- HOW DO WE DRIVE CHANGE IN A SYSTEM THIS LARGE?
WELL, IT TAKES TIME.
IT'S NOT FOR THE FAINT OF HEART,
AND IT TAKES ENVIRONMENTS WHERE WE CAN INNOVATE AND DEMONSTRATE
AND LEARN FROM SUCCESSES AND FROM FAILURES
ABOUT WHAT'S WORKING BEFORE WE DEPLOY THAT ACROSS THE SYSTEM,
AND SO MANY OF YOU ARE DOING PHENOMENAL INNOVATIONS
EVERY DAY AT THE BEDSIDE.
SO HOW DO WE CAPTURE THAT AND LEARN FROM THAT?
WE NEED TO TAKE THE VOICE OF THE VETERAN
AND HAVE THEM PARTNER WITH US IN EVERY STEP OF THE WAY.
WE NEED TO LEARN FROM BOTH BASIC AND SYSTEM RESEARCH
AND THEN USE THAT TO FORM THESE PILOTS THAT ARE ONGOING.
AS WE LEARN AND GROW FROM THOSE, WE'LL CREATE THE EDUCATION
THAT WE NEED TO HELP SPREAD THIS ACROSS THE COUNTRY,
BUT THAT IS AN ITERATIVE PROCESS.
IT GOES AROUND AND AROUND.
IT'S NOT THAT WE HAVE THE ANSWER,
"HERE IT IS. PLUG AND PLAY."
IT'S A PROCESS, AND IT WILL TAKE YEARS.
SO WHAT DOES THIS LOOK LIKE?
WHAT DOES THIS APPROACH TO HEALTH CARE ACTUALLY LOOK LIKE?
WELL, IT'S INTERESTING TO THINK ABOUT THE ELEMENTS
OF PATIENT CENTERED CARE,
WHICH IS PART OF WHAT WE'RE TALKING ABOUT.
THERE'S TWO PRIMARY DOMAINS.
ONE IS ABOUT THE EXPERIENCE OF HEALTH CARE.
WHAT DOES IT FEEL LIKE TO ENTER INTO--
LET'S JUST SAY, FOR EXAMPLE--A HOSPITAL?
I'M GUESSING YOU'VE HAD THE EXPERIENCE,
BECAUSE I CERTAINLY HAVE HAD,
WHERE I WALK INTO AN ENVIRONMENT--
SOMETIMES IT'S A CLINIC; SOMETIMES IT'S A HOSPITAL--
AND EVERY PART OF ME IS TELLING ME TO GET OUT OF THERE.
I DON'T LIKE THE SMELL. I DON'T LIKE THE SOUND.
I DON'T LIKE THE SIGHTS. IT'S NOT A HEALING ENVIRONMENT.
SO WHAT DOES IT LOOK LIKE-- AND MANY VAs AROUND THE COUNTRY
HAVE DONE AMAZING WORK IN THIS AREA--
TO CREATE AN ENVIRONMENT WHERE YOU FEEL SAFE, FIRST OF ALL,
AND IT'S A HEALING SPACE, IT'S A HEALING ENVIRONMENT?
YOU CAN FEEL YOUR SHOULDERS DROP.
YOU FEEL AT EASE.
YOU KNOW YOU'RE GOING TO BE WELL TAKEN CARE OF THERE.
THOSE ENVIRONMENTS ARE CRITICALLY IMPORTANT
AND ACTUALLY AFFECT EVERYTHING, INCLUDING IMMUNE FUNCTION.
AND WHAT ABOUT HEALING RELATIONSHIPS?
WHAT DOES THAT MEAN?
THAT MEANS THAT EVERY HUMAN INTERACTION,
WHETHER IT'S AT THE FRONT DOOR OR WITH THE SURGEON IN THE O.R.,
HAS AN IMPACT NOT ONLY ON YOUR EXPERIENCE,
BUT ALSO IN YOUR OUTCOMES.
WE ALL HAVE HAD EXPERIENCES WHERE A PHYSICIAN
OR SOMEONE IN A WHITE COAT COULD SAY SOMETHING
THAT ACTUALLY BRINGS FEAR OR EVEN INADVERTENTLY CAUSES HARM,
AND I'LL GIVE YOU A QUICK ILLUSTRATION OF THIS.
