Tag Archives: medical home

The Journey Toward Participatory Design – Talk at AAHB 2012

Recently I had the delightful privilege to be asked to speak at the annual conference of the American Academy of Health Behavior. Unlike many conferences I attend, it was intimate, allowed plenty of time to network and relax, and was at a wonderful place – the Four Seasons Hotel in Austin, Texas. Planning was done by my long-time colleague Herb Severson, investigator at the Oregon Research Institute in Eugene, and Elaine Borawski, AAHB President and investigator at Case Western.

The March meeting theme, Applications of Technology in Health Behavior Change Research, brought outstanding presentations, discussions and a hands-on tech demo session. It was fun to catch up with health IT leaders including David Ahern, advisor for RWJF’s Aligning Forces for Quality and Project Health Design, the NCI’s Brad Hesse, Kevin Patrick at UCSD and the Center for Wireless & Population Health Systems, and Audie Atienza, HHS Technology Advisor and leader for mobile health, David Abrams at the Legacy Foundation, Paul Estabrooks at Virginia Tech, and Hope Lab’s Ellen LaPointe.

It was a huge treat to meet BJ Fogg and hear him talk about persuasive technologies. Even better, to hear examples of taking small steps that make a big difference in engaging people in change. If he’d ever entertain a Boot Camp for VA leaders and innovators, we’d be swimming in a Perfect Storm…

I talked about leveraging technology to Let Patients Contribute. I see a ‘journey’ toward participatory design. Some years back (not long ago!) innovators promoted information therapy – providing patients “information prescriptions.” This was followed by patient centered medical homes, or team-based proactive care, with primary care on steroids and all other care that’s coordinated. Participatory medicine — our current destination — is about shared decision making, engaged and empowered patients and families, and liberal use of electronic tools used by patients/consumers. The ideal destiny, however, is participatory design, where patients and families are an integral part of development and improvement…in an ongoing and continuous manner. Some are moving toward this, but it’s still the exception, not the rule.

What will it take? How do we increase consumer demand for participation and contribution? Will we know a tipping point when we’re in the middle of it?

All my slides are available at the AAHB website, here. The last few slides are some findings from open notes/shared clinic notes at the VA. More to come, very soon, on this truly exciting study! Let Patients Contribute!

Medical Home Journey: Patients Validate it’s All About the Relationship

Today is the second day of Portland VA Medical Center’s retreat on the Patient Centered Medical Home. Several hundred clinicians, managers, leaders and others left the hustle and bustle of the medical center, learning and reflecting on transforming toward robust, Veteran-centric care. The speakers have been outstanding. And the attendees are engaged and excited, seemingly ready to embark on the journey. Yes, toward Participatory Medicine!

It’s empowering to listen to Oregon colleagues – inside and beyond the VA. The state’s been a leader bringing stakeholders together to articulate Medical Home goals in a patient-centered framework.

Mary Minniti, Director of Quality Improvement at PeaceHealth Medical Group, shared a wealth of experience bringing patients and families into the design process of improvement. She spoke of patients as the experts in their own health, and presented the Shared Care Plan. This (only?) community-wide patient portal developed in Whatcom County, WA gives people an online vehicle for self-care and communication with experts.

David Shute, Medical Director at Greenfield Health and a long time champion for transforming primary care, shared what it takes to realize Patient Centered (Veteran-Centered) Medical Home. He spoke about the key ingredient, the relationship between a patient and health professional. And how the reliability of that relationship is the goal. He left us with a vision, charging us to build the road map and get going on the journey. He remarked,

I think we have a new job. We need to be students of our medical system, and figure out how to redesign the system as we go. We know [where we want to go]…but getting from here to there is the hard part.

Christina Milano, family medicine doc and clinical lead on the Primary Care Renewal project at Richmond Clinic, spoke about changing personal relationships within the healthcare team.

The hands-down best content was the videos interspersed into the 2 days. Vignettes of patient voices were clear as a bell. Views of Veterans – young, old, male, female – resonated loudly. They had great things to say about the care they receive. And of course some not-so-great thing about their care. A few themes emerged repeatedly…

  • Treat us like people, not the conditions that we represent.
  • Make it easier for me to get to a live person when using the telephone.
  • Allow me to communicate through the Internet.
  • Coordinate my care – it takes a lot out of my day to get to you.
  • I have to be part of making the decisions about me.
  • Now I’m thinking, what do we all do when we go back to work Monday? What might offer some early wins, or at least make it feel palpable and real? Here’s some ideas, blended from attendee comments and questions and my own thoughts:

    1. Brand the journey and make the goals concrete. What does Veteran Centered Medical Home mean? A patient at the conference today said, “I thought people were going to come to my house”. Maybe starting with less confusing terms will help us work toward common goals in an effective way.

    2. Level the Team Playing Field. People I work with often call me “doctor”. I repeatedly ask to use my first name, but it doesn’t seem to work. One day I asked someone why, and was told that when she was first hired by the VA, she was told to call the physicians “doctor”. Now I understand this is out of respect. But if you really want me as a team player, lets lose the title and make us all relate in a more horizontal world.

    3. Create an environment where people are asked to find solutions. The small group discussions we’ve had over 2 days proved this: people who work at the Portland VA, along with patients and families, will identify the best solutions to our challenges – if given the opportunity. Our staff need to feel comfortable sharing ideas, and there should be ways to ensure this is done. Veterans’ and families’ views and voices need to be institutionalized in the process – everywhere along the way.

    4. Start with communication. There were many discussions where the underlying issue was communication. How to be patient centered. How Veterans get hold of us. Telephone tag. Secure email. Communicating within a healthcare team. Primary care and specialist care. Shared decision making. Bringing Veterans into the process. I think that if we start with a focus on messages and messengers, we’ll be racing along the highway. Maybe in a couple years, we won’t even remember getting in the car.