- HI. I'M TRACEY GAUDET.
I'M THE DIRECTOR OF THE OFFICE OF PATIENT CENTERED CARE
AND CULTURAL TRANSFORMATION,
AND IT'S REALLY EXCITING FOR ME TO BE ABLE TO TALK TO YOU TODAY.
WHAT WE WANT TO TALK ABOUT IS
THE CULTURAL TRANSFORMATION OF HEALTHCARE,
THE FUTURE OF VA HEALTH CARE, AND WHERE WE'RE GOING.
THE VA IS INNOVATING AN ENTIRELY NEW APPROACH TO HEALTH CARE
THAT TAKES US FROM OUR CURRENT HEALTH CARE SYSTEM,
WHICH IS PREDOMINANTLY A PROBLEM-BASED,
"FIND IT, FIT IT" APPROACH--
AND I'LL SAY MORE ABOUT WHAT I MEAN BY THAT--
TO ONE THAT IS PERSONALIZED, PROACTIVE, AND PATIENT-DRIVEN.
SO FIRST OF ALL, TO SAY A LITTLE BIT MORE
ABOUT OUR PROBLEM-BASED APPROACH,
I WAS TRAINED AS A PHYSICIAN THAT MY JOB
WAS TO FIND THE DISEASE, DIAGNOSE IT,
CURE IT WHEN I COULD,
AND WHEN I COULDN'T CURE IT, TO MANAGE IT.
THAT WAS THE JOB, VERY MUCH A "FIND IT, FIT IT" STRATEGY,
BUT THERE'S A LOT OF PLACES WHERE THAT FALLS SHORT,
AND I ASKED RECENTLY SOME VA FOLKS TO GIVE ME SOME STORIES
TO REFLECT ON WHEN THEY MAY HAVE SEEN THE LIMITATIONS
OF THIS "FIND IT, FIT IT" STRATEGY.
ONE WOMAN WAS VERY QUICK TO THINK OF A STORY
THAT SHE ACTUALLY SAID WAS A LITTLE PAINFUL FOR HER TO SHARE
PRIMARILY BECAUSE IT WAS ABOUT A VETERAN
WHO WAS IN A DYING PROCESS IN HOSPICE CARE
AND HE HAD SOME PAIN.
HE HAD A FAIR DEGREE OF PAIN.
SHE WAS DOING HER JOB, AND SHE WAS FOCUSED
ON REDUCING THAT PAIN IN ANY WAY SHE COULD
AND QUITE CONSUMED WITH TRYING TO COMPOUND DIFFERENT APPROACHES
AND PHARMACEUTICALS TO GET HIS PAIN TO A LOWER LEVEL.
HE TOLD HER AFTER A WHILE--
IT TOOK HIM A WHILE TO GET HER ATTENTION--
THAT FOR HIM IN THAT EXPERIENCE,
HE ACTUALLY DIDN'T WANT HIS PAIN LEVEL LOWERED.
HE FELT THAT IT WAS AN IMPORTANT PART OF HIS DYING PROCESS
TO GO THROUGH THAT EXPERIENCE,
AND HE WAS ACTUALLY FINE WITH EXACTLY THE WAY IT WAS.
HER REFLECTION WAS THAT IT WAS KIND OF ALARMING TO HER
THAT SHE WAS SO FIXATED
ON WHAT SHE THOUGHT SHOULD HAVE BEEN THE GOAL
THAT SHE ACTUALLY MISSED WHAT WAS IN THE BEST SERVICE OF HIM.
ANOTHER WOMAN SHARED A STORY ABOUT A PATIENT
WHO HAS BIPOLAR DISEASE AND, FOR SOME REASON, YOU KNOW,
SOMETIMES HE'S STABLE AND SOMETIMES HE'S NOT,
AND HE WENT INTO A PHASE WHEN HE WAS NOT STABLE,
AND HE NEEDED TO BE HOSPITALIZED IN THE VA.