AS YOU KNOW, PROBABLY, I'M AN OB/GYN,
AND I HAD A PATIENT THAT HAD A VERY HIGH-RISK PREGNANCY
AND NEEDED A C-SECTION TO DELIVER THE BABY.
WE KNEW THIS IN ADVANCE, SO IT WASN'T AN EMERGENCY.
SHE DID A LOT OF PREPARATION FOR THE SURGERY
AND FELT VERY READY TO HAVE THE SURGERY.
SHE WAS RELAXED.
WE WERE IN THE HOLDING ROOM, WHICH IS THE SPACE
BEFORE YOU GO INTO THE OPERATING ROOM.
SHE'D DONE SOME MIND-BODY APPROACHES
AND SOME IMAGERY WITH ME,
AND SHE FELT VERY COMFORTABLE AND READY AND AT PEACE, REALLY.
THE ANESTHESIOLOGIST WALKED INTO THE ROOM--
WHO I HAD NOT MET, SHE HAD NOT MET--
AND IT WAS INTERESTING BECAUSE YOU TELL HE WAS UNCOMFORTABLE
WITH THE DEGREE OF RELAXATION IN THE SPACE,
LIKE HE WASN'T USED TO IT.
IT WAS ODD.
HE THOUGHT SOMETHING WAS WRONG UNCONSCIOUSLY.
HE WALKED OVER TO HER BEDSIDE,
AND HE LOOKED AT HER, AND HE SAID,
"I NEED YOU TO UNDERSTAND SOMETHING.
THIS IS A VERY HIGH-RISK PROCEDURE,"
AND I JUST SAW THE COLOR WASH OUT OF HER FACE.
HER FEAR RETURNED, AND I UNDERSTOOD
THAT WHAT WE HAD DONE TO PREPARE HER
WAS IN THAT MOMENT REVERSED.
NOW, HE DIDN'T MEAN TO DO HARM,
BUT THESE ARE THE WAYS IN WHICH OUR COMMUNICATIONS
CAN ACTUALLY DO HARM WHEN THE OPPOSITE IS WHAT WE WANT.
SO THAT WHOLE SIDE OF THE EQUATION,
THE EXPERIENCE SIDE OF PATIENT CARE,
WE SHOULD BE DOING EACH AND EVERY DAY
TO THE BEST OF OUR ABILITY NOW.
CURRENTLY, WE'RE ALSO LOOKING AT WHAT ARE THE CORE COMPETENCIES
OR THE BEHAVIORS THAT ALL OF US NEED TO WORK ON
IN ORDER TO DELIVER THIS KIND OF CARE,
AND RIGHT NOW, WE'RE TALKING ABOUT HEALING COMMUNICATION.
HOW DO WE USE THE POWER OF OUR INTERACTIONS AND OUR WORDS
TO SUPPORT HEALTH AND HEALING FOR THE VETERAN?
WHAT ABOUT PARTNERSHIPS?
HOW DO WE FORM THE BEST PARTNERSHIPS?
AND THAT MEANS BOTH WITH THE VETERAN.
IT MEANS WITH EACH OTHER ON OUR TEAMS.
IT MEANS ACROSS TEAMS,
AND IT MEANS UP AND DOWN THE ORGANIZATION.
HOW DO WE HAVE THE FREEDOM TO SAY WHAT WE MEAN
AND TAKE ACTION WHEN IT'S IN THE BEST INTEREST OF OUR PATIENTS?
PERSONAL MASTERY.
PART OF PERSONAL MASTERY IS BEING SELF-AWARE
AND BEING WILLING TO REFLECT ON OUR OWN BEHAVIOR,
OUR OWN EXPERIENCE AND CHANGE THAT
AND ADAPT THAT AS WE MOVE FORWARD,
AND THE FOURTH CORE BEHAVIOR THAT WE'VE IDENTIFIED
IS, ONE WORD, CHANGE.
WE HAVE TO HAVE THE WILLINGNESS TO TAKE SOME RISK TO CHANGE
AND DO THINGS DIFFERENTLY AND NOT PUNISH THAT,
BUT REWARD THAT.
SOMETIMES IT'S GOING TO TURN OUT WELL, BUT NOT ALWAYS.
WE NEED TO LEARN FROM OUR ERRORS
AND INCORPORATE THAT AND ADAPT AS WE MOVE FORWARD.
