Hooking Up: Don Berwick, Integrative Medicine and His Call for a Radical Shift to 'Health Creation'

Hooking Up: Don Berwick, Integrative Medicine and His Call for a Radical Shift to 'Health Creation'
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Yesterday, a colleague reminded me of a question in a survey developed for the 2000 Integrative Medicine Industry Leadership Summit.

The participants in that historic gathering represented all health care stakeholders: academic medicine, insurers, hospitals, policymakers, employers and leaders of professional organizations. Each was, in his or her own domain, pioneering a response to the dawning opportunity for what was then mainly known as "complementary and alternative medicine integration."

Each was asked their level of agreement with this: "Complementary and alternative medicine is a tool of our deeper mission of transformation which will only be successful if we help birth in the U.S. a thriving industry of health creation." Among the 87 percent of respondents, 84 percent agreed. Nearly 60 percent chose "strongly agree."

The disease-based medical industry clearly needed transformation toward "health creation." This concept -- something different than "wellness" or "health promotion" -- was included a year later, by a subset of the participants, as #9 in the Design Principles for Health Care Renewal.

These recollections arose subsequent learning of the recent, profound endorsement of the medical industry's need for a "radical shift" toward health creation by perhaps the single most influential leader of U.S. medicine over the past 20 years: Don Berwick, M.D.

First, a bit about Berwick. He was a principal in the two pivotal Institute of Medicine reports that brought to light the ravages of medical errors(1999) and steps to eliminate them (2001). The CEO and founder of the Harvard-based Institute for Health Improvement (IHI), Berwick started the 100,000 Lives Campaign to force hospitals to take these data or the morbidity and mortality due to errors seriously.

Berwick's perch at the front edge of true health reform is also evident in his patient advocacy and championing of the the Triple Aim as a valued-based alternative to the profit driven medical industry. As Obama's choice to head the Center for Medicare and Medicaid Services, Berwick set plans for the development of "accountable care organizations" and "patient-centered medical homes" as vehicles to drive this change.

Now the man who may be considered the conscience of U.S medicine has embraced a transformation of the medical paradigm that will please all advocates of whole person, health-focused care.

In what may go down as a historic wake-up for an IHI audience of hospital and health system leaders, Berwick guides his audience toward a new vision for the outcomes of their work.

He first brings them along by referencing how it is, "fortunately commonplace now to say that we would be better off to re-direct some of our health care enterprise from fighting illness to pursuing health, going from health care to health creation."

Indeed, Berwick is not the only system leader drawn to "creating health." He echoes the the elevation of this guiding star by Douglas Wood, M.D., the director of strategy and policy at the Mayo Center for Innovation In an April 2013 issue of the American Hospital Association's Hospitals and Health Networks. Wood states: "We will realize fairly quickly that we need to change the focus of the health care industry to creating health, not just producing health care."

Berwick dives in:

The more commonplace claim that we don't now have systems to create health is also correct." He pushes on: "Here is the rub: the new way, the way to health, may be vastly further from the current design of care than we may at first wish it to be, or believe it to be.

He then reflects on the front-line work pushed by IHI and the Affordable Care Act to align medical practices and payment with the values of the Triple AIM. He speaks of the development of ACOs and team care as, "sort of on an expedition now to find those systems."

Then Berwick's kicker for his tertiary care centric colleagues: "The pursuit of health, the creation of health, may require something even bolder. The redesign we need may be even more radical than we have imagined."

Berwick then opens an exploration of elements of this radical shift. He guides his audience through his own awakening. He names his mentors. Most are pioneering leaders in the integrative health and medicine movement. Among these: Jon Kabat Zinn, Ph.D., Dean Ornish, M.D. and, above all, Wayne Jonas, M.D. and his work at the Samueli Institute on Optimal Healing Environments.

Berwick's talk is worth a listen if only to learn from the presentation style of a master. His promotion of a system that focuses on health creation should magnetize the paradigm-shift pushers in the integrative health and medicine communities.

Since the 2001 Design Principles for Health Care Renewal, the "health creation" language that Berwick and Mayo are today promoting has been more deeply imbedded in the evolving movement for integrative health and medicine

The vision statement of the 11-discipline National Education Dialogue to Advance Integrated Health Care (2005-2006) is of a system that "will deliver effective care that is patient centered, focused on health creation and healing, and readily accessible to all populations." This remains in the vision of the Academic Consortium for Complementary and Alternative Health Care, with which I am involved.

Many in the integrative health and medicine fields have complained that "health care reform" has only skimmed the surface. They say what is needed is more profound, transformational change. From the sounds of Mayo's Wood, and here at length from Berwick, a huge door to such a transformation is swinging open. The systems and practices to operationalize this shift need to be adopted or invented.

Looks like the time, as the kids say, to hook up.

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