GAUDET: HI I'M TRACY GAUDET, AND I'M THE DIRECTOR OF THE OFFICE OF PATIENT CENTERED CARE & CULTURAL TRANSFORMATION, AND I'M REALLY GLAD TO BE WITH YOU TODAY TO TALK TO YOU ABOUT REDESIGNING HEALTH CARE TO PROMOTE ONE'S WHOLE HEALTH, SO THE FIRST THING I WANT TO SAY FOR CONTEXT IS THAT THE VERY ASSUMPTIONS UPON WHICH HEALTH SYSTEMS WERE DESIGNED ARE NO LONGER VALID

LIKE EVERY OTHER SYSTEM THAT'S EMERGING FROM THE REDUCTIONISTIC PARADIGM AND TRANSFORMING INTO A SYSTEMS APPROACH, HEALTH CARE NEEDS TO BE RADICALLY RE-ENVISIONED AND REDESIGNED THAT'S WHAT WE'RE GONNA TALK ABOUT TODAY THE IHI, THE INSTITUTE FOR HEALTHCARE IMPROVEMENT, IS CALLING FOR THIS, IN THEIR LANGUAGE, NEW RULES FOR THE RADICAL REDESIGN OF HEALTH CARE I THINK IT'S FASCINATING IF YOU LOOK AT THEIR RULES THERE ARE 10 OF THEM, BUT I'VE HIGHLIGHTED 4

FIRST, CHANGE THE BALANCE OF POWER CO-PRODUCE HEALTH AND WELL-BEING IN PARTNERSHIP WITH PATIENTS, FAMILIES, AND COMMUNITIES SECOND, CUSTOMIZE TO THE INDIVIDUAL, AND I THINK THIS IS AMAZING IF YOU LOOK AT THEIR LANGUAGE CONTEXTUALIZE CARE TO AN INDIVIDUAL'S NEEDS, VALUES, AND PREFERENCES GUIDED BY AN UNDERSTANDING OF WHAT MATTERS TO THE PERSON IN ADDITION TO WHAT'S THE MATTER SOUND FAMILIAR? THIRD, PROMOTE WELL-BEING

FOCUS ON OUTCOMES THAT MATTER THE MOST TO PEOPLE, APPRECIATING THAT THEIR HEALTH AND HAPPINESS MAY NOT REQUIRE HEALTH CARE, AND FOURTH, CREATE JOY IN WORK CULTIVATE AND MOBILIZE THE PRIDE AND THE JOY OF THE HEALTH CARE WORKFORCE, AND THAT'S WHAT WE'RE UP TO HERE IN THE VA, SO THE VISION IS CLEAR WE HAVE ROBERT WOOD JOHNSON CALLING FOR A TOTAL TRANSFORMATION AND A SHIFT TO A CULTURE OF HEALTH WE HAVE THE IHI CALLING FOR 100 MILLION HEALTHIER LIVES, LOOKING AT EMOTIONAL, SPIRITUAL, AND PHYSICAL WELL-BEING WE HAVE KAISER PERMANENTE, WHO STOOD UP A WHOLE NATIONAL EFFORT THAT THEY'RE CALLING TOTAL HEALTH

THE SURGEON GENERAL– WE RECENTLY DID AN EVENT WITH THE US SURGEON GENERAL FOCUSED ON EMOTIONAL WELL-BEING, SO EVERYONE AROUND THE NATION IS CALLING FOR THE SAME FUTURE STATE, WHICH IS GREAT ATUL GAWANDE–I LOVE HIM– ONE OF HIS QUOTES THAT I THINK CAPTURES THIS REALLY WELL– "WE'VE BEEN WRONG ABOUT WHAT OUR JOB IS IN MEDICINE "WE THINK OUR JOB IS TO ENSURE HEALTH AND SURVIVAL, "BUT REALLY, IT IS LARGER THAN THAT

IT IS TO ENABLE WELL-BEING, AND WELL-BEING"– I LOVE THIS LINE– "WELL-BEING IS ABOUT "THE REASONS ONE WISHES TO BE ALIVE "THOSE REASONS MATTER NOT JUST AT THE END OF LIFE OR WHEN DISABILITY COMES, BUT ALL ALONG THE WAY," AND I THINK HE SAYS IT REALLY WELL LET'S STOP FOR A SECOND AND ASK WHY WHY SHOULD WE BE ENTERING INTO A COMPLETE REDESIGN OF HEALTH CARE? WELL, IT DOESN'T TAKE LONG TO FIGURE OUT THAT OUR HEALTH CARE IN THE NATION IS IN A FULL CRISIS, EVERYTHING FROM THE ECONOMICS– THE HEALTH CARE CONSUMES 18% OF OUR GDP, AND THAT'S CRIPPLING OUR ABILITY TO COMPETE GLOBALLY CHRONIC CONDITIONS ARE THE VAST MAJORITY OF THOSE COSTS, ABOUT 75% OR SO, AND WE KNOW THAT CHRONIC CONDITIONS ARE REALLY LARGELY IMPACTED BY PEOPLE'S HEALTH AND LIFE AND THEIR CHOICES THEY MAKE DAY TO DAY

