Before coming to FFI, I spent most of my career practicing medicine in a small and privileged corner of the field that provides highly coordinated care to older people with frailty, complex illness, and chronic mental health issues. This system represents the best we have today, the gold standard of high-quality integrated and coordinated care. And yet. And yet, there is something else that was happening in this setting that was making people better that was more than the coordination of services and improved transitions between hospital and home. Over my last years in this work, I became extremely curious about what this “special sauce” was. Did it have a name, a language? Could we shine a light on it, scale it, build systems around it? These questions are what led me to the Full Frame Initiative.
I now believe that we do have a language and structure for this work, for what was happening in our clinic almost as a side effect of our work, and yet had powerful positive repercussions for the people in our clinic. This is the language and framework of a wellbeing orientation.
Let me share another story. Dr. Atul Gawande wrote in his Hot Spotters article about a patient who Dr. Jeffrey Brenner was able to work with who helped shape Dr. Brenner’s work with the Camden Coalition. This patient was receiving thousands of dollars of medical care and was not getting better. Was it bad care? Or the wrong care? This patient had heart failure, diabetes, morbid obesity, a history of alcohol and cocaine use and had been in the hospital a full half of the last three years. Why? Dr. Brenner spent time with this man, getting to know him and learning his story. As the story unfolds, we see that eventually, this patient gets better. His diabetes and heart failure are controlled, he stops using substances and he loses 200 pounds. What magical medicines or advanced technological interventions did Dr. Brenner use? None. He attended to this man’s wellbeing: the set of needs and experiences that we all require for health and hope.
Dr. Brenner’s team encouraged stability and routine in this man’s life, which included moving from a welfare motel to an apartment, as well as attending church and AA meetings regularly. They watched him reconnect with his girlfriend and children and benefit from the increased safety in his new apartment, as compared to his previous neighborhood. His team encouraged him to return to his prior trade, cooking. Over the next two years, there is no one magical intervention but this gentleman increased his assets in all areas of wellbeing—safety, stability, social connectedness, mastery and meaningful access to resources—and his health improved. It was attention to his wellbeing that led directly to improved health outcomes. He did not return to the hospital. This is almost miraculous. Except that it is so simple. It reflects the deep truth of what we all need and acknowledges that certain groups in this country have greater or lesser access to wellbeing.
We all know that our healthcare system, while so powerful in some ways, is failing us in others. This widespread acknowledgment has led to a welcome imperative for innovation, especially around addressing the social determinants of health. The time is ripe for exploring new models and new approaches. Healthcare is also in the midst of shifting payment structures to allow for funding of services, communities, and people who are supporting wellbeing. We have an opportunity right now to build something that addresses more than care coordination. We can build networks that support wellbeing and equity in our communities
I deeply believe that if we in healthcare attend to wellbeing, if we truly focus resources, innovation, and creativity in building access to wellbeing for all of us, individually and in communities, we will reap significant rewards in improved health outcomes. Let’s build a movement for wellbeing, a movement for increased access to wellbeing for all of us, and let’s put it at the heart of our work in health. I’m in, are you?
Rachel joined FFI having made a leap from medicine to systems and social change. After some time working from the outside in, Rachel has chosen to return to practicing medicine to create change from the inside out. FFI will be recruiting a new Director of Healthcare Transformation. Look for the job announcement and posting towards the end of the year.