{"id":16764,"date":"2014-10-30T16:23:56","date_gmt":"2014-10-30T20:23:56","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=16764"},"modified":"2014-10-31T14:16:06","modified_gmt":"2014-10-31T18:16:06","slug":"spm-at-who","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2014\/10\/spm-at-who.html","title":{"rendered":"WHO in Geneva &#8211; SPM in the house!"},"content":{"rendered":"<p><em>SPM member Casey Quinlan (who&#8217;s posting this) was\u00a0invited to attend an event at the WHO in Geneva. This post originally appeared on her Mighty Casey Media blog, and is reposted here in its entirety by SPM request.<\/em><\/p>\n<p style=\"color: #666666\">Guess who got invited to WHO? No, really.<\/p>\n<p style=\"color: #666666\">The\u00a0<a style=\"font-weight: inherit;font-style: inherit;color: #3e1e6f\" title=\"WHO\" href=\"http:\/\/www.who.int\/en\/\" target=\"_blank\"><strong style=\"font-style: inherit\">World Health Organization<\/strong><\/a>\u00a0(WHO) invited yours truly to its First Global Experts\u2019 Consultation in service of building a WHO framework for patient and family engagement. This is all due to my part in the ongoing anvil chorus that is the new\u00a0<strong style=\"font-style: inherit\"><a style=\"font-weight: inherit;font-style: inherit;color: #3e1e6f\" title=\"PFE Roadmap\" href=\"http:\/\/patientfamilyengagement.org\/\" target=\"_blank\">Patient &amp; Family Engagement Roadmap<\/a><\/strong>, developed by a group of dedicated folks from all parts of the healthcare compass over the last couple years, with funding from the\u00a0<a style=\"font-weight: inherit;font-style: inherit;color: #3e1e6f\" title=\"GBMF\" href=\"http:\/\/www.moore.org\/\" target=\"_blank\"><strong style=\"font-style: inherit\">Gordon &amp; Betty Moore Foundation<\/strong><\/a>.<\/p>\n<p style=\"color: #666666\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-1905\" style=\"font-weight: inherit;font-style: inherit\" src=\"http:\/\/mightycasey.com\/wp-content\/uploads\/2014\/10\/WHO_signs-300x225.jpg\" alt=\"WHO_signs\" width=\"300\" height=\"225\" \/>I spent just over two days in Geneva, most of the time head-down in discussions about how the global health system \u2013 a patchwork of services delivered by an even patchwork-ier cadre of healthcare delivery systems \u2013 can better serve the needs of the people\/patients who seek medical care and health information from them.<\/p>\n<p style=\"color: #666666\">This post will not attempt to report everything I saw\/heard\/thought\/felt in that jam-packed 16 hours of ideas and outlooks. What I\u2019ll share is my perspective on the challenges, the opportunities, the pitfalls, and the hopes that \u2013 in my view, at least \u2013 emerged during that lightning round of global spitballing.<!--more--><\/p>\n<h3 style=\"color: #777777\">Challenges<\/h3>\n<p style=\"color: #666666\">There\u2019s an old joke that asks, \u201cWhat\u2019s an elephant?\u201d The answer: \u201cA mouse designed by a government committee.\u201d<\/p>\n<p style=\"color: #666666\">That\u2019s the risk, and challenge, to any attempt\u00a0to build a definable set of standards for a human effort. Education, transportation, trade, infrastructure, communication, medicine \u2013 all require some sort of standardization to make them useful to more than one or two people huddled over a campfire. A study of history will show that as much as we humans are great idea generators, trying to get the rest of the tribe to adopt our new idea isn\u2019t easy.<\/p>\n<p style=\"color: #666666\">The father of quantum mechanics, Max Planck, said it best: \u201cA new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.\u201d To paraphrase:\u00a0Science advances one funeral at a time.<\/p>\n<p style=\"color: #666666\">Medicine, which has been practiced for millennia by magical beings initiated into secrets of \u201cscience\u201d that could not be understood by the common human, has only become understandable to the average Joe and\/or Jane as public education has become available across the globe. Public education still isn\u2019t available everywhere, and the character and content of that education can be complicated by cultural views of science, of the education of women, and other factors that impact access to information.<\/p>\n<p style=\"color: #666666\">So the challenges I see here are two-fold:<\/p>\n<ul style=\"color: #666666\">\n<li style=\"font-weight: inherit;font-style: inherit\">Calcified thinking in power structures, both scientific and political.<\/li>\n<li style=\"font-weight: inherit;font-style: inherit\">Lack of science education and information access in the wider population.