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Whole Health + Psychologists =>Cultural Transformation
Overview for Division 18, Psychologists in Public Service
Kathy H. Hedrick, PhD & Jennifer Patterson, PhD
Office of Patient Centered Care & Cultural Transformation
April 2019
Objectives
• Describe the major components of the Whole Health System
• Articulate the relationship between Whole Health and Complementary and Integrated Health (CIH)
• Discuss the relationship between Whole Health Clinical Care and the role of psychologists
2
Deficit Model
Initiating Events
Dis
ease B
urd
en
Time
Cost
1/re
vers
ibilit
y
Typical
Current
Intervention
Development of Disease
©2013 RALPH SNYDERMAN
CURRENT SYSTEM
Ralph Snyderman, M.D. Duke Health System
IHI: New Rules for Radical Redesign in Health Care
Change the balance of power: Co-produce health and well being in partnership with patients, families, and communities.
Customize to the individual: Contextualize care to an individual’s needs, values, and preferences, guided by an understanding of what matters to the person in addition to “What’s the matter?”
Promote well being: Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require healthcare.
Create joy in work: Cultivate and mobilize the pride and joy of the healthcare workforce.
http://www.ihi.org/Engage/collaboratives/LeadershipAlliance/Documents/IHILeadershipAlliance_NewRulesRadicalRedesign.pdf
Atul Gawande
“We’ve been wrong about what our job is in medicine.
We think our job is to ensure health and survival.
But really it is larger than that. It is to enable well-being.
And well-being is about the reasons one wishes to be alive.
Those reasons matter not just at the end of life, or when disability comes, but all along the way.”
The VA healthcare system is
CHANGING
GET TO THE REAL MISSION
Honor America’s Veterans by providing exceptional health care that improves their health and well-being.
Initiating Events
Dis
ease
Bur
den
Time
Cos
t
1/re
vers
ibili
ty
Typical Current
Intervention
Earliest Clinical
Detection
Earliest Molecular Detection
Baseline Risk
Personal Engagement
Personalized Health Planning and Self Care
©2013 RALPH SNYDERMAN
TAKE A SYSTEMS APPROACH
VA Secretary Support of Whole Health
“VA’s Whole Health approach helps Veterans live their lives to the fullest,” Veterans Affairs Secretary Nominee Robert Wilkie
“By developing a personal health plan that integrates many areas of their lives, Veterans can truly take charge of their well-being and improve their health all around. I’m pleased to recognize these VA facilities that are helping our Veterans do just that.”
VA Secretary Support of Whole Health
VA 2018 – 2024 Strategic PlanStrategy 2.1.4:Emphasizing Veterans’ And Their Families’ Whole Health & Wellness
• VA will significantly improve Veteran health outcomes by shifting from a system primarily focused on disease management to one that is based on partnering with Veterans throughout their lives and focused on Whole Health. VA will provide personalized, proactive, patient driven health care to empower, equip, and encourage Veterans to take charge of their health, well-being, and to adopt healthy living practices that deter or defer preventable health conditions.
• A Whole Health system focuses not only on treatment but also on self-empowerment, self-healing, self-care, and improvements in the social determinants of health.
• How will we know we have arrived? Performance Measures: Veterans have a good quality of life (presence of positive emotions in daily activities, participation in society, satisfying relationships, and overall life satisfaction).
VA 2018 – 2024 Strategic Plan
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Dr. Stone’s 10 lanes of Effort
Whole Health
is an approach
to health care that
empowers AND equips
people to take charge
of their health and well-being,
and live their life to the fullest.
The Whole Health System
PATHWAY
• Peers
Don't walk behind me; I may not lead. Don't walk in front of me; I may not follow. Just walk beside
me and be my friend.
-Albert Camus
WELL-BEING PROGRAM
• Skill-Building Classes• Whole Health Coaching• Complementary/
Integrative Health therapies
WHOLE HEALTH CLINICAL CARE
Connecting with the Mission/Aspiration/Purpose
JOURNEY TO WHOLE HEALTH CLINICAL CARE
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Whole Health Clinical Care (WHCC)
The Past
“What’s the matter with you?”
Provider
Case-Based Paper Medical Record
“We’ll address your immediate concern.”
Moving Toward Personalized,
Proactive, Patient-Driven Care
“What matters to you?
Whole Clinical Team
Electronic Medical Record Focused on
Disease/Injury/Illness
“You have a risky problem, please follow this plan to
improve by your next visit.”
Personalized,Proactive, Patient-
Driven Care
“How can we help you live the life you want to live?”
Veteran, Family and Health Care Team
ElectronicHealth Record
(with Personal Health Goals)
“Let’s work together to create a plan that fits your life.”
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PHP is the Integrator of the WH System
PHP Key Components
Professional Care: Conventional and Complementary
Health concerns
Prevention/Screening
Treatment (e.g., conventional and complementary approaches, medications, and supplements)
Referrals
Community
Resources
Support Team
Next Steps
Mission, Aspiration, Purpose (MAP):
My mission, aspiration or purpose in life is…
My Goals:
Strengths (what’s going right already)/Challenges:
My Plan for Skill Building and Support
Mindful Awareness:
Areas of Self-Care:
• Working Your Body
• Surroundings
• Personal Development
• Food and Drink
• Recharge
• Family, Friends, and Co-Workers
• Spirit and Soul
• Power of the Mind
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The Circle of Health
Discover Mission/Aspiration/Purpose (MAP)• What REALLY matters to you in your life? • What do you want your health for?• What brings you a sense of joy and happiness?• What is your vision of your best possible health?
