Day 1 - 3 Where We Want to Go 4-7-16projects.hsl.wisc.edu/SERVICE/sites/final/Day 1 - 3 Where...The VA – A Leader in Healthcare - For All of Us The VA healthcare system has consistently

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WHOLE HEALTH:

Change the Conversa5on

Healthcare: Where We’ve Been, Where We Want to Go

VETERANS HEALTH ADMINISTRATION

Do you remember when you were first called to the healing arts?

The Calling

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Brief Exercise

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Write in your binder (page 20): •  What is wrong with the prac5ce of healthcare today?

•  What is right with the prac5ce of healthcare today?


Challenges

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Challenges: Information Technology / Data

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Challenges: Metrics

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Challenges: Incentives

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Challenges: Retaining Quality Personnel

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Challenges: Values

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Challenges: Reduced Opportunities for Collaboration

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Challenges: Health Disparities

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Challenges: Health Literacy

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Challenges: Polypharmacy

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Challenges: Direct to Consumer Marketing

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Challenges: Microbial Resistance

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Challenges: Scheduling

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History

It has been said that the best educaPon for a president of the United States comes from an inPmate study of the lives, leUers, and papers of his predecessors.

Some believe that the study of history can be of as great a spiritual and pracPcal value to a healthcare provider as to a president.


A Brief History of Medicine

•  Ancient healers •  Chinese medicine •  Ayurveda •  Ancient Greeks •  The Romans •  Middle Ages •  19th century •  20th century •  21st century

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PrimiPve Medicine

TradiPonal Chinese medicine

Ayurveda

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vhines200 via Foter.com / CC BY-‐ND



Ancient Egypt

Hippocrates

Aristotle

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idea_hamster via Foter.com / CC BY-‐NC

Lawrence OP via Foter.com / CC BY-‐NC



The Romans

Galen

Middle Ages

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History – Skip to 1800s

1812, first arPcle in NEJM -‐ treaPse on angina pectoris wriUen by founding member of Harvard Medical School

Described paPent treated with bloodlecng, sPmulants, topical ether, opium,

laxaPves, blistering agents over sternum, causPcs to provoke draining blisters on thighs and arms.

Symptoms did not improve – paPent sent on therapeuPc voyage to the

warmer climate for winter, returned in spring. AUacks returned. Bloodlecng, arsenic, tobacco. Death.

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N Engl J Med 2012;367:1077-82.


History – Skip to 1800s

Oliver Wendell Holmes (1860) – “…if the enPre materia medica,

as now used, could be sunk to the boUom of the sea, it would be all the beUer for mankind – and all the worse for the fishes.”

22 N Engl J Med 2012;367:1077-82.

Internet Archive Book Images via Foter.com / No known copyright restricPons



Many years…

1800s Anesthesia – 1842

Germ theory – 1870s 1899 -‐ aspirin

Early 1900s Blood transfusion – 1901

EKG – 1913 Insulin used – 1922 Penicillin -‐ 1928

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A Brief History of Medicine 1950s

Pacemaker – 1952 DNA – 1953

Kidney transplant – 1954

Polio vaccine -‐ 1955

Mid-‐late 1900s Human heart transplant –

1967 HIV idenPfied – 1983 Sheep cloned -‐ 1996

2000s Human genome released

– 2003 Woolly mammoth

genome sequenced – 2015

T. Rex DNA -‐ 2016


Medicine – Yesterday, Today, Tomorrow

Since the days of bleeding and mercury to today’s molecular

medicines, clinicians have sought new and beUer therapies. The task and complexity of the mission are extraordinary.

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N Engl J Med 2012;367:1077-82.


 

There’s More To It

Drugs are necessary but not sufficient for transforming health.

N Engl J Med 2012;367:1077-‐82.


Connecting

“Only connect! … Only connect the prose and the passion, and both will be exalted, and human love will be seen at its height. Live in fragments no longer. Only connect, and the beast and the monk, robbed of the isolaPon that is life to either, will die.”

EM Forster

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The Privilege of Being a Healthcare Provider

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The VA – A Leader in Healthcare - For All of Us

The VA healthcare system has consistently out-performed the non-VA/private sector in quality of care and patient safety. The VA healthcare system has been a model for accountability – detecting problems and working to improve upon them. The VA is full of top professionals, many of whom could earn more elsewhere, who are committed to the values of a system that is anchored in service to our nation’s Veterans. Forbes, May 23, 2014

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Service VA Style

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•  The largest integrated healthcare system in the U.S.