SHE WENT ON TO TALK ABOUT HOW HE KEPT KIND OF "ESCAPING"
OR LEAVING THE SYSTEM, AND THEY'D SPEND MONEY AND TIME
TRYING TO FIND HIM, BRING HIM BACK,
AND THIS WENT THROUGH A COUPLE OF CYCLES
UNTIL SHE WENT TO VISIT HIM
AND REALLY ASKED HIM, "WHAT'S GOING ON?"
WELL, IT TURNS OUT THAT HIS FATHER HAD RECENTLY DIED,
AND HE WAS TRYING, DESPERATELY TRYING,
TO GET BACK TO THIS CABIN WHERE HE HAD SPENT A LOT OF TIME
WITH HIS FATHER WHEN HE WAS GROWING UP AS A CHILD.
SHE REFLECTED THAT AS A STORY.
EVERYBODY WAS TRYING TO DO THE RIGHT THING--
TAKING CARE OF HIS BIPOLAR DISEASE,
KEEPING HIM IN THE HOSPITAL--
BUT, AGAIN, WITH OUR FOCUS ON FINDING AND FIXING THE PROBLEM,
ACTUALLY MISSED THE OPPORTUNITY
TO REALLY HELP THIS MAN IN THE BEST WAY.
ANOTHER EXAMPLE THAT WAS SHARED WAS A PATIENT
THAT WAS SUFFERING WITH DEPRESSION
AND HAVING INCREASING SYMPTOMS OF DEPRESSION
AND SOME SUICIDAL IDEATION.
THE WOMAN THAT WAS SHARING THIS STORY SAID
SHE WAS ASKED TO SEE THE PATIENT,
AND THERE WAS SOME EXPECTATION THAT SHE'D PROBABLY
ADD SOME ANTIDEPRESSANT OR CHANGE HIS MEDICINES AROUND,
BUT SHE TOOK ANOTHER APPROACH,
AND SHE ACTUALLY ASKED THIS GENTLEMAN,
WERE THERE TIMES IN THE DAY OR THE NIGHT
WHERE HE WASN'T FEELING SO SEVERELY DEPRESSED?
WERE THERE TIMES WHEN HE WASN'T THINKING ABOUT SUICIDE,
AND WHAT WAS HE THINKING ABOUT, AND HE WAS QUICK TO SAY YES.
AS A MATTER OF FACT, THERE WERE THOSE TIMES,
AND IT WAS REALLY ABOUT HIS GRANDCHILDREN
AND WHAT A SOURCE OF JOY THEY WERE,
AND WHEN HE WAS FEELING CONNECTED TO THOSE THOUGHTS
OR TO THOSE MEMORIES, HE WASN'T FEELING DEPRESSED OR SUICIDAL.
SO THEY MADE A STRATEGY WHICH WAS ACTUALLY ABOUT
HOW DO YOU DIAL UP THE JOY AND THE SOURCE OF HAPPINESS
RATHER THAN ONLY COMBATING THE DEPRESSION,
SO VERY DIFFERENT APPROACH.
ALL OF THESE ARE EXAMPLES OF A PERSONALIZED APPROACH
RATHER THAN THE "FIND-IT, FIX-IT,"
DISEASE-BASED CARE THAT WE'RE SO TRAINED TO DO.
SO IF YOU THINK ABOUT EVEN THE NAMES OF OUR DRUGS,
WE HAVE ANTIBIOTICS.
WE HAVE ANTIHYPERTENSIVES. WE HAVE ANTIDEPRESSANTS.
WE'RE FIGHTING A WAR. IT'S THEM AGAINST US.
TALK ABOUT REACTIVE. FIND IT, FIX IT. IT'S WARFARE.
THAT'S THE PARADIGM WE WERE TRAINED IN PREDOMINANTLY,
AND AGAIN, I'M MAKING A LOT OF GENERALIZATIONS,
BUT IF WE'RE LOOKING AT THE OVERALL APPROACH TO HEALTH CARE
AND MEDICAL CARE IN THIS COUNTRY,
THESE ARE THE CHARACTERISTICS
IN THE WAY WE'RE TRAINED AND WHAT WE'RE GOOD AT.
