How many people each year suffer some type of preventable harm that contributes to their death after a hospital visit?
| ||10 Years Later: Design Principles for Healthcare Renewal Useful for Integrative Medicine's Future||
Summary: Recently long-time integrative health author, system-consultant and pioneer Roger Jahnke, OMD urged me to "resurrect" a document from the early years of integrative health called the Design Principles for Healthcare Renewal. It wasn't until I decided to re-publish them here that I realized this is almost exactly a decade since these were well-received in October 2001 as a clarifying document by the members of the White House Commission on Complementary and Alternative Medicine Policy. Jahnke's request resonated with a presentation at Bravewell Integrative Medicine in Action event November 10, 2011 in which it was suggested that we might yet see an economic incentive structure to support a "thriving industry of health creation" (Principle #9). Here are those 10 principles, borne out of a Task Force on Principles from the 2000 Integrative Medicine Industry Leadership Summit. Do they have useful resonance for you?
Design Principles for Healthcare Renewal. Wrote Jahnke: "I remain inspired by the 'principles.'" He asked when I thought they might be "resurrected."
I received a recent query from long-time integrative health leader Roger Jahnke, OMD. Ten years ago he and I had been part of a Task Force from the 2000 Integrative Medicine Industry Leadership Summit that developed something that became known as the
Jahnke's note roughly coincided with the November 10, 2011 Integrative Medicine in Action event
sponsored by the Bravewell Collaborative of philanthropists in integrative medicine. There, the comments of Ken
Paulus, the CEO for Allina Hospitals & Systems, reminded me of one of my favorite phrases, in Principle #9: "The renewed healthcare system is a
partnership between an expanded commitment to the public health and a
thriving industry of health creation."
The Design Principles were well-received by the White House Commission
Paulus' view that economic incentives are emerging to support integrative health strategies gave me optimism that a "thriving industry of health creation" might yet find room to grow, amidst the perverse incentives of the fee-for-service system. Perhaps it is time for another look at these "Design Principles of Health Care for Accelerating Personal and Health System Renewal." The 10 principles and their preamble are printed below in their 2011 form.
Background: The suggestion to set up a task force on principles at the 2000 Integrative Medicine Industry Leadership Summit was made by Gary Sandman, presently the president of Signature Supplements. Work began in a January 2001 daylong session in the Rayburn House Office Building of the US Congress. Clement Bezold, PhD, chair of the Institute for Alternative Futures, moderated the discussion. Other participants, besides Jahnke, Sandman and me, were:
- Len Wisneski, MD, now chair of the Integrated Heathcare Policy Consortium
- Pamela Snider, ND, executive editor and founder of the Foundations of Naturopathic Medicine Project
- Writer and integrative health consultant Alan Dumoff, MSW, JD
- Terry Schmidt, PhD currently a faculty member at UC Irvine
- Jery Whitworth, RN, CCP, then a partner with Mehmet Oz, MD in the integrative services department at Columbia Presbyterian Hospital; and
- Beth Clay, then House Government Reform Committee staff member and now a DC lobbyist.
Ten months later, on October 5, 2001, Wisneski submitted these principles to the White House Commission on Complementary and Alternative Medicine Policy where they were well-received as an important contribution to bringing coherence to the 3-ring circus of all things "CAM." Subsequent to a review at Integrative Medicine Industry Leadership Summit 2001, Dumoff took the lead on a revised version that was subsequently published in a Liebert publication.
Core principles drive the way healthcare operates and is
experienced. Times of change and disturbance call us to examine, clarify
and commit to renew our individual and community practices. The
following set of principles emphasizes the integrative nature of optimal
healthcare. Such care seeks to create health by engaging new and old
approaches to health for the individual, system, community and
environment. Integrative care is grounded in relationships, seeks
sustainability, is energized by the unknown and crafted through
continuous exploration of strategies for uniting the best of the world's
evolving practices, outcomes and traditions.
These principles, based on the missions
and visions of diverse stakeholders, are an initial expression of an
effort to create a unifying view of a renewed system for healthcare
delivery and payment. These principles are meant not as ideals, but as
working tools of design, application, evaluation and alignment.
The design principles for accelerating health and well-being in individuals, and in the health system, are:
1. Honor wholeness and interconnectedness in all actions.
Body, mind, spirit, community, and environment are an integral whole
that cannot be separated into isolated parts. All are involved in
healing. Healthcare interventions, regardless of their focus, affect the
2. Enhance the capacity for self-repair and healing.
The innate capacity for healing and the individual's personal
empowerment in supporting these natural processes are fundamental
considerations in all healthcare decisions.
3. Prioritize care in accordance with a hierarchy of treatment.
Care, and the leveraging of resources to affect care, are prioritized
along diagnostic and therapeutic hierarchies which begin with education
and empowerment in healthy choices, then move to the least invasive
approaches and escalate, as necessary, to approaches linked to increased
likelihood of adverse effects or higher costs. The starting point for
intervention is established through clarifying, with the individual
receiving care, the risks associated with foregoing, and with
undertaking, more invasive approaches. Chronology and cause are
fundamental aspects of this healing order.
4. Improve care through continuously expanding the evidence base.
Healthcare is a combined art and science in which personal practices
and clinical choices and services are continuously evaluated and
improved, by practitioners, users and organizations, based on diverse
evidence. Included are the desires, perceptions and outcomes experienced
by the individuals at the center of care, the clinical experience and
understandings of all members of a provider team, and particularly,
systematically gathered evidence of experience and outcomes. More
stringent evidentiary standards are associated with higher risk or more
5. Embrace the fullness of diverse health care systems.
Conventional, traditional, indigenous, complementary and alternative
models of care, and their bodies of knowledge, have contributions to
make to the healthcare which is culturally most appropriate and
effective for individuals and communities. Best practices are discovered
through exploring diverse structures for integration, including
parallel, collaborative and assimilative models.
6. Partner with patients, their families and other practitioners.
Caregivers profoundly enhance healing and strengthen shared
accountability through supporting the informed decision-making of the
individuals/families/loved ones they serve, and through inclusive,
respectful partnerships with other practitioners with whom they
collaborate in care provision.
7. Use illness and symptoms as opportunities for learning and growth.
Illness represents an opportunity in which healing and balance are
always possible even when curing is not. Symptoms are guides to health.
8. Explore integration in one's own care.
Practitioners, administrators and individuals are most effective in
understanding and delivering integrative healthcare, and in embracing
these design principles, when they follow these principles in their own
9. Align resource investment with these healthcare principles.
The renewal of our healthcare payment and delivery systems is fostered
by aligning resource investment, in the personal, public, philanthropic
and private sectors, with these principles. Humble willingness to work
to resolve the tensions between one's personal and professional
interests, and those shared interests expressed in these principles, is
required of all participants. The renewed healthcare system is a
partnership between an expanded commitment to the public health and a
thriving industry of health creation.
10. Respect the time required for personal and health system change.
Interventions may be swift, but healing, habit change, and transformation take time and ongoing commitment.
Comment: Much richness in these 10. The sections I view as most potent, yet under-expressed in the evolution of integrative medicine since, are the concepts of the "hierarchy of treatment" (#4), the respect for the "fullness of diverse health care systems" (#5) and then, the principle that stimulated this re-publication, the need to stimulate a "thriving industry of health creation" (#9). Thanks to Jahnke for his prompting. Is there yet more value in "resurrecting" these further?
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