Identity, Authority, Scope, & Role: What Do Consumers Want?

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Health Care Consumers & “Patient Engagement 2.0”

‘Patient engagement’ has been used as a general term to describe what patients do for their own health. What’s required for engagement? Motivation, either imposed on us (precipitating events like heart attacks can get people’s attention and motivate them to refine lifestyle habits–but not everyone, and not always), driven by personal values, or–for some–rewards.

Other factors matter as well. Health literacy–understanding basics like terms and body systems concepts is often necessary. Technology access and competence matter more and more: much of health care, information, and soon access too and purchasing of health services requires access to the Internet. Ethnicity, race and culture matter: ingrained cultural norms, differences in values, relationship approaches, language, information and activities between caregiver and patient can affect participation, engagement and outcomes. And perhaps the most profound driver of engagement is the tribal cohort factor: peer group activities shape and motivate what its members do.

Some things in health care can be done to a person, but most efforts in recovering and maintaining health and optimal function mean the person has to do something. The provider’s role is one of facilitation and limited intervention. So engagement (motivation) matters: the more I do on my own, the less I need others’ services–so the less I cost the system. “Patient engagement 1.0” has been defined and largely managed by system-side resources. But with the new, consumer-focused retail health care marketplace, the locus of power and control is shifting–and the basis for engagement is changing. We’re likely to see it substantially revised: “Patient Engagement 2.0.” What is it, and what can we do to be prepared? Continue reading

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Requiem for an Integrative Dream

The idea of ‘integrative health care’ has captivated people for several decades, and many examples have come and gone. Some medical delivery systems have incorporated some providers into care delivery; most have not. Some business models have survived; many have not. One of the more important local (Minnesota) sets of accomplishments in integrative health care occurred from 1998-2000, when some novel clinic models were established. As a product of the leadership of Dr. John Allenburg, president of NWCC and its successor host institution Northwestern Health Sciences University, there were five notable experiments, all distinctive and unique–especially for the time.

Dr. Allenburg had held that there were three types of models that reflected real-world needs and thus should inform the school’s efforts. One was a multidisciplinary provider team, housed in a single clinic; another was a virtual team, housed at different locations but functioning together with electronic facilitation; and another was that of an independent solo practitioner, able to craft interdisciplinary referral relationships as their circumstances, values and patient needs dictated. Based on this strategic vision, NW created five experimental clinics. With the news that NWHSU sold the Natural Care Center at Woodwinds in Woodbury MN on 6/29/15, the last chapter in this effort is over. Whatever integrative efforts occur will come from on-campus or other new opportunities. Is this a net gain, neutral, or a net loss? As Dr. John has said many times, “Where you stand depends on where you sit.” Continue reading

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Professional Culture: Value or Not?

As anyone who has spent time looking at different types of providers and integrating them into a common system knows, each health care profession has its own culture. The word “culture” stems from the Latin culturare, ‘to tend, cultivate.’ It is a way of acknowledging, appreciating, respecting–or changing–the ‘customs, arts…institutions and achievements of a particular…people or social group.” It’s also a type of container within which a profession can manage its own growth and maturation. Does this matter in health care? It may be more important in the new health care marketplace than we first think. Continue reading

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“No man is an island…”

In 1624, the poet John Donne wrote the following meditation:

No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thy friend’s
Or of thine own were:
Any man’s death diminishes me,
Because I am involved in mankind,
And therefore never send to know for whom the bell tolls;
It tolls for thee.

I’ve been thinking about that passage today, reflecting on the news that Dave Mjoen had passed away suddenly on Monday of this week. This will be a very personal post, so pass on if that isn’t what you are looking for. Continue reading

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Evolving Professions, Expanding Scope, Ongoing Battles

There isn’t a health care profession that has been exempt from fighting political Western medicine. The unchallenged cultural authority established by allopathic medicine and its professional social ‘norms’ has permitted medical schools to demand compliance from students and practitioners.  Rites of passage for professions trying to grow and mature have included a gantlet of legislative battles against a united front, often with incredible pressure, suppression and retribution. No profession has had it harder than chiropractic, with a painful history that includes thousands of prosecutions, time in jail, and even loss of life from those experiences. Why is this still something to talk about? Because it’s still playing out, but with new and different implications. Continue reading

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The Uncertain Future of Provider Education

One of the more significant problems for doctors of chiropractic coming into the health care marketplace is that it’s increasingly clear our education isn’t just too expensive, but it’s not effectively matched to what we need to be successful.  It’s not just chiropractic–every health provider education process is subject to the same pressures as higher education is across the country. Most predictions are that higher education as we know it is collapsing, because the ‘knowledge delivery model,’ the actual content of those knowledges and the dysfunctional economics of the institutional paradigm all point to a dramatic collapse of the system. What can be done to help the profession survive and thrive? Do we need band-aids, rebuilding, or something in the middle? Continue reading

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Vectors of Change

Northwestern Health Sciences University held an interesting presentation and discussion on May 12, 2015 titled ‘A Different Path: Career Options and Your Northwestern Degree.’ Various speakers gave short presentations about how they are working with other providers, data, and various industry stakeholders to broaden the presence, effectiveness and value of doctors of chiropractic in the health care system.

Every speaker had ‘cracked the code’ of some aspect of deeper participation than customary solo chiropractic, massage and acupuncture/TCM practices. Their accomplishments are worth noting and they are to be commended for their achievements. Their examples  stand as proof that it is possible to take clinical and transferable skills and move to a different position within health care, often with a dramatically larger sphere of potential influence. Can other doctors of chiropractic follow in their footsteps? Or are they unique leaders who are difficult to follow? Continue reading

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Health Care Data Gets Around

Compared to medical record theft, the theft of chiropractic patient records isn’t much of a problem…yet. But because most chiropractic patients are also medical services patients, doctors of chiropractic may have an ethical responsibility to help their own patient/clients understand the risks they are currently facing by having their PHI in someone else’s hands–anyone’s–including, at some point, possibly yours. Think you and your patients are exempt? And how about your own personal health data? Continue reading

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Where Will You Fit In?

Speaking to a group of chiropractors and support staff recently about the chaotic world of health care reform, I was left wondering how to answer a basic question: where will they fit in? This isn’t an off-hand question, and it’s not about a social fit. In many ways, it’s the critical question to ask, because perhaps more than at any time in the short life of the amazing profession of chiropractic, answering ‘where we fit in’ is going to be a much more complex set of considerations. If you’re not thinking about this, you need to be. Continue reading

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