SO THAT'S THE PERSONALIZED PIECE.
THAT'S WHAT IT MEANS TO SHIFT TO A MORE PERSONALIZED APPROACH.
THE OTHER CHARACTERISTIC WE TALK ABOUT IS BEING PROACTIVE.
NOW, THAT'S AN INTERESTING PIECE, TOO.
WHAT DOES THAT MEAN?
FOR SOME PEOPLE, IT MEANS, AH, PREVENTING DISEASE,
AND I WANT TO MAKE SURE PEOPLE UNDERSTAND
THAT YOU CAN BE PROACTIVE AT EVERY PHASE ALONG ONE'S LIFE.
YOU CAN BE PROACTIVE ABOUT DEATH.
SO WHAT DO I MEAN BY THAT?
HOSPICE DOES THIS BEAUTIFULLY, WHICH IS, YOU CAN SIT BACK
IF YOU'RE GIVEN A TERMINAL ILLNESS AND WAIT TO DIE,
OR YOU CAN ACTUALLY ENGAGE IN A PROCESS
THAT THINKS ABOUT HOW WOULD I WANT THAT EXPERIENCE TO BE,
HOW WOULD THAT BEST SERVE ME IN MY LIFE AND IN MY DEATH,
AND HAVE A VERY PROACTIVE APPROACH TO DESIGNING THAT.
ANOTHER GREAT EXAMPLE IS HEADED INTO SURGERY.
MOST OF US, IF AND WHEN WE'RE TOLD WE NEED SURGERY,
IT'S A SCARY THING.
WE CAN HAVE A REACTIVE PROCESS TO THAT
WHERE WE JUST KIND OF WAIT SCARED TILL THEY,
YOU KNOW, WHEEL US DOWN AND CUT US OPEN,
VERY FRIGHTENING,
OR WE CAN TAKE A PROACTIVE APPROACH
TO PREPARING FOR THE SURGERY.
WE CAN BE MENTALLY PREPARED.
WE CAN CHANGE THINGS IN OUR DIET OR OUR FITNESS
IF WE HAVE TIME TO DO THAT.
WE CAN USE MIND-BODY APPROACHES TO REDUCE PAIN AND ANXIETY.
THERE ARE A LOT OF THINGS WE CAN DO
THAT NOT ONLY AFFECT OUR EXPERIENCE
OF THAT HEALTH CONDITION AND PROCESS,
BUT ALSO THE ACTUAL OUTCOMES.
ANOTHER GREAT EXAMPLE IS CANCER.
MANY, MANY PEOPLE KNOW
OR HAVE BEEN THROUGH CANCER DIAGNOSIS AND TREATMENT.
IT'S INCREDIBLY FRIGHTENING,
AND THERE'S KIND OF A SAD STORY, IN A WAY, FOR ME
WHICH IS A CONVERSATION I HAD
WITH THE HEAD OF RADIATION ONCOLOGY
AT A LEADING ACADEMIC INSTITUTION,
AND HE SAID TO ME, HE SAID-- AND HE WAS SO SERIOUS--
HE SAID, "YOU KNOW THE PROBLEM WITH PATIENTS THESE DAYS?
"THEY ALWAYS WANT TO KNOW WHAT THEY CAN DO,
"AND I'M ALWAYS TELLING THEM THERE'S NOTHING YOU CAN DO.
JUST RELAX, WE'LL DEAL WITH IT,"
AND THAT'S A FRIGHTENING THING FOR ME TO SAY.
FIRST OF ALL, IT'S NOT TRUE.
THERE ARE MANY THINGS THAT PEOPLE CAN DO THAT AFFECT
BOTH THE DEGREE TO WHICH THEY MIGHT SUFFER WITH SYMPTOMS
OR SIDE EFFECTS AND ALSO THE COURSE OF THEIR DISEASE,
BUT MORE IMPORTANTLY, IN A WAY, IS THE HARM
THAT THAT KIND OF A STATEMENT DOES FOR SOMEONE
FACING THAT DIAGNOSIS.
