is even more crucial. I can skate ski, but not downhill ski. I cannot run, but I can bicycle. When I walk on the sidewalk, I need to keep my right footfall to the right of the camber.
  • This is the most difficult change of all. Harvey argued for rigor and evidence behind our choices. However, illuminating the functioning of an integrative system of care requires forms of evidence and approaches to learning that are less developed and less honored today than canonical experimental designs founded on Fisherian inference rules. Here are three examples:In integrative care, each individual is an informative experiment of size one, and continuous. Rigorous measurement and evaluation need to be applied to individual learning cycles, not just to groups;In integrative care, the aim of evaluative research is to reduce the “Number Needed to Treat” to exactly 1. That requires individual evidence and research not normally embraced by study sections, peer-reviewed journals, or promotion committees.In integrative care, appropriate knowledge is usually gathered by study and graphing over time, not in cross-sectional, either-or comparisons.This is a major challenge to the IOM and to the academic community at large.
  • Getting the individual more involved in the development and management of their own personal health plan.Exploration of internal, reflective process. Illness is part of the story of someone’s life. E.g., What is the metaphor of this in your life. Thde capacity to look within.
  • Ralph Snyderman mentioned the Health Navigator function.
  • "Patient-Centeredness and Patient Safety: How Are They Interconnected?" Don Berwick, MD

    1. 1. Designing on PurposeSchwartz Center Speaker Series<br />Donald M. Berwick, MD<br />President and CEO<br />Institute for Healthcare Improvement<br />September 17, 2009<br />
    2. 2. Designing on Purpose<br />Integrate what?<br />Integrate why?<br />Begin with an exploration of purpose.<br />Then seek designs capable of achieving that purpose.<br />
    3. 3. The IOM Roundtable<br />“Overuse, Underuse, and Misuse”<br />Quality Is…<br />“The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”<br />
    4. 4. The Woods Hole Meeting - 2002<br />
    5. 5. “New Rules” for Health Care<br />Care based on continuous healing relationships<br />Customization based on patient needs and values<br />The patient as the source of control<br />Shared knowledge and the free flow of information<br />Evidence-based decision making<br />
    6. 6. “New Rules” for Health Care<br />Safety as a system property<br />The need for transparency<br />Anticipation of needs<br />Continuous decrease in waste<br />Cooperation<br />
    7. 7. “They give me exactly the help I need and want exactly when I need and want it.” <br />(John Wasson Modification…)<br />“They give me exactly the help I need and want exactly when and how I need and want it.” <br />IHI Measure of Patient-Centeredness<br />
    8. 8. Deepening the Definition<br />“The needs of the patient come first.” (Mayo Clinic)<br />“Nothing about me without me.”<br />(Diane Plamping)<br />“Every patient is the only patient.”<br />(Art Berarducci)<br />
    9. 9. My Proposed Working Definition<br />Patient-Centeredness:<br />“The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.”<br />
    10. 10. Eliot Freidson: Profession of Medicine<br />A profession is a work group that reserves to itself the authority to judge the quality of its own work.<br />Granted by society in return for an assumption of:<br />Altruism<br />Specialized Expertise<br />Self-Regulation<br />
    11. 11. The “Triple Aim”<br />Population<br />Health<br />Experience<br />of Care<br />Per Capita<br />Cost<br />11<br />
    12. 12. Defining “Health”<br />The Extent to Which the <br />Body Can Heal Itself<br />
    13. 13. A Question<br />What do you want?<br />
    14. 14. A Question<br />What do you really want?<br />
    15. 15. A Question<br />What do you really, really want?<br />
    16. 16. Try This…<br />Integrative Medicine is health care that offers you the best shot at getting what you really, really want.<br />
    17. 17. Design of Integrative Care<br />Place the Patient at the Center<br />
    18. 18. Design of Integrative Care<br />Place the Patient at the Center<br />Individualize<br />
    19. 19. Design of Integrative Care<br />Place the Patient at the Center<br />Individualize<br />Welcome Family and Loved Ones<br />
    20. 20. Design of Integrative Care<br />Place the Patient at the Center<br />Individualize<br />Welcome Family and Loved Ones<br />Maximize Healing Influences within Care<br />
    21. 21. Design of Integrative Care<br />Place the Patient at the Center<br />Individualize<br />Welcome Family and Loved Ones<br />Maximize Healing Influences within Care<br />Maximize Healing Influences outside Care<br />
    22. 22. Design of Integrative Care<br />Place the Patient at the Center<br />Individualize<br />Welcome Family and Loved Ones<br />Maximize Healing Influences within Care<br />Maximize Healing Influences outside Care<br />Rely on Sophisticated, Disciplined Evidence<br />
    23. 23. Design of Integrative Care<br />Place the Patient at the Center<br />Individualize<br />Welcome Family and Loved Ones<br />Maximize Healing Influences within Care<br />Maximize Healing Influences outside Care<br />Rely on Sophisticated, Disciplined Evidence<br />Use All Relevant Capacities – Waste Nothing<br />
    24. 24. Design of Integrative Care<br />Place the Patient at the Center<br />Individualize<br />Welcome Family and Loved Ones<br />Maximize Healing Influences within Care<br />Maximize Healing Influences outside Care<br />Rely on Sophisticated, Disciplined Evidence<br />Use All Relevant Capacities – Waste Nothing<br />Connect Helping Influences with Each Other<br />
    25. 25. Design of Integrative Care<br />Place the Patient at the Center<br />Individualize<br />Welcome Family and Loved Ones<br />Maximize Healing Influences within Care<br />Maximize Healing Influences outside Care<br />Rely on Sophisticated, Disciplined Evidence<br />Use All Relevant Capacities – Waste Nothing<br />Connect Helping Influences with Each Other<br />
    26. 26. Defining “Health”<br />The Extent to Which the <br />Body Can Heal Itself<br />

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