THE BOTTOM LINE IS THIS THE CURRENT HEALTH CARE MODEL DOES NOT WORK BECAUSE WE DO NOT HAVE A CORE COMPETENCY WE'RE NOT DESIGNED TO SUPPORT PEOPLE IN ADDRESSING THE THINGS THAT MOST IMPACT THEIR HEALTH AND WELL-BEING IT'S NOT OUR FAULT IT'S NOT DESIGNED THAT WAY

I THINK IT'S REALLY INTERESTING TO THINK ABOUT WHY– HOW DID WE GET HERE? WHY DO WE HAVE THE HEALTH CARE SYSTEM THAT WE'VE GOT?– AND IF IT GOES BACK TO THE LATE 1800s AND EARLY 1900s, OUR WHOLE MEDICAL PARADIGM WAS BASED ON A REDUCTIONISTIC MODEL WE HAD THINGS LIKE GERM THEORY, AND WE FIGURED OUT, "OH, COOL A DISEASE IS CAUSED BY A CAUSAL FACTOR, "SO ALL WE HAVE TO DO IS FIND A CURE TO THAT CAUSE, AND WE'RE DONE" IT RESULTED IN THIS "FIND IT, FIX IT" APPROACH, WHICH, TO BE HONEST, OUR MEDICAL PARADIGM IS STILL BASED ON TODAY OUR SCIENCE HAS ADVANCED THAT IN THE 2000s, WE HAD A LOT MORE ADVANCE AROUND SYSTEMS APPROACH

WE UNDERSTOOD THINGS LIKE QUANTUM PHYSICS, SYSTEMS BIOLOGY, AND CHAOS THEORY WE KNOW THAT HUMAN BEINGS ARE COMPLEX, ADAPTIVE SYSTEMS, AND YET WE HAVEN'T REDESIGNED OUR HEALTH CARE APPROACH FUNDAMENTALLY IF YOU LOOK AT THIS GRAPH– AND SOME OF YOU HAVE SEEN THIS BEFORE– IT REALLY ORIENTS ACROSS A PERSON'S TIME, ACROSS TIME IN A PERSON'S LIFE, AND WE SEE THAT THERE ARE INITIATING FACTORS OF HEALTH AND DISEASE, AND RIGHT NOW, WE PRETTY MUCH WAIT TILL YOU'RE PRETTY FAR DOWN ON THAT CURVE TO INTERVENE IT DOESN'T WORK VERY WELL, BUT WE CREATED A SYSTEM TO ADDRESS THAT IT'S A CLINICAL CARE MODEL WHICH PREDOMINANTLY RESULTS IN OUTPATIENT AND INPATIENT MEDICAL CARE, AND I'M OVERSIMPLIFYING IT TO MAKE THE POINT, BUT THAT'S OUR DOMINANT PARADIGM

I THINK THERE'LL BE A TIME NOT TOO FAR IN THE FUTURE WHERE WE LOOK AT THAT AND WE THINK, "WHY DID WE THINK ONLY HAVING THAT APPROACH WAS EVER GONNA WORK?" IF WE LOOK AT HOW IT'S WORKING NOW, LET'S LOOK AT HEART DISEASE HEART DISEASE IS THE NUMBER-ONE KILLER OF MEN AND WOMEN NOT ONLY IN AMERICA, BUT AROUND THE GLOBE, AS YOU KNOW WHAT DO WE DO? WE DO A LOT OF ANGIOPLASTIES THEY COST A LOT OF MONEY WE DO A LOT OF BYPASS SURGERIES

THEY COST EVEN MORE MONEY, AND IT'S INTERESTING TO REALIZE THAT ANGIOPLASTIES AND STENTS DO NOT PROLONG LIFE OR PREVENT HEART ATTACKS WHEN PEOPLE HAVE THEM IN A STABLE CONDITION, WHICH IS 95% OF THE TIME, SO IF SOMEONE IS AN ACUTE SITUATION, THEY GO INTO THE EMERGENCY ROOM, AND THEY GET STENTED, PROBABLY SAVED THEIR LIFE, BUT 95% OF THESE PROCEDURES ARE DONE ON STABLE PATIENTS IT DOES NOT PROLONG LIFE, DOES NOT PREVENT HEART ATTACKS WHAT ABOUT BYPASS SURGERY? BYPASS SURGERY PROLONGS LIFE IN LESS THAN 3% OF PEOPLE, SO HERE WE ARE, DOING THESE VERY INVASIVE THINGS, VERY EXPENSIVE THINGS, AND NOT EVEN GETTING THE OUTCOMES WE WOULD LIKE NOW JUXTAPOSE THAT TO THE FACT THAT CHANGING LIFESTYLE COULD PREVENT– NOT JUST TREAT, BUT PREVENT– AT LEAST 90% OF HEART DISEASE, THE NUMBER-ONE KILLER, BUT WE DON'T HAVE A SYSTEM OF HEALTH CARE THAT DOES THAT WE HAVE A SYSTEM OF HEALTH CARE THAT DOES THE TOP STUFF, THE INTERVENTIONS, SO WHAT DOES THIS LOOK LIKE? HOW DO WE RADICALLY REDESIGN HEALTH CARE TO REALLY PROMOTE PEOPLE'S HEALTH AND WELL-BEING, WHETHER THEY'RE ALREADY HEALTHY OR SICK OR AT THE END OF THEIR LIFE? WE'RE CALLING THIS THE WHOLE HEALTH PARTNERSHIP, AND WHOLE HEALTH IS AN APPROACH TO HEALTH CARE THAT EMPOWERS AND EQUIPS– THOSE ARE IMPORTANT WORDS– EMPOWERS PEOPLE AND EQUIPS PEOPLE TO TAKE CHARGE OF THEIR HEALTH AND WELL-BEING AND LIVE THEIR LIFE TO THE FULLEST