"THERE'S NOTHING YOU CAN DO"? JUST SIT BACK"? HOW FRIGHTENING.
SO A PROACTIVE APPROACH TO A DIAGNOSIS OF CANCER
AND TREATMENT IS TO EXPLORE WHAT DOES THAT MEAN TO YOU.
HOW DOES THAT AFFECT YOUR LIFE AND CHANGE WHO YOU ARE?
WHAT APPROACHES COULD YOU PUT INTO PLACE,
WHETHER THAT'S MIND-BODY APPROACHES OR NUTRITION
OR OTHER MODALITIES, THAT COULD HELP REDUCE THE RISKS
OF SIDE EFFECTS AND IMPROVE YOUR IMMUNE SYSTEM
AND YOUR POTENTIAL OUTCOMES.
SO THOSE ARE ILLUSTRATIONS OF WHAT IT MEANS TO BE PROACTIVE
IN YOUR APPROACH TO YOUR HEALTH AND WELL-BEING.
LASTLY AND--IN SOME WAYS, IN MY OPINION--THE MOST IMPORTANT,
WHAT ABOUT THIS PATIENT-DRIVEN THING?
WHAT DOES THAT MEAN EXACTLY?
DOES IT MEAN SIMPLY TAKING THE VETERAN'S OPINIONS INTO ACCOUNT?
I'D SAY IT'S A LOT MORE THAN THAT.
WE SHOULD CERTAINLY BE DOING THAT,
BUT WHEN IT'S PATIENT-DRIVEN, IT MEANS THE WHOLE THING
BEGINS AND ENDS WITH WHAT MATTERS TO THE VETERAN.
THIS IS INCREDIBLY IMPORTANT BECAUSE,
FOR THE VAST MAJORITY OF HEALTH CARE,
IT REALLY DOES DEPEND ON THE INDIVIDUAL'S COMMITMENT
AND INVESTMENT IN THEIR OWN HEALTH AND THEIR OUTCOMES.
SO UNLESS IT BEGINS WITH WHAT MATTERS TO THEM,
WE'RE NOT GONNA GET VERY FAR.
A COUPLE OF QUICK STORIES ABOUT THAT.
WELL, MAYBE NOT SO QUICK.
DON BERWICK, WHO SOME OF YOU MAY KNOW,
TELLS A WONDERFUL STORY ABOUT THIS KIND OF THING.
HE WAS TALKING ABOUT AN ISSUE HE'D HAD WITH HIS KNEE
AND SURGERIES HE'S HAD IN THE PAST
SPANNING 30 YEARS OF HIS LIFE
AND IT CAME TIME FOR HIM TO HAVE A SURGERY, ANOTHER SURGERY,
AND HE WAS REFLECTING ON THAT
BECAUSE NONE OF US LIKE TO HAVE SURGERY IF WE CAN AVOID IT,
AND HE WAS REFLECTING ON, "WHY AM I HAVING THE SURGERY?"
WHAT MATTERS HERE ENOUGH THAT I WOULD HAVE SURGERY?"
AND HE THOUGHT ABOUT IT, AND HE SAID,
"YOU KNOW WHAT? PAIN. I HAVE PAIN.
"I REALLY DON'T WANT TO LIVE WITH PAIN.
THAT'S WHAT MATTERS,"
AND HE GAVE THAT SOME THOUGHT, AND HE THOUGHT,
"WELL, THAT'S TRUE.
"THAT IS TRUE, BUT LET'S GO A LITTLE BIT DEEPER, YOU KNOW?
WHAT DO I REALLY WANT?"
THOUGHT ABOUT THAT, GAVE IT SOME THOUGHT, AND WENT,
"YOU KNOW, WHAT I REALLY WANT IS TO BE ABLE TO BE MOBILE,
"TO MOVE AROUND FREELY IN MY LIFE
AND NOT BE LIMITED IN THE WAYS I CAN MOVE."
