optimal healing environments the next natural step
Download
Skip this Video
Download Presentation
Optimal Healing Environments: The Next Natural Step

Loading in 2 Seconds...

play fullscreen
1 / 93

Optimal Healing Environments: The Next Natural Step - PowerPoint PPT Presentation


  • 112 Views
  • Uploaded on

Optimal Healing Environments: The Next Natural Step. Wayne B. Jonas, MD President and CEO Samueli Institute 10 th Annual Force Health Protection Conference Force Health Protection Through Collaboration August 9, 2007. Goals of this talk.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Optimal Healing Environments: The Next Natural Step' - nash-mccall


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
optimal healing environments the next natural step

Optimal Healing Environments: The Next Natural Step

Wayne B. Jonas, MD

President and CEO

Samueli Institute

10th Annual Force Health Protection Conference

Force Health Protection Through Collaboration

August 9, 2007

slide2

Goals of this talk

1. To define healing and a healing-oriented model

in health care and compare it with cure-oriented

2. To describe the components that facilitate and

stimulate healing in an optimal healing environment

3. To illustrate research on healing and outline future

needs for the investigation of healing environments

4. To describe approaches for the application of optimal healing environments for military experiencing medical challenges

5. Don’t lose sight of the miracle of healing.

slide9

The Success of Biomedicine

1900

Tuberculosis

Pneumonia

Trauma

Influenza

2000

Heart disease

Cancer

Diabetes

Arthritis

Depression

2000

(developing countries)

HIV

Malaria

Malnutrition

Trauma

TB

45 yr

78 yr

39 yr

slide10

Problems with Biomedicine

  • Chronic disease and aging
  • Depersonalization
  • Technology
  • Specialization
  • Cultural dis-connects
  • Costs
  • Dissatisfaction with medical care
  • Patients
  • Payers
  • Professional burnout
slide11

Cure-Oriented Model

Specific Cause Paradigm

Disease

Illness

Cause

Agent

Person

Host

Outcome

Diagnostic

Threshold

slide14

Disease and Illness InvolveMultidimensional Outcomes

Social

Measures

Psychological & Behavioral

Measures

Functional &

Clinical

Measures

Biological Measures

slide15

Healing-Oriented Model

Whole Systems Paradigm

Spiritual

Psychological

Social

Behavioral

Physical

Environmental

Disease

Illness

OE

Diagnostic

Threshold

slide16

Healing Model

Whole Systems Paradigm

Spirit

Mind

Body

Spiritual

Psychological

Social

Behavioral

Physical

Environmental

Disease

Illness

OE

IE

Diagnostic

Threshold

slide17

Healing Model

Whole Systems Paradigm

Disease

Illness

Spirit

Mind

Body

Spiritual

Psychological

Social

Behavioral

Physical

Environmental

Depression

Heart Disease

Diabetes

Cancer

Obesity

OE

DIG

IE

Diagnostic

Threshold

slide18

Healing Model

Whole Systems Paradigm

Disease

Illness

Spirit

Mind

Body

Spiritual

Psychological

Social

Behavioral

Physical

Environmental

Depression

Heart Disease

Diabetes

Cancer

Trauma

Symptoms

Quality of Life

Biomarkers

Risk Factors

OE

DIG

IE

Diagnostic

Threshold

slide19

Consequences of Misapplied Models

(A focus on cure when healing is more appropriate)

  • Interactions and side effects
  • Lures us into complacency
  • Depersonalizes the interaction
  • Favors science over values
    • Objective measures [e.g. biomarkers]
      • over the hard to measure [e.g. hope]
    • Attributional evidence [e.g. RCT, Lab]
      • over qualitative/associative
  • Disempowers the patient
      • do to a person…
      • do or be with a person…
  • Separates prevention, treatment, rehabilitation
  • Encourages high cost
    • Late intervention
    • Technology/drug focus
    • Multiple treatments
slide20

Consequences of Misapplied Models

(A focus on healing when cure is more appropriate)

