GAUDET: HI. I'M TRACY GAUDET,
AND I'M THE DIRECTOR OF THE OFFICE
OF PATIENT CENTERED CARE & CULTURAL TRANSFORMATION,
AND I'M REALLY GLAD TO BE WITH YOU TODAY
TO TALK TO YOU ABOUT REDESIGNING HEALTH CARE
TO PROMOTE ONE'S WHOLE HEALTH, SO THE FIRST THING I WANT TO SAY
FOR CONTEXT IS THAT THE VERY ASSUMPTIONS
UPON WHICH HEALTH SYSTEMS WERE DESIGNED ARE NO LONGER VALID.
LIKE EVERY OTHER SYSTEM THAT'S EMERGING
FROM THE REDUCTIONISTIC PARADIGM
AND TRANSFORMING INTO A SYSTEMS APPROACH,
HEALTH CARE NEEDS TO BE RADICALLY RE-ENVISIONED
AND REDESIGNED.
THAT'S WHAT WE'RE GONNA TALK ABOUT TODAY.
THE IHI, THE INSTITUTE FOR HEALTHCARE IMPROVEMENT,
IS CALLING FOR THIS, IN THEIR LANGUAGE,
NEW RULES FOR THE RADICAL REDESIGN OF HEALTH CARE.
I THINK IT'S FASCINATING IF YOU LOOK AT THEIR RULES.
THERE ARE 10 OF THEM, BUT I'VE HIGHLIGHTED 4.
FIRST, CHANGE THE BALANCE OF POWER.
CO-PRODUCE HEALTH AND WELL-BEING IN PARTNERSHIP
WITH PATIENTS, FAMILIES, AND COMMUNITIES.
SECOND, CUSTOMIZE TO THE INDIVIDUAL,
AND I THINK THIS IS AMAZING IF YOU LOOK AT THEIR LANGUAGE.
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.
SOUND FAMILIAR?
THIRD, PROMOTE WELL-BEING.
FOCUS ON OUTCOMES THAT MATTER THE MOST TO PEOPLE,
APPRECIATING THAT THEIR HEALTH AND HAPPINESS
MAY NOT REQUIRE HEALTH CARE,
AND FOURTH, CREATE JOY IN WORK.
CULTIVATE AND MOBILIZE THE PRIDE AND THE JOY
OF THE HEALTH CARE WORKFORCE,
AND THAT'S WHAT WE'RE UP TO HERE IN THE VA,
SO THE VISION IS CLEAR.
WE HAVE ROBERT WOOD JOHNSON CALLING
FOR A TOTAL TRANSFORMATION AND A SHIFT
TO A CULTURE OF HEALTH.
WE HAVE THE IHI CALLING FOR 100 MILLION HEALTHIER LIVES,
LOOKING AT EMOTIONAL, SPIRITUAL, AND PHYSICAL WELL-BEING.
WE HAVE KAISER PERMANENTE, WHO STOOD UP A WHOLE NATIONAL EFFORT
THAT THEY'RE CALLING TOTAL HEALTH.
THE SURGEON GENERAL--
WE RECENTLY DID AN EVENT WITH THE U.S. SURGEON GENERAL
FOCUSED ON EMOTIONAL WELL-BEING,
SO EVERYONE AROUND THE NATION IS CALLING
FOR THE SAME FUTURE STATE, WHICH IS GREAT.
ATUL GAWANDE--I LOVE HIM-- ONE OF HIS QUOTES
THAT I THINK CAPTURES THIS REALLY WELL--
"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"--
I LOVE THIS LINE-- "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,"
AND I THINK HE SAYS IT REALLY WELL.
LET'S STOP FOR A SECOND AND ASK WHY.
WHY SHOULD WE BE ENTERING
INTO A COMPLETE REDESIGN OF HEALTH CARE?
WELL, IT DOESN'T TAKE LONG TO FIGURE OUT
THAT OUR HEALTH CARE IN THE NATION
IS IN A FULL CRISIS, EVERYTHING FROM THE ECONOMICS--
THE HEALTH CARE CONSUMES 18% OF OUR GDP,
AND THAT'S CRIPPLING OUR ABILITY TO COMPETE GLOBALLY.
CHRONIC CONDITIONS ARE THE VAST MAJORITY OF THOSE COSTS,
ABOUT 75% OR SO, AND WE KNOW THAT CHRONIC CONDITIONS
ARE REALLY LARGELY IMPACTED BY PEOPLE'S HEALTH AND LIFE
AND THEIR CHOICES THEY MAKE DAY TO DAY.
THE BOTTOM LINE IS THIS.
THE CURRENT HEALTH CARE MODEL DOES NOT WORK
BECAUSE WE DO NOT HAVE A CORE COMPETENCY.
WE'RE NOT DESIGNED TO SUPPORT PEOPLE
IN ADDRESSING THE THINGS THAT MOST IMPACT
THEIR HEALTH AND WELL-BEING.