HE THOUGHT ABOUT THAT, WENT, "YEAH. THAT'S RIGHT,"
PUSHED IT A LITTLE FURTHER.
"WHAT DO I REALLY, REALLY WANT?"
AND HE BEGAN TO THINK ABOUT
HOW ONE OF THE THINGS HE LOVES IN LIFE
IS SKATE-SKIING, WHICH IS A FORM OF CROSS-COUNTRY SKIING,
AND HE CAME TO FIND OUT WHEN HE THOUGHT ABOUT THAT
THAT THAT WAS SOMETHING THAT HE LOVED AND BROUGHT JOY TO HIM,
AND HE REALLY DIDN'T WANT TO LIVE A LIFE
WITHOUT IT IF HE COULD,
AND HE SAID, "YEAH. THAT'S WHAT I REALLY, REALLY WANT."
THEN HE TOOK IT ONE STEP EVEN FURTHER.
"WHAT DO I REALLY, REALLY, REALLY WANT?"
AND HE TALKED ABOUT THE EXPERIENCE HE HAS
WHEN HE GOES SKATE-SKIING AND WHAT IT'S LIKE
TO BE IN AN ENVIRONMENT IN NATURE WITH THE SILENCE
IN THIS GROVE OF CEDAR TREES WITH THE RED SQUIRREL,
AND HE DESCRIBES THIS WHOLE THING SO BEAUTIFULLY,
AND HE TALKED ABOUT HOW SIGNIFICANT
THOSE MOMENTS ARE FOR HIM.
HE SAID, "THAT'S WHEN I REALIZED
"THAT THAT'S WHAT I REALLY, REALLY WANT.
"THAT'S WHY I WANT TO GO THROUGH THE SURGERY.
THAT'S WHAT'S WORTH THE PAIN AND THE TRAUMA OF THAT EXPERIENCE,"
AND THEN HE WENT ON TO SAY THAT "I REALIZE THERE IS A DEEP
"AND MEANINGFUL CONNECTION BETWEEN MY KNEE AND ME,
"AND NOT ONE HEALTH CARE PROVIDER OF 30 YEARS
KNOWS THAT ABOUT ME, AND IT'S NOT THEIR FAULT."
HE MAY NOT HAVE KNOWN THAT ABOUT HIM.
WE AREN'T TRAINED TO ASK THOSE QUESTIONS,
BUT THE BOTTOM LINE IS, UNLESS WE HELP PEOPLE
PEEL AWAY THE LAYERS OF WHAT REALLY, REALLY MATTERS TO THEM,
THEY'RE NOT GOING TO ENGAGE FULLY IN THEIR HEALTH
OR BEING PROACTIVE ABOUT THEIR HEALTH CARE.
ANOTHER GREAT EXAMPLE IS A GENTLEMAN WHO CAME IN,
LONG-TIME SMOKER, KNOWS ALL THE RISKS OF SMOKING,
HAS BEEN EDUCATED.
IT'S NOT AN ISSUE OF INFORMATION.
YOU KNOW, THERE'S ALWAYS THIS BIG GAP
BETWEEN INFORMATION AND BEHAVIOR.
SO HE SAID, "I KNOW ABOUT THE RISKS.
"I KNOW I SHOULD STOP SMOKING.
"I'M NOT GONNA, SO GIVE UP THE HOPE.
DON'T EVEN GO THERE."
SO WE DIDN'T, BUT WE ENGAGED HIM IN THIS PROCESS
OF EXPLORING WHAT REALLY, REALLY MATTERS TO HIM,
WHAT DID HE WANT HIS HEALTH FOR, WITHOUT AN AGENDA OF OUR OWN,
BUT REALLY TO HELP HIM EXPLORE THAT,
AND WHEN HE REALLY THOUGHT ABOUT AND REFLECTED ON IT
AND PEELED AWAY THESE LAYERS, HE REALIZED
THAT WHAT HE REALLY LOVED IN LIFE
WAS HIS RELATIONSHIP WITH HIS GRANDSON.