THE RESULT OF THESE CORE BEHAVIORS
IS MEANINGFUL EXPERIENCE AND OUTCOMES,
AND I LOVE THAT LANGUAGE-- MEANINGFUL.
IT'S MEANINGFUL TO THE VETERAN. IT'S MEANINGFUL TO THE EMPLOYEE.
MEANINGFUL EXPERIENCE AND OUTCOMES.
THOSE ARE THE CORE BEHAVIORS THAT WE'VE IDENTIFIED
TO HELP GET US WHERE WE NEED TO GO.
WHAT ABOUT THE PRACTICE SIDE?
THE PRACTICE SIDE INVOLVES WHAT HAPPENS
WHEN YOU ACTUALLY ENTER THE SYSTEM FOR HEALTH CARE,
AND THERE ARE TWO ELEMENTS OF THAT
WE'RE GOING TO TALK A LITTLE BIT MORE ABOUT.
THEY'RE SIGNIFICANTLY DIFFERENT FROM OUR CURRENT SYSTEM.
THEY INTEGRATE AND BUILD ON WHAT WE CURRENTLY DO,
BUT THEY'RE EXPANDED.
ONE IS THE PERSONALIZED HEALTH APPROACH.
WHAT IS ACTUALLY THE PROCESS THAT YOU GO THROUGH
IF YOU'RE HERE IN A WAY THAT WE WANT TO DO
PERSONALIZED, PROACTIVE, PATIENT-DRIVEN HEALTH CARE?
IT'S A DIFFERENT PROCESS.
AND WHAT ARE THE AREAS OF YOUR HEALTH
THAT WE'RE GOING TO LOOK AT?
IF WE'RE GOING TO BE PROACTIVE ABOUT YOUR HEALTH,
WE'RE GOING TO BE LOOKING AT SOME OTHER AREAS
THAT MAYBE TRADITIONALLY YOUR PHYSICIAN
HASN'T LOOKED AT WITH YOU.
WHAT'S INVOLVED
IN A PERSONALIZED APPROACH?
WELL, IT STARTS
FROM A DIFFERENT PLACE.
IT STARTS WITH
A PERSONAL HEALTH MISSION,
HELPING THE VETERAN
EXPLORE WHAT THAT MEANS,
WHAT MATTERS TO THEM,
AND CREATING A PLAN AROUND THAT.
IT'S INTERESTING.
IF YOU THINK ABOUT PLANNING
AND HEALTH, THEY DON'T
USUALLY GO HAND-IN-HAND.
I LIKE TO REMIND OURSELVES,
REMIND EACH OF US,
THAT WE PLAN FOR MOST THINGS
THAT MATTER IN OUR LIFE.
WE ACTUALLY PLAN FOR OUR DEATH.
THINK ABOUT IT.
WE PLAN FOR WHETHER WE WANT
TO BE BURIED OR CREMATED;
WHAT'S GONNA HAPPEN
TO OUR THINGS;
IF WE HAVE YOUNG CHILDREN,
WHAT'S GONNA HAPPEN TO THEM;
AND WE OFTEN HAVE GIVEN
MORE THOUGHT AND PLANNING
TO THE DEATH THAN TO OUR HEALTH.
SO WHAT'S UP WITH THAT,
YOU KNOW?
IT IS PART OF THE REASON WE HAVE
THIS REACTIVE APPROACH.
SO ONE OF THE KEY COMPONENTS
IS STARTING WITH YOUR OWN
PERSONAL HEALTH MISSION
AND CREATING A PLAN.
WE ALSO KNOW IF WE'RE
GOING TO BE PROACTIVE,
WE NEED NEW STRATEGIES
IN ADDITION TO
THE PHARMACEUTICALS
AND THE SURGERIES.
THERE ARE NUTRITIONAL
STRATEGIES,
MIND-BODY STRATEGIES,
RELATIONSHIP STRATEGIES
THAT CAN ALL IMPACT
OUR HEALTH.
SO IT'S A MORE COMPREHENSIVE,
PROACTIVE USE OF STRATEGIES,
BUT EVEN IF WE HAVE
A GREAT MISSION AND PLAN
WITH COMPREHENSIVE STRATEGIES,
WE WILL MOST LIKELY NOT SUCCEED
UNLESS WE GIVE PEOPLE
THE SKILL-BUILDING THEY NEED
TO IMPLEMENT THE PLAN
AND THE SUPPORT ACROSS TIME
TO DO THAT.
