DESIGNING HEALTHCARE

THAT HEALS

Leland R. Kaiser, Ph.D.

Kaiser Institute

Our Challenge

• We have to go beyond the redesign of our

medical care delivery system.

• We have to go beyond the issues of access,

cost and quality, as important as they are.

Our Challenge

• We have to go further upstream.

• We must begin designing out disease.

• We must begin designing for health.

Our Challenge

• Much of what we have to do is go outside what is

normally considered to be a legitimate interest of

the healthcare system.

• We will be working in everyone else’s backyard to

accomplish total environmental design.

• This means overcoming immense social, political

and economic resistance to this kind of approach.

Challenge

• We have to do nothing less than change the

way people live.

• The challenge is total design.

My Belief

• Design is the ultimate human science and

art.

• Design is the end stage of human evolution

• To promote health and longevity, any race

of sentient creatures anywhere in the

universe will eventually have to re-design

both their genes and their habitat.

The Five Most Important Design

Dimensions

• Designing for health

• Designing out disease

• Redesigning the human genome

• Redesigning the human habitat

Our Preferred Future

• Redesign requires us to envision our

preferred health future.

• I suggest this is the highest level of heath

and wellbeing attainable for our population.

• This definition takes us well beyond where

we currently are in health planning and

health services delivery in our country.

Basic Concepts of the Future

• Our future is not fixed.

• Our future may be invented or prevented.

• Our future is not something that happens to

us – it is something we happen to.

Basic Concepts of the Future

• Imagination is our most powerful tool for

redesign.

• We must imagine what we want to see

happen in our country.

• Then, we must act to make our imagination

a reality.

The Futures Mindset

• To achieve a better design we will need to

adopt a new mindset that takes us from

treatment to prevention, potentiation and

design.

• This is the futures design mindset.

The Design Mindset

• Good health happens when everything else works.

• The best design goes the furthest upstream so disease can be designed out rather than treated.

• This requires genetic design and environmental design.

The Design Mindset

• This is the design century.

• As healthcare professionals we should view

ourselves as designers of America’s health

A New Perspective

• When we talk about health we are usually

referring to something we do to the person.

• We now are beginning to realize the

importance of also working on the person’s

environment as well.

• This is called habitat design.

The Design Formula

• Health is a function of the transaction of the

person and the environment.

• H=f (P.E)

• In other words you can change a person’s

health by changing his/her habitat.

• Healthy environments create healthy

people.

Design Environments

• Physical

• Social

• Cultural

• Economic

• Political

• Housing

• Work

• Spiritual

Simple Examples

• Start removing toxins from the air, water and food.

• Improve the health of selected neighborhoods in

our urban areas

• Create model tribal villages

• Design out work stressors

• Help people exit damaging personal relationships

• Design out hazards in the home

Simple Examples

• Design homes you can live in for an entire

lifetime

• Re-design dangerous traffic intersections

Healthy Human Habitats

• Good nutrition

• Physical exercise

• Clean air and water

• Adequate housing

• Adequate clothing

• Good medical care

• Convenient transportation

Healthy Human Habitats

• Diverse recreational experiences

• A safe physical environment

• An empowering educational system

• Opportunity for employment

• Presence of a nurturing mentor

• Opportunity for spiritual development

Healthy Human Habitats

• Opportunity for self expression

• Opportunity for ego enhancement

• Meaningful activity to fill the hours

• Incentives for continued self development

• A feeling of begin needed

• A sense of accomplishment

Healthy Human Habitats

• Opportunity for membership in social

groups

• Opportunity to make friends

• Acquisition of life goals and a sense of

direction

• A measure of control over one’s destiny

• Development of skills and abilities

Healthy Human Habitats

• Development of an interest in other people

• Opportunity to give and receive love

• Support and reassurance

• Variety and change

• Stable and predictable life situation

Healthy Human Habitats

• Development of confidence and ego

strength

• Opportunity to redefine one’s self

• Freedom to try on new life styles

• Reinforcement of desirable social behavior

• Abundance of cognitive sensory stimulation

• Opportunity to be depended upon by others

Healthy Human Habitats

• Opportunity for further education

• Opportunity for leisure

• Opportunity for healthy physical

development

• Competence models for emulation

• Exploration of the world

What We Must Do

• We have all the pieces we need to build a

healthy people, but we do not know how to

put them together.

• We need to build bridges among the many

contributing disciplines.

• We need someone responsible for the

finished product.

What We Must Do

• Convene – involve an array of habitat

specialists

• Converge – bring these specialties together

in an overall community design structure.

• Test the design on demonstration villages

and urban neighborhoods

Questions We Should Be Asking

• Who are the underserved in our nation?

• What health needs are going unmet?

• What can we do to best improve the health

status of our communities?

• What is special and unique about our

nation?

Questions We Should Be Asking

• How can we be a better partner with our

health care providers?

• What can we do to reduce waste and better

conserve our limited resources?

• What new resources should we seek to

develop in our nation?

America’s New Healthcare

• Development of a coherent national health

policy

• Increasing the healthcare GNP

• Movement toward universal health

insurance coverage

• Adoption of a holistic health model with

CAM modalities

America’s New Healthcare

• Tremendous expansion of primary care

capability

• Healthcare becomes innovation driven

• Race to become world class in all that we

do

Summary

• What kind of a future do we want to

precipitate?

• What can we do today to begin moving

toward that future?

• Who can help us along the way?