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Leadership in Integrative Health Certification in Integrative Health Administration (CIHA) Thurs, Oct 30 – Fri, Oct 31, 2014 - San Diego Course Description Health care is undergoing a transformation toward models of integrative medicine, prevention, sustainability and community collaborations. By exploring key components of an integrative health model, this leadership program will provide essential clinical, financial and administrative tools to respond to the emerging challenges of health care delivery. Utilizing a personalized comprehensive approach to health care, attendees will be joining a unique, rapidly growing group of healthcare executive leaders. This certificate program is offered by nationally recognized experts in integrative medicine and administration, and will utilize an integrative health framework to connect with population health, ACO’s, the impact of the ACA, patient and employee satisfaction and sustainability. Evidence-based practices that address wellness and health with multiple benefits will be explored, preparing participants to become inspired change agents who will make a true difference in health care delivery. Health care transformation will require unprecedented changes in treatment and care models. Whole person approaches to health and wellness have been shown to improve the health of populations and reduce the costs of care. Success stories of engaged institutions will be central to the conversation about how innovations can be shared and implemented. The Leadership in Integrative Health Certification After the completion of an additional 6 hours of online content and post-tests (included in your registration fee) for a total of approximately 20 contact hours, recipients will receive The Leadership in Integrative Health Certificate. More information will be emailed after the meeting, this email will come from the American Board of Integrative Holistic Medicine. This certification program is the first of its kind, and will establish participants as a new community of leaders in health care transformation. Faculty Jennifer Blair, LAc, MaOM AHMA Board of Directors Licensed Acupuncturist Penny George Institute for Health and Healing Minneapolis, Minnesota Jeffrey Bland, PhD, FACN, FACB Founder & President Personalized Lifestyle Medicine Institute (PLMI) Seattle, Washington Diego Coira, MD Hackernsack University Medical Center Hackensack, New Jersey Daniel Friedland, MD AIHM Chair President-Elect, ABIHM Founder and CEO, SuperSmartHealth San Diego, California Mimi Guarneri, MD, FACC, ABIHM President, AIHM Founder Scripps Center for Integrative Medicine San Diego, California Robin Guenther FAIA, LEED AP Principal of Perkins+Will Senior Advisor, Health Care Without Harm New York, New York Jamie Harvie, P. Eng Executive Director Institute for a Sustainable Future Duluth, Minnesota F. Nicholas Jacobs AIHM Treasurer International Director Sun Stone Management Resources Harrisburg, Pennsylvania Mary Jo Kreitzer, PhD, RN, FAAN Founder and Director, Center for Spirituality & Healing Professor, School of Nursing Minneapolis, Minnesota Wayne Miller Nura Health Vashon, Washington 1
Leadership in Integrative Health Certification in Integrative Health Administration (CIHA) Thurs, Oct 30 – Fri, Oct 31, 2014 - San Diego Tabatha Parker, ND AIHM Director of Education Co-founder and Executive Director NDI NCNM Co-Chair Masters of Science in Global Health San Diego, California Rauni Prittinen King, RN, BSN, MIH, HNB-BC, CHTP/I Founder, Scripps Center for Integrative Medicine President, Holistic & Integrative Medicine Resources, Inc. San Diego, California Emilie Rowan, LCSW Director, Center for WellBeing Atlantic Health Morristown, New Jersey Mark Tager, MD CEO ChangeWell Inc. Kelly Warshel, MD, ABIHM Medical Director Windber Hospice Johnstown, Pennsylvania Leonard A. Wisneski, MD, FACP Clinical Professor of Medicine George Washington University Medical Center Adjunct Faculty Department of Biochemistry and Molecular Biology, Division of Integrative Physiology Georgetown University Couifer, Colorado Schedule of Events & Table of Contents Thursday, October 30, 2014 8 a.m. Registration & Breakfast 8:15 a.m. Welcome & Introduction 8:30 a.m. Focused Track (Mission Bay Room) Transformational Leadership in Integrative Medicine Daniel Friedland, MD, ABIHM F. Nicholas Jacobs, FACHE Page 5 10:30 a.m. Break & View Exhibits 11 a.m. Focused Track (Mission Bay Room) Transformational Leadership in Integrative Medicine Daniel Friedland, MD F. Nicholas Jacobs, FACHE Page 46 12:30 p.m. Lunch (Paradise and Sunset Terrace) 2 p.m. Plenary Session (Paradise Ballroom) Health as an Economic Strategy F. Nicholas Jacobs, FACHE Page 107 2:45 p.m. Plenary Session (Paradise Ballroom) Spirituality in Health and Medicine Mary Jo Kreitzer, PhD, RN, FAAN Page 175 3:30 p.m. Break & View Exhibits 4 p.m. Plenary Session (Paradise Ballroom) Global Health Tabatha Parker, ND Page 248 4:45 p.m. Plenary Session (Paradise Ballroom) Personalized Integrative Health Care: A Look Ahead Jeffrey Bland, PhD, FACN, FACB Page 284 5:30 p.m. Closing Remarks 6 – 9 p.m. Exclusive reception at Pacific Pearl La Jolla Goldfield Stage will pick up/drop off in front of the Conference Center at Paradise Point 2
Leadership in Integrative Health Certification in Integrative Health Administration (CIHA) Thurs, Oct 30 – Fri, Oct 31, 2014 - San Diego Schedule of Events continued Friday, October 31, 2014 (All functions will be held in the Mission Bay Room) 7:30 a.m. Breakfast 8 a.m. Organizational Transformation: Guiding the Metamorphosis Mark Tager, MD Page 338 8:40 a.m. Administrative Implementation of Integrative Health in Your Health System F. Nicholas Jacobs, FACHE Page 362 9:10 a.m. Leading from the Heart: Reconnecting to Your Mission Mimi Guarneri, MD, FACC, ABIHM Page n/a 9:50 a.m. Break 10:20 a.m. Integrative Health and Medicine: Navigating Policy Trends Leonard Wisneski, MD, FACP Page 374 11 a.m. Integrating Clinical and Behavioral Health Units –Solutions to Difficult Problems Diego Coira, MD, FAPA Page 434 11:30 a.m. Dying with dignity: End of Life conversations in an ACO context Kelly Warshel, MD, ABIHM Page n/a 12:10 p.m. Lunch 12:50 p.m. Healthy Food from the Clinic to the Community – Lessons of Success through Integrated Operations Jamie Harvie, P Eng Page 469 1:20 p.m. An Evolving Narrative: Learning Lessons from Integrative Health Implementation Jennifer Blair, LAc, MaOM Page 504 1:50 p.m. The Business Case for Sustainable Healthcare Buildings: Supporting Community Health and Resilience Robin Guenther, FAIA, LEED AP Page n/a 2:25 p.m. Panel: Billing and Paying for Integrative Health and Medicine F. Nicholas Jacobs, FACHE Mimi Guarneri, MD, FACC, ABIHM Rauni Prittinen King, RN, BSN, MIH Emilie Rowan Wayne Miller Page n/a 3:30 p.m. Adjourn 3
Leadership in Integrative Health Certification in Integrative Health Administration (CIHA) Thurs, Oct 30 – Fri, Oct 31, 2014 - San Diego We’d like to Hear from you We value your feedback, please take some time following the program to complete an online evaluation. 1. After the conference, visit http://cmetracker.net/SCRIPPS/Login?FormName=getCertificate to complete the conference evaluation. 2. Enter your username and password. Please note your email address must match the email account you previously used to register for the conference. If a new user, follow instructions to log in and set up your password for your online account. 3. Enter CME Activity Code 35422 The evaluation will only be available for four weeks after the conference and must be completed by November 18, 2014. 4
Transformational Leadership (Engaging Conscious Leadership) Daniel Friedland, MD Chair, AIHM CEO, SuperSmartHealth © SuperSmartHealth® 2014 5
Qualities of High Performance Leaders © SuperSmartHealth® 2014 6
Qualities of Low Performance Leaders © SuperSmartHealth® 2014 7
Reactivity Creativity Low Performance Leader High Performance Leader Achievement Oriented • Purpose and Vision • Strategically Focused • Decisive • Gets Results Relates Well • Cares • Fosters Team Play • Collaborates well • Mentor Authentic • Integrity • Courage Systems Aware • Concerned for Community • Sustains Productivity Self-Aware • Personal Learner • Composure • Balance • Selfless Leader Complying • Pleasing • Conforming • Conservative • Passive Protecting • Arrogant • Cynical and Critical • Distant Controlling • Autocratic • Driven to Prove Self Worth • Ambitious to Get Ahead • Perfectionistic Adapted from The Leadership Circle © SuperSmartHealth® 2014 8
Leadership Circle Profile™ Graphic 10 20 30 40 50 60 70 80 90 CREATIVE Critical Arrogance Leadership Effectiveness Low High Strategic © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 5 Low Balance 90 80 70 60 50 40 30 20 10 TeamPlay Fosters Connection Caring Interpersonal Mentoring & Intell igence Developing Composure Balance Purposeful& Visionary Achieves Results Systems Thinker Decisiveness Selfless Leader 90 80 70 60 50 40 30 20 10 90 80 70 6 0 50 40 30 20 10 10 20 30 4 0 50 60 70 80 90 10 20 30 40 50 60 70 80 90 10 20 30 40 50 60 70 80 90 10 20 30 40 50 60 70 80 90 TASK RELATI O N SHI P Integrity Courageous Conservative Pleasing Belonging Passive REACTIVE Personal Autocratic Ambition Driven Perfect Self-Awareness Authenticity Learner Controlling Distance Relating Protecting Complying Sustainable Productivity Achieving Authenticity Community Concern Systems Awareness 10 20 30 40 50 60 70 80 90 Leadership Potential Utilization Low High High Balance Relationship-Task Balance Reactive Creative Focus Collaborator 10 20 30 40 50 60 70 80 90 90 80 70 60 50 40 30 20 10 Identity 10 20 30 40 50 60 70 80 90 Reactive-Creative Scale 9
Leadership Effectiveness Scale • I am satisfied with the quality of leadership that he/she provides. • He/she is the kind of leader that others should aspire to become. • He/she is an example of an ideal leader. • His/her leadership helps this organization to thrive. • Overall, he/she provides very effective leadership. © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 6 10
Correlations to Leadership Effectiveness -0.57 0.04 -0.13 © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 7 0.71 0.65 0.41 0.41 0.76 0.79 0.73 0.81 0.79 0.58 0.83 0.63 0.59 0.70 0.69 0.65 0.70 0.85 0.72 0.72 0.72 0.77 0.85 0.08 -0.28 -0.37 -0.60 -0.55 -0.51 -0.50 -0.49 -0.11 -0.59 -0.43 11
Leadership Effectiveness & Creating © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 8 Leadership Effectiveness Total Creating Score R = 0.93 Rsq = 0.86 5.0 4.5 4.0 3.5 3.0 2.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 12
Leadership Effectiveness & Reacting © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 9 Leadership Effectiveness Total Reactive Score R = -0.66 Rsq = 0.44 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.0 1.5 2.0 2.5 3.0 3.5 13
Your Brain and Leadership Reactivity Fight & Flight Creativity Fulfillment Low Performance Leadership High Performance Leadership 14
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Autonomic Nervous System 16
Mirror Neurons Evolution of Neonatal Imitation. Gross L, PLoS Biology Vol. 4/9/2006, e3 17
Social and Emotional Contagion Fight Flight Trigger 1 2 Fight Flight Trigger Give Receive 1 2 Receive Give Cycle of Reactivity Cycle of Creativity © SuperSmartHealth® 2014 18
The Importance of Leadership Reactivity Fight & Flight Creativity Fulfillment Low Performance Leadership Actively Disengaged Employees Cost High Performance Leadership Actively Engaged Employees Benefit © SuperSmartHealth® 2014 19
Perceived Leadership Integrity and Burnout • 287 family medicine and general internal medicine respondents (68.3% response rate) • Correlated burnout to Perceived Leadership Integrity Index (PLII): 1. Support for physician’s core values 2. Prioritizes quality over costs 3. Positive response to physicians raising quality issues 4. Interest in patient care above self-interest 5. Honesty • Low PLII associated with physician burnout (p = 0.0001) and intention to leave (p = 0.026) Poses RM, Baier-Manwell L, Mundt M, Linzer M. Perceived leadership integrity and physicians’ stress, burnout, and intention to leave practice. J Gen Intern Med. 2005;20:S182. © SuperSmartHealth® 2014 20
The Cost and Benefit of Employee Engagement Difference between top and bottom quartile of employee engagement: • Absenteeism 40% • Turnover 25-50% • Patient Safety Incidents 41% • Safety Incidents 49% • Quality Defects 60% • Customer Satisfaction 12% • Productivity 18% • Profitability 16% Employee Engagement. What’s Your Engagement Ratio? http://www.gallup.com/strategicconsulting/121535/Employee-Engagement-Overview-Brochure.aspx 21
Leadership Effectiveness & Business Performance © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 18 Business Performance Index Leadership Effectiveness R = 0.612 Rsq = 0.3752 7.5 7.0 6.5 6.0 5.5 5.0 4.5 4.0 3.5 • Sales/Revenue Growth • Market Share • Profitability/ROA • Quality Products/Services • New Product Development • Overall Performance 2.0 2.5 3.0 3.5 4.0 4.5 5.0 http://www.theleadershipcircle.com/wp-content/uploads/2011/05/12_OrgPerformance.pdf 22
Aggregate Profile of Those Leaders Whose Businesses’ Were Evaluated as Highest Performing © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 19 Top 10% 23
Aggregate Profile of Those Leaders Whose Businesses’ Were Evaluated as Lowest Performing © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 20 Bottom 10% 24
How Do You Shift? Reactivity Fight & Flight Creativity Fulfillment Low Performance Leadership Actively Disengaged Employees Cost Growth and Profitability Actively Engaged Employees Benefit Growth and Profitability SA SELF-ESTEEM BELONGING SAFETY High Performance Leadership © SuperSmartHealth® 2014 25
The 4 in 4 Framework™ to Engage Conscious Leadership Integrating Mental Emotional Social Spiritual Intelligence © SuperSmartHealth® 2014 26
The 4 in 4 Framework™ Make the Turn into What’s Truly Important Cultivate Creativity By Reflecting on What’s Truly Important Reappraise Stress and Self-Doubt Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment 1 2 4 3 © SuperSmartHealth® 2014 27
A practice of paying attention with a sense of openness, curiosity, acceptance, and compassion, of whatever is arising in the present moment © SuperSmartHealth® 2014 28
The 4 in 4 Framework™ Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment 1 © SuperSmartHealth® 2014 29
Recognize Reactivity: 1. Physical Sensations 2. Feelings 3. Thoughts 4. Behaviors 1 Is it doing more harm than good? © SuperSmartHealth® 2014 30
Recognize Reactivity: 1) Pause – 3 breaths and/or exit 2) Assess hunger, thirst and fatigue 3) “Name it to tame it!” 4) Consider best response 1 Is it doing more harm than good? If so: © SuperSmartHealth® 2014 31
The 4 in 4 Framework™ Reappraise Stress and Self-Doubt Reactivity Fight & Flight Creativity Fulfillment Recognize 2 Reactivity Is it doing more harm than good? 1 © SuperSmartHealth® 2014 32
Reappraise Stress and Self-Doubt: Triggers of Stress and Self-Doubt: • What if… • If only... • Judgment and Criticism • Rejection and Abandonment • Neglect and Abuse • Standards and Expectations • Loss • Transition 2 © SuperSmartHealth® 2014 33
Reappraise Stress and Self-Doubt: 2 Appraise Reappraise 1) What happened (just the facts)? 2) What is my belief about what happened? 3) Is my belief true or what is the evidence this should be so? 4) How could I view this differently? Adapted from Albert Ellis et al. Rational Emotive Behavior Therapy. Amer Psychological Assn; 3 edition 2011. © SuperSmartHealth® 2014 34
The 4 in 4 Framework™ Reactivity Fight & Flight Creativity Fulfillment Recognize Reactivity Is it doing more harm than good? 1 Reappraise Stress and Self-Doubt It’s nothing more than psychic gas! 2 Cultivate Creativity By Reflecting on What’s Truly Important 3 © SuperSmartHealth® 2014 35
Cultivate Creativity By Reflecting on What’s Truly Important • Learning • Connecting • Expressing Potential • Being of Service • Creating Opportunity • Experiencing Significance • Leaving a Legacy 3 © SuperSmartHealth® 2014 36
Cultivate Creativity By Reflecting on What’s Truly Important 3 VSIR Process Vision Strategy Implementation Results © SuperSmartHealth® 2014 37
SMART Results Specific Measurable Aligned with your Vision Realistic Time Framed © SuperSmartHealth® 2014 38
Cultivate Creativity By Reflecting on What’s Truly Important Health Relationships Work 3 © SuperSmartHealth® 2014 39
The 4 in 4 Framework™ Reactivity Fight & Flight Creativity Fulfillment Recognize Reactivity Is it doing more harm than good? 1 Reappraise Stress and Self-Doubt It’s nothing more than psychic gas! 2 Cultivate Creativity By Reflecting on What’s Truly Important Learning Connecting Expressing Potential Being of Service Creating Opportunity Experiencing Significance Leaving a Legacy 3 Make the Turn into What’s Truly Important 4 © SuperSmartHealth® 2014 40
4 2 1 3 Find Frame Apply 1 3 Evaluate Make the Turn into What’s Truly Important 4 © SuperSmartHealth® 2014 41
The 4 in 4 Framework™ Cultivate Creativity By Reflecting on What’s Truly Important Reappraise Stress and Self-Doubt Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment Is it doing more harm than good? It’s nothing more than psychic gas! Learning Connecting Expressing Potential Being of Service Creating Opportunity Experiencing Significance Leaving a Legacy Make the Turn into What’s Truly Important Frame 1 2 3 Apply 4 Evaluate Find 1 2 4 3 © SuperSmartHealth® 2014 42
An Inspired Shift in Conversation Reactivity Fight & Flight Creativity Fulfillment Low Performance Leadership Actively Disengaged Employees Cost Growth and Profitability High Performance Leadership Actively Engaged Employees Benefit Growth and Profitability © SuperSmartHealth® 2014 43
For More Information and Resources see: http://supersmarthealth.com/leadership 44
Thank You! Daniel Friedland, MD Chair, AIHM CEO, SuperSmartHealth daniel@supersmarthealth.com 858.481.2393 45
AIHM Leadership 2014 Making the Change 46
Redesigning Your Future “The only thing that is always consistent in life is CHANGE” 47
A different place a different time New ways to see opportunities, produce sustainable growth and reshape organizations for consistent innovation 48
“This Business Model Doesn’t Work Anymore!” Saddle makers- automobiles Watch makers – the quartz watch Newspapers Music Movies 49
What is the Reality of Change? “Change or Die” 50
What do leaders do? Create a vision and direction for the organization, and mobilize to accomplish that vision and direction. 51
Transformation It should NOT be our goal to create what people will LIKE. It should be our goal to create what people will LOVE! 52
Chaos provides opportunity  People who are security dependent won’t change.  Surfing the wave doesn’t mean fighting the ocean. (Don’t resist it.) 53
What Kind of Future Do YOU Want to Occupy?  You have the ability to design your future.  Half the time work in areas that you don’t know  Half the time work in areas that you do know,  And you will GROW. 54
Worst of Times and Best of Times  Collaboration vs. Competition  Healing vs. Curing  Bottom-up vs. Top Down  Patient Centered vs. Employee and Physician Centered What you focus your attention upon IS YOUR reality! 55
There are NO lines . . .WE MADE THEM! From Outer Space:  Township  County  State  Nation  Work all sides. Nothing has to be the way it is. We can INVENT or PREVENT our future 56
The Pale Blue Dot CArL Sagan We succeeded in taking that picture from deep space, and, if you look at it, you see a dot. That's here. That's home. That's us. 57
The Calf Path  by Sam Walter Foss 10/7/2014 13 An Army of ONE! 58
One day, through the primeval wood, A calf walked home, as good calves should; But made a trail all bent askew, A crooked trail as all calves do. Since then two hundred years have fled, And, I infer, the calf is dead. But still he left behind his trail, And thereby hangs my moral tale. The trail was taken up next day By a lone dog that passed that way, And then a wise bell-wether sheep Pursued the trail o'er vale and steep, And drew the flock behind him, too, As good bell-wethers always do. An Army of ONE! 10/7/2014 14 59
And from that day, o'er hill and glade, Through those old woods a path was made; And many men wound in and out, And dodged, and turned, and bent about And uttered words of righteous wrath Because 'twas such a crooked path. But still they followed—do not laugh— The first migrations of that calf, And through this winding wood-way stalked, Because he wobbled when he walked. This forest path became a lane, That bent, and turned, and turned again; This crooked lane became a road, Where many a poor horse with his load Toiled on beneath the burning sun, And traveled some three miles in one. And thus a century and a half An Army of ONE! 10/7/2014 15 They trod the footsteps of that calf. 60
The years passed on in swiftness fleet, The road became a village street; And this, before men were aware, A city's crowded thoroughfare; And soon the central street was this Of a renowned metropolis; And men two centuries and a half Trod in the footsteps of that calf. Each day a hundred thousand rout Followed the zigzag calf about; And o'er his crooked journey went The traffic of a continent. A hundred thousand men were led By one calf near three centuries dead. They followed still his crooked way, And lost one hundred years a day; For thus such reverence is lent To well-established precedent. An Army of ONE! 10/7/2014 16 61
A moral lesson this might teach, Were I ordained and called to preach; For men are prone to go it blind Along the calf-paths of the mind, And work away from sun to sun To do what other men have done. They follow in the beaten track, And out and in, and forth and back, And still their devious course pursue, To keep the path that others do. But how the wise old wood-gods laugh, Who saw the first primeval calf! Ah! many things this tale might teach— But I am not ordained to preach. An Army of ONE! 10/7/2014 17 62