THOSE ARE ELEMENTS THAT ARE
CURRENTLY NOT EMPHASIZED
IN OUR HEALTH CARE SYSTEM,
SO BRINGING THAT ALL TOGETHER--
PERSONALIZED HEALTH MISSION
AND PLAN; WHOLE PERSON,
PROACTIVE STRATEGIES;
AND SKILL BUILDING AND SUPPORT
THAT WORKS.
ONE THING THAT IS ABSOLUTELY CLEAR,
YOU COULD HAVE A WONDERFUL, PERSONALIZED PLAN
FOR OPTIMIZING YOUR HEALTH, AND IT COULD INVOLVE STRATEGIES
AND APPROACHES THAT ARE PROACTIVE,
BUT IF YOU DON'T HAVE BOTH THE TRAINING AND SKILLS
THAT YOU'RE GOING TO NEED TO SUCCEED IN THAT
AND THE ONGOING SUPPORT, NOT MUCH WILL CHANGE.
SO THAT IS REALLY CRITICAL.
ONE OF THE THING THAT'S DIFFERENT IS,
WE START WITH ASKING THE VETERAN TO REFLECT ON SOME THINGS
THAT THEY MAY NOT USUALLY THINK ABOUT,
WHAT REALLY MATTERS TO THEM,
AND WHILE THAT MIGHT SOUND HOITY-TOITY,
YOU KNOW, I HAVE NEWS FOR YOU.
IF YOU ARE A HOMELESS VETERAN
AND WHAT REALLY MATTERS TO YOU IS HAVING FOOD AND SHELTER,
THERE IS NO MORE SIGNIFICANT AND HIGHER PURPOSE THAN THAT.
SO THIS WORKS WHEREVER YOU ARE,
WHATEVER YOUR CONDITIONS IN LIFE.
WHAT REALLY MATTERS TO YOU?
WHAT DO YOU WANT YOUR HEALTH FOR?
AND THESE ARE NOT THINGS THAT WE WALK AROUND THINKING ABOUT.
THESE ARE NOT SUPERFICIAL QUESTIONS, BUT DIGGING DEEP
ABOUT REALLY, REALLY WHAT DO YOU WANT YOUR HEALTH FOR?
WHAT BRINGS YOU A SENSE OF JOY IN YOUR LIFE,
AND WHAT BRINGS YOU A SENSE OF SORROW?
CAN WE DIAL UP THE JOY?
YOU KNOW, BEING AWARE OF YOUR SENSES OF SORROW
AND YOUR PLACES OF SORROW OR PAIN
IS IMPORTANT IN THIS APPROACH TO HEALTH CARE.
WE ASK PEOPLE TO REFLECT ON HOW THEY FEEL PHYSICALLY
IN THEIR BODIES FROM A MINUS 5--MISERABLE
TO A PLUS 5--GREAT,
AND THIS CAME ABOUT BECAUSE WE WERE REFLECTING
ON THE FACT THAT, YOU KNOW, WE TAKE PAIN SCORES.
WE'RE VERY GOOD AT LOOKING AT THE NEGATIVE SIDE OF THE SCALES,
LIKE HOW MUCH PAIN ARE YOU IN OR HOW DEPRESSED ARE YOU,
BUT WE DON'T ASK, "DO YOU FEEL GOOD IN YOUR BODY?"
OR, "ARE YOU HAPPY?"
IT'S INTERESTING, RIGHT?
IT'S ANOTHER ILLUSTRATION OF OUR PARADIGM OF HEALTH CARE,
OUR MODEL OF HEALTH CARE THAT'S ABOUT THE DISEASE SIDE,
BUT IF WE'RE STRIVING FOR OPTIMIZING HEALTH
AND WELL-BEING, WE BETTER PAY ATTENTION TO
ARE YOU ON THE PLUS SIDE AND HOW FAR ON THE PLUS SIDE ARE YOU.
SO WE ASK PEOPLE TO REFLECT ON THEIR PHYSICAL STATE OF BEING
RIGHT NOW, HOW ARE YOU FEELING.
MINUS 5 COULD MEAN YOU'RE IN PAIN, YOU'RE EXHAUSTED,
WHATEVER THAT MEANS FOR YOU.
