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Slide1
Whole Health 202:Implementing Whole Health in Clinical Care
Slide2Introductions for the Journey Together
Your NameYour Role in VA
What brings you joy?In 15 seconds or less!2
This Photo
by Unknown Author is licensed under
CC BY-NC-SA
Slide3Community Agreements for getting on the Rocket Ship
Be Present
Be CuriousBe Respectful
Be HealthyBe Honest
Culture
Slide4Other important matters for getting on the Rocket Ship
Sign in for CEUs
Rest RoomsSchedule
Slide5Recap
What is Whole Health?
Slide6Recap
What are the parts of the Whole Health System?
Slide7Recap
What is it like to consider your own Whole Health?
Slide8Recap
How is health created and supported?
Slide9Shift from
“What’s the matter?” to
“What matters?”
Slide10Agenda
What Why
Unintended consequences of the current health care model (102F)Evidence How1:1 (clinician and patient)With your teamsWith your systems
10
This Photo
by Unknown Author is licensed under
CC BY-SA-NC
Slide11The Evidence
The EvidencePatient Centered CareWhole Person CarePatient Engagement
Personal Health Planning11
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by Unknown Author is licensed under
CC BY-SA-NC
Slide12Systematic Review: Patient Experience
55 studies, >80,000 ptsConsistent associationsImproved patient safetyImproved adherence
Improved clinical outcomesDecreased resource utilization12
Doyle, doi.org/10.1136/bmjopen-2012-001570.
Slide13Emotions
Mind
Relationships
Meaning and Purpose
Culture
Photo credit
:
Jabi - El de verdad via
Foter.com /
CC BY-NC
Values
Life Story
Physical
Systematic Review: Whole Person Care
Chronic Low Back Pain
41 trials, >6,800 pts
Decreased pain, disability (vs usual care)
Kamper
, Cochrane Systematic R
eview
, BMJ 2015.
Slide14Patient Engagement
14
This Photo
by Unknown Author is licensed under
CC BY-NC-ND
Health Care Team
Patient
Slide15Shift in Patient EngagementWant to play active role in medical decision making
79% Want their doctors to be in charge of decisions
21%Lown, Health Affairs Sept 2011, doi.org/10.1377/hlthaff.2011.0539
Slide16Patient Engagement
Understanding the importance of an active role in one’s own healthcareKnowledge, skills and confidence
to manage healthUsing these to engage in health-promoting behaviors16
Simmons, Genome Medicine 2014, doi.org/10.1186/gm533.
.
Slide17Systematic Review: Patient Engagement
17
Simmons, Genome Medicine 2014, doi.org/10.1186/gm533.
10 trials, >3,000 pts
Different interventions
Group workshops Individual (in- person, web-based, telephonic)OutcomesImproved measures (A1C, lipids, BP, depression, etc)Improved quality of life
Slide18Personal Health Planning
19 studies, >10,000 ptsCollaborative goal setting, action planning
Face-to-face/ phonePrimary care/ community settingsOutcomesImproved clinical outcomes (A1C, BP, depression scores, asthma)Improved self-management
18
www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010523.pub2.
Slide19Summary: Systematic Reviews
Patient-centered careWhole person care
Patient engagement Personal health planning19
Positive associations with experience, outcomes and
resource utilization.
Slide20What if we put this all together?
(Patient-centered care) + (Whole person care)
+(Patient engagement) + (Personal health planning) 20
TBD
(This is what is being evaluated at Flagships!)
Slide21Whole Health Education Website
http://wholehealth.wisc.edu
Slide2222
https://wholehealth.wisc.edu/
Under “Get Started”
Slide23The Promise of Whole Health in VHA
VHA National Strategic PlanPACT RoadmapChronic conditionsOpioid crisisMental Health/Suicide Prevention
Employee Health and Well-being23
Slide24Whole Health and Suicide Prevention Mission, Aspiration, and Purpose
Exploring them can identify at-risk Veterans and may help identify what matters Mindful awareness Enhances stress management skills an awareness of thought patterns Self-care
Fosters resilience and buffers against challenging events that might contribute to suicide risk
Slide25Whole Health and Suicide Prevention Professional care
Strong therapeutic relationshipsWhole Health approach powerful for working with complex comorbidities that predispose to suicideCommunity Many resources and organizations
Might reach those who would not seek help otherwise
Slide26Suicide Prevention Resources
Veterans Crisis Line www.veteranscrisisline.net
Suicide Prevention Lifeline www.suicidepreventionlifeline.orgSpread the Word:http://spreadtheword.veteranscrisisline.net/ VA Office of Suicide Preventionhttps://www.mentalhealth.va.gov/suicide_prevention/
National Suicide Prevention Lifeline & Veterans Crisis Line:
1-800-273-8255, Press 1
Slide27E M P O W E R
Journey to Whole Health Clinical Care
Slide28WH Clinical Care Implementation
What is happening at our site?How does this course fit in?