  • Failure to cure the curable
  • Complicates the interventions
  • Personalizes the disease [e.g. blame]
  • Favors anecdotes over evidence
    • Wants over needs
    • Risks false attribution
  • Restricts access to care
    • Readiness
    • Behavior change
    • Resources
  • Medicalization of life [Illich]
  • Wastes resources/lives
    • Delayed intervention
    • Time inefficient
    • Needs a team approach
slide21

The Place of Cure and Healing in Medicine

Health

stimulation

Illness

Specific Diseases

OE

IE

Wellness

DIG

Salutogenesis

Pathogenesis

Health

support

Disease

treatment

slide24

Healing

The physical, mental and spiritual processes of recovery, repair and reintegration that increase order, coherence and holism in the

individual, group

and environment.

Healing may or may not result in cure.

slide25

Optimal Healing Environment

A system and place comprised of people, behaviors, treatments and their psychological and physical parameters.

Its purpose is to provide conditions that stimulate and support the inherent healing capacities of the participants, their relationships and their surroundings.

slide27

OPTIMAL HEALING ENVIRONMENTS

Inner Environment

(Personal)

Interpersonal Environment

(Social)

Outer Environment

(Behavioral)

Cultivating Healing Relationships

Developing Healing Intention

Practicing Healthy Lifestyles

Enhance Awareness

Enhance Health Habits

Enhance Caring

Diet

Exercise

Relaxation

Balance

Compassion

Empathy

Social Support

Communication

Expectation

Hope

Understanding

Belief

Applying Collaborative Medicine

Experiencing Personal Wholeness

Creating Healing Organizations

Enhance Process

Enhance Integration

Enhance Medical Care

Leadership

Mission

Culture

Teamwork

Mind

Body

Spirit

Energy

Conventional

Integrative

Traditional

Person-centered

Building Healing Spaces

Nature Color Light Artwork Architecture Aroma Music

Enhance Natural & Sustainable Structures

slide28

1A. Developing Healing Intention

Awareness: The habitual practice of attention to the present and its full complexity.

Intention: The conscious determination to improve the health of another person or oneself.

Expectation: Belief and anticipation of improvement.

Hope: The expectation that a desired goal can be achieved.

slide30

The Sick Role and Healing

  • The sick role = dis-empowered
  • Belief
    • expectancy in healing
    • management of intention
  • Hope
    • confidence, competence
    • belief congruency – listening
  • Meaning
    • of illness and suffering
    • what does it mean to recover?
slide31

From Pain to Self-Awareness

  • Population was 60 patients with chronic, refractory pain.
  • A 12-week group program designed to change perception:
    • the body ‘as a talking subject’ rather than focusing on pain;
    • the wholeness of participants’ situation rather than pain as either physical or psychological;
    • using everyday language and ways of expressing themselves;
    • respecting, seeing, listening and trusting the group participants;
    • challenging the participants to evoke their internal control rather than use the health care personnel.
  • A year later the participants had:
    • an increased awareness of self,
    • more constructive ways of handling life’s situations; and,
    • less pain

Steen e et al Patient Educ Counsel 2001; 42(1): 35-46.

slide32

2B. Experiencing Wholeness

Healing Presence

A deep emotional presence that enhances recovery and the experience of wholeness.

West: the physical and emotional wholeness from which deep personal engagement, caring and communication emerge.

East: sometimes conceptualized as “bioenergy”, and is said to be accumulated, stored and transmitted between healer and healee.

slide33

The Experience of Wholeness

Integration of Person

Integration of Self

  • Mind
  • Body
  • Emotions
  • Spirit
  • Past – Traumas
  • Present – “Why me?”
  • Future –Hope, purpose
  • Connectivity
  • Coherence
  • Control
  • Commitment

Hardiness

Resilience

slide34

Effect of Structured Writing by Disease: Asthma or Rheumatoid Arthritis

Asthma

Forced Expiratory Volume in

1 S, % Predicted

Rheumatoid Arthritis

Asymptomatic

Mild

Moderate

Severe

Overall Disease Activity

Smyth, J. M. et al. JAMA 1999;281:1304-1309.