PLUS 5, YOU FEEL GREAT,
AND THE SAME ON THE MENTAL/EMOTIONAL SIDE,
WHERE A MINUS 5 COULD BE ANXIOUS OR DEPRESSED OR SAD,
WHATEVER THAT IS FOR THE PERSON,
AND A PLUS 5 REALLY FEELING VITAL
AND AWESOME AND ALIVE AND CONNECTED.
SO BEGINNING WITH THIS REFLECTION
OF WHERE YOU ARE AND HOW YOU'RE FEELING,
IF YOU'RE GOING TO DRIVE YOUR HEALTH CARE,
IT HAS TO START WITH YOU.
SO WHEN WE TALK ABOUT PROACTIVE
COMPONENTS OF HEALTH CARE,
WHAT DO WE MEAN?
THIS GRAPHIC IS GONNA HELP US TO UNDERSTAND THAT.
THE FIRST THING YOU'LL NOTICE IS THAT YOU,
THE PERSON, IS AT THE CENTER.
AS WE'VE TALKED, IF IT DOESN'T START
WITH WHAT MATTERS TO THE PERSON, THE REST REALLY DOESN'T MATTER.
IT DOESN'T MATTER HOW GREAT OF A PLAN WE HAVE.
SO EXPLORING THAT-- AND I JUST WANT TO SAY
THAT WE OFTEN DON'T KNOW IN-DEPTH
WHAT REALLY MATTERS TO US-- IT TAKES SOME EXPLORATION.
THAT'S THE STARTING PLACE.
THEN NOTICE WHAT'S AROUND THAT-- MINDFUL AWARENESS.
WELL, WHAT DOES THAT MEAN,
AND WHAT DOES THAT HAVE TO DO WITH THIS?
THIS CONCEPT IS PRETTY SIMPLE.
IT'S ABOUT PAYING ATTENTION, BUT IT IS ABOUT PAYING ATTENTION
TO OUR CURRENT STATE OF OUR MIND, OF OUR BODY.
WHY?
BECAUSE WE CANNOT BE PROACTIVE AND ACT IN ADVANCE OF SOMETHING
IF WE'RE NOT AWARE,
IF WE'RE NOT HEARING THE WHISPERS OF OUR BODY, OUR SOUL,
THE SMALL SIGNS, THE SMALL SYMPTOMS,
WE DON'T HAVE A CHANCE OF REACTING
UNTIL THOSE SYMPTOMS ARE SCREAMING,
AND THEN YOU'RE FAR DOWN ON THE RIGHT SIDE OF THAT CURVE.
SO TEACHING THE CONCEPT OF HOW DO YOU PAY ATTENTION
AND LISTEN TO THE SIGNS AND SYMPTOMS,
BE AWARE AND MINDFUL IS A CRITICAL PIECE,
AND IT APPLIES TO EVERY ASPECT OF THIS WHEEL OF HEALTH.
THE AREA IN THE GREEN IS SELF-CARE,
AND WE MAY GIVE PROFESSIONAL OPINION OR CONSULTS
OR HELP IN THESE AREAS, BUT FUNDAMENTALLY
IT COMES DOWN TO WHAT AN INDIVIDUAL DOES IN THEIR LIFE
IN THEIR DAY-TO-DAY WORLD, AND YOU'LL SEE THESE AREAS
COMBINE ALL SORTS OF ASPECTS THAT AFFECT OUR HEALTH,
THE CONVENTIONAL ONES YOU WOULD THINK OF--
FITNESS AND HOW DO YOU MOVE YOUR BODY,
WHAT DO WE EAT AND DRINK--
BUT SOME AREAS THAT YOU MAY NOT HAVE THOUGHT ABOUT.
SUCH AS YOUR RELATIONSHIPS, YOUR SPIRITUAL LIFE.
HOW DO THESE THINGS IMPACT YOUR HEALTH,
AND ARE THERE AREAS THAT YOU WOULD LIKE TO DO
TO BRING YOU TO A DIFFERENT LEVEL OF HEALTH?
THE OUTSIDE RING OF THAT IS PROFESSIONAL CARE,
WHAT WE TYPICALLY THINK OF AS MEDICAL CARE,
SO EVERYTHING FROM INTERVENTIONS TO PREVENTION,
EVERYTHING FROM COMPLIMENTARY THERAPIES
TO CONVENTIONAL THERAPIES.