What happens next?28
Slide29Agenda
What Why
Unintended consequences of the current health care modelEvidence How1:1 (clinician and patient)With your teamsWith your systems
29
This Photo
by Unknown Author is licensed under
CC BY-SA-NC
Slide30Your Patients Yesterday (or Last Week)Tell your partner (1 minute each)Who were your patients?
What were their problems?What did you do for them?What did you really do for them? (15 seconds each)
30
Slide31What is it that we do, really?
31
Slide32Race, anyone?
Creating time and space First things firstDealing with chest pain before asking what matters most!
32
Slide33“What Matters Today?”: Agenda setting≈ 30% of Primary Care visitsPotentially increased patient & clinician satisfaction
Fewer “doorknob complaints”Team-based approach likely bestInvolving team membersUsing a form or EHR to capture info
Patient Educ
Couns
2015 May;99(5):718-23
.
JAMA Jan 1999 Jan 20;281(3):283-7.
BMJ 2006.
2006;332:1238
Annals of Family Medicine March/April 2017;15 (2) 158-161
.
Slide34Agenda Setting: A Quick How-To
Solicit patient’s agendaWhat are the most important things to you to cover today?
Reflect and summarize Genuine interest (Mindful presence)
Slide35Agenda Setting: A Quick How-To
Probe furtherWhat else? Anything else?
Is there something else?SOME vs ANY- eliminated 78% of unmet concernsIdentify/communicate your agendaIf necessary, negotiate
J Gen Intern Med.
2007 Oct;22(10):1429-33.
Slide36What matters most?
For our time together todayIn our livesNegotiated agenda = Shared goals
36
Slide37Practice
With a partner, practice agenda-settingPatientThink of 3-4 things you want to talk about. Consider making the last one on your list the “real” issue you are worried about
ClinicianSolicit your patient’s agendaReflect and summarizeProbe furtherIdentify and communicate your agenda to come up with a shared agenda37
Slide38Debrief
38
This Photo by Unknown Author is licensed under CC BY-SA
Slide39Now what?
Creating time and space to support healing and healthFirst things firstPower of you
39
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by Unknown Author is licensed under
CC BY-NC-ND
Slide40BREAK
40
Slide41The Power of You
Slide421:1 with a Patient
42
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by Unknown Author is licensed under
CC BY-NC-ND
Slide43Does Clinical Care ever feel like this?
43
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by Unknown Author is licensed under
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Right tool, anyone?
This Photo
by Unknown Author is licensed under
CC BY-SA-NC
Slide44Personal Health
Inventory
Slide45Whole Health Conversations
Demo (5 min)DebriefYour turn! Use the PHI as a “talking map”In pairs,
explore (5 min total each)What matters mostThe Circle- What stands out, Areas of strength, Areas to explore morePossible next step(s)
45
Slide46Debrief
What went well?What was hard?What surprised you?How might we use this with the “stuck” situations we listed?
46
Slide47Which statement gets the best response?
Statement A“Your A1c is clear up to 10. That means your sugars have been really high for a while.
Studies show this will put your heart, retinas, nerves, and kidneys at risk.”Statement B“I know your goal is to dance at your granddaughter’s wedding. Keeping your sugars in a good place will help your heart, legs, and the rest of your body be up for it! And it will keep that A1c number down, too.”
Slide48Developing a Personal Mission and Creating a Vision
One Way to Start a Conversation
What’s the matter?What concerns you about your health?What are your problems today?A Different Way to Start a Conversation
What matters most?What do you want your health for?