<\/li>\n<\/ul>\n<p style=\"color: #666666\">That\u2019s true in developed nations \u2013 just witness the \u201cscience denial\u201d movement in the US that stubbornly insists on not being confused with facts on issues like climate change or human reproduction \u2013 as well as in emerging nations that are still building basic infrastructure.<\/p>\n<h3 style=\"color: #777777\">Opportunities<\/h3>\n<p style=\"color: #666666\">Well, let\u2019s start with who was in the WHO-room. Clinicians, policy wonks, and healthcare advocates from Uganda, India, Canada, Ecuador, Pakistan, Saudi Arabia, Belgium, Ireland, the UK, the US, Switzerland, the Netherlands, Thailand, Australia, China, and Malaysia, along with a wide array of WHO folks from their Geneva HQ as well as a robust representation of their Western Pacific Region Office (WPRO).\u00a0<strong style=\"font-style: inherit\"><a style=\"font-weight: inherit;font-style: inherit;color: #3e1e6f\" title=\"Liam Donaldson on Twitter\" href=\"https:\/\/twitter.com\/DonaldsonLiam\" target=\"_blank\">WHO\u2019s Envoy for Patient Safety Sir Liam Donaldson<\/a>\u00a0<\/strong>(that link is to his Twitter feed, which I highly recommend) was actively engaged in every part of the discussion over the two days, and I was deeply encouraged by his clear insights into the issues we\u2019re all wrestling with in transforming the global healthcare system.<\/p>\n<p style=\"color: #666666\">The story\u00a0that had the biggest impact on me was the one told by Dr. Jon\u00e1s Gonseth, head of Hospital de Especialidades in Guayaquil, Ecuador. His experience was one that I think spotlights the core problem: lack of trust in the care delivery system by the people that system purportedly serves. I wish I had a link to the video he shared, which clearly showed the lack of trust that the Ecuadorian people had in their healthcare system. Demonstrations outside the hospital, intercut with a number of clips that included a patient on a gurney being rolled toward the hospital door who got dumped on his head when the gurney tipped over as the dweeb hauling it couldn\u2019t figure out how to get it over a curb \u2026 you get the picture.<\/p>\n<p style=\"color: #666666\">Dr. Gonseth was asked (begged?) by the President of Ecuador to tackle the mess that was the Guayaquil Hospital de Especialidades. In just over two years, he\u2019s worked what could be called miraculous change in quality improvement and patient safety, largely by advocating for community social participation in that work, and for patient empowerment. He\u2019s transformed the culture inside the hospital, and the level of community trust in the care delivered by that hospital. The money quote: \u201cIt was such a disaster we had nothing to lose [by involving patients].\u201d<\/p>\n<p style=\"color: #666666\">What that story told me is that grassroots frustration with healthcare systems is a global issue, one that was made clear by all the from-the-ground presentations over the two days. That\u00a0leads me to the opportunities here, which are shared by both developed and emerging countries:<\/p>\n<ul style=\"color: #666666\">\n<li style=\"font-weight: inherit;font-style: inherit\">\u201cStart where you are. Use what you have. Do what you can.\u201d That quote from Arthur Ashe makes it clear that any \u2013 ALL \u2013 of us can work on healthcare system transformation. So let\u2019s get this party started.<\/li>\n<li style=\"font-weight: inherit;font-style: inherit\">Transformation does not happen from the top down. There does need to be a leader, but a successful leader will more likely come from outside the system needing the transformation.<\/li>\n<\/ul>\n<p style=\"color: #666666\">That calcified-thinking challenge I mentioned above presents a solid opportunity to those of us on the ground, working to transform the system.\u00a0<a style=\"font-weight: inherit;font-style: inherit;color: #3e1e6f\" title=\"Outside-in software development theory\" href=\"http:\/\/en.wikipedia.org\/wiki\/Outside%E2%80%93in_software_development\" target=\"_blank\"><strong style=\"font-style: inherit\">Designing from the outside in<\/strong><\/a>\u00a0is a software development approach\u00a0that\u00a0focuses on satisfying the needs of the end user. Healthcare systems *must* look at system transformation from that perspective: start with the people you\u2019re serving, not with the folks running the hospital\/professional society\/medical association. The people being served \u2013 THE PATIENTS \u2013 are the end-user stakeholders.