And still their devious course pursue, To keep the path that others do. But how the wise old wood-gods laugh, Who saw the first primeval calf! Ah! many things this tale might teach— But I am not ordained to preach. An Army of ONE! 10/7/2014 18 63
Reinventing the Patient Experience  Best of a Hotel – Hire a hotel manager  Best of a Spa – Add Integrative Medicine  Best of a Hospital – Become the employer of choice 64
THE FUTURE BECOMES A DESIGN FUNCTION 65
Living on the Edge  The world that is or the world that will be.  Idealsim vs. Realism  Nothing has to be the way it is.  No one way is the Right Way 66
Edge Runners are World Creatures Power to change reality  Let’s make it be some other way.  We have the capacity for self-design.  We can modify our environment. 67
What Kind of Future Do YOU Want to Occupy?  You have the ability to design your future.  Half the time work in areas that you don’t know . . .  Half the time work in areas that you do know,  And you will GROW. 68
The Universe  If you look into an electron microscope you see infinitely lesser.  If you look into a telescope you see infinitely greater. There are Endless Possibilities 69
Science Follows Science Fiction Discovery comes from fiction. Discovery comes from FANTASY. What limitations do you accept? Money will follow ideas. 70
Where is YOUR future?  Excite yourself to get your imagination moving to design your future.  If there are limitations in your frame of reference . . .you are keeping yourself in BONDAGE! 71
There are NO lines WE MADE THEM!  Township  County  State  Nation  Work all sides.  Nothing has to be the way it is.  We can invent or PREVENT our future 72
Boundaries  There are NO boundaries but the boundaries YOU make.  All limitations are self imposed.  The universe is ONE CONNECTED fabric.  What is your vision of the future? ONLY YOU KNOW.  We can empower ourselves to create a new world. 73
The Key to Change Once you have totally accepted it, you can change it. 74
What is the conversation you have with yourself?  Everything makes sense in a large enough context.  Sense what is trying to happen and let it happen.  Be alert to changing environmental conditions.  Reframe any limitations to become opportunities.  Tremendous limitations breed success. They open doors. 75
Steps to the change  Explain the depth of the problem.  Offer nontraditional solutions  Introduce them as a package  Work to ensure they will actually happen 76
The WIFM for the Organization?  Increase innovation and creativity  Improve service to peers and patients  Inspire passion and performance  Increase retention of top performers 77
What we CAN DO! We cannot change the human condition – but we can change the condition under which humans live and work. 78
First Two Weeks as CEO Met with every employee in my office one on one for approximately seven minutes each non-stop. 79
WHY?  It was an effort to begin to BUILD TRUST by being: Open Honest Attentive Sincere Kind Interested (Hawthorne 80
Employee Communications  Nick’s Blog  Open Door Policy  Newsletter  Birthday Pizza with the President  Town Hall Meetings  Management by wandering around  Caught You Caring 81
What was the purpose of these initiatives?  Keep everyone informed – The secret was “there was no secret.”  Opportunities to “Accentuate the Positive”  Opportunities to re-direct energy when things had gone wrong. 82
Employee Physical Wellness Osteoporosis Program Smoking Cessation Eat Well for Life Program Strength Training Cardiac Rehab Walking Trails 83
Employee Fitness  HealthStyles – Nearly 50% of employees were members  Open approximately 90 hours per week.  Employee costs approximately $10 per month  Includes classes in kick boxing, aerobics, water aerobics, yoga, tai chi 84
Mr. Hawthorne AGAIN!  This effort demonstrated that the employees were valued that they were, in fact, THE MOST VALUED ASSET of the organization 85
Employee Empowerment 15 PTO Days Donation of PTO days On site Baby Sitting Social Welfare Death of an in-law or grandchild 86
Employees are NOT children, and I was NOT their Father  If you treat people like adults 90% of them will respect you for this effort  If you show them kindness, they will go the extra mile  If you truly demonstrate that you care, so will they 87
Employee Training & Development Disney Training for ALL employees EQ2/Emotional Quotient Training Planetree Training Team Dale Carnegie 88
Opening doors to show them that:  There are only four types of responses No Response Negative Response Redirection Positive Response 89
What were our goals? Learn Redirection Describe problems clearly and without any BLAME Explain the negative impact of a problem When appropriate, TAKE THE BLAME Make sure the task is understood Demonstrate and express trust and confidence 90
Employee Emotional Health The Greenhouse Planetree Room Healing Gardens Gazebos Live Music Counselors Clergy The Swat Team 91
Other ways to demonstrate our investment in their futures  Praise Immediately  Be specific  Share positive feelings (hugs)  Encourage them to keep up the good work 92
Dr. Dean Ornish Program for Reversing Heart Disease Six Weeks of Ornish Light Personal Nutrition Counseling Healthy Vending Machines Healthy Choice Meals (Fat Free, Vegetarian) 93
Continued Dedication to Employee Personal Growth Reimbursement for additional college level credits and degrees Workshops Conferences Video Teleconferencing 94
More Employee FUN!!!  Sundae Parties  Subs and Pizza Parties  Trips to Pittsburgh Pirates Baseball  Tickets to: The Symphony, The Opera, Theater, Hockey, and lots of DINNERS.  Employee Recognition Dinners  Hospital Week Cookout  BIG HOLIDAY PARTY 95
We Asked the Bullies to RESIGN  Anesthesiology  Critical Care Specialists  Internal Medicine Physicians  Surgeons In 11 years we asked 17 highly qualified physicians and 37 employees to LEAVE because they were bullies 96
Conventional right brain wisdom said: The secret to seeing--really seeing-- was to quiet the bossy, know-it-all left brain! 52  A Whole New Mind by Daniel H. Pink 97
Right Brain Attributes  Artistry  Empathy  Taking the long view  Pursuing the inspirational 53 98
What will get you in the door? Creative thinking Creative ideas Creative approaches Creative solutions (But most importantly) “Relationships” 54 99
The Patient Experience was Redesigned THE FUTURE BECAME A DESIGN FUNCTION 100
Multidisciplinary research team with expertise in:  High throughput research,  Functional genomics,  Proteomics,  Molecular biology,  Cell biology,  Biochemistry,  Histopathology,  Laser capture microdisection  Bioinformatics  Database development & data warehousing Genomics Lab. Laser dissection Lab. PCR Lab. Proteomics Lab. 101
High‐throughput Research  WRI is equipped for high throughput parallel analysis of gene expression.  Parallel examination of global gene expression as a function of disease, habit, therapy or surgery. Ettan Spot Picker 96 Capillary DNA Analyzer DNA Microarray Spotter Automated Slide Processor 102
Protein Research Platforms for parallel analysis characterization of up to 1200 proteins within a 24 hour period LC/MS/MS Electrophoresis Identification Imaging Protein picking Protein digestion MALDI-tof 103
Platform for Large‐scale Biology  Advanced robotics for automated protein spot picking and processing  State of the art instrumentation for:  Global protein profiling  Differential expression  Peptide identification Spot handling robot for high throughput proteomic research 104
Clinical Breast Care Project of Walter Reed National Medical Center 105
No Boundaries 106
Nick Jacobs, FACHE International Director SunStone Management Resources 107
1987 – 2014 Memorable Quote from two centuries! 108
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“Originality is dangerous. If you want to increase the sum of what is possible for human beings to say, to know, to understand and therefore in the end, to be, you actually have to go to the edge and push outwards. . . At its very best, it’s a revolution” 111
Quality vs. Quantity 112
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Medicine in the United States is NOT Integrative 114
Transition from Fee for Service to Value-based Care 115
An Army of ONE! 10/7/2014 10 116
“Obviously, both hospitals and physicians are worried about. . . CHANGE, but it is common knowledge that if something is NOT DONE, our health care system will crash and burn. Think of this, providers would get paid more for keeping their patients healthy and out of the hospital. What a concept.” Dr. Paul Levy 117
THE FUTURE OF HEALTHCARE IN AMERICA 118
Successful new care models are emerging, providing new ways to get and give care, to create and maintain relationships, and organize communities. Many of these offerings replace traditional functions, adding new dimensions of accessibility, value, and transparent activity. Consumers and patients are eagerly adopting these new solutions in their lives. 119
 Concierge,  Membership Model,  Par, No Par,  Insurance vs. Cash,  Combination Insurance and Cash,  Multi-disciplinary Integrative Practitioners: ND’s, Chiropractors, Massage, Energy Medicine, NP’s, PA’s Health Coaches, Yoga 120
Why can’t hospitals and physicians do the same? They can – but not without dramatic changes in the way they think, the strategies they adopt and the innovation processes they use. 121
Physicians, Hospitals, and Health Systems that make this commitment will discover extensive opportunity. They will succeed in engaging large new segments of patients, both among the public and among businesses, and they will discover ways to serve them more effectively than ever before. 122
Find a way to help you migrate from an old model of care to diverse and growing portfolios of services that engage throngs of new patients and supporters through efficiency, quality, transparency and patient centered care. 123
In this fast-changing environment, how can an industry built on a centuries-old model be transformed? Opportunities are hard to see and even harder to capitalize on when you are wearing the blinders imposed by several hundred years of tradition. 124
It is NOT our goal to create what people will LIKE. It is our goal to create what people will LOVE! 125
THE FUTURE BECOMES A DESIGN FUNCTION 126
Population Health 127
$35 billion Annually on diabetes and/or metabolic syndrome 26 million or 8% Americans diagnosed Type II diabetes 70 million or 22% Americans in development stages 128
 About 90 percent of our expenditures are because of stress related issues, and when we take such amazing statistics into consideration as the fact that the United States consumes two times more fat than Asia, three times less fiber, and 90 percent more animal protein, it has to make us think a little bit about this course that we are currently pursuing. 129
24 Million People in the United States live in Food Deserts! 130
Presidents of the United States Reagan – 20 million Geo HW Bush – 30 million Clinton – 33 million George W. Bush – 49 million Obama – 50 million 131
 In 1960 our parents spent approximately 18% of their salaries on Food . . .  In 1960 our parents spent 9% of their salaries on Healthcare  In 2013 we spend 9% of our salaries on food  In 2013, we spend 18% of our salaries on healthcare Could it be OUR FOOD??? 132
 7,000 to 10,000 Baby Boomers turning 65 every day  45% of newly insured will be on Medicaid Creating an imbalance for health care institutions between medical and surgical care 133
Why can’t we reach out to our communities in order to save our health systems, practices, and protect our future? 134
It has long been recognized that it is easier to put into practice wellness and prevention initiatives than to eliminate a service once it has been offered. So, how do health systems address cost pressures, income shortages and shifting demographics? 135
 With the creation of Accountable Care Organizations as prescribed through the Affordable Care Act, Integrative Medicine could become a fully endorsed service-line by all Health Systems to be utilized in income creation and expense reduction for numerous aspects of care. 136
 Integrative Medicine — the practice of medicine that:  Reaffirms the importance of the relationship between the practitioner and the patient,  Focuses on the whole person,  Is informed by evidence, and  Makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing. 137
 Holistic Medicine — from the root HEALTH  Medical care that views physical and mental and spiritual aspects of life as closely interconnected and equally important approaches to treatment. 138
 Diet  Exercise  Stress Management  Group Support  Expanded from 36 to 72 visits  Paying $80 and in 2014 this goes to $112 a visit  Over $7000 per patient 139
 Because Integrative Medicine deals directly with root cause medical issues, protocols implemented by Integrative Medicine health coaches that follow patients post discharge, ensure follow-up appointments and increase patient satisfaction at all levels through individualized attention and care, several of the cost/price issues will be addressed and marginalized. 140
 A complete community health related effort that includes the creation of well-being centers, workshops, appropriate screenings, as well as wellness and prevention classes can ignite community wide awareness and participation in health changing attitudes and activities; hence, lowering the need for expensive inpatient care on many levels. 141
 By assisting the residents of the greater service area to become the CEO of their own health, we are creating an awareness movement not dissimilar to those psycho-social societal efforts that we’ve seen over the past two decades to reduce inappropriate consumption of alcohol, drugs and tobacco. 142
Integrative health coaching is a co-creative and dynamic partnership between a consumer (patient) and professional coach embedded into a healthcare management system designed to identify, monitor, and motivate behavior in order to maximize the physical, mental, social and spiritual health of the consumer. Health coaches are medically licensed and coaching certified. 143
Having patient advocates co-ordinate the care of the 18 Club, patients with nine physicians with whom they interact annually and nine different drugs that they take daily, would be of tremendous benefit. It would help them avoid unneeded duplications, millions could be saved. 144
 Help to alter labor cost by redesigning inpatient care models and supplementing nursing care.  This will improve nursing quality and the nursing work environment, prevent demand of less profitable services and create a healing environment that also contributes to lower lengths of stay and fewer hospital acquired infections. 145
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Show me the money . . .HCHAPS! 147
Do the Math! 148
Transformational Practices  Increases in Patient Satisfaction  Increases in Employee Satisfaction  Increase in Patients  Increase in Quality  Reduction in number of lawsuits  Reduction in readmissions prior to 30 days 149
1.6 Hosp. * 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 Hosp. A Hosp. B Hosp. C Hosp. D Hosp. E Hosp. F Hosp. G Risk-adjusted index is statistically significant at a confidence level of 95% Medical Center had the lowest mortality rate of 0.8% compared to 8 peer hospitals all above 1% 150
Come to OUR Hospital You’ll Die Less Often! 151
 Judy Rich, CEO Tucson Medical Center/TMC Healthcare  This has been a journey that has required an “all-in” leadership commitment. No dabbling in an ACO… This model fundamentally changes the way we do business. This journey is not for the timid; it is full of risk and potential obstacles, but it is the necessary path for us to fulfill a core mission of providing exemplary healthcare with access for all in our community. It puts us into a full partnership with our medical staff . . . 152
 Some have embraced it because they believe that it links payment to performance.  Others will embrace it because it focuses on clinical integration and coordination  And finally, some believe that it is a true competitive destination and one to which the organizations are committed before the system takes on more water! 153
 Their vision was to transform the “MONEY SYSTEM” into a SYSTEM OF CARE!”  And the pitfalls are: complexity, resistance, trade-offs, missteps . . . to name just a few. 154
These partnerships of primary-care and specialists doctors with hospitals and clinics might help to produce a model that, although directed toward Medicare, could also have a positive impact on all of U.S. health-care. 155
 “ACOs were brought into effect with three major aims which are:  Better care for individuals,  Better health for populations, and  Slower growth in costs through improvements in care.” Don Berwick, MD, Administrator of the Centers for Medicare and Medicaid Services 156
They would be structured to coordinate care and their reward would be to share financially in savings with the government if they could come in lower than expected, but they could also be PENALIZED if they go over the projected costs. 157
The most powerful fix would be to change the relative fees paid to primary care and other cognitive specialists, compared to specialists. Giving a primary care doctor the ability to spend more than 18 minutes with a patient could change the nature of those doctors from having a triage function to allowing proper management of care. 158
Medicare can also engage in real clinical transparency, insisting on the publication of real-time information about infections and other important aspects of quality and safety as one of its Conditions for Participation. 159
 ABIHM – Holistic Integrative Medicine  Biotech – SYSTEMS BIOLOGY  Dr. Leroy Hood – Founder and Director of Institute for Systems Biology - Dedicated to identifying strategies for predicting and preventing diseases. His inventions have permanently changed the course of biology, and revolutionized the understanding of genetics, life and human health.  Hood invented four instruments that have unlocked much of the mystery of human biology, including the automated DNA sequencer, a powerful device for sequencing proteins, A machine for synthesizing proteins and An automated tool for synthesizing DNA. 160
Within the next ten years, healthcare will fundamentally change from reactive to proactive This is because medicine will become predictive, personalized, preventative and participatory WHY? Because biology is evolving into an informational science and it will NOT stop going in that direction 161
Proteomics and Genomics will contribute to the continued morphing of our current diagnostic medicine into this new world order Spectacular computational power will map 2500 blood organ specific proteins from 50 organs to diagnose our patients and provide them with wellness assessments Vaccinations will be developed as specific therapies for hundreds of different diagnosis 162
SNP analysis will be used to monitor toxicity, response dose and combinational therapies. These types of advancements will result in “Planned strategies for health.” Hence Systems BIOLOGY 163
It cost $3,000,000,000 to map the human genome in 2003. This year? Less than $1000. It cost $1M for a terabyte of storage for data. Today? 2 TB of Cloud Storage - $16.00. 164
Regenerative medicine is the "process of replacing or regenerating human cells, tissues or organs to restore or establish normal function". Regenerative medicine also empowers scientists to grow tissues and organs in the laboratory and safely implant them when the body cannot heal itself. 165
Reagan launched SDI in a March 23, 1983, speech. "Let me share with you a vision of the future which offers hope," he said, and then he described a system that could "intercept and destroy strategic ballistic missiles before they reached our own soil." Algorithms that could analyze 1500 incoming intercontinental ballistic missiles to determine which were real and which were dummy warheads. Jess Granone’s sister-in-law 166
“Not only would it allow us to cure cancer by repairing or destroying malignant cells one by one but it would revolutionize gene therapy as well.” 167
IBM has found a way to meld biology and computing to create a new chip that could become the basis for a fast, inexpensive, personal genetic analyzer. The DNA sequencer involves drilling tiny nanometer-size holes through computer-like silicon chips, then passing DNA strands through them to read the information contained in their genetic code. 168
The “DNA transistor” could make it faster and cheaper to sequence individuals’ complete genomes. In so doing, it could help facilitate advances in bio-medical research and personalized medicine. For instance, having access to a person’s genetic code could help doctors create customized medicine and determine an individual’s predisposition to certain diseases or medical conditions. 169
Saddle makers- automobiles Watch makers – the quartz watch Newspapers Music Movies 170
Where to put your focus! 171
CLEAR Do not bury the lead  RELEVANT Make sure to paint a picture and always make sure to demonstrate relevance to the potential investor ENGAGING Bring them to their senses: sight, sound, smell, taste, and touch 172
ACCURATE THERE IS NO EXCUSE FOR FACTUAL INACCURACY TIMELY It is very important to remember that information is time-sensitive ENTHUSIASTIC/PASSIONATE Enthusiasm makes your audience glad to see you 173
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Spirituality & Wellbeing Mary Jo Kreitzer PhD, RN, FAAN Director, Center for Spirituality & Healing University of Minnesota 175
One could call every illness an illness of the soul. ~ Novalis 176
Overview Discuss the evidence base linking spirituality with health outcomes. Describe spiritual practices that promote health and wellbeing. Discuss strategies for advancing wellbeing in the lives of people, organizations, and communities. 177