•  150 medical centers, ~ 1,400 community-‐based outpaPent clinics, community living centers, Vet Centers and Domiciliaries.

•  Over 53,000 independent licensed health care pracPPoners

providing comprehensive care to more than 8 million Veterans each year.

VHA’s Path of Transformation

The Past

“What’s the maUer with you?”

Physician Dependent

Case-‐Based Paper Medical Record

“We’ll address your immediate concern.”

Moving Toward Personalized, Proac5ve, Pa5ent-‐Driven Care

“What maUers to you?

Clinical Team, PACT

Electronic Medical Record Focused on

Disease/Injury/Illness

“You have a risky problem, please follow this plan to improve by

your next visit.”

Personalized, Proac5ve, Pa5ent-‐Driven Care

“How can we help you live the life

you want to?”

Veteran, Family and Health Care Team

Electronic Health Record

(with Personal Health Goals)

“Let’s work together to create a plan that fits your

life.”

Changing Approach to Care Connecting the Dots

Enhancing Veteran Health & Well-‐being

Mission

Strategic Planning Priority #1

Blueprint for

Excellence Strategy 6

My VA

USH Priori5es

Honor America’s Veterans by providing exceptional health care that improves their health and well-being.

Goal 1: Provide Veterans personalized, proactive, and patient-driven health care.

Strategy 6: Advance a model of health care that is personalized, proactive, and patient-driven, and engages and inspires Veterans to their highest possible level of health and well-being.

VA is shifting the current culture of medical care from problem-‐based ”sick care” to “whole health care,” which engages and inspires Veterans to their highest level of health and well-‐being.

1. Access to Care 2. Employee Engagement 3. Consistency of Best Practices and Resource Prioritization 4. Development of a High Performance Network 5. Restore Trust and Confidence


Beyond the VA Crisis – Becoming a High-Performance Network

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“Our “whole health” model of care is a key component of the VA’s proposed future delivery system. This model incorporates physical care with psychosocial care focused on the veteran’s personal health and life goals, aiming to provide personalized, proacPve, paPent-‐driven care through mulPdisciplinary teams of health professionals.”

David J. Shulkin, M.D. N Engl J Med 2016; 374:1003-‐1005


Whole Health Key Characteristics •  Personalized:

“My care is customized to me – my health concerns, my life, my values, even my genes (if available)”

•  Proac5ve: “This approach not only addresses my specific medical treatments, but it also addresses ways to strengthen my innate capacity to heal – such as mind-‐body and nutriPonal approaches before surgery or during chemo.”

•  Pa5ent Driven: “My care is based in an exploraPon of what maUers to me, and is designed to help me live my fullest life. This makes my healthcare truly important to me.”

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Mission: ‘Sick care to Health care’

•  In 2011, the NLC and the former USH approved the whole health model of care as VHA’s healthcare delivery model

•  Earlier this year, the Secretary’s MyVA plan highlighted a shis from a problem-‐based ‘sick care’ to ‘whole health care’ by engaging and inspiring Veterans to their highest level of health and well-‐being.


Pathways: Whole Health Partnership

Whole Health Partnership: SystemaPc approach to form a lasPng partnership with Veterans at the point of enrollment, and support their whole health, integraPng their self care and clinical care, where ever it is received. Includes: Whole Health Pathway

Health & Well-‐Being Center

Healthcare Clinic


Integrative Health Coordinating Center

•  Guide and support development of IntegraPve Health throughout VHA –  Clinical InnovaPon, Research &

EvaluaPon, EducaPon –  Policy, Human Resources,

Veteran Benefits, Metrics –  Seamless integraPon with

exisPng OPCC, VHA, VA iniPaPves

•  Demonstrate improved health outcomes and return on investment


Whole Health Education Programs

Whole Health: Change the Conversation

Whole Health Coaching Education Course

Whole Health Facilitator Training Program


Each one of you is an integral part of the largest healthcare system in the naPon.

The VA - A Team to be Celebrated


Passion, Expertise, Commitment

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To this day, healthcare is a calling.

The Calling

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Solidarity

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Day 1 - 3 Where We Want to Go 4-7-16projects.hsl.wisc.edu/SERVICE/sites/final/Day 1 - 3 Where...The VA – A Leader in Healthcare - For All of Us The VA healthcare system has consistently

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