-- Map all we do to the Veteran’s MAP --
Getting to What Matters
CIH Role in WH
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Complementary and Integrative Health Approaches (CIH)
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CIH Directive
• LIST I: Evidence of promising or potential benefit
– VA must provide a mechanism to offer these approaches either within the VA facility or in the community if they are recommended by the Veterans health care team.
• LIST II: Generally Considered Safe– Optional for inclusion in VA facility, depending on
capability (staff/space) at sites
26
CIH Directive
List 1 – CIH Directive Approaches Approved by USH
List 2 - CIH Directive Approaches “Generally Considered Safe” Approved by IHCC Advisory Workgroup
Acupuncture Healing Touch
Meditation Acupressure
Yoga Alexander Technique
Tai Chi Reflexology
Biofeedback Reiki
Hypnosis Therapeutic Touch
Guided Imagery Emotional Freedom Technique
Massage Animal Assisted Therapy (RT)
*Chiropractic Aromatherapy*
Additional approaches currently under review
27
CIH Directive 1137 - May 2017List 1 – CIH Directive Approaches Approved by USH
List 2 - CIH Directive Approaches “Generally Considered Safe” Approved by IHCC Advisory Workgroup
Acupuncture Healing Touch
Meditation Acupressure
Yoga Alexander Technique
Tai Chi Reflexology
Biofeedback Reiki
Hypnosis Therapeutic Touch
Guided Imagery Emotional Freedom Technique
Massage Animal Assisted Therapy (RT)
*Chiropractic Aromatherapy*
Additional approaches currently under review
List 1
VA must provide a mechanism to offer these approaches either within the VA facility or in the community if they are recommended by the Veterans health care team.
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CIH DirectiveList 1 – CIH Directive Approaches Approved by USH
List 2 - CIH Directive Approaches “Generally Considered Safe” Approvedby IHCC Advisory Workgroup
Acupuncture Healing Touch Meditation AcupressureYoga Alexander TechniqueTai Chi ReflexologyBiofeedback ReikiHypnosis Therapeutic TouchGuided Imagery Emotional Freedom
TechniqueMassage Animal Assisted
Therapy (RT)*Chiropractic Aromatherapy*
Additional approaches currently under review
List 2Optional for inclusion in VA facility, depending on capability (staff/space) at sites
Psychologists and WH
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Psychologists and WH
• Facilitating and supporting behavior change– Change experts– Enhancing motivation, activation and engagement
• Experience providing patient-centered care• Philosophy of values-driven care• Attending to the whole person care• Years of experience with cultural transformation -Recovery Model• Systems thinking• Integrated care• Leadership
30
THE RECOVERY MODEL
According to the National Consensus Statement on Mental Health Recovery, “Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.
Implementation and Preliminary Outcomes
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System Transformation: Key Progress
WHOLE HEALTH HYPOTHESES
• Empowered veterans focused on wellbeing with ownership of their health will be happier and healthier individuals
• Improved health outcomes• Improved patient reported outcomes• Decrease prescription drug use (e.g., opioids)• Improved healthcare experience and satisfaction• Decreased healthcare costs
• Healthcare optimization • Less burdened Primary and Specialty Care• Easier to connect with patients• Decreased provider burn out• Improved employee wellbeing
Whole Health Users Receiving More Behavioral Health
FY 17-18 Other Utilization
FY 17-18 National Pharmaceutical Costs
FY 17-18 National Opioid Use/Cost
Flagship Evaluation: Health Outcomes Overview
Key Outcomes Measures
Sense of life meaning and purpose • Life Engagement Test• IHI/100 Million Healthier Lives measure
Engagement in health care and management
• Perceived Health Competency Scale• Altarum Consumer Engagement (ACE)• IHI measure
Goal setting and attainment • Goal attainment questions adapted from the FY15 PHP survey
Perceived improvement in health and well-being
• Perceived Stress Scale (PSS)• PROMIS-10 (functional outcomes)• Social Support (Partners in Care)
Experience of Pain • Site of Pain and Pain Chronicity (IMPROVE QUERI)• Defense and Veterans Pain Rating Scale (DVPRS)• Pain, Enjoyment, General Activity (PEG)
Patient Centered Care(Healing relationships)
• CollaboRATE• Consultation and Relational Empathy (CARE)• Satisfaction with Care
Clinical Outcomes • Pain, depression, common biomedical markers (BP, HbA1c, LDL, BMI), and opioid Rxn
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Veteran Demand and Experience
Veterans Health and Life Survey (18 flagship sites):Patient-Reported Interest in Whole Health
97% of respondents interested in Whole
Health* (n=1395)
Interested inWhole Health
Not Interested
*Indicated they were somewhat interested in, very interested in, or already using at least one of the Whole Health components
• Veterans Health and Life survey item asking about patients’ interest in Whole Health Services (target n=10000)
• Results based on analysis of 1395 returned surveys
• 97 % responded they were either somewhat interested, very interested or already using at least one WH service listed.
Whole Health – Veteran Demand for WH approach
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
SomewhatInterestedVery Interested
Using In VA
WH Clinical=“Discuss with aclinicianwhat matters most to you”
Interest in Whole Health Components at 18 Flagship Sites (n=1395)
Whole Health – Veteran Demand
Whole Health:
Employee Wellbeing
Change the Conversation
Photos by Steve Rosenfield, What I Be Project
MEANING & PURPOSE
PARTNERSHIP
SELF-CARE
PEER CONNECTION
WELL-BEING
RESILIENCE
RELATIONSHIPS
EMPOWERMENT
HEALTH
STRENGTH
The Changing Culture of Health Care