Defining Spirituality Spirituality is broadly defined as that which gives meaning and purpose to life. “Spirit” – comes from the Hebrew word “ruah” which means wind, breath or air, that which gives life. Essence of one’s humanity (Frankl, 1963) 178
Defining Spirituality Power, force, or energy that stimulates creativity, motivation or striving for inspiration. (Chiu, 2004) Search for the sacred. (Pargament, 1997) Purpose, meaning and connectedness with self, others and higher power. 179
Defining Spirituality Spirituality is the aspect of being human that refers to the way individuals seek and express meaning and purpose, and the way they experience connectedness to the moment, to self, to others, to nature and to the significant or sacred. (Puchalski and Ferrell, 2010) 180
Religion Organized system of beliefs, practices, and rituals associated with a particular faith tradition. Religion may or may not be part of a person’s spirituality. 181
Relevance for health care providers? 182
“Close to the Bone” – Jean Shinoda Bolen 183
Diagnosis of a Chronic or Life-Threatening illness Feelings of anger, grief, loss, despair, and hopelessness. Why me? Why now? What is the meaning of this? May provoke a spiritual crisis. 184
Greek Temples Sanctuaries of Healing Body, mind and spirit were the focus of care. 185
Hildegaard of Bingen 12th Century Mystic and Healer Use of art, music, use of herbs and prayer 186
Florence Nightingale Role of the Nurse …“Put the patient in the best possible condition so that nature can act and healing occur”. 187
Nightingale Tenets of holistic practice – importance of natural light, fresh air, touch, diet, noise control and spirituality Hygiene, sanitation and infection rates 188
Osler It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has. William Osler 189
Historically, the healing professions were grounded in spirituality. 190
17th Century Dualism Wall of separation divided the care of people into mutually exclusive and often antagonistic camps. 191
Contemporary Western Science Often dealt poorly with the spiritual side of human nature by ignoring it. Viewing spirituality as being beyond the scope of professional practice. 192
CAM Professions Excelled Relationship-based Care of the whole person Body, mind and spirit Listening to the story 193
“We have traded mystery for mastery and paid a great price”. Rachel Naomi Remen 194
What do patients want? In two national surveys, over 70% of patients polled believed that spiritual faith and prayer can aid in recovery from illness; 64% of those surveyed believe that health professionals should talk to patients about spiritual issues as part of their care. 195
45 Year Gallup Poll Beliefs and Attitudes 50% describe themselves as religious. 33% describe themselves as spiritual but not religious. 78% report the need in their life to experience spiritual growth - compared to 20% - 5 years ago. (2002) 196
Spirituality in College Students Findings from a National Study Over half of third-year college students place a high value on “integrating spirituality into my life”. More than 2/3 report that they have had a spiritual experience. Three-fourths of the students believe that we are all spiritual beings. – Higher Education Research Institute, UCLA, 2003 197
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Spirituality and Health Outcomes Patients who score higher on spirituality or religious scales have lower mortality due to coronary artery disease or cardiac surgery-related complications. (Haskell, 2003) Degree of spiritual well-being may be an important factor in progression or regression of coronary artery disease. (Morris, 2001) In heart failure patients, spiritual well-being was associated with less depression. (Bekelman et al, 2007) 206
Spirituality and Health Outcomes Spirituality was associated with less distress and better quality of life in cancer patients. (Zakowski and Bair, 2004) Existential well-being was found to have a strong negative correlation with depression. (Nelson et al, 2002) Spiritual struggle was associated with poorer QOL and life satisfaction. (Hills et al, 2005) 207
“Love and Survival: The Scientific Basis for the Healing Power of Intimacy” Opening your heart – when the emotional and spiritual heart begin to open, the physical heart often follows. Dean Ornish MD 208
Assessing Spirituality What gives you hope and meaning? What spiritual practices are living-giving for you? Are there any specific practices or restrictions that we should know about? Do you have spiritual concerns or issues you need to address? Are you part of a religious or spiritual community? 209
FICA Interview Guide Faith What is your faith? Importance/Influence How important is your faith? Community Are you part of a religious community? Address How would you like spiritual issues addressed? (Puchalski) 210
Research Instruments Spiritual Transformation Scale Brief Serenity Scale Spiritual Well-Being Scale Meaning in Life Scale Self-Compassion Scale Index of Core Spiritual Experiences (INSPIRIT) 211
Addressing Spiritual Issues The predominant orientation of biomedicine is on curing – diagnosing, treating and repairing the broken or damaged part of the body. Healing – restoring wholeness and integration. Requires attending to the whole person – body, mind and spirit. 212
Shift from a biopsychosocial model of care to a biopsychosocial – spiritual model. 213
Integrative Approach to Care “Being with” - healing “Doing to” – curing –J Milstein (2005) 214
“Being With” – a way to provide spiritual support Cultivation of skills: Deep listening Compassion Mindfulness Presence 215
Providing Spiritual Care Is at once both simple and extremely difficult. It requires that the health care professionals bring their humanness to the medical encounter. 216
Who provides spiritual care? Healthcare professionals – spiritual care can effectively and interchangeably be provided by multiple members of the care team. Professionals trained in spiritual care. 217
Spiritual Care Providers Chaplain Community-based religious or spiritual leader (priest, rabbi, shaman) Spiritual director or counselor 218
Barriers of Spiritual Care Lack of sufficient time. Lack of skills. Institutional obstacles – lack of privacy and continuity of providers. Social, religious or cultural discordance between caregivers and patients. (Daaleman et al, 2008) 219
Spiritual Care Practices Prayer Meditation Music and Art Nature Journaling Walking a labyrinth 220
“Diseases of the soul are more dangerous and more numerous than those of the body”. Cicero 221
Spirituality of Health Professionals Personal growth and well-being Job satisfaction and burnout Clinical effectiveness 222
Spirituality of Health Professionals Making a spiritual connection with patients will help physicians at least as much as it helps their patients. If physicians reconceptualize themselves as healers, as opposed to solely technicians, who dedicate their lives to reducing human suffering, they will reconnect with the passion and dedication that initially directed them to medicine. (Grubb, 2003) 223
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Nurturing the Soul and Spirit of Health Care Providers Friends, nature, relationships, beauty, food, art, family, contemplation, travel, solitude, education, retreat, community, books, and home. 225
Signs of Change A growing number of medical and nursing schools teach content or even whole courses on spirituality. 226
US Hospital Accreditation Spiritual care is a criteria for accreditation of hospitals by JCAHO. Hospitals must document assessments of spiritual beliefs and practices. Pastoral care must be available to patients who request it. Hospitals must meet the spiritual needs of dying patients and their families. 227
Vinland National Center in Loretto Minnesota 228
Vinland National Center Full lives for people with disabilities. Treating the whole person. One of three programs in US that specializes in clients with brain injury and chemical dependency. 229
Unique Residential Approach 1:1 and group counseling Personalized fitness Indoor and outdoor physical activities Comprehensive vocational services Family Program Courses – include, anger management, self-esteem, grief and loss, wellness, nutrition, aromatherapy, tai chi, leisure education, and conflict resolution 230
Spirituality Native American Healing Ceremonies Meditation Journaling Mindfulness Nature Culture Art Therapy 231
Art Therapy – Mask Making Art is used to raise spiritual, psychological and emotional issues. What are you hiding behind? What is your street face? What is your love face? What is your sacred face? 232
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Recent Outcomes Data – 6 months post discharge (residential program) 97% reported 0 times/week use of alcohol. 0 % homeless or unsafe living environment. 71% good living and 28% great living environment. 70% return to work (work, training, volunteer). 94% reduction in incarceration. 236
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66 Move Beyond “Fixing” Health Care…… Building Capacity in People and Communities 240
67 WELLBEING • Whole person • Increase capacity and expand potential • Possible even with chronic illness and maturing bodies • Individual, family, organization, community and nation 241
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Summary A commitment to caring for the whole person requires that we go beyond caring for the physical body. Human beings are spiritual beings. Whether healthy, injured or ill, human beings naturally ask transcendent questions about meaning value and relationships. 243
Summary Attending to spiritual needs of patients is not just a moral option. It constitutes a moral imperative. 244
Reflection “Perhaps our best work as health professionals is not about something we do but about something we are, something we become and bring into all of our relationships”. Rachel Naomi Remen 245
Reflection At the dawn of the 21st century, the most profound revolution awaiting western biomedicine may not be genomics, nanotechnology, or artificial organs, but rather the re-introduction of spirituality into the practice of health care. 246
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Global Health & Integrative Medicine the Future of Health for the Planet & Humanity Dr. Tabatha Parker Naturopathic Doctor Executive Director Natural Doctors International (NDI) 248
Inspiration Inspire yourself and others will be inspired. Motivate yourself and others will be motivated. Develop yourself and others will start to develop themselves. Be an example first and then the world changes around you Author Unknown 249
Who are we: USA health providers? Profession Designation in USA Source Acupuncturist/Oriental Medicine LAc 25000 ACCAHC Chiropractors DC 70000 ACCAHC Massage Therapist ‐ Licensed LMP 250000 ACCAHC Medical Doctors (Primary Care) MD 425000 Kaiser Medical Doctors (Speciality) MD 428000 Kaiser Midwives (Certified Nurse Midwife) CNM 12692 ACNM Midwives (Certified Midwives) CM 73 ACNM Midwives (Direct Entry‐homebirth) CMP 1800 ACCAHC Naturopathic Doctor ND 5000 ACCAHC Nurse (Registered Nurse) RN 2,725,000 Kaiser Nurse Practitioner NP 180000 Kaiser Osteopaths DO 80000 AOA Physical Assistant PA 83000 Kaiser Phyiscal Therapist PT 183000 APTA 250
Natural Doctors International Where I came from we are • 1st international service NGO created for licensed natural medicine providers • ND Founders - Dr. Tabatha Parker, Dr. Laurent Chaix, and Dr. Michael Owen. • 501(c)3 designation in 2003 • Started in Moyogalpa Hospital in 2005 • Opened NDI clinic in February 2010 251
Natural Doctors International • Expansion of 6 Naturopathic Principles into Global Health, Social Justice, Ecology. • Integrative and Collaborative • Accept and reach out to all professions: NDs, DCs, LaCs, Acupuncturists, MDs, DOs, Midwives, PTs, OTs, herbalists, MPHs, activists, students of all kinds, anyone with a genuine desire to contribute. 252
NDI a glimpse at our work 253
Key principles, practices & opportunities for integrative medicine in global health The Principles of Holistic Primary Health Care The principles of Holistic Primary Health Care (HPHC) are a unification of four of the most important international declarations to have emerged in the modern era, presented in a manner which summarises this declaration’s vision of the interdependence of human rights, community health, ecological harmony, and the necessity of multi-sectoral integrative approaches to world health. 254
Three pillars • The Universal Declaration of Human Rights (1948) - upholds the rights of the individual in relation to health. • The Alma Ata Declaration of Primary Health Care (1978) –upholds the rights of communities in relation to health. • The Earth Charter (2000) –upholds the rights and importance of the environment in relation to health. And rests upon the following platform: • The Beijing Declaration on Traditional Medicine (2008) –upholds the value of holistic medical practices from around the globe and the necessity for them to work in an integrated fashion with existing healthcare services. 255
One Health Organisation Our vision of the interdependence of human rights, community health, ecological harmony, and the necessity of multi-sectoral integrative approaches to world health. 256
models of global health: service learning programs vs voluntourism Which will you choose: Sustainability or convenience? This is our responsibility. Traditional Model – 1 – 2 week medical mission tours, no permanent links, band-aid medicine, fix-it mentality, convenient for the provider. Social Justice Model – Service learning, linked to long term projects, community links, listening to needs, partnership, sustainability. 257
Stories from abroad Best intentions • 1 church 7 paintings • 1 patients, 3 enalapril • Morphine lollipops • Unlabeled medicine • Our trash, your present, your problem 258
best practices in service work & social justice medicine Work legally Respect local cultures Work with local long-term organizations Do not just join short-term medical trips Take the time, build the relationships 259
global health policies impacting integrative medicine Benchmarks WHO 2014-2023 Traditional Medicine Strategy Federations 260
Benchmarks for Training in Naturopathy – edits 2006, published 2010 261
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WHO – Strategy on 2014 - 2023 The strategy has two key goals o support Member States (192) in 1. harnessing the potential contribution of T&CM to health, wellness and people centered health care and to promote the safe and 2. effective use of T&CM through the regulation of products, practices and practitioners. Goals reached by implementing 3 strategic objectives: 1) Build knowledge base and formulate national policies; 2) strengthen safety, quality, effectiveness by regulation; 3) promote universal health coverage by integrating T&CM services and self-health care into national health systems. 264
T&CM Definitions Traditional medicine (TM): Traditional medicine has a long history. It is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, use in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. Complementary medicine (CM): The terms “complementary medicine” or “alternative medicine” refer to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system. They are used interchangeably with traditional medicine in some countries. Traditional and complementary medicine (T&CM): T&CM merges the terms TM and CM encompassing products, practices and practitioners. 265
From the Strategy 266
Traditional Medicine Levels of education, accreditation and regulation of T&CM practices and practitioners vary considerably. In an increasingly globalized world, individuals move freely from country to country in order to live and work. Given this trend, a better understanding of T&CM practitioners is needed to ensure professional consistency and safety. 267
What professions have world federations? Physicians (MDs) Hydrotherapists Chiropractors Chinese Medicine Acupuncture Osteopaths Nurses Public Health 268
Annex B of the WHO Strategy World Federation of Hydrotherapy World Federation of Acupuncture & Moxibustion World Federation of Chiropractic World Federation of Chinese Medicine Societies Osteopathic Alliance 269
Purpose of Federations • International Professional Associations • Ensure professional consistency/safety • Create international standards to reduce variability in education, accreditation & regulation • Facilitate international collaboration which is beneficial & necessary • Facilitate relations with health ministries: MINSA (Ministry of Health) 270
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FORMATION Paris, France July 2014 2nd International Congress of Naturopathic Medicine 272
Paris – WNF formed At the 2nd International Congress on Naturopathic Medicine (ICNM), July 4-6, 2014, Paris, over 30 participants representing national associations from around the world voted unanimously on Sunday July 6th, 2014, to form the World Naturopathic Federation (WNF). 273
Interim Committee Anne Marie Narboni (France), Babu Joseph (India), Iva Lloyd (Canada), Yannick Pots (Belgium), Phillip Cottingham (New Zealand), Tabatha Parker (USA), Tina Hausser (Spain/Germany), Jon Wardle (Australia) 274
global health priorities impacting integrative medicine WHO World Health Assembly MDG’s NCD’s 275
WHO & Geneva • Every year the WHO has a WORLD HEALTH ASSEMBLY, convening their 193 nations in MAY. This is the largest most important health assembly in the world. • In 2014 of this year, 2 NDs attended the 67th WHO WHA - Michael Cronin, ND and Tabatha Parker, ND – becoming the first NDs to attend this assembly in history. 276
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Having a world federation that is has the stamp of the WHO is important for individual associations & countries to move forward policy in individual countries – ex. Zambia, Democratic Republic of Congo, New Zealand, France – all of these countries have expressed how important this would be for their work! 278
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1) 40% Reduction in # Children Under 5y/o who are stunted 2) 50% Reduction of Anemia in women of reproductive age 3) 30% reduction in low birth weight 4) No increase in kids being overweight 5) Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50% 6) Reduce and maintain childhood wasting to less than 5% 280
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"You're only given one little spark of madness. You mustn't lose it.” Robin Williams 283
Personalized Integrated Healthcare: A Look Ahead Jeffrey Bland, Ph.D., FACN President Personalized Lifestyle Medicine Institute www.plminstitue.org 284
Learning Objectives • What do we mean by “personalized integrated healthcare”? • What is meant by the term “metabolic inflammation”? • How does this approach apply to the management of the dominant chronic metabolic diseases? • Type 2 diabetes, cardiovascular disease, inflammatory airway diseases, obesity, autoimmune diseases, osteoporosis, dementia • How do pattern recognition receptors and specifically toll-like receptors play a role in the etiology of these chronic metabolic diseases? • What specific therapies derive from the understanding of toll-like receptors and their relationship to chronic diseases? 285
The Present Health Challenge • Present system poor outcome in patients with 2 or more diseases • More than ¼ of adults have multiple chronic conditions • 2/3 of Medicare have multiple with 14% having 6 or more conditions • Goals: Foster Systems Change, Empower people, Equip clinicians, Enhance research JAMA 2014; 312: 1199. Question: Can we find a common cause of many chronic diseases? 286
Do Our Genes Directly Control Our Health Outcomes? • Why are 370 million people projected to have type 2 diabetes within the next 20 years? • Is type 2 diabetes monogenetic? • Is type 2 diabetes one disease or many? • What is difference between genetic and epigenetic factors ? • What is the role of bioactives from food in the etiology of type 2 diabetes? • Does our environment have anything to do with the type 2 diabetes pandemic? 287
Monogenetic vs Gene-Environment Etiology of Disease 288
YOUR BOOK OF LIFE IN 23 CHAPTERS Expressed Differently in Different Environments Ridley M. Genome – the Autobiography of a Species in 23 Chapter. 1999. 289
30% of chronic disease is genetically-related: 70% of chronic disease is lifestyle, nutrient and environment-related What impact will this understanding have on healthcare? 290
What a Chromosome Looks Like 291
May 27, 2013…Genes and Disease 292
Mary Claire King and BRCA 1 and 2 “The lifetime risk of breast cancer among female mutation carriers is presently 82%. Risks appear to be increasing with time. Before 1940 it was 24%. Lack of physical exercise and obesity in adolescence may be important modulating factors for risk in carriers”. Science 2003; 302: 643-50. 293
Incidence of Breast Cancer in Women with BRCA1/2 mutations Ag2e94
Health is personal. 295
Where it all starts--Parenting 296
• Genetics • Nuclear DNA • Mitochondrial DNA • Epigenetics • Prenatal environment • Postnatal exposures • Sociobiology • Breast milk • The first “Functional Food“ • Preconceptional • Parenting before conception Science 2014; 345: 743. 297
Parenting Before Conception • Environmental exposures of both parents • Michael Skinner • Methylation patterns • Transgenerational effects • Mitochondrial DNA • Noncoding RNAs • Chromatin Integrity • Nutritional status of both parents 298 10/7/2014 15
Epigenetics “Father of Nutritional Epigenetics” • Randy Jirtle • Visiting Professor, McArdle Laboratory, University of Wisconsin • Pioneered the use of Agouti mouse to look at the effect of diet, nutrients and environmental agents including BPA on the mammalian epigenome and disease 299
Randy Jirtle and Nutritional Epigenomics— The Agouti Mouse Story Methylation Support Dams (f0) Offspring (f1) Cooney CA et al. Maternal methyl supplements in mice affect epigenetic variation and DNA methylation of offspring. J Nutr. 2002 Aug;132(8 Suppl):2393S-300 2400S.