WHAT DOES PROFESSIONAL MEDICINE
BRING TO BEAR ON YOUR FUTURE HEALTH?
AND THE LAST PIECE AND, IN SOME WAYS, THE MOST IMPORTANT--
THE COMMUNITY, THE COMMUNITY IN WHICH YOU LIVE AND WORK,
AND HOW CAN THAT FURTHER FUEL AND SUPPORT
YOUR HEALTH AND WELL-BEING?
AND WHAT'S INTERESTING ABOUT THIS AND WHAT'S AMAZING ABOUT IT
BEING A PART OF THE VA IS THAT WE HAVE RESOURCES IN AREAS
THAT MAINSTREAM, PRIVATE-SECTOR HEALTH CARE
DOESN'T ACTUALLY EVEN HAVE RESOURCES.
SO WE ARE IN SUCH A GREAT POSITION TO OFFER THIS APPROACH
TO OUR VETERANS AND TO MODEL IT FOR THE COUNTRY.
JUST A FEW EXAMPLES.
THIS IS A DYNAMIC KIND OF SCHEME,
AND YOU CAN ADD YOUR OWN ELEMENTS
TO THE ENVIRONMENT YOU'RE IN, BUT JUST A COUPLE OF EXAMPLES.
WORKING THE BODY,
WE HAVE MOVE!, THAT WEIGHT MANAGEMENT PROGRAM
THAT NCP HAS DEVELOPED.
WE HAVE TELE-MOVE.
WE HAVE PLACES DOING SHARK ATTACKS WHERE THEY COME IN
AND THEY HELP PEOPLE AT THEIR DESK
MOVE AND DO DIFFERENT THINGS,
PROGRAMS LIKE TAI CHI.
WE HAVE THE ENTIRE REHAB PROGRAMS.
WE COULD GO ON AND ON.
WE HAVE SO MANY RESOURCES THAT ARE AVAILABLE IN THE VA
AND IN THE COMMUNITY AROUND WORKING THE BODY.
WHAT DO WE MEAN BY SURROUNDINGS?
WELL, THAT MEANS ARE YOU IN AN ENVIRONMENT THAT, FIRST OF ALL,
IS SAFE, AND IF NOT, WHAT CAN WE DO ABOUT THAT?
AND FURTHERMORE, IS IT THIS ENVIRONMENT,
BOTH PHYSICAL AND EMOTIONAL,
THAT ALLOWS YOU TO BE HEALTHY AND WELL?
THINK OF THE PROGRAMS AND OFFERINGS WE HAVE,
EVERYTHING FROM HOUSING AND URBAN DEVELOPMENT
WITH VA SUBSIDIZED HOUSING
TO THINGS LIKE CREATIVE ARTS FESTIVAL;
HOME-BASED PRIMARY CARE WHERE YOU CAN HAVE
YOUR PRIMARY CARE IN YOUR HOUSE,
YOU CAN HAVE YOUR HOSPITAL CARE IN YOUR HOUSE;
VA HOME LOANS;
COORDINATED TELEHEALTH; THE DOMICILIARY PROGRAMS;
THE SEXUAL TRAUMA COUNSELING;
THE CAREGIVER SUPPORT PROGRAM;
THE LIST GOES ON AND ON.
WE HAVE SO MANY OFFERINGS, BUT HOW CAN WE HELP ADDRESS
THE PERSON'S SURROUNDING THAT CLEARLY AFFECTS
THEIR HEALTH, THEIR WELL-BEING?
PERSONAL DEVELOPMENT BOTH FROM A WORK SIDE AND A PERSONAL SIDE.
WHAT ABOUT VOCATIONAL REHAB, THE GI BILL,
COMPENSATED WORK THERAPY, VOLUNTARY SERVICES,
VETERANS HEALTH LIBRARY, MOBILE APPLICATIONS,
THE VET CENTERS, VETERAN SERVICE ORGANIZATIONS?
AGAIN, THE LIST GOES ON AND ON.
IN THE AREA OF FOOD AND DRINK, WHAT DOES IT MEAN
TO HAVE A HEALTHY RELATIONSHIP BOTH WITH FOOD AND WITH DRINK?