IT'S NOT OUR FAULT. IT'S NOT DESIGNED THAT WAY.
I THINK IT'S REALLY INTERESTING TO THINK ABOUT WHY--
HOW DID WE GET HERE?
WHY DO WE HAVE THE HEALTH CARE SYSTEM THAT WE'VE GOT?--
AND IF IT GOES BACK TO THE LATE 1800s
AND EARLY 1900s, OUR WHOLE MEDICAL PARADIGM
WAS BASED ON A REDUCTIONISTIC MODEL.
WE HAD THINGS LIKE GERM THEORY, AND WE FIGURED OUT,
"OH, COOL. A DISEASE IS CAUSED BY A CAUSAL FACTOR,
"SO ALL WE HAVE TO DO IS FIND A CURE TO THAT CAUSE,
AND WE'RE DONE."
IT RESULTED IN THIS "FIND IT, FIX IT" APPROACH,
WHICH, TO BE HONEST, OUR MEDICAL PARADIGM
IS STILL BASED ON TODAY.
OUR SCIENCE HAS ADVANCED THAT IN THE 2000s,
WE HAD A LOT MORE ADVANCE AROUND SYSTEMS APPROACH.
WE UNDERSTOOD THINGS LIKE QUANTUM PHYSICS,
SYSTEMS BIOLOGY, AND CHAOS THEORY.
WE KNOW THAT HUMAN BEINGS ARE COMPLEX, ADAPTIVE SYSTEMS,
AND YET WE HAVEN'T REDESIGNED OUR HEALTH CARE APPROACH
FUNDAMENTALLY.
IF YOU LOOK AT THIS GRAPH--
AND SOME OF YOU HAVE SEEN THIS BEFORE--
IT REALLY ORIENTS ACROSS A PERSON'S TIME,
ACROSS TIME IN A PERSON'S LIFE,
AND WE SEE THAT THERE ARE INITIATING FACTORS
OF HEALTH AND DISEASE, AND RIGHT NOW,
WE PRETTY MUCH WAIT TILL YOU'RE PRETTY FAR DOWN ON THAT CURVE
TO INTERVENE.
IT DOESN'T WORK VERY WELL, BUT WE CREATED A SYSTEM
TO ADDRESS THAT.
IT'S A CLINICAL CARE MODEL WHICH PREDOMINANTLY RESULTS
IN OUTPATIENT AND INPATIENT MEDICAL CARE,
AND I'M OVERSIMPLIFYING IT TO MAKE THE POINT,
BUT THAT'S OUR DOMINANT PARADIGM.
I THINK THERE'LL BE A TIME NOT TOO FAR IN THE FUTURE
WHERE WE LOOK AT THAT AND WE THINK,
"WHY DID WE THINK ONLY HAVING THAT APPROACH
WAS EVER GONNA WORK?"
IF WE LOOK AT HOW IT'S WORKING NOW,
LET'S LOOK AT HEART DISEASE.
HEART DISEASE IS THE NUMBER-ONE KILLER
OF MEN AND WOMEN NOT ONLY IN AMERICA,
BUT AROUND THE GLOBE, AS YOU KNOW.
WHAT DO WE DO?
WE DO A LOT OF ANGIOPLASTIES.
THEY COST A LOT OF MONEY. WE DO A LOT OF BYPASS SURGERIES.
THEY COST EVEN MORE MONEY, AND IT'S INTERESTING TO REALIZE
THAT ANGIOPLASTIES AND STENTS DO NOT PROLONG LIFE
OR PREVENT HEART ATTACKS WHEN PEOPLE HAVE THEM
IN A STABLE CONDITION, WHICH IS 95% OF THE TIME,
SO IF SOMEONE IS AN ACUTE SITUATION,
THEY GO INTO THE EMERGENCY ROOM, AND THEY GET STENTED,
PROBABLY SAVED THEIR LIFE, BUT 95% OF THESE PROCEDURES
ARE DONE ON STABLE PATIENTS.
IT DOES NOT PROLONG LIFE, DOES NOT PREVENT HEART ATTACKS.
WHAT ABOUT BYPASS SURGERY?
BYPASS SURGERY PROLONGS LIFE IN LESS THAN 3% OF PEOPLE,
SO HERE WE ARE, DOING THESE VERY INVASIVE THINGS,
VERY EXPENSIVE THINGS, AND NOT EVEN GETTING
THE OUTCOMES WE WOULD LIKE.
NOW JUXTAPOSE THAT TO THE FACT THAT CHANGING LIFESTYLE
COULD PREVENT-- NOT JUST TREAT, BUT PREVENT--
AT LEAST 90% OF HEART DISEASE, THE NUMBER-ONE KILLER,
BUT WE DON'T HAVE A SYSTEM OF HEALTH CARE THAT DOES THAT.
WE HAVE A SYSTEM OF HEALTH CARE THAT DOES THE TOP STUFF,
THE INTERVENTIONS, SO WHAT DOES THIS LOOK LIKE?