Foods and Phytochemicals that Influence Genome Methylation and Sirutins 301
Ice Storm Babies Show Unique Methylation Signature PlosOne 2014; 9: e107653 302 Moshe Szyf and November 2010 FMU interview
What we can learn from breast milk about optimal nutrition • Unique carbohydrates • Oligosaccharides • Bifidobacterium longum biovar infantis (B. longum bv.infantis) • Unique fatty acids • Rich in n-3 DHA • Bioactive proteins • Delivers specific immune active peptides • Enzymes • Activated in the gut Science 2014; 330346:747-50.
There is a BIG new idea What makes us different? that will change the health of the world. Personalized Medicine Lifestyle 304
We are not pathways, but networks of genes regulated by our environment 305
What makes us different? 306
Scientific World Journal 2013 307
The Origins of Functional Medicine-- 308
Dr. Willoughby Wade and Functional Medicine-1871 • Concepts • “All disease is disordered function” • Drugs often treat symptoms not cause of disease • Pathology is preceded by alteration in function • Root cause of diverse symptoms may come from primary alteration in core function • Symptoms of disease may arise from a distant alteration in function (systems biology) • Disease is a limiting concept and should be replaced by understanding of origin of the dysfunction • Biography • 1827-1906, Irish, knighted 1896, Head Kings College & Hospital 309
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The Functional Medicine Operating Model Structure Energy (Production & Utilization) Cellular Transport Assimilation/Elimination Detoxification Immune Defense Cellular Communication (Hormones) Genes Environment Personalized Lifestyle Healthcare/Medicine Lifestyle Behaviors Diet 312
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Proof of Concept Generating the Data Necessary to Change the Medical Paradigm 314
The Institute for Systems Biology Pioneer 100 Wellness Project 315
The 21st Century Framingham Project 316 10/7/2014 33
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Trends in Diagnosed Type 2 Diabetes: 1980-2012 • Rapid increase in T2D from 1990-2008 but leveled off 2009-2012 • Tracks very closely with increase in obesity • Suggestion that obesity “causes” T2D • But is that correct? • Association or cause? JAMA 2014; 312: 1217-25. 318
Trends in waist circumference as a marker of central adiposity • Trends from 1999 to 2012 indicate continued increase in waist circumference • Waist size is the most convenient surrogate marker for central adiposity • Central adiposity is most correlated with metabolic disease • “Angry Fat” • Metabolic inflammation, sleep apnea, endocrine disruptors, certain medications JAMA 2014; 312: 1218. 319
Cardiovascular Diabetology32 02012; 11: 133-42.
Nutritionally Related SNPs of Potential Importance to Disorders Associated with Metabolic Inflammation • Methylenetetrahydrofol ate Reductase (MTHFR) • Apo E4 • COMT • IL-1beta receptor • PON1 • Vitamin D receptor • Deiodinase • TLR-4 • HDL • Adiponectin • Fatty acid binding protein 3, 4 (FABP4) • FTO • PPAR gamma • IGF 1 • IRS1 • PAI1 321
Where Metabolic Inflammation Starts Toll-like Receptors and Pattern Recognition 322 N Engl J Medicine 2011; 364: 60-70.
Toll-like receptor 4 activation Atherosclerosis, Arthritis, Diabetes, IBD, Dementia,Chronic Pulmonary Disease 323 N Engl J Medicine 2002; 347: 185-92
Toll-like receptor signaling and gene expression (TLRs are expressed in gut, liver, macrophage, adipocyte, brain, lung, kidney, beta-cells and bone) 324
TLR-4 Signaling and NFkB activation 325 TLR ligands Include: LPS, saturated fatty acids, xenobiotics, hypoxia, oxidized lipids
Ingestion of Bacterial LPS Inhibits Taste Response to Sugar • Bacterially-derived lipopolysaccharide (LPS) modulates neural response to taste stimuli • Response to sugar was significantly reduced upon exposure to LPS • This effect is seen through alteration in taste receptor activity (Tastr1/2) • This is the same receptor that is found in the mucosa of the distal ileum and controls GLP-1 secretion • The process of altered Tastr1/2 activity is initiated by activation of TLR-4 receptors 326 Neuroscience 2014; 258: 47-61
Bacterial LPS induces insulin resistance due to chronic inflammation • Chronic elevation of gut-derived LPS(i.e. metabolic endotoxemia) plays role in insulin resistance • LPS levels found elevated in obese, diabetic humans • LPS stimulates TLR-4 activity in muscle cells from obese, diabetic humans • Enhanced metabolic inflammation in the muscle blocks insulin signaling • Antagonists of TLR-4 may improve insulin action in these individuals 327 PlosOne 2013; 8: e63983
Insulin resistance is activated by TLR-4 action through gut hormones 328
Toll-like receptor status in obesity and diabetes • Toll-like receptors are well characterized immune modulators that enhance inflammation • TLR-4 activation induces insulin resistance • This is suggested as a primary step in the pathogenesis of obesity and metabolic syndrome • TLR-4 is activated by both LPS from gut bacteria and dietary fatty acids • Increased gut permeability (eg. leaky gut) results in increased systemic TLR-4 activation • Targeting TLR-4 induced inflammation can prevent the initiation of diabetes, obesity and cardiovascular disease J Clin Endocrinol Me32t9ab 2014; 99: 39-48 10/7/2014 46
Artificial Sweeteners, Diabetes and Gut Microbiota 330
• Pharmacology of metformin is related to gut microbial activity • Influences GLP-1/PYY production through microbiome/gut immune interaction • Bacteroides versus Fermicules abundance associated with different clinical effects of metformin • Stool samples indicated difference among individuals in response to metformin PlosOne 2014; 9: e100778 331
332 Thorax 2012; 67: 456-63.
Lancet 2014;33 3384: 691-700
Dysbiosis, Systemic Inflammation and Allergic COPD 334
Microbial abnormalities in inflammatory airway diseases- Potential for therapy • Microbiome of the lung has been demonstrated to be altered in patients with inflammatory airway diseases • A tempting therapeutic approach is to share the microbiota to restore microbial balance • The airway microbiome might soon join the intestinal microbiome as a target of intervention • The concept of “whole body microbiome manipulation” represents an ecological approach to diseases associated with altered bacterial diversity 335 Pharmacol Ther 2014; 141: 32-39.
• Intestinal epithelium responses to bacterial products differently than other organs • Luminal bacteria are needed for healthy gut • Modest activation of toll-like receptors is important in gut mucosal remodeling • Optimal function is achieved with control of toll-like receptor activity through proper diversity of microbiome 336 N Engl J Medicine 2008; 359: 756-58.
Summary Takeaways • The future for managing chronic disease is personalized medicine that takes into account lifestyle, environment, diet and activity issues • Insulin resistance and its relationship to metabolic inflammation represents a major unifying principle in chronic disease • The initiation of metabolic inflammation is related to activation of pattern recognition receptors of which the toll-like receptors are important members • Toll-like receptor 4 activation is initiated in the gastrointestinal-associated immune system • Treatment of TLR-4 activation through interventions including pre and probiotics can serve as primary approaches to the treatment of multiple chronic diseases 337
Great Leadership in Integrative Medicine Mark J. Tager, MD CEO, ChangeWell Inc. mtager@changewell.com 338
The IM Question for Leaders As a leader, how do you transfer the whole person attitudes, values and skills of IM into cultures that may or may not be supportive of the same? 339
The Turbulent Waters of Healthcare Motivate Team Maintain Stamina & Optimism Stay on Course Keep the Ship Afloat 340
Objectives n Understand the powers of leadership n Recognize the strengths & weaknesses of your current style n Understand culture, context and communication in rapidly changing environments n Review key attitudes and behaviors for successful leadership in changing environments. 341
Leadership The process of influencing others to obtain results. 342
Leaders Depend on Power Positional Power Professional Power Peer Power Personal Power 343
You Have an Existing Style n Direction & Support n Natural Tendencies n Work Experience n Attitudes & Beliefs n Training Programs 344
WHAT MAKES A LEADER “GREAT?” 345
Worst Boss/Best Boss nWhat did s/he do? nHow did it affect your energy, competence, willingness, enthusiam, performance, motivation, desire to go the extra mile? nHow did s/he affect your health? Stress-related behaviors? Signs? Sx? 346
Leaders are Paid to Stress People In a changing environment people don’t always act “rationally” Productivity Low Stress High Stress 347
In a World of Multiple Inputs, Some People Are Only There in Body Perceptions Interpretation Compete for attention, hearts and minds 348
Leaders and the New Competition What can I do? Direction and Support To people stay focused and productive? To create greater team resilience and improve communication? To foster trust and inspire confidence? To keep my own energy, enthusiasm, health and stamina up in the process? 349
Stable vs. Changing Environments REQUIREMENTS: Perspective Flexibility Empathy Trustworthiness 350
The Power of Perspective Remain calm and positive under pressure “Maintain an optimistic outlook. Develop the will to win by capitalizing on your unit's abilities. The more difficult the situation is, the better your chance is to display an attitude of calmness and confidence.” 351
Clarify the New Context Context: a joining together..to weave together…the whole situation or relevant environment Understanding Context/Content in stable vs. changing environment Understanding culture Around here, it’s normal for … 352
Bringing Awareness to Culture When you first joined the organization, what details struck you? With regard to the change process, what typifies to you “the way we do things around here?” What rules? What procedures? What habits? Which norms support change positively? Which get in the way? Homework: Select one positive and one negative. Do a data dump 353
Communicate with Credibility The Two-Way Street How good is your relationship? Openness Honesty Give and receive feedback Trust How do you develop one? 354
Developing + Relationships Listen------Praise-----Catch em’ doing something right---build positivity. Now you can give feedback First, must understand motivation Intrinsic Extrinsic Praise and recognition Task specific Timely For them 4/1 Strokes/Pokes Use the rule of 2-1+1 355
Trustworthiness: Validity in Communication Differences in how people perceive and interpret information A consequence of genetics and early childhood upbringing Concept of temperament--Jung and others Personality determines what stresses people To be credible: speak others’ language The PowerSource Profile™ 356
Valid Communication by Type Grounding Creative Perception Logic Relationship Interpretation 357
Valid Communication Grounding Traits Creative Traits  Intuitive  Open to new ideas  Future oriented  Visionary  Ask: “Why not?”  Predictable  Practical and realistic  Information from senses  Detail oriented  Focused on here and now 358
Valid Communication Logic Traits Relationship Traits  Sensitive to others  Appreciate feelings  Emotional decision making  Considerate  Time is circular  Objective  Quantitative  Sequential  If A, then B; cause effect  Historical past 359
Empathy: Dealing with Resistance Resistance takes many form Leaders marginalize people’s resistance and pain R ‐1 +1 Diminished Answers Ignored Assurances Invalidated Solutions Answers Assurances +1 Solutions R They feel You respond with 360
Bringing the Best of IM to Leadership Maintain perspective Focus on context/understand culture Be flexible in leadership/communication style Orient messages for receiver Build trust in others 361
Integrative Medicine Certification in Administration WHY HERE? WHY NOW? 362
Qualitative meets quantitative Reimbursement Impact: ◦Wrong site surgeries ◦Hospital acquired infections ◦Readmissions prior to 30 days ◦HCHAP scores ◦Quality 363
One possible cure? Integrative Medicine: ◦ Massage ◦ Acupuncture ◦ Reiki ◦ Stress management ◦ Music therapy ◦ Aroma therapy ◦ Pet therapy ◦ Guided meditation 364
Atlantic Health Integrative Medicine Treatment Room 365
Hackensack University Medical Center 366
Atlantic Health System’s New Chambers Center for Well‐Being 367
Center Kitchen 368
Exam ROOMS 369
Massage ROOM 370
Dr Mimi Guarneri Senior Medical Advisor 371
EXAMPLE: The American Board of Integrative Holistic Medicine – 2700 docs Academy of Integrative Health and Medicine – 420,000 practitioners IHPC – Integrative Health and Policy Consortium – 200,000 practitioners 372
Contact Information F. Nicholas Jacobs FACHE International Director SunStone Management Resources 112 Washington Place Unit 4D Pittsburgh, PA 15219 E‐mail: nickjacobs@sunstoneconsulting.com Mobile: 412‐992‐6197 Home: 412‐381‐3136 Fax: 866‐381‐0219 www.sunstonemanagement resources.com www.nickjacobs.org 373
Integrative Health and Medicine: Navigating Policy Trends Len Wisneski, MD 374
All the tumult and seeming chaos, when viewed in the light of historical perspective, can be seen to represent not only the death agonies of an old order but also the birth pangs of a new epoch - a new golden age which assuredly will outshine those of the past. - Historian L. S. Stavrianos 375
Integrative Healthcare and Medicine THE FUTURE OF HEALTHCARE DELIVERY IN THEUNITED STATES 376
Institute of Medicine Report Current state of affairs – population health Unsustainable expenditures Primary care system challenges Public health infrastructure Uninsured populations Health behaviors Social and economic conditions 377
The Health of the Nation: Poor Value for the Money Life expectancy at birth Total spending on health 378
Mortality from Non-Communicable Diseases, 2008 Among the 17 peer countries, the US had 2nd highest Non-Communicable Disease mortality rate in 2008 (418:100,000) 379
The US performs poorly in health and places low on health rankings Source: National Research Council and Institute of Medicine Report: U.S. Health in International Perspective: Shorter Lives, Poorer Health (2013) Health 7 Promotion: Empowering Change through Policy Source: Human Capital Report 2013 published by Mercer and the World Economic Forum Average body mass index in 17 peer countries US Ranks 43rd in Health 380
Conditions More Prevalent in the U.S. (Age 50) Obesity Inactivity Smoking Diabetes Hypertension Heart Disease Stroke Chronic Lung Disease Cancer Arthritis 381
The Answer: Prevention and Well-Being 382
A ROSE BY ANY OTHER NAME Holistic Medicine- Consumers Integrative Medicine- Universities Complementary and Alternative Medicine (CAM) – Government Emergent- Integrative Healthcare 383
INTEGRATIVE MEDICINE MILESTONES 1978 Founding of AHMA 1990 Study by Dean Ornish MD, shows that lifestyle changes can reverse heart disease. 1992 Congress establishes the NIH’s Office of Alternative Medicine. 1993 Study by David Eisenberg, MD demonstrates that one in three Americans use CAM therapies. 384
1996 Founding of ABHM 1996 Interest in St. John’s wort explodes after British Medical Journal study finds the herb effective in treating depression. 1997 First class of physician–Fellows begins training at the University of Arizona’s Program in Integrative Medicine. NIH consensus panel supports use of acupuncture for various conditions. 385
1998 The Journal of the American Medical Association devotes an entire issue to alternative medicine. NIH’s Office of Alternative Medicine is upgraded in status, and renamed the National Center for Complementary and Alternative Medicine. 2000 President Clinton establishes the White House Commission on Complementary and Alternative Medicine Policy. Nineteen universities form CAHCIM 386
2001 Formation of the Integrated Healthcare Policy Consortium 2003 Institute of Medicine CAM Conference 2004 Founding of ACCAHC 2009 Institute of Medicine CAM Conference 2011 American College of Lifestyle Medicine 2012 Integrative Medicine in America Report 2013 National Coordinating Center for IM IMPriME 387
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SITE SELECTION AND METHODS • 60+ sites identified from Bravewell Clinical Network, Consortium of Academic Health Centers for Integrative Medicine and suggested by IM leaders • 29 chosen to represent the field • Directed by MD, other doctoral level provider or nurse • In operation at least three years • Significant patient volume • Prior clinical contributions to the field • Sites only delivering non-conventional care not included • Directors responded to REDCap-based questionnaire • Site visits made by study team for qualitative data 389
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CIHA Syllabus

  • 1. Leadership in Integrative Health Certification in Integrative Health Administration (CIHA) Thurs, Oct 30 – Fri, Oct 31, 2014 - San Diego Course Description Health care is undergoing a transformation toward models of integrative medicine, prevention, sustainability and community collaborations. By exploring key components of an integrative health model, this leadership program will provide essential clinical, financial and administrative tools to respond to the emerging challenges of health care delivery. Utilizing a personalized comprehensive approach to health care, attendees will be joining a unique, rapidly growing group of healthcare executive leaders. This certificate program is offered by nationally recognized experts in integrative medicine and administration, and will utilize an integrative health framework to connect with population health, ACO’s, the impact of the ACA, patient and employee satisfaction and sustainability. Evidence-based practices that address wellness and health with multiple benefits will be explored, preparing participants to become inspired change agents who will make a true difference in health care delivery. Health care transformation will require unprecedented changes in treatment and care models. Whole person approaches to health and wellness have been shown to improve the health of populations and reduce the costs of care. Success stories of engaged institutions will be central to the conversation about how innovations can be shared and implemented. The Leadership in Integrative Health Certification After the completion of an additional 6 hours of online content and post-tests (included in your registration fee) for a total of approximately 20 contact hours, recipients will receive The Leadership in Integrative Health Certificate. More information will be emailed after the meeting, this email will come from the American Board of Integrative Holistic Medicine. This certification program is the first of its kind, and will establish participants as a new community of leaders in health care transformation. Faculty Jennifer Blair, LAc, MaOM AHMA Board of Directors Licensed Acupuncturist Penny George Institute for Health and Healing Minneapolis, Minnesota Jeffrey Bland, PhD, FACN, FACB Founder & President Personalized Lifestyle Medicine Institute (PLMI) Seattle, Washington Diego Coira, MD Hackernsack University Medical Center Hackensack, New Jersey Daniel Friedland, MD AIHM Chair President-Elect, ABIHM Founder and CEO, SuperSmartHealth San Diego, California Mimi Guarneri, MD, FACC, ABIHM President, AIHM Founder Scripps Center for Integrative Medicine San Diego, California Robin Guenther FAIA, LEED AP Principal of Perkins+Will Senior Advisor, Health Care Without Harm New York, New York Jamie Harvie, P. Eng Executive Director Institute for a Sustainable Future Duluth, Minnesota F. Nicholas Jacobs AIHM Treasurer International Director Sun Stone Management Resources Harrisburg, Pennsylvania Mary Jo Kreitzer, PhD, RN, FAAN Founder and Director, Center for Spirituality & Healing Professor, School of Nursing Minneapolis, Minnesota Wayne Miller Nura Health Vashon, Washington 1
  • 2. Leadership in Integrative Health Certification in Integrative Health Administration (CIHA) Thurs, Oct 30 – Fri, Oct 31, 2014 - San Diego Tabatha Parker, ND AIHM Director of Education Co-founder and Executive Director NDI NCNM Co-Chair Masters of Science in Global Health San Diego, California Rauni Prittinen King, RN, BSN, MIH, HNB-BC, CHTP/I Founder, Scripps Center for Integrative Medicine President, Holistic & Integrative Medicine Resources, Inc. San Diego, California Emilie Rowan, LCSW Director, Center for WellBeing Atlantic Health Morristown, New Jersey Mark Tager, MD CEO ChangeWell Inc. Kelly Warshel, MD, ABIHM Medical Director Windber Hospice Johnstown, Pennsylvania Leonard A. Wisneski, MD, FACP Clinical Professor of Medicine George Washington University Medical Center Adjunct Faculty Department of Biochemistry and Molecular Biology, Division of Integrative Physiology Georgetown University Couifer, Colorado Schedule of Events & Table of Contents Thursday, October 30, 2014 8 a.m. Registration & Breakfast 8:15 a.m. Welcome & Introduction 8:30 a.m. Focused Track (Mission Bay Room) Transformational Leadership in Integrative Medicine Daniel Friedland, MD, ABIHM F. Nicholas Jacobs, FACHE Page 5 10:30 a.m. Break & View Exhibits 11 a.m. Focused Track (Mission Bay Room) Transformational Leadership in Integrative Medicine Daniel Friedland, MD F. Nicholas Jacobs, FACHE Page 46 12:30 p.m. Lunch (Paradise and Sunset Terrace) 2 p.m. Plenary Session (Paradise Ballroom) Health as an Economic Strategy F. Nicholas Jacobs, FACHE Page 107 2:45 p.m. Plenary Session (Paradise Ballroom) Spirituality in Health and Medicine Mary Jo Kreitzer, PhD, RN, FAAN Page 175 3:30 p.m. Break & View Exhibits 4 p.m. Plenary Session (Paradise Ballroom) Global Health Tabatha Parker, ND Page 248 4:45 p.m. Plenary Session (Paradise Ballroom) Personalized Integrative Health Care: A Look Ahead Jeffrey Bland, PhD, FACN, FACB Page 284 5:30 p.m. Closing Remarks 6 – 9 p.m. Exclusive reception at Pacific Pearl La Jolla Goldfield Stage will pick up/drop off in front of the Conference Center at Paradise Point 2
