Posts Tagged Healthcare
Let’s dig a little deeper into the concept of Salutogenesis and what it might mean at your workplace.
Antonovsky’s explanation of Salutogenesis was well depicted by a river. His concern with the current model of health (Pathogenesis) is that it’s generally believed that we are healthy from the beginning but that because of environmental / circumstantial events, we become sick. Antonovsky expressed this as a river, where all healthy people stand on the bank, safe from the raging river’s flow. Once one stepped into the river – got sick – then something needed to be done. Salutogenesis, however, sees all people already in the river; but at different distances from the mouth. General resistance resources (GRRs), a term Antonovsky used as well, are the supportive mechanisms that make it possible to engage in their health generating activities. These allow for someone to swim against the current or maintain a position against the current. The result of thinking this way is the freedom to abandon the bias that one has failed at being healthy, but rather that they are always working at generating more health.
Sense of Coherence
Antonovsky’s continued his explanation of Salutogenesis as hinged on a Sense of Coherence. Sense of Coherence is defined by three major parts:
- Comprehensibility (I get this). The ability to understand one’s circumstances. If you look back at some of my previous postings on Cognitive Bias, we are unable to fully comprehend our experience because, as Kahneman has pointed out in Thinking Fast and Slow, we are subject to a number of biases including base rate neglect (not having the ability to assess, objectively, where things are from the start before making an opinion of what is possible).
- Manageability (I got this). The ability to assess resources for dealing with one’s circumstances. “The right tool for the right job” comes to mind here. To adequately meet the needs of Manageability, one must not only have the resources available, but the knowledge that they can be used.
- Meaningfulness (I’m good to go). The ability to comprehend the anticipated results as helpful. We oftentimes recognize that there is a change to be had, but taking that step can be difficult without a fire under your bottom.
Taken together, these three points sit at the nexus of the ability for any given person to be able to effectively engage with their health. When all three are maximized for performance, individuals can effectively mitigate the potential of their circumstances. Education obviously plays a big role in the process of becoming healthier, but education alone cannot make people healthier.
Your role as a benefits provider
As someone that is providing benefits to a group of people, you have a key role in the ability to help those covered to become healthier; to actually create health. It’s easy to provide a benefit that is available when it’s needed and provided by an external vendor, but that doesn’t have to be the end. Visionary organizations are engaging their population in small, but every day, ways.
What can be done
Engagement is key. First off, you have to take on an organizational wellbeing plan in earnest. If you’re willing to put in the effort, your population will be more likely to stay engaged. If you’re not behind it 100%, they probably won’t be either. But what can be done to engage in health more actively in the worksite?
Let’s look at some of the GRRs that Antonovsky identified and where they may occur in the workplace.
Money: Money enables us to purchase services and products that can enable health generating activities. It can also be used to incentivize or disincentivize activities – the so-called carrot and/or stick approach. But, money also has some significant impact on engagement. When individuals make a purchase, they are actively exchanging the value of their dollar for the value of what is being purchased. If you’re familiar with the concept of Behavioral Economics, this might include devaluation of a certain program because it is provided for free. Instead, incentivizing purchase of products or services that help in the generation of health means personal investment in its use.
Knowledge: You know that conference or meeting room that is usually set aside for meetings with clients, or teams within your organization? It may also be a great location to have a training or two related to health generating activities. Including helpful information in your break room, like healthful recipes, may be a continual reminder of what your population is putting into their bodies.
Commitment: Commitment may be especially easy to generate in the workplace because you’re already showing an investment in those you provide benefits for. Showing your commitment to the program can help create mutual investment, as well!
Social Support: Encourage people to support each other in your health generating activities by rewarding employees who provide assistance or encouragement in the health of other employees. This creates a social structure for engaging in health, and we know that community is the key to health.
Taken together, this is a powerful recipe for getting the kind of motivation needed to stay actively engaged in your population’s health. And, the long-term benefit of a healthier and happier workforce is what drives productivity and profitability.
To our health,
Have you read the book The Experience Economy? To explain it very quickly (and not do true justice to the ideas proposed in the book), there are various levels of economic offering that warrant different valuations, and thereby ability to generate revenue. The levels of development discussed in the book are elegantly displayed in the graph below by Pine and Gilmore (the authors of the book):
This progression has expanded over time with new levels being added as the market strives for differentiation. Many of the examples brought up are clear and concise, such as Starbucks as a purveyor of coffee (a commodity) that really charges the market at the level of a Service. Pine and Gilmore stop at the level of Service in their description of Starbucks, but I would readily argue that they reach towards the level of experience. Starbucks actually refers to this in their training materials as creating “The Third Place;” it’s not your work, or your home, it’s that other place where you can unwind a little bit. Even though the customer isn’t actually brewing their own coffee, as is a hallmark of many experiences, they are engaging with the sounds and smells of the coffee shop in a very intentional way.
The book spends a great deal of time discussing offerings that are on the level of Experience but certainly takes a moment to tip its hat toward Transformations, a burgeoning new market offering. Transformations are marked by the engagement of the customer in a way that enables that person to learn or grow, exactly to Transform, themselves in a way that is truly valuable to the customer. It includes giving the customer the skills and motivation to make changes that will both provide some immediate value but also cascade down into further value down the road.
In healthcare, this understanding of the market is significant and valuable. As we, as an industry, discuss Accountable Care Organizations, capitated care models, and participatory medicine, it’s important for us to keep in mind where value is derived in the typical marketplace. Healthcare, while arguably different in many ways from other industries by its virtual necessity in every citizen’s timeline, still must compete under the same rules as many other industries. Many times, in healthcare, we present ourselves on the level of Service – that is that we are doing something for someone, for a fee. As we look at these new systems, it is time for us to consider what the future of healthcare delivery will require under a population health model of delivery.
Eschewing the fee-for-service model opens up the possibility for the healthcare industry to reconsider offering the long-term value of teaching individuals how to keep themselves healthy, at least in terms of the 80% of healthcare costs that are mediated by behavior. This decreases the time and services that must be provided creating new forms of cost savings. As we move further up the economic offering ladder, it will become more necessary to move our industry into the Transformation realm. In fact, there is no other industry more suited to it.
To our health,
Now is a great time to work in the Healthcare industry. While the changes in the landscape following the Affordable Care Act (and the challenges to the Affordable Care Act) have led to some pretty interesting scrambling to meet “the market,” it has also been fun to see new, emerging voices that have the foresight to begin considering the effect that Health IT can have on our overall well-being as patients.
Today’s inSite highlights a very well-written article (Do We Need Doctors or Algorithms?) that lays out some of the ways in which Healthcare may be changing, be it through our intentional effort or our naturally-occurring social meanderings (I use the Wikipedia article intentionally!).
Consider some of these possibilities with a view of their overall impact on our Healthcare landscape. While some of these may, at first, seem far-flung, they are quite insightful and not as far off as one might think when you consider what we are already capable of accomplishing with mobile technology as well as data integration and management systems. While it may be a natural reaction to respond with some concern – how fantastic would it be to have systems that imbue all providers with the confidence and accuracy that a system like the one mentioned in this article could provide. Then our providers could be really focused on treating the relapse issues that can often creep their way into the patient’s treatment compliance. It’s very possible that our docs’ roles may be shifting once again from diagnosis to advising to (now) nudging as patients become more empowered and informed to make their own decisions.