slide35

Positive Emotional Change:

Effects of Self-forgiveness and Spirituality

Levenson MR et al. Explore 2006; 2(6): 506.

slide37

Mind-Body-Energy Practicesand the Relaxation-Response

  • Yoga
  • Tai Chi
  • Bioenergetics
  • Cranial Sacral
  • Alexander
  • Johrei
  • Polarity
  • Reiki
slide38

Mindfulness-Based Stress Reduction Meditation for Early Stage Breast and Prostate Cancer Patients

59 patients with breast cancer and 10 with prostate cancer enrolled in 8-week program that incorporated relaxation, meditation, gentle yoga and daily home practice

  • Significant improvements in overall quality of life,
  • Side effects included reduced stress symptoms, improved sleep quality and beneficial changes in hypothalamic-pituitary-adrenal axis functioning
  • Was this due to increased time and attention?

Carlson LE, et al. Psychoneuroendocrinology 2004; 29:448-474.

slide39

Neural Immune Connections

Integrative Neural Immune Program

http://neuralimmune.nih.gov/index.html

slide42

2A. Cultivating Healing Relationships

  • Consist of two domains that involve those designated clinical or socio-cultural.
  • Primary domain is social support and service for the household, family, friends, support groups and community.
  • Therapeutic alliance: the embodied social and psychological interactions between healer and healee that facilitate healing.
slide43

Social Support Lowers Cardiovascular Reactivity

to an Acute Stressor

Change from Baseline (mmHg)

Lepore SJ et al. Psychosomatic Med 1993; 55: 518-524.

slide44

Relationship Effects

SPECIFIC

Tone and affect of encounter

Communication and listening

Non-verbal behavior

THE EFFECTS OF OUR DOING

NON SPECIFIC

Intention, attention

Mindfulness

Healing presence

THE EFFECTS OF OUR BEING

slide45

Effect of Type of Physician Consultation

Improvement

Thomas KB. Br Med J.1987; 294: 1200-2.

slide46

Physician Knowledge Affects Outcome

Gracely RH. Society for Neuroscience Abstracts. 1979; 5: 609.

slide47

Developing a Healing Alliance

  • Self-care – “in a good space”
  • Compassion and caring skills
  • Communication skills
    • Listening, feedback, language, culture
  • Partnerships and continuity
    • Person-centered
    • Relationship-centered
slide48

The Therapeutic Instrument

“… virtually all the doctor’s healing power

flows from the doctor’s self-mastery.”

Eric J. Cassell, MD,

The Nature of Suffering and the Goals of Medicine.

2nd Edition, 2004.

slide49

2B. Creating Healing Organizations

  • Leadership, staff, vision, mission
  • Organization, team building, payment
slide51

Healing Relationships as the Core of Health Care Quality

The call for “providing patients with appropriate services … with good communication, shared decision making, and with cultural sensitivity” ...

Crossing the Quality Chasm: A New Health System for the 21st Century

Institute of Medicine 2001

slide52

A Model of Relationship-Centered Organizations

Safran DG, et al. J Gen Intern Med 2006; 21: S9-S15.

effect of teamwork on mortality risk
Effect of Teamwork on Mortality Risk
  • Teamwork model included:
    • a structured collaborative communication protocol,
    • daily rounds attended by every team member,
    • the patient and available family members.
  • 56% reduction in risk-adjusted mortality among cardiac surgery patients after introduction of a new “interdisciplinary care team” model

Uhlig PN et al. Joint Comm J Qual Improv 2002; 28: 666-72.

slide54

Organizational Dimensions

of Relationship-Centered Care

  • Has an Effect on:
    • Reduced mortality
    • Improved functional health outcomes
    • Shorter length of stay
    • Workforce morale and turnover

Safran DG, et al. J Gen Intern Med 2006; 21: S9-S15.

slide57

3A. Practicing Healthy Lifestyles (Behavioral Medicine)

The employment of adequate amounts

and types of exercise, diet, relaxation, creative outlets, and balancing work and leisure.