What is your vision of your best possible health?
Slide49Shared Goals
“I know your goal is to climb Mt. Kilimanjaro. Keeping your sugars in a good place will help your heart, legs, and the rest of your body be up for it!
And it will keep that A1c number down, too.”
49
Slide50Shared Goals
“I know you are worried about lowering your pain medications. I also know you want to keep doing things you enjoy, like walking outdoors with your wife and your dog.
Our goal is to help keep you walking with your family. Let’s talk about how we might do that together.”50
Slide51Shared Goals
You want to ….I want to support you with that…Our goal is…Let’s talk about how to do this together…
51
Slide52We are on the same team.
How else can we convey this?
This Photo
by Unknown Author is licensed under CC BY-NC-ND
Slide53Has this ever happened to you?
Your patient has a highly specialized problem outside of your usual area of expertise, and wants your thoughts on how to proceed.
Why does this happen?53
Slide54NIH-Funded Empathy Research
Good Doc
“Standard” DocNo Doc
Slide55UW Cold Study: Perception of Perfect Empathy
IL-8
Neutrophils
No Visit Standard Enhanced
No Visit Standard Enhanced
Rakel,
Hoeft
, Barrett, et al.
Fam
Med. 2009; 41(7):494-501.
Rakel
, Barrett, Zhang, et al. Patient Ed & Counseling, 2011;85:390-7.
Slide56No Visit
< Perfect
Perfect
P Value
Duration
6.75 days
7.0 days
5.89 days
0.003
Severity
262.19
270.58
223.38
0.04
UW Cold Study: Effects of Perceived Empathy
Rakel,
Hoeft
, Barrett, et al.
Fam
Med, 2009; 41(7):494-501.
Rakel
, Barrett, Zhang, et al. Patient Ed & Counseling, 2011;85:390-7.
Slide57Listening Research
The average doc interrupts after 18 seconds (1984 study)Improved to 23 seconds (2002 study)
How long will patients talk with no interruption?Mean: 92 seconds Median: 59 secondsIn all 335 sessions, the info was rated as ‘useful.’
1ohww.org
Beckman et al, Ann Intern Med, 1984;101:692-6
.
Langewitz et al. BMJ, 2002;325:682-3
.
We have two ears and one mouth so we can listen twice as much as we speak.
-Epictetus
Slide58Generous Listening
58
Attention is the rarest and purest form of generosity
.
Slide59Reflective Listening
Repeating, paraphrasing
Inferring meaningAppreciating emotionTrying to go deeperSometimes a guess
59
Downward Inflections
MI
Microskills
- Use Your OARS
Open-ended questions
Affirmations
Reflections
Summaries
Remember to use Reflective Listening when agenda-setting!
Slide60Reflective Listening
With a partner (1 min each)Speaker- tell your partner one thing you like about yourself.Listener- make reflective statements – nothing else
Try to get deeperSpeaker will respond only with one word at a time- “yes”, “no”, “maybe”, or “sometimes”.60
Downward Inflections
Slide61Discussion
What was it like to be the person making the reflections?What was it like to be the person receiving the reflections?
61
Slide62Insight
Slide63Insight
53 man with poorly controlled diabetes, depression, chronic pain
I don’t have any mental health issues. I guess these might be related.Which of your patients might benefit from this type of “a-ha” moment?
Slide64The Circle – a Tool for Assessment
How might these be interconnected?
How might these affect your health?What are your strengths?Where are you?Where would you like to be?
Slide65Vitality Signs
93 yo man with metastatic cancer, recent admission for CHF
How do you rate your physical health (from 1-5, 5 best)?“4 - I know I have some issues but I still have all my limbs!”How do you rate your emotional health?“5 - I have a wonderful family!”How do you rate your day to day life?“4 - I am grateful for each day!”
65
Slide66Vitality Signs
34 yo man, former Marine, depressed with PTSD
How do you rate your physical health (from 1-5, 5 best)?“2 - As a Marine, I was in excellent physical condition. Now I’m not.”How do you rate your emotional health?“3 - My PTSD symptoms are bad sometimes.”How do you rate your day to day life?“3 –Depends on the day I guess.”
66
Slide67“I am giving you the good stuff!”
