H4 – What If We Tried for Health?Donald M. Berwick, MD, MPP

19th Annual International Forum on Quality and Safety in Healthcare

This presenter has nothing to disclose

April, 10 2014

Caleb

Caleb3

“Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.”

—WHO

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Royal Observatory

Prime Meridian

Dava Sobel’s Longitude

Cloudesley Shovell Shipwreck

John Harrison

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H211

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H4

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Harrison’s Clocks15

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Richie Davidson

Davidson’s Findings

Meditation cultivates emotional well-being, empathy, and compassion.

Mindfulness reduces stress, and reducing stress reduces inflammation.

Adversity and stress negatively impact brain structure and function, which can be reversed by stress-reducing interventions.

Jon Kabat-Zinn

Wayne Jonas

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Salutogenesis

The process of healing and health creation

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Optimal Healing Environment

Facilitate healing processes that focus on people’s resources and capacity to create health.

Three goals:– Preventive– Restorative– Palliative

Four Pillars of Human Flourishing

Psychological resilience

Social support and cohesion

Exercise movement and sleep

Healthy exposure to substances in the diet and environment

23HEALTHYENVIRONMENT

Mind-body Skills &

PsychologicalResilience

HEALTHY CULTURE

Social Support &Cohesion

ExerciseMovement

& Sleep

OptimumNutrition & Substance

Use

PURPOSE &

MEANING

Placebo Effect 24

Real surgery vs. sham surgery for angina

No difference in outcomes

Pain relief in 70% - 80% of patients in both groups

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Placebo Effect

Real vs. sham laser myocardial revascularization

No difference in outcomes– 60% of patients in

both groups improved by an entire functional class

Benefits lasted over six months

Dan Buettner

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Characteristics of “Blue Zone” Communities

Characteristics of “Blue Zone” Communities

Move naturally

Know your purpose – have a reason for waking up

Kick back – shed stress

Eat less

Eat less meat

Drink in moderation

Have faith

Power of love – family first

Stay social

Dean Ornish

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Ornish’s Program

10% fat vegetarian diet

Moderate aerobic exercise

Stress management training

Smoking cessation

Group psychosocial support

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Ornish’s Results

Experimental group: – 8% less stenosis in coronary arteries

Control Group:– 28% more stenosis in coronary arteries– Cardiac events occurred 2.5 times more frequently

Themes

Embrace a positive view of health

Resources to support positive health reach beyond current boundaries of health care

Significant effect sizes from wellness efforts

Systemic designs that change how we live

Connectedness and interpersonal interactions

Loving kindness

Stanley Milgram35

Milgram Experiment36

Milgram Experiment

Prod 1: Please continue.

Prod 2: The experiment requires you to continue.

Prod 3: It is absolutely essential that you continue.

Prod 4: You have no other choice but to continue.

Health Effects of Prosocial Behavior

Prosocial behavior leads to lower stress and sense of well-being.

Giving correlates with happiness in 88% of countries surveyed.

Even children are happier when giving.

People who give are happier and have lower cortisol levels than those who keep money.

Older adults who help others live longer.

Giving to charity is associated with improved grip strength.

“The benefits of prosocial spending are evident in givers old and young in countries around the world, and extend not only to subjective well-being, but to objective health.”

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Elizabeth Dunn

What can you do?

1. Reconsider your own concept of health.

2. Reconsider the form and function of your piece of the health care system.

3. Take account of healing tools you and your patients have that lie outside the boundaries of the health care system.

4. Bring systems thinking to the pursuit of well-being.

5. Re-establish your faith in and use of connectedness and interpersonal relationships.

6. Remember, embrace, and celebrate that kindness is inseparable from healing and good health.

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