When Don Berwick features the Dalai Lama in a keynote presentation, you know something is going on. When he compounds that by linking health to an 18th century British clockmaker and talks about being kind to one another and the benefits of charity giving, you might be forgiven for thinking he’d sort of lost the plot.
Well maybe except for two things. Firstly, it was his delivery. The keynote was delivered in his very understated style. Those reassuring East Coast tones lend gravitas and are so reminiscent of Alastair Cooke – not the England cricket captain but the BBC’s long time US correspondent – and his Letters from America. We trust this man not to lead us astray.
Secondly it was about the evidence. He began by quoting the World Health Organisation. This is hardly a place radicals might start. The WHO definition of health says “[Health] is a state of complete physical, mental and social well-being; and not merely the absence of disease or infirmity.” So according to Don, we need to be students of well-being. And he took us on a Cook’s tour of the publications in this area – Richie Davidson, Jon Kabat-Zinn, Wayne Jonas, Dan Buettner and Dean Ornish.
What Don extracted from this whirlwind tour were some really interesting themes that have more than an echo of prudent healthcare. The first is that efforts to promote wellness can have a significant effect. We are not talking about 1% or 2% improvements but more like five or ten times that. The importance of family and wider connections has a definite effect too. And these of course don’t feature in any financial balance sheet. They are not ‘free goods’, of course they have to be nurtured and that leads to another feature; that the resources to support positive health reach beyond the current boundaries of health care. The final point that Don makes is that ‘loving kindness’ has the effect it has on health because it changes the brain.
So does that mean we chuck out everything we’ve known so far and start again? No it doesn’t. The Triple Aim is the right compass for delivering healthcare but we need a different mindset for creating health. Don left us with these thoughts:
- Reconsider your own concept of health. Think positively.
- Take account of healing tools you and your patients have that lie outside the boundaries of the health care system.
- Bring systems thinking to the pursuit of well-being. We have used this improvement approach in fixing healthcare; let’s apply the same discipline to health.
- Re-establish your faith in and use of connectedness and interpersonal relationships.
- Remember that kindness is inseparable from healing and good health.