“I am turning off the good stuff!”
10 mg Morphine
10 mg Diazepam
Pain
Anxiety
Colloca
L, et al. Lancet
Neurol
, 2004;3(11):679-84.
Expectation
Slide68Lack of Hope
Think of a patient who doesn’t seem to believe they can get betterWhat is it like to see this patient?How might their expectations impact the outcome?
How about your expectations?What about a patient who is hopeful?68
Slide69Hope
I have no areas of strength.
I survived my divorce.
I guess I’m stronger than I thought.
64 woman, morbid obesity, depression, chronic pain
Slide70Empowerment
70
Confidence: Building Hope and Possibility
Slide71Empowering and Equipping
71
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Slide72Ready, Willing and Able
72
Ready and willing?
Ready and able?
MI
Microskills
- Use Your OARS
Open-ended questions
Affirmations
Reflections
Summaries
Confidence
- strong predictor of successful behavior change
Empower the patient
“What makes you say a 6 instead of a 4?”
“What would it take to make that a 7 or 8?”
Slide73Open Ended Questions for GoalsWhere would you like to start?
What is a reasonable next step?What appeals to you the most?What would you commit to?What else might you do?
Sparkpeople.com
This Photo
by Unknown Author is licensed under
CC BY-NC-ND
Slide74Effective Goals
SMART Goals
Specific Measurable Action-oriented Realistic Time-bound
74
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by Unknown Author is licensed under
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Slide75Assess and Address BarriersWhat might get in the way?
What might help you overcome that barrier?What helped in the past?Would you like to hear some things that have worked for other people?Now, what is your plan?
Slide76What else might be helpful?
Ask what might help
Set up for successReferrals- create a Whole Health teamResources- handouts, websites, etcSkill-buildingFollow up
Slide77Your New Toolbox
Engagement/Motivation
The Big PictureInsightHope Moving ForwardsWhich is your favorite?Which do you plan to try first?
77
Slide78Having Whole Health Conversations
Best therapeutic presence
PHI As your Talking Map Or use “back pocket” mini-tools prnExploreWhat matters mostThe Circle- make sure “patient” decides where to focusPossible next step(s), if ready
78
Slide79Never underestimatethe power of your therapeutic presence!
Slide80BREAK
80
Slide81Professional Care: Complementary And Integrative Health (CIH)
Slide82Prevention & Treatment
Conventional & Complementary Approaches
Slide83Acupuncture
Homeopathy
Chiropractic
Reiki
Alexander Technique
Clinical Hypnosis
Healing Touch
Guided Imagery
Biofeedback
Yoga
Tai Chi &
Qigong
Naturopathy
Slide84Mindful AwarenessChecking in With Yourself About CIH
I advise against using
I am OK if there are no other optionsI am OK as long as they don’t interfere with meds, surgery, etc.I recommend them to complement what I doI refer to practitionersI offer the approach myselfI weave it in as much as possible with an array of CIH practitioners on my team
1
2
3
4
5
6
7
Slide85The Reality
Drugs and supplements together- 20% Gardiner et al. Arch Intern Med. 2006;166(18):1968-74.People often do not report useOver 1/3 in many studies
Fear negative responseDon’t think care team can help Blendon, et al. Arch Int Med. 2001;161:805-10.Tens of thousands of products out there
Photo by A. Rindfleisch
?
Slide86Hmmm… I’m feeling tired lately….
Slide87They Will Go to Other Sources
if We Don’t Help
Health food store clerksGave advice 89% of the time to researchers posing as 8 weeks pregnant with nausea<4% of the time, ginger rec’s agreed with research on dose or type of product5% of products suggested were contraindicated in pregnancy Buckner et al. Ann Pharmacother, 2005;39(2):274-9.
Slide88Top 5 CIH Approaches in US (2012 data)
Supplements* (17.7%)
Deep breathing (10.9%)Yoga/Tai Chi/Qi-gong (10.1%)Chiropractic/Osteopathic manipulation**(8.4%) Meditation (8.0%)
*Excludes vitamins and minerals
**Since 2011, considered conventional care by VHA.
1 in 3 people living in US
use a CIH approach.