WE HAVE THE MOVE WEIGHT MANAGEMENT PROGRAM.
WE HAVE NUTRITION CLASSES, THINGS LIKE FARMER'S MARKETS,
THE DEMONSTRATION KITCHENS IN THE NUTRITION & FOOD SERVICES,
THE DIABETES EDUCATION CLASSES, INPATIENT MENU ORDERING.
WE HAVE TREMENDOUS OFFERINGS THERE.
RECHARGE IS AN INTERESTING AREA.
IT'S AN AREA I WAS NEVER ACTUALLY TAUGHT
TO ASK PATIENTS ABOUT--
NOT JUST DO THEY GET ENOUGH SLEEP,
BUT WHAT'S THE QUALITY OF THEIR SLEEP.
DO THEY ACTUALLY FEEL INVIGORATED
AND READY TO START THEIR DAY IN THE MORNING,
OR DO THEY WAKE UP FEELING EXHAUSTED,
AND HOW CAN WE IMPROVE THE WAY WE REST AND RECHARGE?
WELL, THERE ARE PROGRAMS IN THE HOSPITAL AROUND NOISE REDUCTION.
THERE ARE SLEEP CLINICS.
THERE ARE TOOLS LIKE PROGRESSIVE MUSCLE RELAXATION
AND SLEEP HYGIENE,
LOTS OF DIFFERENT APPROACHES THAT CAN HELP IN THESE AREAS.
HOW ABOUT THE WHOLE AREA OF FRIENDS,
FAMILIES, AND COWORKERS?
YOU KNOW, IT'S INTERESTING, AGAIN, ANOTHER AREA
WHERE I WAS NOT CONVENTIONALLY TRAINED TO ASK ABOUT,
AND YET LET ME GIVE YOU AN INTERESTING STATISTIC.
IF YOU ARE ISOLATED EMOTIONALLY--
SO YOU MAY HAVE A LOT OF PEOPLE AROUND YOU,
BUT YOU DON'T FEEL LIKE YOU HAVE SOMEONE OR PEOPLE
THAT YOU CAN SAY ANYTHING TO, THAT YOU CAN REALLY CONNECT WITH
SO YOU'RE ISOLATED IN THAT WAY--
YOU HAVE A FOURFOLD RISK, 400% INCREASED RISK,
OF PREMATURE DEATH AT EVERY AGE,
WHETHER YOU'RE A TEENAGER OR AN 80-YEAR OLD PERSON,
AND LET ME TELL YOU, A 400% INCREASED RISK
IS A BIGGER RISK FACTOR THAN ALL THE THINGS
I WAS TRAINED TO ASK ABOUT AS A PHYSICIAN.
THAT'S HUGE, AND YET WE DON'T TYPICALLY ADDRESS THAT.
WELL, NOW WE'RE GOING TO BECAUSE THAT'S SOMETHING
PEOPLE CAN DO SOMETHING ABOUT,
AND WE HAVE TREMENDOUS RESOURCES TO HELP--
THE VET CENTER, COUNSELING, WARRIOR TO SOUL MATE PROGRAMS,
MARRIAGE AND FAMILY THERAPY, PEER SUPPORT PROGRAMS,
RESIDENT AND FAMILY COUNCILS, VSOs, THINGS LIKE PET THERAPY--
PETS ARE PHENOMENAL AT CONNECTING WITH PEOPLE'S HEARTS
AND BREAKING DOWN THAT ISOLATION--
SHARED MEDICAL APPOINTMENTS WHERE YOU'RE IN A GROUP,
GROUP THERAPY.
THE LISTS GO ON AND ON.
SPIRIT AND SOUL.
THIS, FOR MANY PEOPLE, RELATES TO THEIR RELIGIOUS PRACTICE
OR BELIEFS, BUT FOR MANY PEOPLE
HAS NOTHING TO DO WITH ORGANIZED RELIGION.
IT'S WHERE DO THEY FEEL CONNECTED
TO THINGS LARGER THAN THEMSELVES?
SO THESE ARE THE AREAS.
FOR SOME PEOPLE, IT'S NATURE OR ART.
WE HAVE TREMENDOUS RESOURCES-- CHAPLAINCY SERVICE,
LIVING HISTORY PROGRAM, DRUM CIRCLES, SWEAT LODGES,
THE WALLS OF HEROES, NARRATIVE MEDICINE,
STORY TELLING, WALKING LABYRINTHS.