  • 3. Leadership in Integrative Health Certification in Integrative Health Administration (CIHA) Thurs, Oct 30 – Fri, Oct 31, 2014 - San Diego Schedule of Events continued Friday, October 31, 2014 (All functions will be held in the Mission Bay Room) 7:30 a.m. Breakfast 8 a.m. Organizational Transformation: Guiding the Metamorphosis Mark Tager, MD Page 338 8:40 a.m. Administrative Implementation of Integrative Health in Your Health System F. Nicholas Jacobs, FACHE Page 362 9:10 a.m. Leading from the Heart: Reconnecting to Your Mission Mimi Guarneri, MD, FACC, ABIHM Page n/a 9:50 a.m. Break 10:20 a.m. Integrative Health and Medicine: Navigating Policy Trends Leonard Wisneski, MD, FACP Page 374 11 a.m. Integrating Clinical and Behavioral Health Units –Solutions to Difficult Problems Diego Coira, MD, FAPA Page 434 11:30 a.m. Dying with dignity: End of Life conversations in an ACO context Kelly Warshel, MD, ABIHM Page n/a 12:10 p.m. Lunch 12:50 p.m. Healthy Food from the Clinic to the Community – Lessons of Success through Integrated Operations Jamie Harvie, P Eng Page 469 1:20 p.m. An Evolving Narrative: Learning Lessons from Integrative Health Implementation Jennifer Blair, LAc, MaOM Page 504 1:50 p.m. The Business Case for Sustainable Healthcare Buildings: Supporting Community Health and Resilience Robin Guenther, FAIA, LEED AP Page n/a 2:25 p.m. Panel: Billing and Paying for Integrative Health and Medicine F. Nicholas Jacobs, FACHE Mimi Guarneri, MD, FACC, ABIHM Rauni Prittinen King, RN, BSN, MIH Emilie Rowan Wayne Miller Page n/a 3:30 p.m. Adjourn 3
  • 4. Leadership in Integrative Health Certification in Integrative Health Administration (CIHA) Thurs, Oct 30 – Fri, Oct 31, 2014 - San Diego We’d like to Hear from you We value your feedback, please take some time following the program to complete an online evaluation. 1. After the conference, visit http://cmetracker.net/SCRIPPS/Login?FormName=getCertificate to complete the conference evaluation. 2. Enter your username and password. Please note your email address must match the email account you previously used to register for the conference. If a new user, follow instructions to log in and set up your password for your online account. 3. Enter CME Activity Code 35422 The evaluation will only be available for four weeks after the conference and must be completed by November 18, 2014. 4
  • 5. Transformational Leadership (Engaging Conscious Leadership) Daniel Friedland, MD Chair, AIHM CEO, SuperSmartHealth © SuperSmartHealth® 2014 5
  • 6. Qualities of High Performance Leaders © SuperSmartHealth® 2014 6
  • 7. Qualities of Low Performance Leaders © SuperSmartHealth® 2014 7
  • 8. Reactivity Creativity Low Performance Leader High Performance Leader Achievement Oriented • Purpose and Vision • Strategically Focused • Decisive • Gets Results Relates Well • Cares • Fosters Team Play • Collaborates well • Mentor Authentic • Integrity • Courage Systems Aware • Concerned for Community • Sustains Productivity Self-Aware • Personal Learner • Composure • Balance • Selfless Leader Complying • Pleasing • Conforming • Conservative • Passive Protecting • Arrogant • Cynical and Critical • Distant Controlling • Autocratic • Driven to Prove Self Worth • Ambitious to Get Ahead • Perfectionistic Adapted from The Leadership Circle © SuperSmartHealth® 2014 8
  • 9. Leadership Circle Profile™ Graphic 10 20 30 40 50 60 70 80 90 CREATIVE Critical Arrogance Leadership Effectiveness Low High Strategic © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 5 Low Balance 90 80 70 60 50 40 30 20 10 TeamPlay Fosters Connection Caring Interpersonal Mentoring & Intell igence Developing Composure Balance Purposeful& Visionary Achieves Results Systems Thinker Decisiveness Selfless Leader 90 80 70 60 50 40 30 20 10 90 80 70 6 0 50 40 30 20 10 10 20 30 4 0 50 60 70 80 90 10 20 30 40 50 60 70 80 90 10 20 30 40 50 60 70 80 90 10 20 30 40 50 60 70 80 90 TASK RELATI O N SHI P Integrity Courageous Conservative Pleasing Belonging Passive REACTIVE Personal Autocratic Ambition Driven Perfect Self-Awareness Authenticity Learner Controlling Distance Relating Protecting Complying Sustainable Productivity Achieving Authenticity Community Concern Systems Awareness 10 20 30 40 50 60 70 80 90 Leadership Potential Utilization Low High High Balance Relationship-Task Balance Reactive Creative Focus Collaborator 10 20 30 40 50 60 70 80 90 90 80 70 60 50 40 30 20 10 Identity 10 20 30 40 50 60 70 80 90 Reactive-Creative Scale 9
  • 10. Leadership Effectiveness Scale • I am satisfied with the quality of leadership that he/she provides. • He/she is the kind of leader that others should aspire to become. • He/she is an example of an ideal leader. • His/her leadership helps this organization to thrive. • Overall, he/she provides very effective leadership. © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 6 10
  • 11. Correlations to Leadership Effectiveness -0.57 0.04 -0.13 © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 7 0.71 0.65 0.41 0.41 0.76 0.79 0.73 0.81 0.79 0.58 0.83 0.63 0.59 0.70 0.69 0.65 0.70 0.85 0.72 0.72 0.72 0.77 0.85 0.08 -0.28 -0.37 -0.60 -0.55 -0.51 -0.50 -0.49 -0.11 -0.59 -0.43 11
  • 12. Leadership Effectiveness & Creating © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 8 Leadership Effectiveness Total Creating Score R = 0.93 Rsq = 0.86 5.0 4.5 4.0 3.5 3.0 2.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 12
  • 13. Leadership Effectiveness & Reacting © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 9 Leadership Effectiveness Total Reactive Score R = -0.66 Rsq = 0.44 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.0 1.5 2.0 2.5 3.0 3.5 13
  • 14. Your Brain and Leadership Reactivity Fight & Flight Creativity Fulfillment Low Performance Leadership High Performance Leadership 14
  • 15. 15
  • 17. Mirror Neurons Evolution of Neonatal Imitation. Gross L, PLoS Biology Vol. 4/9/2006, e3 17
  • 18. Social and Emotional Contagion Fight Flight Trigger 1 2 Fight Flight Trigger Give Receive 1 2 Receive Give Cycle of Reactivity Cycle of Creativity © SuperSmartHealth® 2014 18
  • 19. The Importance of Leadership Reactivity Fight & Flight Creativity Fulfillment Low Performance Leadership Actively Disengaged Employees Cost High Performance Leadership Actively Engaged Employees Benefit © SuperSmartHealth® 2014 19
  • 20. Perceived Leadership Integrity and Burnout • 287 family medicine and general internal medicine respondents (68.3% response rate) • Correlated burnout to Perceived Leadership Integrity Index (PLII): 1. Support for physician’s core values 2. Prioritizes quality over costs 3. Positive response to physicians raising quality issues 4. Interest in patient care above self-interest 5. Honesty • Low PLII associated with physician burnout (p = 0.0001) and intention to leave (p = 0.026) Poses RM, Baier-Manwell L, Mundt M, Linzer M. Perceived leadership integrity and physicians’ stress, burnout, and intention to leave practice. J Gen Intern Med. 2005;20:S182. © SuperSmartHealth® 2014 20
  • 21. The Cost and Benefit of Employee Engagement Difference between top and bottom quartile of employee engagement: • Absenteeism 40% • Turnover 25-50% • Patient Safety Incidents 41% • Safety Incidents 49% • Quality Defects 60% • Customer Satisfaction 12% • Productivity 18% • Profitability 16% Employee Engagement. What’s Your Engagement Ratio? http://www.gallup.com/strategicconsulting/121535/Employee-Engagement-Overview-Brochure.aspx 21
  • 22. Leadership Effectiveness & Business Performance © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 18 Business Performance Index Leadership Effectiveness R = 0.612 Rsq = 0.3752 7.5 7.0 6.5 6.0 5.5 5.0 4.5 4.0 3.5 • Sales/Revenue Growth • Market Share • Profitability/ROA • Quality Products/Services • New Product Development • Overall Performance 2.0 2.5 3.0 3.5 4.0 4.5 5.0 http://www.theleadershipcircle.com/wp-content/uploads/2011/05/12_OrgPerformance.pdf 22
  • 23. Aggregate Profile of Those Leaders Whose Businesses’ Were Evaluated as Highest Performing © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 19 Top 10% 23
  • 24. Aggregate Profile of Those Leaders Whose Businesses’ Were Evaluated as Lowest Performing © 2011 The Leadership Circle, All Rights Reserved. Company Confidential 20 Bottom 10% 24
  • 25. How Do You Shift? Reactivity Fight & Flight Creativity Fulfillment Low Performance Leadership Actively Disengaged Employees Cost Growth and Profitability Actively Engaged Employees Benefit Growth and Profitability SA SELF-ESTEEM BELONGING SAFETY High Performance Leadership © SuperSmartHealth® 2014 25
  • 26. The 4 in 4 Framework™ to Engage Conscious Leadership Integrating Mental Emotional Social Spiritual Intelligence © SuperSmartHealth® 2014 26
  • 27. The 4 in 4 Framework™ Make the Turn into What’s Truly Important Cultivate Creativity By Reflecting on What’s Truly Important Reappraise Stress and Self-Doubt Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment 1 2 4 3 © SuperSmartHealth® 2014 27
  • 28. A practice of paying attention with a sense of openness, curiosity, acceptance, and compassion, of whatever is arising in the present moment © SuperSmartHealth® 2014 28
  • 29. The 4 in 4 Framework™ Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment 1 © SuperSmartHealth® 2014 29
  • 30. Recognize Reactivity: 1. Physical Sensations 2. Feelings 3. Thoughts 4. Behaviors 1 Is it doing more harm than good? © SuperSmartHealth® 2014 30
  • 31. Recognize Reactivity: 1) Pause – 3 breaths and/or exit 2) Assess hunger, thirst and fatigue 3) “Name it to tame it!” 4) Consider best response 1 Is it doing more harm than good? If so: © SuperSmartHealth® 2014 31
  • 32. The 4 in 4 Framework™ Reappraise Stress and Self-Doubt Reactivity Fight & Flight Creativity Fulfillment Recognize 2 Reactivity Is it doing more harm than good? 1 © SuperSmartHealth® 2014 32
  • 33. Reappraise Stress and Self-Doubt: Triggers of Stress and Self-Doubt: • What if… • If only... • Judgment and Criticism • Rejection and Abandonment • Neglect and Abuse • Standards and Expectations • Loss • Transition 2 © SuperSmartHealth® 2014 33
  • 34. Reappraise Stress and Self-Doubt: 2 Appraise Reappraise 1) What happened (just the facts)? 2) What is my belief about what happened? 3) Is my belief true or what is the evidence this should be so? 4) How could I view this differently? Adapted from Albert Ellis et al. Rational Emotive Behavior Therapy. Amer Psychological Assn; 3 edition 2011. © SuperSmartHealth® 2014 34
  • 35. The 4 in 4 Framework™ Reactivity Fight & Flight Creativity Fulfillment Recognize Reactivity Is it doing more harm than good? 1 Reappraise Stress and Self-Doubt It’s nothing more than psychic gas! 2 Cultivate Creativity By Reflecting on What’s Truly Important 3 © SuperSmartHealth® 2014 35
  • 36. Cultivate Creativity By Reflecting on What’s Truly Important • Learning • Connecting • Expressing Potential • Being of Service • Creating Opportunity • Experiencing Significance • Leaving a Legacy 3 © SuperSmartHealth® 2014 36
  • 37. Cultivate Creativity By Reflecting on What’s Truly Important 3 VSIR Process Vision Strategy Implementation Results © SuperSmartHealth® 2014 37
  • 38. SMART Results Specific Measurable Aligned with your Vision Realistic Time Framed © SuperSmartHealth® 2014 38
  • 39. Cultivate Creativity By Reflecting on What’s Truly Important Health Relationships Work 3 © SuperSmartHealth® 2014 39
  • 40. The 4 in 4 Framework™ Reactivity Fight & Flight Creativity Fulfillment Recognize Reactivity Is it doing more harm than good? 1 Reappraise Stress and Self-Doubt It’s nothing more than psychic gas! 2 Cultivate Creativity By Reflecting on What’s Truly Important Learning Connecting Expressing Potential Being of Service Creating Opportunity Experiencing Significance Leaving a Legacy 3 Make the Turn into What’s Truly Important 4 © SuperSmartHealth® 2014 40
  • 41. 4 2 1 3 Find Frame Apply 1 3 Evaluate Make the Turn into What’s Truly Important 4 © SuperSmartHealth® 2014 41
  • 42. The 4 in 4 Framework™ Cultivate Creativity By Reflecting on What’s Truly Important Reappraise Stress and Self-Doubt Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment Is it doing more harm than good? It’s nothing more than psychic gas! Learning Connecting Expressing Potential Being of Service Creating Opportunity Experiencing Significance Leaving a Legacy Make the Turn into What’s Truly Important Frame 1 2 3 Apply 4 Evaluate Find 1 2 4 3 © SuperSmartHealth® 2014 42
  • 43. An Inspired Shift in Conversation Reactivity Fight & Flight Creativity Fulfillment Low Performance Leadership Actively Disengaged Employees Cost Growth and Profitability High Performance Leadership Actively Engaged Employees Benefit Growth and Profitability © SuperSmartHealth® 2014 43
  • 44. For More Information and Resources see: http://supersmarthealth.com/leadership 44
  • 45. Thank You! Daniel Friedland, MD Chair, AIHM CEO, SuperSmartHealth daniel@supersmarthealth.com 858.481.2393 45
  • 46. AIHM Leadership 2014 Making the Change 46
  • 47. Redesigning Your Future “The only thing that is always consistent in life is CHANGE” 47
  • 48. A different place a different time New ways to see opportunities, produce sustainable growth and reshape organizations for consistent innovation 48
  • 49. “This Business Model Doesn’t Work Anymore!” Saddle makers- automobiles Watch makers – the quartz watch Newspapers Music Movies 49
  • 50. What is the Reality of Change? “Change or Die” 50
  • 51. What do leaders do? Create a vision and direction for the organization, and mobilize to accomplish that vision and direction. 51
  • 52. Transformation It should NOT be our goal to create what people will LIKE. It should be our goal to create what people will LOVE! 52
  • 53. Chaos provides opportunity  People who are security dependent won’t change.  Surfing the wave doesn’t mean fighting the ocean. (Don’t resist it.) 53
  • 54. What Kind of Future Do YOU Want to Occupy?  You have the ability to design your future.  Half the time work in areas that you don’t know  Half the time work in areas that you do know,  And you will GROW. 54
  • 55. Worst of Times and Best of Times  Collaboration vs. Competition  Healing vs. Curing  Bottom-up vs. Top Down  Patient Centered vs. Employee and Physician Centered What you focus your attention upon IS YOUR reality! 55
  • 56. There are NO lines . . .WE MADE THEM! From Outer Space:  Township  County  State  Nation  Work all sides. Nothing has to be the way it is. We can INVENT or PREVENT our future 56
  • 57. The Pale Blue Dot CArL Sagan We succeeded in taking that picture from deep space, and, if you look at it, you see a dot. That's here. That's home. That's us. 57
  • 58. The Calf Path  by Sam Walter Foss 10/7/2014 13 An Army of ONE! 58
  • 59. One day, through the primeval wood, A calf walked home, as good calves should; But made a trail all bent askew, A crooked trail as all calves do. Since then two hundred years have fled, And, I infer, the calf is dead. But still he left behind his trail, And thereby hangs my moral tale. The trail was taken up next day By a lone dog that passed that way, And then a wise bell-wether sheep Pursued the trail o'er vale and steep, And drew the flock behind him, too, As good bell-wethers always do. An Army of ONE! 10/7/2014 14 59
  • 60. And from that day, o'er hill and glade, Through those old woods a path was made; And many men wound in and out, And dodged, and turned, and bent about And uttered words of righteous wrath Because 'twas such a crooked path. But still they followed—do not laugh— The first migrations of that calf, And through this winding wood-way stalked, Because he wobbled when he walked. This forest path became a lane, That bent, and turned, and turned again; This crooked lane became a road, Where many a poor horse with his load Toiled on beneath the burning sun, And traveled some three miles in one. And thus a century and a half An Army of ONE! 10/7/2014 15 They trod the footsteps of that calf. 60
  • 61. The years passed on in swiftness fleet, The road became a village street; And this, before men were aware, A city's crowded thoroughfare; And soon the central street was this Of a renowned metropolis; And men two centuries and a half Trod in the footsteps of that calf. Each day a hundred thousand rout Followed the zigzag calf about; And o'er his crooked journey went The traffic of a continent. A hundred thousand men were led By one calf near three centuries dead. They followed still his crooked way, And lost one hundred years a day; For thus such reverence is lent To well-established precedent. An Army of ONE! 10/7/2014 16 61
  • 62. A moral lesson this might teach, Were I ordained and called to preach; For men are prone to go it blind Along the calf-paths of the mind, And work away from sun to sun To do what other men have done. They follow in the beaten track, And out and in, and forth and back, And still their devious course pursue, To keep the path that others do. But how the wise old wood-gods laugh, Who saw the first primeval calf! Ah! many things this tale might teach— But I am not ordained to preach. An Army of ONE! 10/7/2014 17 62
  • 63. And still their devious course pursue, To keep the path that others do. But how the wise old wood-gods laugh, Who saw the first primeval calf! Ah! many things this tale might teach— But I am not ordained to preach. An Army of ONE! 10/7/2014 18 63
  • 64. Reinventing the Patient Experience  Best of a Hotel – Hire a hotel manager  Best of a Spa – Add Integrative Medicine  Best of a Hospital – Become the employer of choice 64
  • 65. THE FUTURE BECOMES A DESIGN FUNCTION 65
  • 66. Living on the Edge  The world that is or the world that will be.  Idealsim vs. Realism  Nothing has to be the way it is.  No one way is the Right Way 66
  • 67. Edge Runners are World Creatures Power to change reality  Let’s make it be some other way.  We have the capacity for self-design.  We can modify our environment. 67
  • 68. What Kind of Future Do YOU Want to Occupy?  You have the ability to design your future.  Half the time work in areas that you don’t know . . .  Half the time work in areas that you do know,  And you will GROW. 68
  • 69. The Universe  If you look into an electron microscope you see infinitely lesser.  If you look into a telescope you see infinitely greater. There are Endless Possibilities 69
  • 70. Science Follows Science Fiction Discovery comes from fiction. Discovery comes from FANTASY. What limitations do you accept? Money will follow ideas. 70
  • 71. Where is YOUR future?  Excite yourself to get your imagination moving to design your future.  If there are limitations in your frame of reference . . .you are keeping yourself in BONDAGE! 71
  • 72. There are NO lines WE MADE THEM!  Township  County  State  Nation  Work all sides.  Nothing has to be the way it is.  We can invent or PREVENT our future 72
  • 73. Boundaries  There are NO boundaries but the boundaries YOU make.  All limitations are self imposed.  The universe is ONE CONNECTED fabric.  What is your vision of the future? ONLY YOU KNOW.  We can empower ourselves to create a new world. 73
  • 74. The Key to Change Once you have totally accepted it, you can change it. 74
  • 75. What is the conversation you have with yourself?  Everything makes sense in a large enough context.  Sense what is trying to happen and let it happen.  Be alert to changing environmental conditions.  Reframe any limitations to become opportunities.  Tremendous limitations breed success. They open doors. 75
  • 76. Steps to the change  Explain the depth of the problem.  Offer nontraditional solutions  Introduce them as a package  Work to ensure they will actually happen 76
  • 77. The WIFM for the Organization?  Increase innovation and creativity  Improve service to peers and patients  Inspire passion and performance  Increase retention of top performers 77
  • 78. What we CAN DO! We cannot change the human condition – but we can change the condition under which humans live and work. 78
  • 79. First Two Weeks as CEO Met with every employee in my office one on one for approximately seven minutes each non-stop. 79