slide58

Health PromotionBehavioral Medicine

  • The Healthy Lifestyle:
  • Addiction management
    • Smoking, alcohol, food, drugs, sex, violence
  • Exercise
    • 30 minutes aerobic 3 X week; strength; balance
  • Diet content and amount
    • Low fat, high-fiber, 5 fruits and vegetable-a-day diet
  • Stress management and life balance
    • work/school-personal life balance
    • relaxation response for 20 minutes, 1-2 X day
slide59

Behavioral Medicine

  • Success at Lifestyle Change:
  • Clinical
  • Requires special training
  • Family and social aspects
  • Public health
  • Worksites/schools
  • Homes/places of worship
  • Commercial pressures
slide60

Workplace Program Reduces Illness & Healthcare Utilization

Rahe RH et al Psychosomatic Med 2002; 64(2): 278-286.

slide61

Health Promotion at the Worksite

Return on Investment

Comprehensive Programs $3-8 ROI

Disease management $7-10 ROI

Risk Management $4-5 ROI

Participation?

Disease Treatment?

RW Whitmer, et al., JOEM. 45: 2003

slide62

3B. Applying Collaborative Medicine(Integrative Medicine)

  • Conventional Medical Care
  • Person-centered Health Care
  • Complementary Medicine
  • Traditional and Folk Medicine
slide64

CAM

(excluding prayer)

Any CAM

CAM

(excluding megavitamins)

Barnes, P.M. et al. Advance Data from Vital Health Statistics. Number 343, May 27, 2004. CDC p.4

slide65

CAM: American Use

NHIS: 2002

Interventions:

  • Prayer by others
  • Prayer for self
  • Natural products
  • Breathing exercises
  • Prayer groups
  • Meditation
  • Chiropractic care
  • Yoga
  • Massage
  • Diet therapies
  • Progressive relaxation
  • Guided imagery
  • Homeopathic treatment
  • Tai chi
  • Acupuncture
  • Energy healing/Reiki
  • Naturopathy
  • Biofeedback
slide66

Non-mainstream Medicine

  • Popular (1997 and 2002)
    • 80 % use world wide (WHO)
    • 40% of Americans use (50% of women)
    • 50-75% of cancer patients; AIDS users
  • Paid - $24 Billion out-of-pocket in 1997
  • Concealed - 72% don\'t talk about it to doctor
  • Combined - 83% used conventional treatment
slide68

Herbs and Drugs Interact

  • Anticoagulant and coagulant* activity:

alfalfa feverfew poplar

angelica fucus prickly ash

aniseed garlic quassia

asafoetida ginger red clover

celery ginseng willow bark

chamomile horse-chestnuts agrimony*

clove horseradish goldenseal*

enugreek licorice mistletoe*

feverfew meadowsweet yarrow*

Newall, 1996

slide69

Quality of Supplements

140

120

100

80

60

40

20

0

% of Label

1 2 3 4 5 6 7 8 9 10

slide74

4. Building Healing Spaces

  • Light, air, nature, color, art, music
  • Function, flow, privacy and community
sunny hospital rooms expedite recovery
Sunny Hospital Rooms Expedite Recovery

In an inpatient psychiatric unit:

  • Those in sunny rooms had an average stay of 16.9 days compared to 19.5 days for those in dull rooms, a difference of 2.6 days (15%): P < 0.05

In post-operative recovery:

  • Rooms with windows decrease length of stay by 1 day. (p<0.05)

Beauchemin KM et al. J Affective Dis 1996; 40: 49-51.

music as a healing space
Music as a Healing Space
  • Music can
    • promote a sense of well-being and distract patients from pain
    • improve mood and decrease anxiety, pain in acute and chronic conditions
  • Music may
    • help premature babies to gain weight
    • improve depression in the elderly
    • enhance care-giving behavior

Kemper, K. et al. South Med J 2005; 98(3): 282-288.

