Healthcare Design and the Medical Home

Paul GroenierGilbert Jones

Associates for Healthcare Improvement

Goals of session

Consider definitions of Health/WellnessConsider how design principles can improve

communication and healthcare service in the Medical Home

Examine control structures in healthcare design

Focus on prototyping strategies which incorporate all principles of service design

Key Principles of the Patient-Centered Medical Home

Patient-driven: The primary care team is focused

on the whole person. Patient preferences guide the care provided to the patient.

Team-based: Primary care is delivered by an interdisciplinary team led by a primary care provider using facilitative leadership skills.

   

Key Principles of the Patient-Centered Medical Home

 Efficient: Patients receive the care they need at

the time they need it from an interdisciplinary team functioning at the highest level of their competency.

 Comprehensive: Primary care serves as a point of first contact for a broad range of medical, behavioral and psychosocial needs that are fully integrated with other health services and community resources.

 

Key Principles of the Patient-Centered Medical Home

Continuous: Every patient has an established and

continuous relationship with a personal primary care provider.

 Communication: The communication between the patient and other team members is honest, respectful, reliable, and culturally sensitive.

Key Principles of the Patient-Centered Medical Home

Coordinated: The primary care team coordinates

care for the patient across and between the health care systems.

Health/Wellness

How do you define health/wellness?

Definitions provided by Master of Arts students exploring Health Geography.

Adapted from Herrick, Journal of Geography in Higher Education, 34; 345-362, 2010

Domains of Wellness

Physical WellnessEmotional WellnessMental-Intellectual wellnessSocial WellnessEnvironmental WellnessOccupational WellnessSpiritual Wellness

1. Physical wellness/health

Reflects a healthy body maintained by eating right, exercising regularly, avoiding harmful habits, making informed and responsible decisions about health,

seeking medical care when needed, participating in activities that help prevent

illness.

2. Emotional wellness/health

Requires understanding emotions and coping with problems that arise in everyday life.

can have and express a wide range of emotions such as anger, sadness, or joy and love.

3. Mental -Intellectual wellness/health

open to new ideas and concepts. open to learning a variety of lessons (in life

and in the classroom). will ask questions about health care needs unhealthy person will remain closed to new

ideas or will blame others for their poor performance.

Racial, religious, gender, and age prejudices factor into this area

4. Spiritual wellness/health

reflects a state of harmony between you and others.

understanding of your place in the greater universe.

this does not mean religion specifically, although religion can factor into a personal sense of harmony and spirituality.

5. Environmental wellness/health:

Refers to an appreciation of the external environment and the role individual’s play in preserving, protecting, and improving environmental conditions.

This domain looks at the impact that environmental pollutants have on all of us physically, mentally, spiritually, emotionally, and socially,

also looks at our impact upon the environment and the circle of involvement and effect this can create. Therefore, recycling and pollution are part of this domain, but understanding the human role as part of the environment is also important.

6. Social wellness/health

refers to the ability to perform social roles effectively, comfortably, and without harming others.

looks at relationships, social norms and an individual’s reaction to those relationships and norms.

7. Occupational wellness

reflects ability to enjoy what you are doing to earn a living or to contribute to society.

Principles of Service Design

Orientation to the futureCollaborative teamworkingPrototyping to improve dialogueMutual enhancement of design capabilityIntegration between emotional and

functional benefitsOpen-ended adaptability

Principles of Service Design

Orientation to the futureCollaborative teamworkingPrototyping within dialogueMutual enhancement of design capabilityIntegration between emotional and

functional benefitsOpen-ended adaptability

Examining control structures in healthcare designTaken from Lee, Design participation tactics: the challenges and new rolesfor designers in the co-design process; CoDesign, Vol. 4, No. 1, March 2008, 31–50

Control Structures and Task Requirements

Task requirements and the resources available within frames of activity them

Secondary Control Structures

• Professionals use secondary control structures to make their primary techniques work.

• Some secondary control structures are necessary to achieve health or wellness.– Examples: • Infection control to prevent hospital-acquired infections• Holding a baby still to safely perform lumbar puncture

(spinal tap)

Examining control structures in healthcare design

What are your experiences of feeling controlled when receiving healthcare?

Successful design requires restructuring conditions

Prototyping to enhance dialogue

Dialogue may be induced by many types of shared objects

Orientation to the future

Agency: requires – awareness of how one is influenced by the past – orientation toward the future – capacity to imagine alternative possibilities within

the contingencies of the moment), – and ability to use these to critically evaluate and

choose a course of action (Emirbayer and Mische 1998:963)

Agency

• This definition of agency is consistent with interpretive habits-of-action, but is not consistent with reactive habits of-action.

• It requires heedfulness, mindfulness, and the development of frameworks of understanding that place relevant features of the task environment in relationship interpreted through the lens of desirable outcomes.