Healthcare Design And The Medical Home, G Jones, 6.12.11
Healthcare Design and the Medical Home Paul Groenier Gilbert Jones Associates for Healthcare Improvement
Goals of sessionConsider definitions of Health/WellnessConsider how design principles can improve communication and healthcare service in the Medical HomeExamine control structures in healthcare designFocus on prototyping strategies which incorporate all principles of service design
Key Principles of the Patient-Centered Medical HomePatient-driven: The primary care team is focusedon the whole person. Patient preferences guide thecare provided to the patient.Team-based: Primary care is delivered by aninterdisciplinary team led by a primary careprovider using facilitative leadership skills.
Key Principles of the Patient-Centered Medical Home Efficient: Patients receive the care they need atthe time they need it from an interdisciplinaryteam functioning at the highest level of theircompetency.Comprehensive: Primary care serves as a pointof first contact for a broad range ofmedical, behavioral and psychosocial needs thatare fully integrated with other health services andcommunity resources.
Key Principles of the Patient-Centered Medical HomeContinuous: Every patient has an established andcontinuous relationship with a personal primarycare provider. Communication: The communication betweenthe patient and other team members ishonest, respectful, reliable, and culturallysensitive.
Key Principles of the Patient-Centered Medical HomeCoordinated: The primary care team coordinatescare for the patient across and between the healthcare systems.
Health/WellnessHow do you define health/wellness?
Definitions provided by Master of Arts studentsexploring Health Geography.Adapted from Herrick, Journal of Geography in Higher Education, 34;345-362, 2010
Domains of Wellness Physical Wellness Emotional Wellness Mental-Intellectual wellness Social Wellness Environmental Wellness Occupational Wellness Spiritual Wellness
1. Physical wellness/healthReflects a healthy body maintained by eating right, exercising regularly, avoiding harmful habits, making informed and responsible decisions about health,seeking medical care when needed,participating in activities that help prevent illness.
2. Emotional wellness/healthRequires understanding emotions and coping with problems that arise in everyday life.can have and express a wide range of emotions such as anger, sadness, or joy and love.
3. Mental -Intellectual wellness/healthopen to new ideas and concepts.open to learning a variety of lessons (in life and in the classroom).will ask questions about health care needsunhealthy person will remain closed to new ideas or will blame others for their poor performance.Racial, religious, gender, and age prejudices factor into this area
4. Spiritual wellness/healthreflects a state of harmony between you and others.understanding of your place in the greater universe.this does not mean religion specifically, although religion can factor into a personal sense of harmony and spirituality.
5. Environmental wellness/health: Refers to an appreciation of the external environment and the role individual’s play in preserving, protecting, and improving environmental conditions. This domain looks at the impact that environmental pollutants have on all of us physically, mentally, spiritually, emotionally, and socially, also looks at our impact upon the environment and the circle of involvement and effect this can create. Therefore, recycling and pollution are part of this domain, but understanding the human role as part of the environment is also important.
6. Social wellness/healthrefers to the ability to perform social roles effectively, comfortably, and without harming others.looks at relationships, social norms and an individual’s reaction to those relationships and norms.
7. Occupational wellnessreflects ability to enjoy what you are doing to earn a living or to contribute to society.
Principles of Service DesignOrientation to the futureCollaborative teamworkingPrototyping to improve dialogueMutual enhancement of design capabilityIntegration between emotional and functional benefitsOpen-ended adaptability
Principles of Service DesignOrientation to the futureCollaborative teamworkingPrototyping within dialogueMutual enhancement of design capabilityIntegration between emotional and functional benefitsOpen-ended adaptability
Examining control structures in healthcare designTaken from Lee, Design participation tactics: the challenges and new rolesfor designers in the co-design process; CoDesign, Vol. 4, No. 1, March2008, 31–50
Control Structures and Task RequirementsTask requirements and the resources availablewithin frames of activity them
Secondary Control Structures• Professionals use secondary control structures to make their primary techniques work.• Some secondary control structures are necessary to achieve health or wellness. – Examples: • Infection control to prevent hospital-acquired infections • Holding a baby still to safely perform lumbar puncture (spinal tap)
Examining control structures in healthcare designWhat are your experiences of feeling controlled when receiving healthcare?
Dialogue may be induced by many types of shared objects
Orientation to the futureAgency: requires – awareness of how one is influenced by the past – orientation toward the future – capacity to imagine alternative possibilities within the contingencies of the moment), – and ability to use these to critically evaluate and choose a course of action (Emirbayer and Mische 1998:963)
Agency• This definition of agency is consistent with interpretive habits-of-action, but is not consistent with reactive habits of-action.• It requires heedfulness, mindfulness, and the development of frameworks of understanding that place relevant features of the task environment in relationship interpreted through the lens of desirable outcomes.