Health Care with a Focus on Communities and Families




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Mar 13, 2017
by Oscar Tollast
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Health Care with a Focus on Communities and Families

Fellows consider how health care can affect families, friends, and communities  Participants and faculty members of Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship

During the session Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship, participants have learned knowledge is not enough when it comes to tackling issues and creating pathways forward. A successful patient-clinician relationship is not only built on facts and figures. It should also be based on trust, understanding, and taking into consideration the patient’s motivation. These factors take on a further degree of importance when it comes to providing care in the communities and supporting family members.

In between plenary sessions held on Saturday, participants learned about motivation in health care, and what changes for families, friends, and communities. Session co-chair Professor Tobias Esch discussed the neuroscience of motivation and self-care.

The word motivation comes from the Latin word “movere” - to move. Building on this, Esch said there were three types of motivation. Type A concerns moving toward something or wanting something. Type B is about avoiding or escaping something. Type C, meanwhile, is about staying and attaching yourself to something.

Type A is associated with pleasure, which you can obtain after passing through stages of creativity and learning. Type B, on the other hand, is linked to a state of relief, which can stem from protection and survival. Type C, simply put, is associated with happiness. 

All three types of motivation can be linked with patients at different stages of their lives, according to Professor Esch. He suggested Type A was often found in young people, while Type C involved those aged 65 and over. The majority of people in between these age groups are linked to Type B.

Esch cited research which suggested humans had three basic needs: existence, relatedness, and growth. Existence is a concern for those with a Type B form of motivation, while relatedness is closer to those experiencing Type C. Growth, meanwhile, has a closer match with Type A, as young people look to grow and move toward something.

Insights from behavioral economics 

Following this talk from Professor Esch, participants received new insights from behavioral economics and how this could affect decisions made by health care professionals.

To begin with, the speaker discussed the shaky foundations of health policy. These foundations included shared decision making, nutrition and calories labeling, performance incentives, informed consent, health care cost or quality transparency, and health insurance deductibles and copayments. These approaches are based on the view that given enough information, people will make decisions most likely to achieve self-interest. 

By bypassing cognition, however, the speaker suggested health care professionals could obtain more positive results using behavioral reflexes. He claimed the science of motivation had evolved. Participants heard, “Once you recognize that people are irrational, you are in a better position to help them.” The speaker provided a list of examples of where this irrationality could be used for good. For example, a solution to regret aversion is alerting people to what might have happened. 

Discussing life in the U.S., the speaker remarked upon health insurance choices, which can be presented in a fashion difficult to understand. He said an incentive you cannot understand could not work, and in designing complex incentives, you are giving up some value. 

Participants were asked to consider what they heard through the lens of a patient and that of a clinician. One responded, “If you want to change a behavior, the new behavior has to feel as good as the one you change.” 

What changes for families, friends, and communities? 

On Saturday afternoon, participants were also asked to consider certain scenarios and how they might play out. They broke off into six groups and were given individual topics to develop a presentation around. These topics included chronic condition, elder care, the personal experience of using OpenNotes, the family caregiver, the problem patient and the problem clinician, end of life care, and sexual health. 

In this interactive plenary session, participants considered how private, and secure AI tools similar to Siri could tackle the taboo of discussing sexual health. An idea for an online platform called “Check-in Now” was also put forward, which would allow patients with a chronic condition, their family members, and doctors to have access to data in one place. 

Participants heard family caregivers want to be able to communicate with health providers quickly, and should receive more tools and support. One participant said caregivers would like a seat at the table, one as important as the patient’s and the health care professional’s. 

Transparency with socially at-risk and culturally diverse patient populations 

Participants also looked at transparency with socially at-risk and culturally diverse patient populations. The speaker leading the event talked about the origins of mistrust in medical care found in socially at-risk groups. This mistrust can stem from a legacy of discrimination, disparities in access and quality of care, and disparities in interpersonal treatment. 

She said those at risk included ethnic minorities, religious cultural minorities, low-income groups, people with low health literacy, people with disabilities, and people from the LGBTQ community. 

The speaker said to enhance transparency there should be a focus on disclosure, clarity, and accuracy. To engage patients, health providers should consider one-on-one coaching, group-based classes, web-based interventions, patient portals, and mobile apps. What’s important to remember, she claimed, is that cultural, social, language and literacy adaptation remains critical in this process. 

Read more in our session newsletter.

Download Issue 2 as a PDF

 The Salzburg Global program Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship is part of the multi-year series Health and Health Care Innovation in the 21st Century. The session is being supported by OpenNotes. More information on the session can be found here: You can follow all the discussions on Twitter by following the hashtag #SGShealth

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