OUR CURRENT HEALTH CARE SYSTEM ISN'T REALLY DESIGNED TO DO THAT, IF WE'RE HONEST, SO WHAT DOES THIS FUTURE STATE LOOK LIKE, THE STATE THAT VA IS PRODUCING AND DELIVERING WITH OUR VETERANS? THEY NEED TO HELP PEOPLE LEARN THE SKILLS AND HAVE THE SUPPORT THEY NEED TO ADDRESS THEIR SELF-CARE THIS IS HOW WE EQUIP PEOPLE TO ADDRESS THEIR HEALTH AND WELL-BEING, AND THAT PLUS HOLISTIC, INTEGRATIVE HEALTH CARE CREATES THE WHOLE HEALTH SYSTEM, SO IF WE THINK ABOUT HOW DOES THAT WORK, HOW DO YOU MAKE THAT REAL, WE NOW HAVE 3 ELEMENTS OF THE WHOLE HEALTH SYSTEM, THE FUTURE HEALTH SYSTEM FOR VA THAT DOES HAVE CLINICAL CARE WITH A MORE HOLISTIC APPROACH THAT BEGINS WITH A PATHWAY WHERE PEERS AND OTHER FOLKS WHO ARE NOT NECESSARILY CLINICIANS ARE TRAINED TO WORK WITH VETERANS AND THEIR FAMILIES ABOUT EXPLORING WHAT REALLY MATTERS TO THEM TO IDENTIFY WHY THEY WANT THEIR HEALTH AND BE VERY CLEAR ABOUT THAT PERSONAL MISSION OR ASPIRATION OR SENSE OF PURPOSE IN THEIR LIFE THAT THEY WANT THEIR HEALTH FOR THAT'S THE FOUNDATION OF THEIR HEALTH AND HEALTH CARE THEY BEGIN TO PUT TOGETHER A PERSONAL HEALTH PLAN IN THAT PROCESS, AND THAT PERSONAL HEALTH PLAN HELPS INTEGRATE THEIR CARE WHEREVER THEY'RE HAVING IT, WHETHER IT'S THEIR SELF-CARE, THEIR LIFE IN THEIR COMMUNITY, OR THEIR CLINICAL CARE, SO THE PATHWAY IS REALLY CRITICAL THE HEALTH AND WELL-BEING PROGRAMS HELP PEOPLE LEARN THE SKILLS THEY NEED, HOW TO EAT DIFFERENTLY, HOW TO DEAL WITH THEIR STRESS, HOW TO IMPROVE THEIR SLEEP, BRINGING IN APPROACHES LIKE TAI CHI OR ACUPUNCTURE IF THOSE ARE HELPFUL TO PEOPLE, AND WE GIVE PEOPLE THE SKILLS THEY NEED AND THE SUPPORT THEY NEED TO REALLY CHANGE THEIR HEALTH AND WELL-BEING, SO THE WHOLE HEALTH SYSTEM ADDRESSES THESE ELEMENTS– THE HUMAN ELEMENT, THE SELF-CARE, AND THE CLINICAL CARE, AND COMPLEMENTARY AND INTEGRATIVE APPROACHES ARE INTEGRAL TO SELF-CARE AND CLINICAL CARE IN THIS, SO I'D LIKE TO JUST CLOSE BY SHARING A REFLECTION OF MINE THAT MODERN MEDICINE STARTS WITH THE BODY, RATHER THAN THE SOUL; THE MIND, RATHER THAN THE HEART, BUT WHAT WE KNOW IS THAT THE SOUL AND THE HEART ARE THE DOORWAYS TO HEALING AND HEALTH OF THE BODY AND MIND, SO NOW WE'RE AT THIS REALLY EXCITING PLACE WHERE WE CAN DESIGN FOR THIS APPROACH WITH OUR VETERANS AND LEAD THE WAY NOT ONLY FOR OUR VETERANS, BUT FOR OUR NATION

THANKS SO MUCH FOR BEING A PART OF THIS

Source: Youtube