<\/p>\n<h3 style=\"color: #777777\">Pitfalls<\/h3>\n<p style=\"color: #666666\">There\u2019s much inertia confronting transformation of a massive human system like healthcare delivery. It\u2019s exhausting if you look at it as a \u201csystem,\u201d but since it is a system, any action has to be considered in the context of what sort of dominoes \u2013 or dynamite \u2013 that action might trigger. Plus, attempts at transforming bureaucratic process lead to what I\u2019m going to call Donaldson\u2019s Dictum (in honor of Sir Liam Donaldson, who said it): \u201cAbility to simplify bureaucratic complexity draws heavy fire from the bureaucrats who create that complexity.\u201d<\/p>\n<p style=\"color: #666666\">And then there\u2019s the elephant in every room: the money. Whatever the economic basis is for the healthcare delivery system in question, getting quality improvement and patient safety into the budget is a daunting task. Dr. Jon\u00e1s Gonseth effected his hospital transformation in Ecuador without any increase in budget, but I wonder how much heavy lifting he had to do to sell his ideas to the bureaucrats? Since he\u2019d been asked by the country\u2019s President to take charge and fix a major mess, that might have gotten him through the first week. But transformation at this level takes months and years, so figuring out where the money\u2019s gon\u2019 come from is critically important.<\/p>\n<p style=\"color: #666666\">So, in short:<\/p>\n<ul style=\"color: #666666\">\n<li style=\"font-weight: inherit;font-style: inherit\">Is there a budget for real system transformation?<\/li>\n<li style=\"font-weight: inherit;font-style: inherit\">Is there enough\u00a0political will to allow that transformation to occur?<\/li>\n<\/ul>\n<h3 style=\"color: #777777\">Hopes<\/h3>\n<p style=\"color: #666666\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-1906 size-full\" style=\"font-weight: inherit;font-style: inherit\" src=\"http:\/\/mightycasey.com\/wp-content\/uploads\/2014\/10\/Health_Care_is_a_Right_Not_a_Privilege.gif\" alt=\"Health_Care_is_a_Right_Not_a_Privilege\" width=\"172\" height=\"172\" \/>When it comes to complex systems thinking, I\u2019m a simple creature. I believe that the more complex the system you\u2019re looking at gets, the more you have to go right down to the molecular level to regain perspective.<\/p>\n<p style=\"color: #666666\">If you\u2019re trying to end a disease like polio, you have to start where Jonas Salk did: with the virus itself. If you\u2019re trying to create a healthcare system that delivers human health, you have to start with \u2026 the people who are seeking health care. June Boulger, Ireland\u2019s National Lead for Patient and Public Involvement in Healthcare, said the overarching message of her work is \u201cpeople helping people.\u201d<\/p>\n<p style=\"color: #666666\">When I took the mic to make a comment on Monday afternoon, I told everyone in the room to run\u00a0right back to the ground level whenever they got too \u201csystem\u201d-y in their thinking or their approach to quality improvement, delivery improvement, and\/or patient safety.<\/p>\n<h4 style=\"color: #777777\">Design from the outside in, begin with the end in mind, \u201cstart where you are, use what you have, do what you can,\u201d lather, rinse, repeat.<\/h4>\n<p style=\"color: #666666\">That\u2019s my entire philosophy of healthcare system transformation in one sentence.<\/p>\n<p style=\"color: #666666\">Let\u2019s get this party started.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>SPM member Casey Quinlan (who&#8217;s posting this) was\u00a0invited to attend an event at the WHO in Geneva. This post originally appeared on her Mighty Casey Media blog, and is reposted [&hellip;]<\/p>\n","protected":false},"author":57,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"give_campaign_id":0,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[59,62,2],"tags":[76,82,8,7475,1063,312,413,169,3680,1844,55,7710,3592,7474,1798],"coauthors":[],"class_list":["post-16764","post","type-post","status-publish","format-standard","hentry","category-policy-issues","category-reforming-healthcare","category-trendsprinciples","tag-doctors","tag-e-patient","tag-e-patients","tag-global-health","tag-health-care-system","tag-healthcare-system","tag-medicine","tag-participatory-medicine","tag-patient-centered-care","tag-patient-empowerment","tag-patients","tag-shared-decision-making","tag-spm","tag-who","tag-world-health-organization"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>WHO in Geneva - SPM in the house! - SPM Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/participatorymedicine.org\/epatients\/2014\/10\/spm-at-who.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"WHO in Geneva - SPM in the house! - SPM Blog\" \/>\n<meta property=\"og:description\" content=\"SPM member Casey Quinlan (who&#8217;s posting this) was\u00a0invited to attend an event at the WHO in Geneva. 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