Slide89Why CIH is Used- US Adults
6 of Top 10 Reasons-
PainBack PainNeck PainJoint PainArthritis
Other MusculoskeletalHeadache/Migraine
Other Top 10 ReasonsAnxiety
CholesterolCold symptoms
Insomnia
Natl Health Stat Report. 2008 Dec 10;(12):1-23.
Slide90Most Common Conditions in VA for CIH Use
Stress 2. Anxiety
3. PTSD 4. Depression 5. Pain
Healthcare Analysis & Information Group (HAIG) Report
A Field Unit of the Office of Strategic Planning & Analysis
Slide91ConsiderationsEfficacyCo$t
HarmsOpinions
Slide92What is Integrative Health?
Holistic: Mind, body, spirit, communityHonors tradition and innovation
Focuses beyond cure on healingTailored toward patient goalsBased on strong relationshipsCan draw in complementary approachesEvidence informed
Slide93An Important ReminderWhole Health is inclusive
of conventional clinical treatment and prevention, self-care strategies, and complementary practices.
Slide94“Find it, Fix it” and CIH therapies
Slide95Approved CIH Approaches- List 1
Promising/Potential benefit, Standard Benefits Package
AcupunctureMeditationTai ChiYogahttp://vaww.infoshare.va.gov/sites/OPCC/SitePages/IHCC-Approved-CIH.aspx
Massage for treatment
Guided imageryBiofeedbackClinical hypnosis
Note: Chiropractic care considered conventional in VA
Slide96NIH- NCCIH
Slide97Slide98Chronic Low Back Pain
98
Slide99Talking with patients about CIH referrals
Collaboration with the care teamFraming in terms of self-care role“Active” vs. “Passive” therapiesManaging expectationsNational Guidance
Local considerations99
Demand
Supply
Slide100LBP studies (low risk of bias)- Improved pain scores and disability
Depression studies (high risk of bias)- Improved depressive symptomsFew adverse effects
Yoga – Most studied in Low Back Pain, Depression
100
Slide101Slide102Tai Chi
107 systematic reviews, through February 2014
Y axis = size of the literature
X axis = efficacy
Size of circle = Number of reviews
https://www.hsrd.research.va.gov/publications/esp/taichi-REPORT.pdf
Potential Positive Effect
Falls, Balance
Osteoarthritis
Pain
Depression
HTN
Cognitive performance
Etc.
Slide103Acupuncture
Y axis = size of the literature
X axis = efficacy
Size of circle = Number of reviews
https://www.hsrd.research.va.gov/publications/esp/acupuncture.cfm
Positive Effect
Chronic Pain
Headache
Migraine
Potential Positive Effect
Cancer Pain
General Pain
Dysmenorrhea
TMJ
Osteoarthritis
Labor
Etc.
Slide104Auricular Acupuncture
sushiphotos via Foter.com / CC BY
Battlefield Acupuncture one exampleNow called “Protocolized Needling”Used for pain management
Slide105The Passport has a chapter on each group of therapies
Chapter 14 – Intro to CIH12, Power of the Mind (covers mind-body therapies)
15 – Biologically Based16 – Manipulative and Body-Based17 – Energy Medicine18 – Whole Systems of Medicine
https://wholehealth.wisc.edu/
Under “Get Started”
Slide106In Summary...
Many CIH approaches out there
Veterans use them and want them
Research variable, but promising for some
Know about them, know how you feel about them.
Perhaps try them yourself. How might they fit into your self-care?
The VA is covering List 1 CIH therapies now!
Slide107DolfinDans via Foter.com / CC BY
Tai Chi and Qigong
Mindful Movement Break
Slide108Whole Health Clinical Care:
Working with
Teams and Systems
Slide1091:1 with a Patient
109
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by Unknown Author is licensed under
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Slide110Agenda
What Why
Unintended consequences of the current health care modelEvidence How1:1 (clinician and patient)With your teamsWith your systems
110
This Photo
by Unknown Author is licensed under
CC BY-SA-NC
Slide111Bringing Whole Health Clinical Care to Life
Link care to MAPEmpower & Equip
Optimize Teams and Systems
Align with Current
Work
Infuse into Daily W
ork
Slide112Personal Health Planning- A Team Approach
Slide113Optimizing Care Teams
Incorporate patients as team membersDevelop scripts for explaining team-based care to patients
Expand team membership to include others
Knox, Primary Care Practice Facilitation Curriculum (Module 30). Agency for Healthcare Research and Quality 2015.