  • 80. WHY?  It was an effort to begin to BUILD TRUST by being: Open Honest Attentive Sincere Kind Interested (Hawthorne 80
  • 81. Employee Communications  Nick’s Blog  Open Door Policy  Newsletter  Birthday Pizza with the President  Town Hall Meetings  Management by wandering around  Caught You Caring 81
  • 82. What was the purpose of these initiatives?  Keep everyone informed – The secret was “there was no secret.”  Opportunities to “Accentuate the Positive”  Opportunities to re-direct energy when things had gone wrong. 82
  • 83. Employee Physical Wellness Osteoporosis Program Smoking Cessation Eat Well for Life Program Strength Training Cardiac Rehab Walking Trails 83
  • 84. Employee Fitness  HealthStyles – Nearly 50% of employees were members  Open approximately 90 hours per week.  Employee costs approximately $10 per month  Includes classes in kick boxing, aerobics, water aerobics, yoga, tai chi 84
  • 85. Mr. Hawthorne AGAIN!  This effort demonstrated that the employees were valued that they were, in fact, THE MOST VALUED ASSET of the organization 85
  • 86. Employee Empowerment 15 PTO Days Donation of PTO days On site Baby Sitting Social Welfare Death of an in-law or grandchild 86
  • 87. Employees are NOT children, and I was NOT their Father  If you treat people like adults 90% of them will respect you for this effort  If you show them kindness, they will go the extra mile  If you truly demonstrate that you care, so will they 87
  • 88. Employee Training & Development Disney Training for ALL employees EQ2/Emotional Quotient Training Planetree Training Team Dale Carnegie 88
  • 89. Opening doors to show them that:  There are only four types of responses No Response Negative Response Redirection Positive Response 89
  • 90. What were our goals? Learn Redirection Describe problems clearly and without any BLAME Explain the negative impact of a problem When appropriate, TAKE THE BLAME Make sure the task is understood Demonstrate and express trust and confidence 90
  • 91. Employee Emotional Health The Greenhouse Planetree Room Healing Gardens Gazebos Live Music Counselors Clergy The Swat Team 91
  • 92. Other ways to demonstrate our investment in their futures  Praise Immediately  Be specific  Share positive feelings (hugs)  Encourage them to keep up the good work 92
  • 93. Dr. Dean Ornish Program for Reversing Heart Disease Six Weeks of Ornish Light Personal Nutrition Counseling Healthy Vending Machines Healthy Choice Meals (Fat Free, Vegetarian) 93
  • 94. Continued Dedication to Employee Personal Growth Reimbursement for additional college level credits and degrees Workshops Conferences Video Teleconferencing 94
  • 95. More Employee FUN!!!  Sundae Parties  Subs and Pizza Parties  Trips to Pittsburgh Pirates Baseball  Tickets to: The Symphony, The Opera, Theater, Hockey, and lots of DINNERS.  Employee Recognition Dinners  Hospital Week Cookout  BIG HOLIDAY PARTY 95
  • 96. We Asked the Bullies to RESIGN  Anesthesiology  Critical Care Specialists  Internal Medicine Physicians  Surgeons In 11 years we asked 17 highly qualified physicians and 37 employees to LEAVE because they were bullies 96
  • 97. Conventional right brain wisdom said: The secret to seeing--really seeing-- was to quiet the bossy, know-it-all left brain! 52  A Whole New Mind by Daniel H. Pink 97
  • 98. Right Brain Attributes  Artistry  Empathy  Taking the long view  Pursuing the inspirational 53 98
  • 99. What will get you in the door? Creative thinking Creative ideas Creative approaches Creative solutions (But most importantly) “Relationships” 54 99
  • 100. The Patient Experience was Redesigned THE FUTURE BECAME A DESIGN FUNCTION 100
  • 101. Multidisciplinary research team with expertise in:  High throughput research,  Functional genomics,  Proteomics,  Molecular biology,  Cell biology,  Biochemistry,  Histopathology,  Laser capture microdisection  Bioinformatics  Database development & data warehousing Genomics Lab. Laser dissection Lab. PCR Lab. Proteomics Lab. 101
  • 102. High‐throughput Research  WRI is equipped for high throughput parallel analysis of gene expression.  Parallel examination of global gene expression as a function of disease, habit, therapy or surgery. Ettan Spot Picker 96 Capillary DNA Analyzer DNA Microarray Spotter Automated Slide Processor 102
  • 103. Protein Research Platforms for parallel analysis characterization of up to 1200 proteins within a 24 hour period LC/MS/MS Electrophoresis Identification Imaging Protein picking Protein digestion MALDI-tof 103
  • 104. Platform for Large‐scale Biology  Advanced robotics for automated protein spot picking and processing  State of the art instrumentation for:  Global protein profiling  Differential expression  Peptide identification Spot handling robot for high throughput proteomic research 104
  • 105. Clinical Breast Care Project of Walter Reed National Medical Center 105
  • 107. Nick Jacobs, FACHE International Director SunStone Management Resources 107
  • 108. 1987 – 2014 Memorable Quote from two centuries! 108
  • 109. 109
  • 110. 110
  • 111. “Originality is dangerous. If you want to increase the sum of what is possible for human beings to say, to know, to understand and therefore in the end, to be, you actually have to go to the edge and push outwards. . . At its very best, it’s a revolution” 111
  • 113. 113
  • 114. Medicine in the United States is NOT Integrative 114
  • 115. Transition from Fee for Service to Value-based Care 115
  • 116. An Army of ONE! 10/7/2014 10 116
  • 117. “Obviously, both hospitals and physicians are worried about. . . CHANGE, but it is common knowledge that if something is NOT DONE, our health care system will crash and burn. Think of this, providers would get paid more for keeping their patients healthy and out of the hospital. What a concept.” Dr. Paul Levy 117
  • 118. THE FUTURE OF HEALTHCARE IN AMERICA 118
  • 119. Successful new care models are emerging, providing new ways to get and give care, to create and maintain relationships, and organize communities. Many of these offerings replace traditional functions, adding new dimensions of accessibility, value, and transparent activity. Consumers and patients are eagerly adopting these new solutions in their lives. 119
  • 120.  Concierge,  Membership Model,  Par, No Par,  Insurance vs. Cash,  Combination Insurance and Cash,  Multi-disciplinary Integrative Practitioners: ND’s, Chiropractors, Massage, Energy Medicine, NP’s, PA’s Health Coaches, Yoga 120
  • 121. Why can’t hospitals and physicians do the same? They can – but not without dramatic changes in the way they think, the strategies they adopt and the innovation processes they use. 121
  • 122. Physicians, Hospitals, and Health Systems that make this commitment will discover extensive opportunity. They will succeed in engaging large new segments of patients, both among the public and among businesses, and they will discover ways to serve them more effectively than ever before. 122
  • 123. Find a way to help you migrate from an old model of care to diverse and growing portfolios of services that engage throngs of new patients and supporters through efficiency, quality, transparency and patient centered care. 123
  • 124. In this fast-changing environment, how can an industry built on a centuries-old model be transformed? Opportunities are hard to see and even harder to capitalize on when you are wearing the blinders imposed by several hundred years of tradition. 124
  • 125. It is NOT our goal to create what people will LIKE. It is our goal to create what people will LOVE! 125
  • 126. THE FUTURE BECOMES A DESIGN FUNCTION 126
  • 128. $35 billion Annually on diabetes and/or metabolic syndrome 26 million or 8% Americans diagnosed Type II diabetes 70 million or 22% Americans in development stages 128
  • 129.  About 90 percent of our expenditures are because of stress related issues, and when we take such amazing statistics into consideration as the fact that the United States consumes two times more fat than Asia, three times less fiber, and 90 percent more animal protein, it has to make us think a little bit about this course that we are currently pursuing. 129
  • 130. 24 Million People in the United States live in Food Deserts! 130
  • 131. Presidents of the United States Reagan – 20 million Geo HW Bush – 30 million Clinton – 33 million George W. Bush – 49 million Obama – 50 million 131
  • 132.  In 1960 our parents spent approximately 18% of their salaries on Food . . .  In 1960 our parents spent 9% of their salaries on Healthcare  In 2013 we spend 9% of our salaries on food  In 2013, we spend 18% of our salaries on healthcare Could it be OUR FOOD??? 132
  • 133.  7,000 to 10,000 Baby Boomers turning 65 every day  45% of newly insured will be on Medicaid Creating an imbalance for health care institutions between medical and surgical care 133
  • 134. Why can’t we reach out to our communities in order to save our health systems, practices, and protect our future? 134
  • 135. It has long been recognized that it is easier to put into practice wellness and prevention initiatives than to eliminate a service once it has been offered. So, how do health systems address cost pressures, income shortages and shifting demographics? 135
  • 136.  With the creation of Accountable Care Organizations as prescribed through the Affordable Care Act, Integrative Medicine could become a fully endorsed service-line by all Health Systems to be utilized in income creation and expense reduction for numerous aspects of care. 136
  • 137.  Integrative Medicine — the practice of medicine that:  Reaffirms the importance of the relationship between the practitioner and the patient,  Focuses on the whole person,  Is informed by evidence, and  Makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing. 137
  • 138.  Holistic Medicine — from the root HEALTH  Medical care that views physical and mental and spiritual aspects of life as closely interconnected and equally important approaches to treatment. 138
  • 139.  Diet  Exercise  Stress Management  Group Support  Expanded from 36 to 72 visits  Paying $80 and in 2014 this goes to $112 a visit  Over $7000 per patient 139
  • 140.  Because Integrative Medicine deals directly with root cause medical issues, protocols implemented by Integrative Medicine health coaches that follow patients post discharge, ensure follow-up appointments and increase patient satisfaction at all levels through individualized attention and care, several of the cost/price issues will be addressed and marginalized. 140
  • 141.  A complete community health related effort that includes the creation of well-being centers, workshops, appropriate screenings, as well as wellness and prevention classes can ignite community wide awareness and participation in health changing attitudes and activities; hence, lowering the need for expensive inpatient care on many levels. 141
  • 142.  By assisting the residents of the greater service area to become the CEO of their own health, we are creating an awareness movement not dissimilar to those psycho-social societal efforts that we’ve seen over the past two decades to reduce inappropriate consumption of alcohol, drugs and tobacco. 142
  • 143. Integrative health coaching is a co-creative and dynamic partnership between a consumer (patient) and professional coach embedded into a healthcare management system designed to identify, monitor, and motivate behavior in order to maximize the physical, mental, social and spiritual health of the consumer. Health coaches are medically licensed and coaching certified. 143
  • 144. Having patient advocates co-ordinate the care of the 18 Club, patients with nine physicians with whom they interact annually and nine different drugs that they take daily, would be of tremendous benefit. It would help them avoid unneeded duplications, millions could be saved. 144
  • 145.  Help to alter labor cost by redesigning inpatient care models and supplementing nursing care.  This will improve nursing quality and the nursing work environment, prevent demand of less profitable services and create a healing environment that also contributes to lower lengths of stay and fewer hospital acquired infections. 145
  • 146. 146
  • 147. Show me the money . . .HCHAPS! 147
  • 148. Do the Math! 148
  • 149. Transformational Practices  Increases in Patient Satisfaction  Increases in Employee Satisfaction  Increase in Patients  Increase in Quality  Reduction in number of lawsuits  Reduction in readmissions prior to 30 days 149
  • 150. 1.6 Hosp. * 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 Hosp. A Hosp. B Hosp. C Hosp. D Hosp. E Hosp. F Hosp. G Risk-adjusted index is statistically significant at a confidence level of 95% Medical Center had the lowest mortality rate of 0.8% compared to 8 peer hospitals all above 1% 150
  • 151. Come to OUR Hospital You’ll Die Less Often! 151
  • 152.  Judy Rich, CEO Tucson Medical Center/TMC Healthcare  This has been a journey that has required an “all-in” leadership commitment. No dabbling in an ACO… This model fundamentally changes the way we do business. This journey is not for the timid; it is full of risk and potential obstacles, but it is the necessary path for us to fulfill a core mission of providing exemplary healthcare with access for all in our community. It puts us into a full partnership with our medical staff . . . 152
  • 153.  Some have embraced it because they believe that it links payment to performance.  Others will embrace it because it focuses on clinical integration and coordination  And finally, some believe that it is a true competitive destination and one to which the organizations are committed before the system takes on more water! 153
  • 154.  Their vision was to transform the “MONEY SYSTEM” into a SYSTEM OF CARE!”  And the pitfalls are: complexity, resistance, trade-offs, missteps . . . to name just a few. 154
  • 155. These partnerships of primary-care and specialists doctors with hospitals and clinics might help to produce a model that, although directed toward Medicare, could also have a positive impact on all of U.S. health-care. 155
  • 156.  “ACOs were brought into effect with three major aims which are:  Better care for individuals,  Better health for populations, and  Slower growth in costs through improvements in care.” Don Berwick, MD, Administrator of the Centers for Medicare and Medicaid Services 156
  • 157. They would be structured to coordinate care and their reward would be to share financially in savings with the government if they could come in lower than expected, but they could also be PENALIZED if they go over the projected costs. 157
  • 158. The most powerful fix would be to change the relative fees paid to primary care and other cognitive specialists, compared to specialists. Giving a primary care doctor the ability to spend more than 18 minutes with a patient could change the nature of those doctors from having a triage function to allowing proper management of care. 158
  • 159. Medicare can also engage in real clinical transparency, insisting on the publication of real-time information about infections and other important aspects of quality and safety as one of its Conditions for Participation. 159
  • 160.  ABIHM – Holistic Integrative Medicine  Biotech – SYSTEMS BIOLOGY  Dr. Leroy Hood – Founder and Director of Institute for Systems Biology - Dedicated to identifying strategies for predicting and preventing diseases. His inventions have permanently changed the course of biology, and revolutionized the understanding of genetics, life and human health.  Hood invented four instruments that have unlocked much of the mystery of human biology, including the automated DNA sequencer, a powerful device for sequencing proteins, A machine for synthesizing proteins and An automated tool for synthesizing DNA. 160
  • 161. Within the next ten years, healthcare will fundamentally change from reactive to proactive This is because medicine will become predictive, personalized, preventative and participatory WHY? Because biology is evolving into an informational science and it will NOT stop going in that direction 161
  • 162. Proteomics and Genomics will contribute to the continued morphing of our current diagnostic medicine into this new world order Spectacular computational power will map 2500 blood organ specific proteins from 50 organs to diagnose our patients and provide them with wellness assessments Vaccinations will be developed as specific therapies for hundreds of different diagnosis 162
  • 163. SNP analysis will be used to monitor toxicity, response dose and combinational therapies. These types of advancements will result in “Planned strategies for health.” Hence Systems BIOLOGY 163
  • 164. It cost $3,000,000,000 to map the human genome in 2003. This year? Less than $1000. It cost $1M for a terabyte of storage for data. Today? 2 TB of Cloud Storage - $16.00. 164
  • 165. Regenerative medicine is the "process of replacing or regenerating human cells, tissues or organs to restore or establish normal function". Regenerative medicine also empowers scientists to grow tissues and organs in the laboratory and safely implant them when the body cannot heal itself. 165
  • 166. Reagan launched SDI in a March 23, 1983, speech. "Let me share with you a vision of the future which offers hope," he said, and then he described a system that could "intercept and destroy strategic ballistic missiles before they reached our own soil." Algorithms that could analyze 1500 incoming intercontinental ballistic missiles to determine which were real and which were dummy warheads. Jess Granone’s sister-in-law 166
  • 167. “Not only would it allow us to cure cancer by repairing or destroying malignant cells one by one but it would revolutionize gene therapy as well.” 167
  • 168. IBM has found a way to meld biology and computing to create a new chip that could become the basis for a fast, inexpensive, personal genetic analyzer. The DNA sequencer involves drilling tiny nanometer-size holes through computer-like silicon chips, then passing DNA strands through them to read the information contained in their genetic code. 168
  • 169. The “DNA transistor” could make it faster and cheaper to sequence individuals’ complete genomes. In so doing, it could help facilitate advances in bio-medical research and personalized medicine. For instance, having access to a person’s genetic code could help doctors create customized medicine and determine an individual’s predisposition to certain diseases or medical conditions. 169
  • 170. Saddle makers- automobiles Watch makers – the quartz watch Newspapers Music Movies 170
  • 171. Where to put your focus! 171
  • 172. CLEAR Do not bury the lead  RELEVANT Make sure to paint a picture and always make sure to demonstrate relevance to the potential investor ENGAGING Bring them to their senses: sight, sound, smell, taste, and touch 172
  • 173. ACCURATE THERE IS NO EXCUSE FOR FACTUAL INACCURACY TIMELY It is very important to remember that information is time-sensitive ENTHUSIASTIC/PASSIONATE Enthusiasm makes your audience glad to see you 173
  • 174. 174
  • 175. Spirituality & Wellbeing Mary Jo Kreitzer PhD, RN, FAAN Director, Center for Spirituality & Healing University of Minnesota 175
  • 176. One could call every illness an illness of the soul. ~ Novalis 176
  • 177. Overview Discuss the evidence base linking spirituality with health outcomes. Describe spiritual practices that promote health and wellbeing. Discuss strategies for advancing wellbeing in the lives of people, organizations, and communities. 177
  • 178. Defining Spirituality Spirituality is broadly defined as that which gives meaning and purpose to life. “Spirit” – comes from the Hebrew word “ruah” which means wind, breath or air, that which gives life. Essence of one’s humanity (Frankl, 1963) 178
  • 179. Defining Spirituality Power, force, or energy that stimulates creativity, motivation or striving for inspiration. (Chiu, 2004) Search for the sacred. (Pargament, 1997) Purpose, meaning and connectedness with self, others and higher power. 179
  • 180. Defining Spirituality Spirituality is the aspect of being human that refers to the way individuals seek and express meaning and purpose, and the way they experience connectedness to the moment, to self, to others, to nature and to the significant or sacred. (Puchalski and Ferrell, 2010) 180
  • 181. Religion Organized system of beliefs, practices, and rituals associated with a particular faith tradition. Religion may or may not be part of a person’s spirituality. 181
  • 182. Relevance for health care providers? 182
  • 183. “Close to the Bone” – Jean Shinoda Bolen 183
  • 184. Diagnosis of a Chronic or Life-Threatening illness Feelings of anger, grief, loss, despair, and hopelessness. Why me? Why now? What is the meaning of this? May provoke a spiritual crisis. 184
  • 185. Greek Temples Sanctuaries of Healing Body, mind and spirit were the focus of care. 185
  • 186. Hildegaard of Bingen 12th Century Mystic and Healer Use of art, music, use of herbs and prayer 186