HOW DO WE RADICALLY REDESIGN HEALTH CARE
TO REALLY PROMOTE PEOPLE'S HEALTH AND WELL-BEING,
WHETHER THEY'RE ALREADY HEALTHY OR SICK
OR AT THE END OF THEIR LIFE?
WE'RE CALLING THIS THE WHOLE HEALTH PARTNERSHIP,
AND WHOLE HEALTH IS AN APPROACH TO HEALTH CARE
THAT EMPOWERS AND EQUIPS-- THOSE ARE IMPORTANT WORDS--
EMPOWERS PEOPLE AND EQUIPS PEOPLE
TO TAKE CHARGE OF THEIR HEALTH AND WELL-BEING
AND LIVE THEIR LIFE TO THE FULLEST.
OUR CURRENT HEALTH CARE SYSTEM ISN'T REALLY DESIGNED
TO DO THAT, IF WE'RE HONEST,
SO WHAT DOES THIS FUTURE STATE LOOK LIKE,
THE STATE THAT VA IS PRODUCING
AND DELIVERING WITH OUR VETERANS?
THEY NEED TO HELP PEOPLE LEARN THE SKILLS
AND HAVE THE SUPPORT THEY NEED TO ADDRESS THEIR SELF-CARE.
THIS IS HOW WE EQUIP PEOPLE TO ADDRESS
THEIR HEALTH AND WELL-BEING, AND THAT
PLUS HOLISTIC, INTEGRATIVE HEALTH CARE
CREATES THE WHOLE HEALTH SYSTEM,
SO IF WE THINK ABOUT HOW DOES THAT WORK,
HOW DO YOU MAKE THAT REAL, WE NOW HAVE 3 ELEMENTS
OF THE WHOLE HEALTH SYSTEM, THE FUTURE HEALTH SYSTEM FOR VA
THAT DOES HAVE CLINICAL CARE WITH A MORE HOLISTIC APPROACH
THAT BEGINS WITH A PATHWAY WHERE PEERS AND OTHER FOLKS
WHO ARE NOT NECESSARILY CLINICIANS ARE TRAINED
TO WORK WITH VETERANS AND THEIR FAMILIES
ABOUT EXPLORING WHAT REALLY MATTERS TO THEM
TO IDENTIFY WHY THEY WANT THEIR HEALTH
AND BE VERY CLEAR ABOUT THAT PERSONAL MISSION
OR ASPIRATION OR SENSE OF PURPOSE IN THEIR LIFE
THAT THEY WANT THEIR HEALTH FOR.
THAT'S THE FOUNDATION OF THEIR HEALTH AND HEALTH CARE.
THEY BEGIN TO PUT TOGETHER A PERSONAL HEALTH PLAN
IN THAT PROCESS, AND THAT PERSONAL HEALTH PLAN
HELPS INTEGRATE THEIR CARE WHEREVER THEY'RE HAVING IT,
WHETHER IT'S THEIR SELF-CARE, THEIR LIFE IN THEIR COMMUNITY,
OR THEIR CLINICAL CARE,
SO THE PATHWAY IS REALLY CRITICAL.
THE HEALTH AND WELL-BEING PROGRAMS HELP PEOPLE LEARN
THE SKILLS THEY NEED, HOW TO EAT DIFFERENTLY,
HOW TO DEAL WITH THEIR STRESS, HOW TO IMPROVE THEIR SLEEP,
BRINGING IN APPROACHES LIKE TAI CHI OR ACUPUNCTURE
IF THOSE ARE HELPFUL TO PEOPLE, AND WE GIVE PEOPLE THE SKILLS
THEY NEED AND THE SUPPORT THEY NEED
TO REALLY CHANGE THEIR HEALTH AND WELL-BEING,
SO THE WHOLE HEALTH SYSTEM ADDRESSES THESE ELEMENTS--
THE HUMAN ELEMENT, THE SELF-CARE,
AND THE CLINICAL CARE, AND COMPLEMENTARY
AND INTEGRATIVE APPROACHES ARE INTEGRAL TO SELF-CARE
AND CLINICAL CARE IN THIS, SO I'D LIKE TO JUST CLOSE
BY SHARING A REFLECTION OF MINE THAT
MODERN MEDICINE STARTS WITH THE BODY,
RATHER THAN THE SOUL;
THE MIND, RATHER THAN THE HEART,
BUT WHAT WE KNOW IS THAT THE SOUL AND THE HEART
ARE THE DOORWAYS TO HEALING AND HEALTH
OF THE BODY AND MIND, SO NOW WE'RE AT
THIS REALLY EXCITING PLACE WHERE WE CAN DESIGN
FOR THIS APPROACH WITH OUR VETERANS
AND LEAD THE WAY NOT ONLY FOR OUR VETERANS,
BUT FOR OUR NATION.
THANKS SO MUCH FOR BEING A PART OF THIS.