Slide114Letting Our Patients Know
Setting the StageHelpful to hear this from different team membersRelatively brief interventions
What happens over time when a patient starts to understand they have a central role in caring for their own whole person?Practice (30 seconds each)Patient as a Core Team Member ScriptWhole Health Elevator Speech
114
Slide115Force Multipliers
115
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Slide116Systems
116
Slide117Scheduling Systems- Working with Groups
Health Coaching groupsShared Medical AppointmentsPeer groupsAccess
EfficiencyTeams117
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Slide118Whole Health Groups- Possibilities
Shared Medical Appt- Chronic PainPrimary Care (Birmingham, AL)Group health coaching, ACT, chaplain, mindful movement
Empower Veterans Program (EVP, Atlanta)Graduated skill-buildingPain University (Tomah)And many others!
118
Slide119Technological Systems: Tele-Health
Peer groupsMindfulnessYogaSkill-buildingEtc.
119
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Slide120Data Systems: Population Management
Pre- and post-clinical visit workRegistry workWhom to target first?Consider
Importance of “easy wins” as people are learning“Patient profiling”120
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Slide121Whole Health in CPRS-examples
PHI using patient data objectsChronic Low Back Pain order menuWhole Health-infused Clinical Reminders
121
Slide122End-User Friendly PHI (Portland)
Flexible- do all, or just one question
Easy- automatically pulls in most recent PHI responses where you are already chartingUses Patient Data Objects (like Vital Signs, Med List, etc)Customizable- only what you really wantPull in What Matters Most, or whole PHI- you choose!
122
Slide123Low Back Pain Order Menu (Portland- in progress)
Conversation tool Message the importance of self-care
Support the whole person- other therapeutic targets in working with painEvidence-informed order menu Preferential active careNon-pharmacological approaches and pharmacological approachesHelps manage expectations for CIH referrals
123
Decision Aid tool
- Easy to use, one-stop shopping
Slide124MI languageShared Decision-makingEmbedded orders and consults Linking to Whole Health ResourcesNurses can order per protocol
Increased satisfaction by nurses and providers
Whole Health Clinical Reminders (VA NJ)
Highlighted by VHA National Office of Primary Care’s Task Group to Reduce Provider Burden
Slide125Infusing into Daily Work
125
Patient letters/Lab results lettersDischarge Instructions/After Visit SummariesMyHealtheVetWaiting Rooms
Etc.
Slide126Getting it Done
Bits and piecesOver timeDifferent placesDifferent team members
126
Slide127Health Care Teams
127
Slide128Best Team Ever
Consider the best team you have ever been on.What made it so good?
128
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Slide129Whole Health Teams
129
Slide130Your Team
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Resource orDemand?
Slide131Good Teams, Bad Teams
Not the team, it’s the behaviorsBehaviors can be changed, developed, improved
131
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Slide132Principles of High-Functioning Teams
Shared goalsClear rolesMutual trustEffective communication
Measurable processes/outcomes132
Smith, et al. Implementing Optimal Team-Based Care Reduce Clinician Burnout. National Academy of Medicine, Sept 2018.
Slide133Exercise 1
90 seconds to do
133
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Slide134Debrief
What team behaviors helped you?What made it hard?
Slide135Exercise 2
30 seconds to plan/huddle90 seconds to do
135
Slide136Debrief
What team behaviors helped you?What made it hard?
Slide137Way to go, Team!
137
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Slide138Personal Health Planning- A Team Approach
Possible Team Members
PatientFamilyCommunityPeersHealth CoachesCIH Team Members
Slide139Exercise 1
Introduce and reinforce the idea that your patients are key members of your team. Introduce Whole Health to your patients.
Who on your team will do what?Consider systems changes your team (or other teams) might work on to support this.
139
Slide140Exercise 2
Begin using PHI’s or PHI content with patients. Think about where patients can enter the system.
Who on your team will do what?Consider systems changes your team (or other teams) might work on to support this.
140
*
Note: Peer and Health Coach may not always be available to you (not every patient will engage with these folks). Then what?