  • 187. Florence Nightingale Role of the Nurse …“Put the patient in the best possible condition so that nature can act and healing occur”. 187
  • 188. Nightingale Tenets of holistic practice – importance of natural light, fresh air, touch, diet, noise control and spirituality Hygiene, sanitation and infection rates 188
  • 189. Osler It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has. William Osler 189
  • 190. Historically, the healing professions were grounded in spirituality. 190
  • 191. 17th Century Dualism Wall of separation divided the care of people into mutually exclusive and often antagonistic camps. 191
  • 192. Contemporary Western Science Often dealt poorly with the spiritual side of human nature by ignoring it. Viewing spirituality as being beyond the scope of professional practice. 192
  • 193. CAM Professions Excelled Relationship-based Care of the whole person Body, mind and spirit Listening to the story 193
  • 194. “We have traded mystery for mastery and paid a great price”. Rachel Naomi Remen 194
  • 195. What do patients want? In two national surveys, over 70% of patients polled believed that spiritual faith and prayer can aid in recovery from illness; 64% of those surveyed believe that health professionals should talk to patients about spiritual issues as part of their care. 195
  • 196. 45 Year Gallup Poll Beliefs and Attitudes 50% describe themselves as religious. 33% describe themselves as spiritual but not religious. 78% report the need in their life to experience spiritual growth - compared to 20% - 5 years ago. (2002) 196
  • 197. Spirituality in College Students Findings from a National Study Over half of third-year college students place a high value on “integrating spirituality into my life”. More than 2/3 report that they have had a spiritual experience. Three-fourths of the students believe that we are all spiritual beings. – Higher Education Research Institute, UCLA, 2003 197
  • 198. 198
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  • 204. 204
  • 206. Spirituality and Health Outcomes Patients who score higher on spirituality or religious scales have lower mortality due to coronary artery disease or cardiac surgery-related complications. (Haskell, 2003) Degree of spiritual well-being may be an important factor in progression or regression of coronary artery disease. (Morris, 2001) In heart failure patients, spiritual well-being was associated with less depression. (Bekelman et al, 2007) 206
  • 207. Spirituality and Health Outcomes Spirituality was associated with less distress and better quality of life in cancer patients. (Zakowski and Bair, 2004) Existential well-being was found to have a strong negative correlation with depression. (Nelson et al, 2002) Spiritual struggle was associated with poorer QOL and life satisfaction. (Hills et al, 2005) 207
  • 208. “Love and Survival: The Scientific Basis for the Healing Power of Intimacy” Opening your heart – when the emotional and spiritual heart begin to open, the physical heart often follows. Dean Ornish MD 208
  • 209. Assessing Spirituality What gives you hope and meaning? What spiritual practices are living-giving for you? Are there any specific practices or restrictions that we should know about? Do you have spiritual concerns or issues you need to address? Are you part of a religious or spiritual community? 209
  • 210. FICA Interview Guide Faith What is your faith? Importance/Influence How important is your faith? Community Are you part of a religious community? Address How would you like spiritual issues addressed? (Puchalski) 210
  • 211. Research Instruments Spiritual Transformation Scale Brief Serenity Scale Spiritual Well-Being Scale Meaning in Life Scale Self-Compassion Scale Index of Core Spiritual Experiences (INSPIRIT) 211
  • 212. Addressing Spiritual Issues The predominant orientation of biomedicine is on curing – diagnosing, treating and repairing the broken or damaged part of the body. Healing – restoring wholeness and integration. Requires attending to the whole person – body, mind and spirit. 212
  • 213. Shift from a biopsychosocial model of care to a biopsychosocial – spiritual model. 213
  • 214. Integrative Approach to Care “Being with” - healing “Doing to” – curing –J Milstein (2005) 214
  • 215. “Being With” – a way to provide spiritual support Cultivation of skills: Deep listening Compassion Mindfulness Presence 215
  • 216. Providing Spiritual Care Is at once both simple and extremely difficult. It requires that the health care professionals bring their humanness to the medical encounter. 216
  • 217. Who provides spiritual care? Healthcare professionals – spiritual care can effectively and interchangeably be provided by multiple members of the care team. Professionals trained in spiritual care. 217
  • 218. Spiritual Care Providers Chaplain Community-based religious or spiritual leader (priest, rabbi, shaman) Spiritual director or counselor 218
  • 219. Barriers of Spiritual Care Lack of sufficient time. Lack of skills. Institutional obstacles – lack of privacy and continuity of providers. Social, religious or cultural discordance between caregivers and patients. (Daaleman et al, 2008) 219
  • 220. Spiritual Care Practices Prayer Meditation Music and Art Nature Journaling Walking a labyrinth 220
  • 221. “Diseases of the soul are more dangerous and more numerous than those of the body”. Cicero 221
  • 222. Spirituality of Health Professionals Personal growth and well-being Job satisfaction and burnout Clinical effectiveness 222
  • 223. Spirituality of Health Professionals Making a spiritual connection with patients will help physicians at least as much as it helps their patients. If physicians reconceptualize themselves as healers, as opposed to solely technicians, who dedicate their lives to reducing human suffering, they will reconnect with the passion and dedication that initially directed them to medicine. (Grubb, 2003) 223
  • 224. 224
  • 225. Nurturing the Soul and Spirit of Health Care Providers Friends, nature, relationships, beauty, food, art, family, contemplation, travel, solitude, education, retreat, community, books, and home. 225
  • 226. Signs of Change A growing number of medical and nursing schools teach content or even whole courses on spirituality. 226
  • 227. US Hospital Accreditation Spiritual care is a criteria for accreditation of hospitals by JCAHO. Hospitals must document assessments of spiritual beliefs and practices. Pastoral care must be available to patients who request it. Hospitals must meet the spiritual needs of dying patients and their families. 227
  • 228. Vinland National Center in Loretto Minnesota 228
  • 229. Vinland National Center Full lives for people with disabilities. Treating the whole person. One of three programs in US that specializes in clients with brain injury and chemical dependency. 229
  • 230. Unique Residential Approach 1:1 and group counseling Personalized fitness Indoor and outdoor physical activities Comprehensive vocational services Family Program Courses – include, anger management, self-esteem, grief and loss, wellness, nutrition, aromatherapy, tai chi, leisure education, and conflict resolution 230
  • 231. Spirituality Native American Healing Ceremonies Meditation Journaling Mindfulness Nature Culture Art Therapy 231
  • 232. Art Therapy – Mask Making Art is used to raise spiritual, psychological and emotional issues. What are you hiding behind? What is your street face? What is your love face? What is your sacred face? 232
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  • 236. Recent Outcomes Data – 6 months post discharge (residential program) 97% reported 0 times/week use of alcohol. 0 % homeless or unsafe living environment. 71% good living and 28% great living environment. 70% return to work (work, training, volunteer). 94% reduction in incarceration. 236
  • 237. 237
  • 238. 64 238
  • 239. 65 239
  • 240. 66 Move Beyond “Fixing” Health Care…… Building Capacity in People and Communities 240
  • 241. 67 WELLBEING • Whole person • Increase capacity and expand potential • Possible even with chronic illness and maturing bodies • Individual, family, organization, community and nation 241
  • 242. 68 242
  • 243. Summary A commitment to caring for the whole person requires that we go beyond caring for the physical body. Human beings are spiritual beings. Whether healthy, injured or ill, human beings naturally ask transcendent questions about meaning value and relationships. 243
  • 244. Summary Attending to spiritual needs of patients is not just a moral option. It constitutes a moral imperative. 244
  • 245. Reflection “Perhaps our best work as health professionals is not about something we do but about something we are, something we become and bring into all of our relationships”. Rachel Naomi Remen 245
  • 246. Reflection At the dawn of the 21st century, the most profound revolution awaiting western biomedicine may not be genomics, nanotechnology, or artificial organs, but rather the re-introduction of spirituality into the practice of health care. 246
  • 247. 247
  • 248. Global Health & Integrative Medicine the Future of Health for the Planet & Humanity Dr. Tabatha Parker Naturopathic Doctor Executive Director Natural Doctors International (NDI) 248
  • 249. Inspiration Inspire yourself and others will be inspired. Motivate yourself and others will be motivated. Develop yourself and others will start to develop themselves. Be an example first and then the world changes around you Author Unknown 249
  • 250. Who are we: USA health providers? Profession Designation in USA Source Acupuncturist/Oriental Medicine LAc 25000 ACCAHC Chiropractors DC 70000 ACCAHC Massage Therapist ‐ Licensed LMP 250000 ACCAHC Medical Doctors (Primary Care) MD 425000 Kaiser Medical Doctors (Speciality) MD 428000 Kaiser Midwives (Certified Nurse Midwife) CNM 12692 ACNM Midwives (Certified Midwives) CM 73 ACNM Midwives (Direct Entry‐homebirth) CMP 1800 ACCAHC Naturopathic Doctor ND 5000 ACCAHC Nurse (Registered Nurse) RN 2,725,000 Kaiser Nurse Practitioner NP 180000 Kaiser Osteopaths DO 80000 AOA Physical Assistant PA 83000 Kaiser Phyiscal Therapist PT 183000 APTA 250
  • 251. Natural Doctors International Where I came from we are • 1st international service NGO created for licensed natural medicine providers • ND Founders - Dr. Tabatha Parker, Dr. Laurent Chaix, and Dr. Michael Owen. • 501(c)3 designation in 2003 • Started in Moyogalpa Hospital in 2005 • Opened NDI clinic in February 2010 251
  • 252. Natural Doctors International • Expansion of 6 Naturopathic Principles into Global Health, Social Justice, Ecology. • Integrative and Collaborative • Accept and reach out to all professions: NDs, DCs, LaCs, Acupuncturists, MDs, DOs, Midwives, PTs, OTs, herbalists, MPHs, activists, students of all kinds, anyone with a genuine desire to contribute. 252
  • 253. NDI a glimpse at our work 253
  • 254. Key principles, practices & opportunities for integrative medicine in global health The Principles of Holistic Primary Health Care The principles of Holistic Primary Health Care (HPHC) are a unification of four of the most important international declarations to have emerged in the modern era, presented in a manner which summarises this declaration’s vision of the interdependence of human rights, community health, ecological harmony, and the necessity of multi-sectoral integrative approaches to world health. 254
  • 255. Three pillars • The Universal Declaration of Human Rights (1948) - upholds the rights of the individual in relation to health. • The Alma Ata Declaration of Primary Health Care (1978) –upholds the rights of communities in relation to health. • The Earth Charter (2000) –upholds the rights and importance of the environment in relation to health. And rests upon the following platform: • The Beijing Declaration on Traditional Medicine (2008) –upholds the value of holistic medical practices from around the globe and the necessity for them to work in an integrated fashion with existing healthcare services. 255
  • 256. One Health Organisation Our vision of the interdependence of human rights, community health, ecological harmony, and the necessity of multi-sectoral integrative approaches to world health. 256
  • 257. models of global health: service learning programs vs voluntourism Which will you choose: Sustainability or convenience? This is our responsibility. Traditional Model – 1 – 2 week medical mission tours, no permanent links, band-aid medicine, fix-it mentality, convenient for the provider. Social Justice Model – Service learning, linked to long term projects, community links, listening to needs, partnership, sustainability. 257
  • 258. Stories from abroad Best intentions • 1 church 7 paintings • 1 patients, 3 enalapril • Morphine lollipops • Unlabeled medicine • Our trash, your present, your problem 258
  • 259. best practices in service work & social justice medicine Work legally Respect local cultures Work with local long-term organizations Do not just join short-term medical trips Take the time, build the relationships 259
  • 260. global health policies impacting integrative medicine Benchmarks WHO 2014-2023 Traditional Medicine Strategy Federations 260
  • 261. Benchmarks for Training in Naturopathy – edits 2006, published 2010 261
  • 262. 262
  • 263. 263
  • 264. WHO – Strategy on 2014 - 2023 The strategy has two key goals o support Member States (192) in 1. harnessing the potential contribution of T&CM to health, wellness and people centered health care and to promote the safe and 2. effective use of T&CM through the regulation of products, practices and practitioners. Goals reached by implementing 3 strategic objectives: 1) Build knowledge base and formulate national policies; 2) strengthen safety, quality, effectiveness by regulation; 3) promote universal health coverage by integrating T&CM services and self-health care into national health systems. 264
  • 265. T&CM Definitions Traditional medicine (TM): Traditional medicine has a long history. It is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, use in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. Complementary medicine (CM): The terms “complementary medicine” or “alternative medicine” refer to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system. They are used interchangeably with traditional medicine in some countries. Traditional and complementary medicine (T&CM): T&CM merges the terms TM and CM encompassing products, practices and practitioners. 265
  • 267. Traditional Medicine Levels of education, accreditation and regulation of T&CM practices and practitioners vary considerably. In an increasingly globalized world, individuals move freely from country to country in order to live and work. Given this trend, a better understanding of T&CM practitioners is needed to ensure professional consistency and safety. 267
  • 268. What professions have world federations? Physicians (MDs) Hydrotherapists Chiropractors Chinese Medicine Acupuncture Osteopaths Nurses Public Health 268
  • 269. Annex B of the WHO Strategy World Federation of Hydrotherapy World Federation of Acupuncture & Moxibustion World Federation of Chiropractic World Federation of Chinese Medicine Societies Osteopathic Alliance 269
  • 270. Purpose of Federations • International Professional Associations • Ensure professional consistency/safety • Create international standards to reduce variability in education, accreditation & regulation • Facilitate international collaboration which is beneficial & necessary • Facilitate relations with health ministries: MINSA (Ministry of Health) 270
  • 271. 271
  • 272. FORMATION Paris, France July 2014 2nd International Congress of Naturopathic Medicine 272
  • 273. Paris – WNF formed At the 2nd International Congress on Naturopathic Medicine (ICNM), July 4-6, 2014, Paris, over 30 participants representing national associations from around the world voted unanimously on Sunday July 6th, 2014, to form the World Naturopathic Federation (WNF). 273
  • 274. Interim Committee Anne Marie Narboni (France), Babu Joseph (India), Iva Lloyd (Canada), Yannick Pots (Belgium), Phillip Cottingham (New Zealand), Tabatha Parker (USA), Tina Hausser (Spain/Germany), Jon Wardle (Australia) 274
  • 275. global health priorities impacting integrative medicine WHO World Health Assembly MDG’s NCD’s 275
  • 276. WHO & Geneva • Every year the WHO has a WORLD HEALTH ASSEMBLY, convening their 193 nations in MAY. This is the largest most important health assembly in the world. • In 2014 of this year, 2 NDs attended the 67th WHO WHA - Michael Cronin, ND and Tabatha Parker, ND – becoming the first NDs to attend this assembly in history. 276
  • 277. 277
  • 278. Having a world federation that is has the stamp of the WHO is important for individual associations & countries to move forward policy in individual countries – ex. Zambia, Democratic Republic of Congo, New Zealand, France – all of these countries have expressed how important this would be for their work! 278
  • 279. 279
  • 280. 1) 40% Reduction in # Children Under 5y/o who are stunted 2) 50% Reduction of Anemia in women of reproductive age 3) 30% reduction in low birth weight 4) No increase in kids being overweight 5) Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50% 6) Reduce and maintain childhood wasting to less than 5% 280
  • 281. 281
  • 282. 282
  • 283. "You're only given one little spark of madness. You mustn't lose it.” Robin Williams 283
  • 284. Personalized Integrated Healthcare: A Look Ahead Jeffrey Bland, Ph.D., FACN President Personalized Lifestyle Medicine Institute www.plminstitue.org 284
  • 285. Learning Objectives • What do we mean by “personalized integrated healthcare”? • What is meant by the term “metabolic inflammation”? • How does this approach apply to the management of the dominant chronic metabolic diseases? • Type 2 diabetes, cardiovascular disease, inflammatory airway diseases, obesity, autoimmune diseases, osteoporosis, dementia • How do pattern recognition receptors and specifically toll-like receptors play a role in the etiology of these chronic metabolic diseases? • What specific therapies derive from the understanding of toll-like receptors and their relationship to chronic diseases? 285
  • 286. The Present Health Challenge • Present system poor outcome in patients with 2 or more diseases • More than ¼ of adults have multiple chronic conditions • 2/3 of Medicare have multiple with 14% having 6 or more conditions • Goals: Foster Systems Change, Empower people, Equip clinicians, Enhance research JAMA 2014; 312: 1199. Question: Can we find a common cause of many chronic diseases? 286
  • 287. Do Our Genes Directly Control Our Health Outcomes? • Why are 370 million people projected to have type 2 diabetes within the next 20 years? • Is type 2 diabetes monogenetic? • Is type 2 diabetes one disease or many? • What is difference between genetic and epigenetic factors ? • What is the role of bioactives from food in the etiology of type 2 diabetes? • Does our environment have anything to do with the type 2 diabetes pandemic? 287
  • 288. Monogenetic vs Gene-Environment Etiology of Disease 288
  • 289. YOUR BOOK OF LIFE IN 23 CHAPTERS Expressed Differently in Different Environments Ridley M. Genome – the Autobiography of a Species in 23 Chapter. 1999. 289
  • 290. 30% of chronic disease is genetically-related: 70% of chronic disease is lifestyle, nutrient and environment-related What impact will this understanding have on healthcare? 290
  • 291. What a Chromosome Looks Like 291
  • 292. May 27, 2013…Genes and Disease 292
  • 293. Mary Claire King and BRCA 1 and 2 “The lifetime risk of breast cancer among female mutation carriers is presently 82%. Risks appear to be increasing with time. Before 1940 it was 24%. Lack of physical exercise and obesity in adolescence may be important modulating factors for risk in carriers”. Science 2003; 302: 643-50. 293
  • 294. Incidence of Breast Cancer in Women with BRCA1/2 mutations Ag2e94
  • 296. Where it all starts--Parenting 296
  • 297. • Genetics • Nuclear DNA • Mitochondrial DNA • Epigenetics • Prenatal environment • Postnatal exposures • Sociobiology • Breast milk • The first “Functional Food“ • Preconceptional • Parenting before conception Science 2014; 345: 743. 297
  • 298. Parenting Before Conception • Environmental exposures of both parents • Michael Skinner • Methylation patterns • Transgenerational effects • Mitochondrial DNA • Noncoding RNAs • Chromatin Integrity • Nutritional status of both parents 298 10/7/2014 15
  • 299. Epigenetics “Father of Nutritional Epigenetics” • Randy Jirtle • Visiting Professor, McArdle Laboratory, University of Wisconsin • Pioneered the use of Agouti mouse to look at the effect of diet, nutrients and environmental agents including BPA on the mammalian epigenome and disease 299
  • 300. Randy Jirtle and Nutritional Epigenomics— The Agouti Mouse Story Methylation Support Dams (f0) Offspring (f1) Cooney CA et al. Maternal methyl supplements in mice affect epigenetic variation and DNA methylation of offspring. J Nutr. 2002 Aug;132(8 Suppl):2393S-300 2400S.
