Will our model of care soon become obsolete?

Aging baby boom generation is driving change

Your facility has spent months — maybe years — in a major service lines reorganization throughout the healthcare continuum: From acute care settings to hospice, clinical care paths — complete with patient and family education — run smoothly. Patient, staff, and physician satisfaction scores soar higher than ever.

What’s wrong with this picture?

Such traditional models of patient-focused care concentrating only on medical management may become obsolete in the 21st century, as aging baby boomers demand services geared toward healing the mind and the spirit, as well as the body, says Stacy Nelson, EDD, manager of staff development and performance enhancement at Celebration Health. The new 315,000-square foot health care center, located south of Orlando, FL, was built on the principle that hospitals of the future should be more than places for episodic illness.

"We want to provide true patient-focused care; that is, offer patients tools and support that will enable them to gain optimum health and vitality, not just manage an illness until discharge," he explains.

The model Celebration uses to illustrate the various stages of health and wellness — or lack thereof — is called the "Circle of Life."

The first quadrant, Illness, represents the traditional treatment model: Patients who are dependent on medical professionals for precise diagnosis and treatment of disease. "The goal for anyone in this quadrant is simply survival and stability," Nelson says.

Many health care facilities don’t move out of that quadrant, which is only concerned with treating the physical nature of disease and illness, he points out. "Hospitals are places where people come when their body is sick, not where they go to get well or stay well."

Some facilities have ventured into the second quadrant, Wellness, in which the individual takes on the status not just of a patient, but a partner in the healing process. "This is the quadrant of independence where the partner assumes a proactive responsibility for health," Nelson explains.

Only a handful have ventured into the territory of the third quadrant: Wholeness. "This quadrant is characterized by freedom; not just from disease, but freedom to be yourself. It’s a restoration of your true identity — physically, mentally and spiritually," he explains.

For example, a cardiac rehab patient in the wholeness quadrant doesn’t exercise because he or she must (illness quadrant), or should (wellness), but if he or she wants to. "It has become part of how they live a satisfying and full life," Nelson says.

The last quadrant is Death. "Death happens to all of us, but how you live until you die is the real question," says Nelson.

Life expectancy is America is 74 years, he points out. "However, the healthy expectancy is only 62 years. This means we live with some sort of chronic condition for almost 12 years."

Approaching Death through the Illness quadrant yields results in stark contrast to approaching Death through the Wholeness quadrant, he notes. "Both the quality and economics of health care are directly affected," he says. For example, most of Medicare’s health care dollars are consumed by frail elders older than 80.

The sudden decline of the elderly is not inevitable, exacerbated by lifestyle habits begun earlier in life, such as poor nutrition and no exercise. "By offering services and programs based on the Wholeness quadrant, hospitals help people prepare to operate powerfully and independently until the very end of life," he says.

What baby boomers want, baby boomers get

That’s just what patients of the future will demand, Nelson believes. "As we near the turn of the century, what seems to be ailing the masses are lifestyle’ diseases [such as diabetes, high blood pressure, and heart disease] that contribute to almost half of all deaths," Nelson says. "To fully address these diseases, patients must make difficult lifestyle changes."

However, such changes won’t occur if the physician or other care team member merely instructs the patient on the importance of modifying behavior.

"It’s not enough to say, go home and make better nutritional choices,’ or get more exercise,’" Nelson stresses. "It’s one thing for a patient know that, but another for a patient to actually do it. Being patient focus-minded means helping them fill in this gap."

Even top-notch patient education programs fail in tackling lifestyle diseases because they don’t teach patients how to take responsibility for their health.

Take diabetic education, for example. "Just checking off whether or not a patient can verbalize accurately the procedure for blood sugar monitoring’ does not guarantee a change in behavior," he points out. "It still leaves a gap between the patient knowing what he or she should do, and actually being motivated and able to do it."

Tools for true patient-focused care

To help patients make successful lifestyle changes, Celebration Health uses a model called the "Personal Vitality Program," adapted from the Praxis Group in Provo, UT.

"It is a vehicle to carry the content about wellness," says Ron McMillian, Praxis partner and cofounder of the Covey Leadership Center.

Rather than simply offering knowledge about wellness, the program gives patients practical tools to find out "where they are and where they want to be, physically, emotionally, and spirituality," he says.

Through a series of simple steps, patients can learn the answers to these critical questions:

• What do I have and why?
• What do I want?
• What will I do to get it?

"One man discovered he had no desire at all to exercise; but he did have a strong desire to live well and long enough not just to see his grandchildren — but to take them on vacations," Nelson explains.

Then the critical behavior is identified. "This is one behavior, that, if you do it, many other behaviors follow. It’s often the behavior that’s the key to getting unstuck, and the one that will most likely lead to the desired result," Nelson explains. "For example, one woman found that if she was on the porch at 7 a.m. with her walking shoes on, she would exercise."

Such lifestyle change is experiential rather than theoretical, "because when the individual discovers what is really important, change is possible," says McMillian. "This is often the missing link in preventative health care."

Practice what you preach

Celebration employees also use concepts from the Vitality program in their professional and personal lives.

"If employees are able to deal with the whole person, [it] changes the whole nature of the encounter," Nelson says. "Instead of the attitude, I’m only here to draw blood,’ there is the recognition that the patient is a person with spiritual and emotional needs."

After a basic orientation program, all staff members go through the Vitality Program to learn how to master the competing demands of their lives.

"The rationale is that all corporate behavior is ultimately private behavior; we take the time and effort to give our staff these tools," says Nelson.


Stacy Nelson, Manager of Staff Development, Celebration Health, 400 Celebration Place, Celebration, FL 34747. Telephone: (407) 764-4000.

Ron McMillian, The Praxis Group, 55 N. University, Suite 225, Provo, UT 84601. Telephone: (801) 373-2233.