A Critical Pathway to Healthcare Transformation
A closer look at the conditions necessary for change
In dialogue about healthcare, a single refrain echoes across disciplines and industries:
Our current healthcare business models aren’t keeping us healthy.
This self-diagnosis of our system proliferates in part because we can’t argue with the data. Or maybe we can’t argue with a single fact that emerges from the data, cited so frequently it could be called cliché if it weren’t so troubling:
The United States healthcare system is the most expensive in the world, yet it fails to achieve better outcomes than other systems that cost and spend less.
So we’re failing on two counts. But this refrain isn’t just an indictment of where our system has fallen short; it’s also a call to action, motivated by a deep and personal sense of urgency. “Us” means the people we work and live with, care for and love. Being “healthy” implies not just being physically fit and able, but also emotionally and socially well.
What can we do to ensure that our healthcare system keeps us healthy, allowing us to live meaningful and productive lives?
When we say our current healthcare business models don’t result in better health outcomes, the question we’re really implying is, why don’t they?
And even more importantly, how might we build models that do?
Models for Engagement
The only possible way to imagine new models is to begin, or, as our Chief Catalyst Saul Kaplan might say, to “start more stuff.” But to start, we need to transform how we think about doing that work:
We need to understand, enable, and involve families and communities in the process.
In part, involving families and communities in transforming our healthcare system is essential because of the changes characterizing the current market. In the context of the Affordable Care Act and the staggeringly advanced medical technologies at our disposal, patients are becoming savvier consumers and hospitals face more pressure to provide better care and a better care experience, at lower costs. Recognizing these realities makes collaboration between healthcare systems and the communities they serve more crucial now than ever.
But getting to the heart of why we care so much about our healthcare business models in the first place, the vital — and less-discussed — reason to engage families and communities is that engagement could also be a critical pathway to health and well-being in itself.
Our Patient Experience Lab’s work with Children’s Health in Dallas was initially focused on designing a new model: one that would move away from a singular focus on “sick care” to more broadly encompass care that encourages well-being. In order to understand what well-being looks like for Dallas families and what prevents or enables it, we did something that shouldn’t be so novel:
We asked them.
After listening to, observing, shadowing and engaging with Dallas families, the Patient Experience Lab emerged with a model of wellness, which illustrates exactly why families should inform the healthcare transformation process.
It looks like this:
Wait. What?
A model for wellness that asserts sense of self, connected knowledge, and support systems as critical pathways might seem simplistic or idealistic at first glance. In fact, though, this model for understanding what keeps Dallas families well is not only informed by our families’ own insights, but also supported by other research:
In a recent study conducted at Fairview Health Services, researchers found that higher levels of “patient activation” meant greater odds of better health outcomes and lower costs. Activated patients —or, those who self-assessed as confident, knowledgeable, and skilled — were more likely to obtain potentially life-saving screening tests like pap smears, less likely to end up hospitalized or in the emergency room in the two years following the study, and more likely to have better health outcomes in 9 of 13 indicators.
A seemingly simple insight with the potential to be revolutionary: the people who self-assessed as possessing the abilities, resources, and tools to influence their own health were the people who actually did.
Thomas Goetz, founder of Flip the Clinic and co-founder of Iodine, echoes this same observation in his TedTalk when he identifies one key driver of health behavior change:
A sense of efficacy.
That is, we are much more likely to adapt healthy behaviors if we perceive the change as both relevant and possible for us.
This is worth repeating, especially since what impacts our health isn’t just access to or quality of care, but also a host of socioeconomic factors, our environment, and our health behaviors. It also indicates the power of our families’ and communities’ insights — the research is telling us just what our Dallas families already did:
In order to imagine healthcare business models that actually keep families well, we have to understand the factors that shape motivations, values, and decisions.
It’s not enough to think solely about our care delivery models, though this is an integral piece of the transformation puzzle. We also have to talk about — and test — models for family & community engagement that encourage well-being. We have to understand what conditions must exist in order to affect behavior changes in our families and communities, and to make those changes stick.
Theories of Change
With a nod to the fact that our families, however we define them and in whatever shape they come, are one of the biggest influences on our health and lifestyle choices, the Patient Experience Lab and Children’s Health of Dallas is exploring what a healthcare business model that engages families and keeps them well might look like:
Can we introduce new roles, rules, signals, tools, or interactions that ignite new behaviors, or help families make forward progress toward wellness?
Our Lab will spend the coming few months in Dallas, working with local families to test models based on the above theory of change — models that move beyond the delivery of care. These models will strive to engage families in ways that address obstacles to their well-being, provide the resources they identify as necessary, and integrate striving for health and wellness into their daily lives.
We’ll emerge with stories to share: of successes and failures (or, as the dutiful innovator should say, successes and insights), and a deeper understanding of what might drive healthcare transformation that is owned by families and communities.
But the Patient Experience Lab believes fervently in the power of one already apparent insight:
Our healthcare business models, which spend much to get little, could use a dose of transformation.
Given the new technologies available, the evolving expectations for healthcare, and the increasingly apparent depth of our communities’ health needs, change in our models is inevitable. Our choice lies in whether the change will happen to healthcare, or whether we — as patients, families, communities, healthcare consumers, and leaders — will have agency in a transformation with staying power that keeps us healthy and well.
The only way to start? Swapping the healthcare institution’s lens for our families’ and communities’ eyes.
Want to connect or collaborate with the Patient Experience Lab? Learn more about this project and others, find us on Twitter, or meet us and other passionate innovators at BIF’s annual Summit.