THESE ARE JUST A FEW RESOURCES THAT CAN HELP PEOPLE
ADDRESS THESE AREAS IN THEIR LIFE AND THEIR HEALTH.
POWER OF THE MIND, ONE OF MY FAVORITE TOPICS,
AND THE REASON IT'S ONE OF MY FAVORITE TOPICS IS,
I THINK IT'S ONE OF THE MOST UNDERUTILIZED ASPECTS
OF WHAT CAN AFFECT OUR HEALTH, OUR HEALING, OUR DISEASE.
JUST TO GIVE YOU AN ILLUSTRATION OF THE POWER OF THE MIND,
THERE ARE MANY DOCUMENTED CASES NOW OF PEOPLE UNDERGOING
INVASIVE SURGERIES WITH NO DRUGS, NO ANESTHESIA, NOTHING,
JUST MEDICAL HYPNOSIS, AND I USE THAT AS AN EXAMPLE
BECAUSE THAT'S A PRETTY POWERFUL THING--
I MEAN, C-SECTIONS, MAJOR SURGERIES--
AND IF THE MIND HAS THE POWER TO BLOCK THAT KIND
OF INVASIVE PROCEDURE AND DO THE WHOLE THING WITHOUT ANESTHESIA,
THE MIND IS INCREDIBLY POWERFUL.
I DON'T THINK WE'VE BEGUN TO UNDERSTAND
ALL OF THE OPPORTUNITIES TO USE THE MIND PROACTIVELY.
IT'S AN INCREDIBLY IMPORTANT PART
OF BEING PROACTIVE ABOUT YOUR HEALTH.
ON THE NEGATIVE SIDE, STRESS REDUCES YOUR IMMUNE SYSTEM,
EVEN AFFECTS YOUR GENE EXPRESSION,
AND THE ACTUAL THINGS THAT HOLD TELOMERES,
WHICH ACTUALLY ARE INCREDIBLY IMPORTANT IN OUR AGING PROCESS,
ALL AFFECTED BY STRESS.
SO WE CAN USE MIND-BODY APPROACHES TO REDUCE OUR STRESS.
WE CAN ALSO USE MIND-BODY APPROACHES
TO PROACTIVELY OPTIMIZE OUR HEALTH,
AND WE HAVE A TREMENDOUS NUMBER OF TOOLS IN THIS AREA--
STRESS MANAGEMENT PROGRAMS, GUIDED IMAGERY TOOLS,
HEALING TOUCH, EMDR, MEDICAL HYPNOSIS,
MINDFULNESS BASED STRESS REDUCTION,
BIOFEEDBACK, MEDITATION, YOGA.
THE LIST GOES ON AND ON.
NOW, ARE ALL OF THESE THINGS IMMEDIATELY
AND READILY AVAILABLE TODAY FOR EVERY VETERAN ACROSS THE SYSTEM?
NO, NOT YET, BUT WHAT I DO WANT US TO UNDERSTAND IS,
WE HAVE SO MUCH MORE IN PLACE TO BUILD ON AND GROW
THAN ANY OTHER HEALTH SYSTEM IN THE COUNTRY,
THAT WE AND OUR VETERANS ARE VERY, VERY FORTUNATE.
THE WHEEL OUTSIDE OF THE SELF-CARE AREA
IS OUR PROFESSIONAL CARE.
SO THAT INCLUDES EVERYTHING THAT WE WOULD DO FOR PREVENTION
AND EARLY DETECTION AND SCREENING
ALL THE WAY THROUGH INTERVENTION.
IT DRAWS ON THE BEST OF CONVENTIONAL MEDICINE
AND COMPLEMENTARY THERAPIES,
AND BEYOND THAT IS OUR COMMUNITY.
WE LIVE IN COMMUNITIES,
AND WHAT AND HOW CAN WE DRAW ON THAT
TO OPTIMIZE OUR HEALTH AND WELL-BEING?
SO THE WAY THIS ALL COMES TOGETHER IS, YOU, THE PERSON,
PLUS YOUR SELF-CARE, PLUS YOUR PROFESSIONAL CARE
PLUS THE COMMUNITY
CREATES YOUR PROACTIVE WHOLE HEALTH CARE.