Whole Health in Your Practice Day 1 Afternoon 1 0 Whole Health in Your Practice Advancing Skills in the Delivery of Personalized, Proactive, and Patient‐Driven Care Day 1 Afternoon • Me at the Center: Mission, Aspiration, Purpose • Mindful Awareness • Resilience and Clinician Self‐Care • The Personal Health Inventory • Setting the Stage for Implementation: Local Resources Welcome back to an afternoon of excitement and intrigue... Reflection How “Whole Health‐y” is Your Practice? Based on doing this self‐assessment, what are some specific things you would like to do differently in your daily work? Photo: Zimio.com
34
Embed
Whole Health in Your Practice...Whole Health in Your Practice Day 1 Afternoon 1 0 Whole Health in Your Practice Advancing Skills in the Delivery of Personalized, Proactive, and Patient‐Driven
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Whole Health in Your PracticeDay 1 Afternoon
1
0
Whole Health in Your PracticeAdvancing Skills in the Delivery of Personalized, Proactive, and
Patient‐Driven Care
Day 1 Afternoon• Me at the Center: Mission, Aspiration, Purpose• Mindful Awareness• Resilience and Clinician Self‐Care• The Personal Health Inventory• Setting the Stage for Implementation: Local Resources
Welcome back to an afternoon of excitement and intrigue...
Reflection
How “Whole Health‐y” is Your Practice?
Based on doing this self‐assessment, what are some specific things you would like to do differently in your daily work?
Photo: Zimio.com
Whole Health in Your PracticeDay 1 Afternoon
2
Partner Discussion
How “Whole Health‐y” is Your Practice?
Based on doing this self‐assessment, what are some specific things you would like to do differently in your daily work?
Image: Shutterstock.com
4
Whole Health in Your Practice
4. “Me” at the Center:Mission, Aspiration,
Purpose
Video – Purpose in Life 0‐100
https://www.youtube.com/watch?v=mK66az43EOI
Whole Health in Your PracticeDay 1 Afternoon
3
Video – Dream Rangers
https://www.youtube.com/watch?v=t5RBN97aBNc
Reflection on What Really MattersFind a partner. Each person will take a turn sharing while the other listens.
You will each choose one topic to share about:
JOY: What brings you a sense of joy and happiness?
DREAMS: What is one of your life‐long dreams?
HEALTH: What is your vision of your best possible health?
Photo: thoughtcatalog.com
Don’t start just yet! More info
on the next slide!
Don’t start just yet! More info
on the next slide!
1. Ask the question to your partner
2. Listen, reflect, and ask clarifying questions. Don’t try to “solve” anything
3. As time allows, take it deeper:
– “How would your life or health change if you focused more on this part of your life?”
o“What would you be doing?”
o“What would be different?”
o“How would you feel?”
Some Suggestions for the Listener
OK, now you can start!OK, now you can start!
Ima
ge
: you
ng
pa
rne
nts.com
.sg
Whole Health in Your PracticeDay 1 Afternoon
4
Group Discussion:
What did you notice?
Clip Art: laoblogger.com
The Healing Power of Purpose
• Lowers mortality
• It decreases risk of death as much as it is increased by tobacco use, poor diet, inactivity, or high stress levels
• Reduces stroke, heart attack, Alzheimer’s
• Improves sleep, mood, sex life, mental health
• Increases success of staying substance free, seeking prevention
• ↑ HDL, ↓ inflamma on
• Ramps up DNA repair
Almujiang et al, JAMA Network Open, 2019;2(5)e194270. Strecher V, Life on Purpose, New York: Harper Collins, 2016.Burrow et al, Pers Individ Diff, 2016;90:187-9.
Mapping to the “MAP”() • Mission, Aspiration, Purpose
(MAP)
• “The Game Changer”
• Focusing there gets you “buy in” right away
• Even if time is short, still try
to do this part for a moment
• Foundational to the Personal Health Planning Process
Ima
ge
: sbn
atio
n.co
m
Whole Health in Your PracticeDay 1 Afternoon
5
“What do you want your health for?”
People’s answers may surprise you!
Ph
oto
: Pu
revia
ge
m.co
m.b
r
Think About Your Own Mission
• Why are you here in the VA?
• Why are you here on the planet?
• What REALLY matters to you?
• What do you want your health for?
