Connecting relationships (and complexity) to optimal outcomes

170310 Fierce-Healthcare-Hospital-Impact

Originally published by Hospital Impact and promoted by FierceHealthcare.

I have written a number of blog posts focused on bringing time, relationship, caring, continuity, trust, empathy and love (healthCARING) back into the healthcare system. While many readers agree that these are essential elements of an optimal healthcare model, others “bucketed” these items as “fluff,” impractical, and unimportant to scientifically valid (evidence-based) medicine.

So today I have decided to make the connection between this “fluff” with optimal healthcare outcomes.

171107 Newton.jpgNewtonian scientific principles view the universe and its subsystems as machines. Under this view, linear cause and effect models can predict future outcomes and/or behaviors. Or in other words, by identifying the straight-line cause of a defect and addressing that cause at the root, improvement can be made with a predicted effect.

Complexity science (requiring systems thinking) views systems as non-linear with parts (subsystems) that adapt and evolve (i.e., Complex Adaptive Systems). 171107 Fish School (Pixdaus)It focuses on a web of patterns and relationships amongst and between the subsystems to assess the unpredictable nature of effects. It is critical to not only study the individual subsystems but also the interconnections and relationships between the subsystems.

 

Why is this distinction between the two views important?

The current medical model tends to follow Newtonian scientific principles and thus linear episodes of care, linear metrics to assess outcomes and success, and linear causes and effects.

For example, consider the myriad of stories you have heard of patients showing up at the doctor’s office, being diagnosed as obese and subsequently instructed to eat “right” and exercise. A linear cause and effect, i.e., not eating right and/or not exercising has led to obesity. Address the cause (improper diet and/or lack of exercise) and impact the effect (obesity).

171107 noncomplianceAnd yet many of these individuals never achieve their goal of losing weight and becoming healthier. And when they don’t, what happens? What do we do as a healthcare system? These patients are typically labeled non-compliant, many are shamed, many change doctors (or are fired from physician practices due to their ‘non-compliance‘), and many over time incur serious health issues related to their obesity which could have been mitigated.

This is a basic example of Newtonian scientific principles in healthcare. This is also an example of a failed healthcare encounter and a broken healthcare model.

Now let’s bring time, relationship, caring, continuity, trust, empathy and love back into healthcare and change the story. (Yes, let’s bring complexity and systems thinking back into healthcare.)171107 symposium_proceedings_cover.gif

A patient who is clearly overweight walks into a doctor’s office to see HER doctor, the doctor she knows and who knows her. The doctor and patient have ample time together to develop relationship. Through this relationship they develop trust. With time, relationship, continuity, trust they share empathy and agape love. This healing encounter becomes a safe place in a safe space. This is a place where the patient can share non-linear aspects of her life, which in this case are impacting her ability to address her weight challenge.

Perhaps this individual has an unhealthy relationship with food due to abuse when she was a child. Or maybe the individual has an unhealthy relationship with exercise due to a traumatic series of events in organized sports promulgated by a coach who clearly should not be coaching. Perhaps there are family dynamics, other socioeconomic factors, and additional environmental inputs all impacting this individual’s ability to manage her weight.

This patient is a complex adaptive system (as we all are) living in a complex adaptive world and seeking help in a complex adaptive healthcare system. Understanding the connections of all of the sub-challenges and then addressing the non-linear root causes, interconnections and relationships will best position this individual to achieve her health goal. But without time, relationship, caring, continuity, trust, empathy and love, the physician-patient encounter is limited at best (with less than optimal information being shared and lack of mutual understanding) and must rely on the sub-optimal Newtonian linear cause and effect method of healing.

Leveraging the “fluff” and seeing each patient as a complex adaptive system leads to an optimal healing encounter in which both parties together identify the non-linear factors impacting the patient’s health and co-create a patient-specific healing protocol that addresses those challenges.

Healthcare leaders must remember that connecting healthCARING to the healing encounter (and thus seeking complex adaptive solutions) is truly a key to reforming healthcare and best positioning our patients, their families, and our communities for optimal health as we each also reconnect to the reason we are in healthcare (our why) and honor our calling.

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