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Decmeber 2007: Healing Across the Divides meeting with PMRS. Meeting Objectives. Evaluation of community assessment/ readiness – 1 hr minutes Measurement of improvement in women’s health and measurement of empowerment as it pertains to health- 1 hr.
If a team were trying to assess the degree of political empowerment of women as it pertains to health, information would first need to be gathered on the existence of women’s access to health services. Then the question would be asked, do women choose to access these services and why/why not? Finally, the team would assess the health outcome of these choices; that is, does the health of women actually improve?
The use of these principles requires health practitioners to take a very different stance (e.g., nonconfrontational) with respect to the patient. The basic goal is to develop a ‘shared’ understanding of the health issue and to stimulate the patient’s commitment to change.
It’s easy to get the players. Getting’ ‘em to play together that’s the hardest part.
Approximately 85% of opportunities for improvement lie with system changes such as role assignment, whereas 15% lie with people - Deming
Cohen (1983) found that a simple change in the clinic routine had a profound effect on physicians’ behavior regarding preventative care of diabetic patients. Whether or not the physician performed a foot examination was largely determined by whether the nurse instructed the patient to remove his/her shoes and socks before being seen by the physician. Physicians were almost five times as likely to examine the feet when patients presented barefoot (70%) than when wearing shoes (15%).
The Group Health Cooperative of Puget Sound (GHC), located in Seattle, Washington, is a consumer-governed Health Maintenance Organization (HMO) with almost 500,000 members residing in the greater Puget Sound area and approximately 675,000 members overall in Washington and Idaho. The GHC employs approximately 1000 physicians (40% in primary care). The population served by the GHC is similar to that in the surrounding area in terms of age, race, gender distribution and income. What sets GHC apart from other HMO’s in the region (and in the country) is its approach to primary and secondary prevention. Indeed, this focus has been evident since the GHC’s inception in 1947; the original bylaws decree:
The Cooperative shall endeavor to develop some of the most outstanding hospitals and medical centers to be found anywhere, with special attention to preventive medicine.
This program uses research on barriers to, and effectiveness of, bicycle helmet use and relies on broad-based community participation to achieve its positive outcomes. GHC was one of 18 community groups participating in this campaign, which included extensive media coverage and discount coupons for helmets. Participation by primary care physicians in distributing the discount coupons was a significant component. Between 1987 and 1992, a 67% decrease was found in the rate of GHC emergency department attendee head injuries due to bicycling in the target population of children aged 5 to 14 years.
GHC began in 1947 with a mission statement that emphasized prevention-quite unique at this time. Guided by its mission, GHC determined exactly what it needed to constitute an ideal or ‘gold standard’ system for preventive care. Clearly articulating the details of a prevention system ensures organizational cohesiveness, sets the directions of efforts, plans the route and establishes the criteria by which an organization tests its interventions.
Because a wide variety of GHC departments and individuals are involved in preventative care, effective leadership and good communication is critical to ensure that prevention remains a priority and that preventive efforts are effectively coordinated.
The work of a Preventive Care Task Force in 1973 led to the establishment of the Department of Preventive Care. The Department undertook the following initiatives:
Miller and Rollnick (1991) divide motivational counseling into two major phases. The first phase, Building Motivation for change, is directed at patients who are fairly early in their readiness for change (precontemplation). They may be reluctant about change or even show marked resistance at the outset. Using eight related strategies the aim is to work with the patient in ways that will tip the motivational balance in favor of change; that is, increase perceived concerns of change.