Slide141Exercise 3
Map to the MAP. Routinely align Clinical Care with individual’s Mission/Aspiration/Purpose.
Who on your team will do what?Consider systems changes your team (or other teams) might work on to support this.
141
Slide142Exercise 4
Decrease the number of patients readmitted with heart failure after discharge (or improve another clinical metric of your choice) through more effectively empowering and equipping patients.
Who on your team will do what?Consider systems changes your team (or other teams) might work on to support this.
142
Slide143Way to go, Team!
143
Slide144Continuous Process Improvement
144
Plan
Study
Act
Do
Slide145Bringing Whole Health Clinical Care to Life
Link care to MAPEmpower & Equip
1:1 with patients
Optimize Teams and Systems
Align with Current W
ork
Infuse into Daily Work
Slide146Ideal State
Infrastructure supports a Whole Health approach as standard work and the default option.
146
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Slide147Ideal State: Patient/Staff Experience
Healing environmentRelationship, connectionCommunicationCoordinationAligned
Empowered 147
Slide148Are we so different than our patients?
We don’t always make choices consistent with our values.We know what we want to do, but not always how.
We also want the quick fix.We get discouraged and give up.148
Slide149We may not always have total control over everything…
But what might we have some control over?
149
Just as with our Veterans…
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Slide151The Way Forward
Focus on what really mattersLink to MAPWork smarter, not harderEmpower and Equip
Force multipliers- our teams and systemsCelebrate successes151
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Slide152Teamwork
152
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Slide153What will you try this week?
153
Slide154Slide155Now, we can help them be mission ready for their lives, optimizing their health in service of what matters to them.
How Will We Identify Success?
When Veterans achieve outcomes they never even imagined.
VETERANS HEALTH ADMINISTRATION
Slide156Thank you!
156
Slide157To Learn More About Whole Health
VA Patient Centered Care (External–OPCC&CT resources for Veterans & family members)
http://www.va.gov/patientcenteredcare/OPCC&CT SharePoint Hub (Internal–OPCC&CT SharePoint) https://vaww.infoshare.va.gov/sites/OPCC/Pages/Default.aspxWhole Health Education Website
https://wholehealth.wisc.edu/Field Implementation Team Consultant
Insert your FIT Consultant email here
Slide158Definitions
Slide159Comprehensive Addiction & Recovery Act (CARA) 2016MandatesExpand research, education on CIH for Veterans
Pilot integration of CIH for VeteransCARA funds support creation of Whole Health Systems at 18 flagship sites throughout the VA
Slide160Integrative Health Coordinating Center (IHCC)
Two major functions: Identify and address barriers to offering CIH in the VAProvide resources, clinical expertise, and education for Veterans, clinicians, and leadership
Slide161ResearchVA’s Office of Health Services Research & Development (HSR&D)
More than 80 ongoing CIH research projectshttp://www.hsrd.research.va.gov/research/portfolio_description.cfm?Sulu=24
PRIMIER (Patients Receiving Integrative Medicine Interventions Effectiveness Registry)Includes 3 VA systemsCollects patient-reported outcomes and extracted HER data for a large national registryhttp://www.bravewell.org/current_projects/bravenet/bravenet/
Slide162Manipulative/Body-Based Practices: Massage Therapy
ivva via
Foter.com / CC BY-SA
Slide163QUERI Evidence Map
https://www.hsrd.research.va.gov/publications/esp/massage-abstract.pdf
Massage Therapy for Pain
Summary of Systematic Reviews
Massage Therapy
Slide164Yoga- other potential benefits
Summary of Benefits
Lowered stressIncreased functional abilityImproved sleepIncreased cardiovascular healthLower cholesterolDecrease general pain (as in fibromyalgia)Improved autonomic function
See the Passport to Whole Health, Chapter 5, for a detailed research summary
Slide165Talking with Patients about CIH
If you have recommended this for patients, what did you say to them?What was their reaction?
If you haven’t yet, are there patients you might consider now?165
Slide166Manipulative/Body-Based Practices: ChiropracticChiropractors provide up to 40% of the low back pain care in the United States
Since 2004, VA has provided it (by law)
South Med J 2010;103:738–747.planetc1 via Foter.com / CC BY-SA