HE WAS ABOUT 7 AT THE TIME,
AND HE WAS A PRIMARY CARE PROVIDER FOR HIS GRANDSON,
AND HE LOVED THAT RELATIONSHIP.
WE ASKED HIM TO THINK ABOUT WHAT THAT WOULD BE LIKE
IN 5 YEARS, IN 10 YEARS, IN 15 YEARS,
WHAT WOULD HE LIKE IT TO BE,
AND WERE THERE ANY THINGS THAT WERE IN THE WAY
OF THAT WHICH HE WANTED,
AND HE CAME TO THE CONCLUSION IN DOING THIS REFLECTION
THAT HIS SMOKING WAS ACTUALLY A BARRIER.
IT WAS A BARRIER TODAY IN LIMITING SOME OF THE ACTIVITIES
HE COULD DO BECAUSE HE WAS HAVING RESPIRATORY ISSUES.
IT WAS A BARRIER THAT HE DIDN'T LIKE THE FACT
THAT HIS CLOTHES SMELLED LIKE SMOKE AND HE WAS IN SOME WAYS
MODELING THIS BEHAVIOR FOR HIS GRANDSON.
IT WAS CERTAINLY AN ISSUE WHEN HE THOUGHT
ABOUT WHAT HIS HEALTH WOULD BE LIKE
AND HIS VITALITY WOULD BE LIKE 5, 10, 15 YEARS OUT,
AND HE REALIZED FOR THE REASONS THAT MATTERED MOST TO HIM,
NOT BECAUSE OF PICTURES OF DISEASED LUNGS OR STATISTICS,
BUT BECAUSE OF HIS RELATIONSHIP WITH HIS GRANDSON.
HE SAID, "YOU KNOW WHAT? I WANT TO QUIT."
THEN WE COULD STEP IN AND HELP.
OUR TOOLS COULD THEN BE SUCCESSFUL.
IT'S A REALLY WONDERFUL ILLUSTRATION,
AND LAST ILLUSTRATION I WANT TO SHARE, BECAUSE THIS IS IMPORTANT
WITH CHRONIC ILLNESS SUCH AS TOBACCO USE
AND ISSUES LIKE THAT,
WITH AN ISSUE LIKE SURGERY THAT WE TALKED ABOUT,
ANOTHER EXAMPLE THAT WAS GIVEN TO ME, ACTUALLY,
WHEN I WAS HAVING A MEETING WITH SOMEBODY IN THE VA
WHEN I WAS JUST NEW TO THE SYSTEM.
I WENT TO MEET WITH THIS PERSON AND SHE WASN'T THERE,
AND HER STAFF SAID,
"OH, WE'RE SO SORRY YOU DIDN'T GET THE MESSAGE.
"SHE REALLY WANTS TO MEET WITH YOU,
BUT SHE'S IN INTENSIVE CARE,"
AND I THOUGHT FOR A MINUTE BECAUSE I KNEW
THIS PERSON WASN'T A MEDICAL PROVIDER.
I SAID, "SHE IS INTENSIVE CARE?"
THEY SAID, "YEP. SHE'S ON A RESPIRATOR
BATTLING BREAST CANCER, BUT SHE REALLY WANTS TO MEET WITH YOU."
SO THE FIRST THING THAT FREAKED ME OUT A BIT
WAS LIKE, "REALLY?"
LIKE, I'M HOPING SHE'S NOT LYING THERE
THINKING ABOUT MEETING WITH ME,
BUT YOU KNOW WHAT WAS AMAZING TO ME, ABSOLUTELY AMAZING?
THEY SAID, "NO, NO.
"SHE WANTS TO ME WITH YOU. SHE'S ANXIOUS TO MEET WITH YOU.
"WE'LL GET YOU BACK ON HER CALENDAR
JUST AS SOON AS SHE'S BACK," AND I THOUGHT "OK," YOU KNOW?
3 WEEKS LATER, I HAD AN APPOINTMENT WITH HER,
AND I THOUGHT IT HAD TO BE A MISTAKE.
