KEY WASHINGTON HEALTH FOUNDATION STRATEGIC INITIATIVES:
HEALTH HOMES AND PEOPLE-CENTERED HEALTH CARE
In 2010, WHF’s Healthiest State in the Nation Campaign remained in full swing. Washington State had moved up the state health ranking scoreboard over the course of the Campaign, though the Great Recession was negatively impacting the state’s health, and challenging the Foundation’s long term viability.
The Foundation put aside the headwinds and instead continued to lean into what it considered to be the most vital issues and opportunities to preserve and promote health across the state. It remained especially interested in helping to influence efforts to reform the health care system. National and local interest in this topic had grown dramatically with revived political activity and then the consideration, and ultimately passage, of the Affordable Care Act.
WHF had advocated for its key health reform beliefs during the Congressional consideration of the ACA. Many related to the prevention and health improvement assets of the debate, and others related to support of the access expansion provisions. WHF was also concerned over the reality that Congress was punting on many of the imperatives to to redesign the health care system, both to control costs and to make the system work better for people. Most of these issues were addressed through demonstration programs and research studies funded by the federal government.
WHF wanted to make sure these redesigns produced health and better health care, not just new and more complicated organizational models. The Foundation chose to emphasize the message and system reform context by adopting an initiative to produce what it called Health Homes. At the time, the term was largely unused, and was intended to be a new concept calling for health care to revolve around the notion of service to individuals and families. It was loosely modeled on some of the principles of the established Medical Home, but went intentionally far beyond this concept in its principles.
The core principle was that people should be in charge of their health, and this should not just be delegated to health care providers. Rather than just say this, the Foundation looked for creative ways to demonstrate what it meant for Washingtonians to take greater control over their health.
A critical element of this effort became the creation of “Health Home Tools”. These were consumer guides and forms made available through the Foundation website at no cost to people who wished to take greater control over their health.
One of the first such tools produced by WHF was a Guide for Managing Your Hospital Care. The “Just What the Patient Ordered” tool was intended for patients and families about to be admitted to a hospital for inpatient care. It outlined what to generally expect, and how to take greater control over the experience. It included forms that one could fill out and bring with them to the hospital, such as medication lists, questions the patient had, and discharge understandings. Odd as it might seem, few hospitals had such information available for patients at the time, and most such document were long and confusing explanations serving the hospital’s legal or information needs, not the patients.
The positive reception to this guide by patients, and even many hospitals, led WHF to consider other guides that would help people take greater control over their health. For example, it developed a guide to help people take control over their visits to primary care physicians, including a simple downloadable form that allowed one to put one’s major questions for the upcoming visit on a piece of paper to be hand to the physician or his staff. This created an expectation, and even a legal obligation, for the physician to address these questions, rather than just quickly and simply manage the patient visit. Again, patients and many physicians applauded the tool.
Over the next couple of years, WHF designed a series of Health Home Tools. These are still relevant and can be found in the Current Resources section of this website under our Future. These include a Wellness Checklist, a Wellness Plan, a Kick the Habit, an Oral Health, an Emotional Wellbeing, a Stress Management a Nutrition, a Family Health History, a Medical Record, and other Health Home Tools. (Link to this section of the website!!!)
WHF not only created and made these tools available to Washingtonians, it also spread the broader change concept underlying their logic to organizations and policy leaders. Many of the ideas took root in evolving delivery models across the state. Still, it was clear that most health system change reforms were being done to people, not empowering their participation.
WHF decided to bring even greater public attention to this problem, and the imperative that health care be designed “of, by and for the people”. It did so by creating a virtual Center for People’s Health. The Center embraced the concept of patient centered care, and presented a comprehensive set of the necessary inputs to create this in practice. As feasible, WHF not just Health Home tools but other resource support toward these inputs. It also messaged the importance of the concept to policy makers.
One important element of the Center and its message the development of a set of design principles for people centered health care. WHF was greatly influenced by Don Norman’s seminal work “The Design of Everyday Things” that sparked a revolution regarding the design of everyday consumer products. WHF engaged system designers to develop a set of design principles that would apply such new thinking to health systems for people.
A draft set of design principles were developed through meetings, conferences, and on line debate, and adopted by WHF:
Feedback - Embeds feedback loops that empower people to interact with the system as partners and individuals, not just patients
Affordance/Constraints - Requires shared responsibility to select among a bounded set of trustworthy options, so that people’s outcomes and experiences meet their expectations
Mapping - Allows people to easily understand the relationship between parts of the health system and the value they are seeking from it
Networked - Connects people and provides them with the tools to relate to others openly and freely, in ways that build from their communication needs
Enhancement - Reshapes diverse knowledge into frameworks that people can use to improve their health and make sound personal care decisions
Accessibility - Responds to the changing demands and needs of people by providing flexible services that can adapt to emerging trends
The Foundation convened a Health 3.0: People Designing Change conference in November 2010. It built a network of advocates for the concept and continued to press policy leaders to recognize this new notion of a health system change context up until WHF was forced by financial circumstances to suspend operations. The notion is expected to remain an important concept as the Foundation considers its new activities into the future.