  • 301. Foods and Phytochemicals that Influence Genome Methylation and Sirutins 301
  • 302. Ice Storm Babies Show Unique Methylation Signature PlosOne 2014; 9: e107653 302 Moshe Szyf and November 2010 FMU interview
  • 303. What we can learn from breast milk about optimal nutrition • Unique carbohydrates • Oligosaccharides • Bifidobacterium longum biovar infantis (B. longum bv.infantis) • Unique fatty acids • Rich in n-3 DHA • Bioactive proteins • Delivers specific immune active peptides • Enzymes • Activated in the gut Science 2014; 330346:747-50.
  • 304. There is a BIG new idea What makes us different? that will change the health of the world. Personalized Medicine Lifestyle 304
  • 305. We are not pathways, but networks of genes regulated by our environment 305
  • 306. What makes us different? 306
  • 308. The Origins of Functional Medicine-- 308
  • 309. Dr. Willoughby Wade and Functional Medicine-1871 • Concepts • “All disease is disordered function” • Drugs often treat symptoms not cause of disease • Pathology is preceded by alteration in function • Root cause of diverse symptoms may come from primary alteration in core function • Symptoms of disease may arise from a distant alteration in function (systems biology) • Disease is a limiting concept and should be replaced by understanding of origin of the dysfunction • Biography • 1827-1906, Irish, knighted 1896, Head Kings College & Hospital 309
  • 310. 310
  • 311. 28 311
  • 312. The Functional Medicine Operating Model Structure Energy (Production & Utilization) Cellular Transport Assimilation/Elimination Detoxification Immune Defense Cellular Communication (Hormones) Genes Environment Personalized Lifestyle Healthcare/Medicine Lifestyle Behaviors Diet 312
  • 313. 30 313
  • 314. Proof of Concept Generating the Data Necessary to Change the Medical Paradigm 314
  • 315. The Institute for Systems Biology Pioneer 100 Wellness Project 315
  • 316. The 21st Century Framingham Project 316 10/7/2014 33
  • 317. 317
  • 318. Trends in Diagnosed Type 2 Diabetes: 1980-2012 • Rapid increase in T2D from 1990-2008 but leveled off 2009-2012 • Tracks very closely with increase in obesity • Suggestion that obesity “causes” T2D • But is that correct? • Association or cause? JAMA 2014; 312: 1217-25. 318
  • 319. Trends in waist circumference as a marker of central adiposity • Trends from 1999 to 2012 indicate continued increase in waist circumference • Waist size is the most convenient surrogate marker for central adiposity • Central adiposity is most correlated with metabolic disease • “Angry Fat” • Metabolic inflammation, sleep apnea, endocrine disruptors, certain medications JAMA 2014; 312: 1218. 319
  • 321. Nutritionally Related SNPs of Potential Importance to Disorders Associated with Metabolic Inflammation • Methylenetetrahydrofol ate Reductase (MTHFR) • Apo E4 • COMT • IL-1beta receptor • PON1 • Vitamin D receptor • Deiodinase • TLR-4 • HDL • Adiponectin • Fatty acid binding protein 3, 4 (FABP4) • FTO • PPAR gamma • IGF 1 • IRS1 • PAI1 321
  • 322. Where Metabolic Inflammation Starts Toll-like Receptors and Pattern Recognition 322 N Engl J Medicine 2011; 364: 60-70.
  • 323. Toll-like receptor 4 activation Atherosclerosis, Arthritis, Diabetes, IBD, Dementia,Chronic Pulmonary Disease 323 N Engl J Medicine 2002; 347: 185-92
  • 324. Toll-like receptor signaling and gene expression (TLRs are expressed in gut, liver, macrophage, adipocyte, brain, lung, kidney, beta-cells and bone) 324
  • 325. TLR-4 Signaling and NFkB activation 325 TLR ligands Include: LPS, saturated fatty acids, xenobiotics, hypoxia, oxidized lipids
  • 326. Ingestion of Bacterial LPS Inhibits Taste Response to Sugar • Bacterially-derived lipopolysaccharide (LPS) modulates neural response to taste stimuli • Response to sugar was significantly reduced upon exposure to LPS • This effect is seen through alteration in taste receptor activity (Tastr1/2) • This is the same receptor that is found in the mucosa of the distal ileum and controls GLP-1 secretion • The process of altered Tastr1/2 activity is initiated by activation of TLR-4 receptors 326 Neuroscience 2014; 258: 47-61
  • 327. Bacterial LPS induces insulin resistance due to chronic inflammation • Chronic elevation of gut-derived LPS(i.e. metabolic endotoxemia) plays role in insulin resistance • LPS levels found elevated in obese, diabetic humans • LPS stimulates TLR-4 activity in muscle cells from obese, diabetic humans • Enhanced metabolic inflammation in the muscle blocks insulin signaling • Antagonists of TLR-4 may improve insulin action in these individuals 327 PlosOne 2013; 8: e63983
  • 328. Insulin resistance is activated by TLR-4 action through gut hormones 328
  • 329. Toll-like receptor status in obesity and diabetes • Toll-like receptors are well characterized immune modulators that enhance inflammation • TLR-4 activation induces insulin resistance • This is suggested as a primary step in the pathogenesis of obesity and metabolic syndrome • TLR-4 is activated by both LPS from gut bacteria and dietary fatty acids • Increased gut permeability (eg. leaky gut) results in increased systemic TLR-4 activation • Targeting TLR-4 induced inflammation can prevent the initiation of diabetes, obesity and cardiovascular disease J Clin Endocrinol Me32t9ab 2014; 99: 39-48 10/7/2014 46
  • 330. Artificial Sweeteners, Diabetes and Gut Microbiota 330
  • 331. • Pharmacology of metformin is related to gut microbial activity • Influences GLP-1/PYY production through microbiome/gut immune interaction • Bacteroides versus Fermicules abundance associated with different clinical effects of metformin • Stool samples indicated difference among individuals in response to metformin PlosOne 2014; 9: e100778 331
  • 332. 332 Thorax 2012; 67: 456-63.
  • 334. Dysbiosis, Systemic Inflammation and Allergic COPD 334
  • 335. Microbial abnormalities in inflammatory airway diseases- Potential for therapy • Microbiome of the lung has been demonstrated to be altered in patients with inflammatory airway diseases • A tempting therapeutic approach is to share the microbiota to restore microbial balance • The airway microbiome might soon join the intestinal microbiome as a target of intervention • The concept of “whole body microbiome manipulation” represents an ecological approach to diseases associated with altered bacterial diversity 335 Pharmacol Ther 2014; 141: 32-39.
  • 336. • Intestinal epithelium responses to bacterial products differently than other organs • Luminal bacteria are needed for healthy gut • Modest activation of toll-like receptors is important in gut mucosal remodeling • Optimal function is achieved with control of toll-like receptor activity through proper diversity of microbiome 336 N Engl J Medicine 2008; 359: 756-58.
  • 337. Summary Takeaways • The future for managing chronic disease is personalized medicine that takes into account lifestyle, environment, diet and activity issues • Insulin resistance and its relationship to metabolic inflammation represents a major unifying principle in chronic disease • The initiation of metabolic inflammation is related to activation of pattern recognition receptors of which the toll-like receptors are important members • Toll-like receptor 4 activation is initiated in the gastrointestinal-associated immune system • Treatment of TLR-4 activation through interventions including pre and probiotics can serve as primary approaches to the treatment of multiple chronic diseases 337
  • 338. Great Leadership in Integrative Medicine Mark J. Tager, MD CEO, ChangeWell Inc. mtager@changewell.com 338
  • 339. The IM Question for Leaders As a leader, how do you transfer the whole person attitudes, values and skills of IM into cultures that may or may not be supportive of the same? 339
  • 340. The Turbulent Waters of Healthcare Motivate Team Maintain Stamina & Optimism Stay on Course Keep the Ship Afloat 340
  • 341. Objectives n Understand the powers of leadership n Recognize the strengths & weaknesses of your current style n Understand culture, context and communication in rapidly changing environments n Review key attitudes and behaviors for successful leadership in changing environments. 341
  • 342. Leadership The process of influencing others to obtain results. 342
  • 343. Leaders Depend on Power Positional Power Professional Power Peer Power Personal Power 343
  • 344. You Have an Existing Style n Direction & Support n Natural Tendencies n Work Experience n Attitudes & Beliefs n Training Programs 344
  • 345. WHAT MAKES A LEADER “GREAT?” 345
  • 346. Worst Boss/Best Boss nWhat did s/he do? nHow did it affect your energy, competence, willingness, enthusiam, performance, motivation, desire to go the extra mile? nHow did s/he affect your health? Stress-related behaviors? Signs? Sx? 346
  • 347. Leaders are Paid to Stress People In a changing environment people don’t always act “rationally” Productivity Low Stress High Stress 347
  • 348. In a World of Multiple Inputs, Some People Are Only There in Body Perceptions Interpretation Compete for attention, hearts and minds 348
  • 349. Leaders and the New Competition What can I do? Direction and Support To people stay focused and productive? To create greater team resilience and improve communication? To foster trust and inspire confidence? To keep my own energy, enthusiasm, health and stamina up in the process? 349
  • 350. Stable vs. Changing Environments REQUIREMENTS: Perspective Flexibility Empathy Trustworthiness 350
  • 351. The Power of Perspective Remain calm and positive under pressure “Maintain an optimistic outlook. Develop the will to win by capitalizing on your unit's abilities. The more difficult the situation is, the better your chance is to display an attitude of calmness and confidence.” 351
  • 352. Clarify the New Context Context: a joining together..to weave together…the whole situation or relevant environment Understanding Context/Content in stable vs. changing environment Understanding culture Around here, it’s normal for … 352
  • 353. Bringing Awareness to Culture When you first joined the organization, what details struck you? With regard to the change process, what typifies to you “the way we do things around here?” What rules? What procedures? What habits? Which norms support change positively? Which get in the way? Homework: Select one positive and one negative. Do a data dump 353
  • 354. Communicate with Credibility The Two-Way Street How good is your relationship? Openness Honesty Give and receive feedback Trust How do you develop one? 354
  • 355. Developing + Relationships Listen------Praise-----Catch em’ doing something right---build positivity. Now you can give feedback First, must understand motivation Intrinsic Extrinsic Praise and recognition Task specific Timely For them 4/1 Strokes/Pokes Use the rule of 2-1+1 355
  • 356. Trustworthiness: Validity in Communication Differences in how people perceive and interpret information A consequence of genetics and early childhood upbringing Concept of temperament--Jung and others Personality determines what stresses people To be credible: speak others’ language The PowerSource Profile™ 356
  • 357. Valid Communication by Type Grounding Creative Perception Logic Relationship Interpretation 357
  • 358. Valid Communication Grounding Traits Creative Traits  Intuitive  Open to new ideas  Future oriented  Visionary  Ask: “Why not?”  Predictable  Practical and realistic  Information from senses  Detail oriented  Focused on here and now 358
  • 359. Valid Communication Logic Traits Relationship Traits  Sensitive to others  Appreciate feelings  Emotional decision making  Considerate  Time is circular  Objective  Quantitative  Sequential  If A, then B; cause effect  Historical past 359
  • 360. Empathy: Dealing with Resistance Resistance takes many form Leaders marginalize people’s resistance and pain R ‐1 +1 Diminished Answers Ignored Assurances Invalidated Solutions Answers Assurances +1 Solutions R They feel You respond with 360
  • 361. Bringing the Best of IM to Leadership Maintain perspective Focus on context/understand culture Be flexible in leadership/communication style Orient messages for receiver Build trust in others 361
  • 362. Integrative Medicine Certification in Administration WHY HERE? WHY NOW? 362
  • 363. Qualitative meets quantitative Reimbursement Impact: ◦Wrong site surgeries ◦Hospital acquired infections ◦Readmissions prior to 30 days ◦HCHAP scores ◦Quality 363
  • 364. One possible cure? Integrative Medicine: ◦ Massage ◦ Acupuncture ◦ Reiki ◦ Stress management ◦ Music therapy ◦ Aroma therapy ◦ Pet therapy ◦ Guided meditation 364
  • 365. Atlantic Health Integrative Medicine Treatment Room 365
  • 367. Atlantic Health System’s New Chambers Center for Well‐Being 367
  • 371. Dr Mimi Guarneri Senior Medical Advisor 371
  • 372. EXAMPLE: The American Board of Integrative Holistic Medicine – 2700 docs Academy of Integrative Health and Medicine – 420,000 practitioners IHPC – Integrative Health and Policy Consortium – 200,000 practitioners 372
  • 373. Contact Information F. Nicholas Jacobs FACHE International Director SunStone Management Resources 112 Washington Place Unit 4D Pittsburgh, PA 15219 E‐mail: nickjacobs@sunstoneconsulting.com Mobile: 412‐992‐6197 Home: 412‐381‐3136 Fax: 866‐381‐0219 www.sunstonemanagement resources.com www.nickjacobs.org 373
  • 374. Integrative Health and Medicine: Navigating Policy Trends Len Wisneski, MD 374
  • 375. All the tumult and seeming chaos, when viewed in the light of historical perspective, can be seen to represent not only the death agonies of an old order but also the birth pangs of a new epoch - a new golden age which assuredly will outshine those of the past. - Historian L. S. Stavrianos 375
  • 376. Integrative Healthcare and Medicine THE FUTURE OF HEALTHCARE DELIVERY IN THEUNITED STATES 376
  • 377. Institute of Medicine Report Current state of affairs – population health Unsustainable expenditures Primary care system challenges Public health infrastructure Uninsured populations Health behaviors Social and economic conditions 377
  • 378. The Health of the Nation: Poor Value for the Money Life expectancy at birth Total spending on health 378
  • 379. Mortality from Non-Communicable Diseases, 2008 Among the 17 peer countries, the US had 2nd highest Non-Communicable Disease mortality rate in 2008 (418:100,000) 379
  • 380. The US performs poorly in health and places low on health rankings Source: National Research Council and Institute of Medicine Report: U.S. Health in International Perspective: Shorter Lives, Poorer Health (2013) Health 7 Promotion: Empowering Change through Policy Source: Human Capital Report 2013 published by Mercer and the World Economic Forum Average body mass index in 17 peer countries US Ranks 43rd in Health 380
  • 381. Conditions More Prevalent in the U.S. (Age 50) Obesity Inactivity Smoking Diabetes Hypertension Heart Disease Stroke Chronic Lung Disease Cancer Arthritis 381
  • 382. The Answer: Prevention and Well-Being 382
  • 383. A ROSE BY ANY OTHER NAME Holistic Medicine- Consumers Integrative Medicine- Universities Complementary and Alternative Medicine (CAM) – Government Emergent- Integrative Healthcare 383
  • 384. INTEGRATIVE MEDICINE MILESTONES 1978 Founding of AHMA 1990 Study by Dean Ornish MD, shows that lifestyle changes can reverse heart disease. 1992 Congress establishes the NIH’s Office of Alternative Medicine. 1993 Study by David Eisenberg, MD demonstrates that one in three Americans use CAM therapies. 384
  • 385. 1996 Founding of ABHM 1996 Interest in St. John’s wort explodes after British Medical Journal study finds the herb effective in treating depression. 1997 First class of physician–Fellows begins training at the University of Arizona’s Program in Integrative Medicine. NIH consensus panel supports use of acupuncture for various conditions. 385
  • 386. 1998 The Journal of the American Medical Association devotes an entire issue to alternative medicine. NIH’s Office of Alternative Medicine is upgraded in status, and renamed the National Center for Complementary and Alternative Medicine. 2000 President Clinton establishes the White House Commission on Complementary and Alternative Medicine Policy. Nineteen universities form CAHCIM 386
  • 387. 2001 Formation of the Integrated Healthcare Policy Consortium 2003 Institute of Medicine CAM Conference 2004 Founding of ACCAHC 2009 Institute of Medicine CAM Conference 2011 American College of Lifestyle Medicine 2012 Integrative Medicine in America Report 2013 National Coordinating Center for IM IMPriME 387
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  • 389. SITE SELECTION AND METHODS • 60+ sites identified from Bravewell Clinical Network, Consortium of Academic Health Centers for Integrative Medicine and suggested by IM leaders • 29 chosen to represent the field • Directed by MD, other doctoral level provider or nurse • In operation at least three years • Significant patient volume • Prior clinical contributions to the field • Sites only delivering non-conventional care not included • Directors responded to REDCap-based questionnaire • Site visits made by study team for qualitative data 389
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