slide78

Designing the Outer

with the Inner and the Inter in Mind

slide79

Healing Environments

in Military Operations

ohe in the military setting
OHE in the Military Setting
  • There are no universal metrics for OHE assessment used in the military
  • The delivery of OHE in a military settings is likely no better or worse than in a civilian settings.
    • Recent Walter Reed situation
    • VA/DoD and PTSD syndrome management
  • Outside of the health care system programs for delivery of human optimal performance is active in the military
slide81

Examples of OHE Domains

in the Military

  • INTERNAL
    • 1. Mind – Mission and meaning, spiritual care
    • 2. Experience – little formal focus
    • 3. Relationships – Camaraderie and community
  • EXTERNAL
    • 4. Lifestyle - Health Promotion, addiction Rx
    • 5. Treatments – Collaborative, little Integrative
    • 6. Spaces and 7. Places – mission oriented
slide82

Integrative Medicine

Emerges in the Military

  • CIM, WBAMC, Ft. Bliss
  • Chiropractic in VA and Military
  • MIL-CAM, VET-HEAL – Samueli Institute
  • DARPA, Persistence in Combat
  • MIL-PIM – University of Arizona
  • Acupuncture
    • PMR Departments
    • Naval Medical Center, San Diego
  • VA – Integrative Medicine Unit, SLC
  • DOD-FDA Dietary Supplement Committee
cultivating healing relationships
Cultivating Healing Relationships
  • Development of a Pilot Study to Develop and Test Improved Communication Training Strategies in the Care of Military Populations
    • Walter Reed Army Medical Center
    • Jeffrey Jackson, MD, PhD
  • Development of a Military Empowerment Program- a program that would empower families by teaching mind/body practices that could be shared with returning loved ones (injured soldiers) while residing at the Fisher House. 
    • Walter Reed Army Medical Center
    • National Naval Medical Center
    • Mark Chapin, MD
experiencing personal wholeness
Experiencing Personal Wholeness
  • Yoga as an Adjunctive Therapy for Post-Traumatic Stress Disorder: A Feasibility Study
    • Walter Reed Army Medical Center
slide85

Ear Acupuncture for Acute Pain in the ER

P=0.503

P<0.001

Goertz, CM et al. Auricular Acupuncture in the Treatment of Acute Pain Syndromes: A Pilot Study. Military Medicine, 2006;171(10):1010-1014.

slide86

Samueli Institute OHE Program(Current Activities)

  • In-depth case studies of eight hospitals and their experiences implementing ‘healing initiatives’
  • Systematic review of the ‘healing-oriented’ literature, looking specifically for cost-value data
  • Environmental scan of hospitals across the country (electronic survey n=2000)
  • “Living Laboratories.” Collaborative relationships with healthcare systems to access and assess health services that measure clinical, professional and economic outcomes of OHE components
slide87

Partnership Opportunities

AHA Health Forum

April 10-14, 2007

San Diego, California

“Evaluating Optimal Healing Environments”

Contact Information

Barb Findlay, RN, BSN

Vice President, OHESM Program

Samueli Institute

[email protected]

703-299-4800

slide88

Organizations with Health Care Quality Initiatives

  • The Samueli Institute
  • The Picker Institute
  • The Institute for Health Care Improvement
  • Corporate Health Improvement Program
  • Robert Wood Johnson Foundation
  • Bayer Foundation
  • Commonwealth Fund
  • The Fetzer Institute
  • Pew Trust
  • Planetree
  • The American Hospital Association
  • Centers for Medicaid and Medicare Services
  • The “Medical Home” concept in Primary Care Medicine
  • “TransforMED” of the AAFP
  • The Institute for Patient and Family Centered Care
  • The Agency for Healthcare Research and Quality
  • The Veterans Health Administration
slide93

Acknowledgements

Barbara Findlay, R.N.

Sita Ananth, Ph.D.

Ian Coulter, Ph.D.

Mike Finch, Ph.D.

Kelly Gourdin

Katherine Smith

William Beckner, M.S.

Ronald A. Chez, M.D.

Christine Choate, D.C, Ph.D.

And the innovative leaders of the patient-centered

healing-oriented initiatives

ad