Ph
oto
: Pu
revia
ge
m.co
m.b
r
List ideas on page 37
Map to the “MAP”: Examples of ?’s
• It would really help me partner with you in your care, if I understood what is important to you in your life.
• What really matters to you in your life? What do you want your health for?
• What brings you a sense of joy and happiness?
• How does your current health impact what is most important to you?
• What is your vision of your best possible health?
Whole Health in Your PracticeDay 1 Afternoon
6
Demo: Mapping to the MAP
Image: moddb.com
Image: washington.edu
Large Group Discussion:
Any experiences using MAP in your practice?
Photo: physician-employment-opportunities.com
Explore the “MAP”: Your Turn
• Find a new partner. Decide who will ask questions first.
• Ask about Mission, Aspirations, and Purpose.
• Practice generous listening. Fine to paraphrase or reflect back what they are saying.
Photo: raw
pixel.com
Whole Health in Your PracticeDay 1 Afternoon
7
Reflection:
Could you use this with your Veterans?
What does that look like?
Image: Shutterstock.com
Group Discussion:
Could you use this with your Veterans?
What does that look like?
Image: Shutterstock.com
Whole Health in Your PracticeDay 1 Afternoon
8
CASE STUDY – Dave Page 17
• 68 year old Army Veteran (Vietnam)
• Married, one son (47) and one daughter (45)
• Retired mechanic
Current concerns:
• Difficulty falling asleep, ‐ has flashbacks and nightmares
• Poorly‐controlled type 2 diabetes for 25 years
• Right below‐the‐knee amputation 4 years ago
• Chronic pain in left leg; poor circulation and leg ulcers
• Left foot removed 3 days ago. Admitted to have left lower leg removed tomorrow
DiscussionChanging the Conversation
Imagine you are about to meet with Dave…
• What feelings come up about working with Dave, when you hear about this case?
• Any assumptions you find yourself making about him?
• Do you feel connected to him, based on this information?
• What would you guess is Dave’s MAP?
DAVE
The story from the Veteran’s perspective(Page 18)
Photo: w
jla.com
Whole Health in Your PracticeDay 1 Afternoon
9
DiscussionChanging the ConversationImagine (again) you are about to meet with
Dave…
• How do you feel about working with Dave now?
• What did you learn from his story that will affect how you interact with Dave?
• Would you document differently to share his information with other staff?
• Is the information from the narrative useful/helpful? What provides MAP for Dave?
My Life, My Story
• Narratives
– Veterans interviewed their life stories. Narrative is transcribed and reviewed by the Veteran.
• Personal Health Inventories
- Team helps Veterans complete a PHI and identify wellness goals
- Data passed on to outpatient team and recorded in CPRS
• Writing Workshops
– VA staff can write their own stories, focusing on their experiences as care providers
My Life, My Story
There are Narrative Medicine Tools available in the Whole Health Library at www.wholehealth.wisc.edu
Whole Health in Your PracticeDay 1 Afternoon
10
Video: My Life, My Story:
VA’s healthcare improvements through sharing stories
https://youtu.be/fpzgVlExS20
To Sum Up
• Focus on a person’s values – stay attuned to the “why”
• We’ll see that a Personal Health Inventory can help capture MAP even before the visit begins
• Knowing someone’s story allows for a richer connection and better care, along with better outcomes
• If you explore the MAP, you are well on your way to offering Whole Health in your practice
Paying more attention to my body and mind helps me make better decisions in
my self care
With practice, I can change my focus and my thinking and my responses to benefit my
health
Definition of Mindful Awareness
• Way of being
• In the present moment
• On purpose
• Non‐judgmentally
• With kindnessPhoto: dailywildlifephoto.nathab.com
Other Ways to Define it…
• Jack Kornfield: Loving awareness
• Sharon Salzberg: a special kind of awareness characterized by openness, curiosity and acceptance
• Ron Epstein: Remembering who you are and what is important, every moment of every day.
• Paying extraordinary attention to ordinary experiences…as if your life depended on it!
Whole Health in Your PracticeDay 1 Afternoon
13
Some Clarifications Passport, Ch. 4
• Mindful awareness is a general concept. You can cultivate it informally, or through formal practice.
• Mindfulness is often used as a synonym for Mindfulness Based Stress Reduction, a course that focuses on teaching approaches that can help enhance mindful awareness.
• Meditation comes in many forms. Some forms support mindful awareness; others focus on other goals.
