h4 – what if we tried for health? donald m. berwick, md, mpp 19th annual international forum on...
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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
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Caleb
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Caleb3
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“Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.”
—WHO
4
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Royal Observatory
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Prime Meridian
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Dava Sobel’s Longitude
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Cloudesley Shovell Shipwreck
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John Harrison
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H110
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H211
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H312
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H4
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H414
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Harrison’s Clocks15
H1 H2 H3 H4
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Richie Davidson
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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.
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Jon Kabat-Zinn
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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
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Four Pillars of Human Flourishing
Psychological resilience
Social support and cohesion
Exercise movement and sleep
Healthy exposure to substances in the diet and environment
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23HEALTHYENVIRONMENT
Mind-body Skills &
PsychologicalResilience
HEALTHY CULTURE
Social Support &Cohesion
ExerciseMovement
& Sleep
OptimumNutrition & Substance
Use
PURPOSE &
MEANING
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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
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Dan Buettner
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Characteristics of “Blue Zone” Communities
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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
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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
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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
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Stanley Milgram35
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Milgram Experiment36
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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.
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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.
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“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.”
—
Elizabeth Dunn
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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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H1 H441
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Caleb42