I GO TO HER OFFICE.
SHE'S THERE, AND SHE'S LOOKING GREAT,
AND I SAT DOWN WITH HER, AND I STARTED TALKING TO HER
ABOUT THIS VISION FOR THE FUTURE OF HEALTH CARE,
AND SHE SAID, "CAN I STOP YOU FOR A MINUTE?"
AND I SAID, "SURE. OF COURSE."
SHE SAID, "I DON'T KNOW IF YOU'RE AWARE, BUT 3 WEEKS AGO,
I WAS IN THE INTENSIVE CARE UNIT ON A RESPIRATOR,"
AND I SAID I WAS AWARE.
SHE SAID, "LET ME TELL YOU ABOUT THIS."
SHE SAID, "THE FIRST THING YOU NEED TO KNOW ABOUT ME IS,
I AM THE MOST TYPE "A" PERSON YOU WOULD EVER WANT TO MEET."
SHE SAID, "I LIVE FOR MY WORK.
I LOVE MY WORK," AND THAT'S THE WAY SHE SAID IT.
YOU KNOW, PAY ATTENTION TO THAT.
"I LIVE FOR MY WORK. I LOVE MY JOB," SHE SAID.
SHE SAID, "NOBODY ON MY HEALTH CARE TEAM,
MY INTENSIVE CARE TEAM, KNEW THAT ABOUT ME,
AND THEY HAD A LOVELY, TOUCHY-FEELY,
GENTLE PLAN FOR MY TREATMENT AND RECOVERY,"
AND SHE SAID, "IT WAS DRIVING ME NUTS."
SO SHE FINALLY GOT SOMEONE'S ATTENTION,
A THERAPIST'S ATTENTION WHO WAS LISTENING,
AND EXPLAINED IN WRITING THIS IS NOT WORKING FOR HER.
SHE NEEDED AND WANTED TO GET WELL TO GET BACK TO WORK,
AND SHE WANTED
THE MOST AGGRESSIVE TREATMENT PLAN POSSIBLE
WITH EVERYBODY PUSHING AS HARD AS THEY COULD
TO GET HER OUT OF THERE.
SO THEY DID. THEY LISTENED.
THEY REDESIGNED THE TREATMENT PLAN
TO BE THE MOST AGGRESSIVE, ASSERTIVE.
THEY WERE ALL ON THE SAME PAGE.
THEY WERE ALL DRIVING WITH HER GOAL IN MIND, AND IT WORKED.
SHE GOT BETTER.
SHE ALSO SAID, "LET ME TELL YOU ANOTHER STORY.
THE WOMAN IN THE BED NEXT TO ME WAS A 75-YEAR OLD INDIAN WOMAN,
"AND," SHE SAID, "HER FAMILY EVERY DAY,
"SOMETIMES MULTIPLE TIMES A DAY,
"WOULD BRING IN INDIAN FOOD, NOT BECAUSE SHE COULD EAT IT--
SHE WAS ON A RESPIRATOR-- BUT SO SHE COULD SMELL IT
AND SEE IT AND REMEMBER THAT WHAT SHE LOVED MOST
WAS TO COOK WITH AND FOR HER FAMILY,"
AND THEN THE TYPE "A" PART CAME OUT, AND SHE SAID,
"AND THAT WOMAN GOT BETTER FASTER THAN ME,"
BUT THESE ARE THE THINGS.
IF WE UNDERSTAND AND HELP PEOPLE EXPLORE
WHAT MATTERS MOST TO THEM AND LINE UP BEHIND THAT,
THAT IS WHAT ALLOWS THE PATIENT-DRIVEN PART
OF THIS NEW MODEL OF CARE TO WORK.
THAT'S THE MAGIC INGREDIENT.
THEN OUR PROACTIVE STRATEGIES CAN TAKE EFFECT.
THEN OUR PERSONALIZED APPROACHES WILL MAKE A DIFFERENCE.
SO THAT'S WHAT WE'RE UP TO.