Photo: foxnew
s.com
Photo: beginningfarm
ers.org
Whole Health in Your PracticeDay 1 Afternoon
14
Mindful Awareness
We all have it...the natural
capacity to pay attention with curiosity and openness.
Photo: chuchutv.com
Mindful Awareness
We also have the capacity for
mindlessness, inattention, or
going on autopilot.
Photo: callminer..com
Whole Health in Your PracticeDay 1 Afternoon
15
Mindful Awareness Experience
Mindful Awareness Research
Photo: Nationalgeographic.com
What research
findings have you seen?
For More Information...Passport, Chapter 4
(See the resource list at the end of that chapter)
• Accidents• Poor decision making• Less empathy• Medical errors• Poor communication• Health problems• Quitting, early retirement
Photo:marksdailyapple.com
Whole Health in Your PracticeDay 1 Afternoon
26
Your Own Self‐Care and Patients
• Your well‐being matters in its own right, AND...
• You preach what you practice
–That is, you mention behaviors to patients if you do them yourself
• They practice what you preach
–Patients engage more with you if they know you are doing self‐care
–E.g., the ‘apple and helmet’ studyFrank E, et al. CMAJ 2013;185(8):649‐53.Frank E, et al. Arch Fam Med 2000;9(4):359‐67.Frank E, et al. Arch Fam Med 2000;9(3):287‐90. Images: Road.cc and techflourish.com
Patients follow your example
Patients follow your example
Impact of Professional Fulfillment
• Clinicians who have higher job satisfaction receive higher patient satisfaction ratings
• Higher professional fulfillment for a clinician is linked to more patient adherence
– Includes taking medications, exercise, and food choices
DiMatteo et al. Health Psychol. 1993;12(2):93‐102.Haas et al. J Gen Intern Med 2000;15(2):122‐8.
Photo: Familycircle.com
What Leads to Burnout?
1. Lack of control over office processes
2. Lack of control over schedule
3. Excessive paperwork4. Difficult and
complicated patients5. Not enough time in
the day; not enough for for self care
6. Lack of coping skills for stress
7. Personal bad habits (smoking, drug use)
8. Not enough time in the day
9. Regret over chosen career
10. Perfectionism*
Eckleberry‐Hunt et al, Acad Med 2009; 84:269‐277.
IndividualInstitutional
*Perfectionism and other traits need not be a liability. And we can’t blame the victim!
Photo:juniordoctorblog.com
Whole Health in Your PracticeDay 1 Afternoon
27
Drivers of Resilience & Burnout
Shanafelt et al, Mayo Clin Proc. 2017;92(1)129‐146.
The Quadruple Aim
Better Outcomes
Lower CostImproved Patient
Experience
Improved Clinician
Experience
Bodenheimer, Ann Fam Med. 2014;12(6): 573-6.
The Quadruple Aim
Better Outcomes
Lower CostImproved Patient
Experience
Improved Clinician
Experience
Bodenheimer, Ann Fam Med. 2014;12(6): 573-6.
Whole Health in Your PracticeDay 1 Afternoon
28
The Opposite of Burnout:Resilience Discussion
• In general, what makes a person more resilient?
• What helps you be/stay resilient?
• What would help your team?
Resilience Can Be Trained!
1. Think flexibly
2. Have a positive attitude
3. Develop “active coping skills”
4. Fine‐tune your moral compass
5. Have role models
Can also do a web search for “The Resilience Prescription”
for a summary
Resilience Can Be Trained!
6. Face your fears
7. Have strong social support
8. Maintain Physical well‐being
9. Train regularly (plan ahead)
10.Recognize and foster your strengths
Photo:H
dFlo
werW
allpap
er.comP
hoto: valleybusine
ssreport.com
Whole Health in Your PracticeDay 1 Afternoon
29
Short Mindfulness Intervention:Maslach Burnout Inventory Changes
Fortney, et al., Ann Fam Med, 2013;11(5):412‐20.
Even brief meditation training decreased elements of burnout in clinicians.
Discussion: Resilience Superstars
At your table, each person chooses one of the following to share about for for a minute or two.
1. Who do you admire for their resilience? Why?
2. When have you shown resilience in your own life? How? What helped you succeed?
3. How can you cultivate more resilience in your life?
4. Share an example of when a patient or colleague demonstrated strength and resilience.
5. How can you enhance resilience in your workplace?