Pritpal S Tamber: Creating health—the emerging principles

pritpal_tamber_2014The Creating Health Collaborative was formed to understand why, despite their potential, broader definitions of health remain only a fringe of health innovation. In today’s post, I am sharing their first report (opens a PDF) and have reproduced below an edited version of what the Collaborative thought were the emerging principles for creating health.

We are struggling to meet the growing demand for care and yet it will only grow. At the heart of this struggle is our inability to define health as more than just the absence of disease. Broader definitions of health may enable us to create health and so offset the growing demand for care.

To embrace broader definitions we need to accept the idea that health, as defined as the absence of disease, may not be what people want per se. Instead, they want to lead satisfying lives, with the absence of disease being only part of it. Other parts include things such as: physical functioning, financial security, fulfilment from daily activities, emotional security, nourishing relationships, a sense of community, and a sense of meaning.

Some people call this broader definition “wellbeing;” others call it “life satisfaction.” There is no doubt that the language of the space needs clarifying. Whatever it’s to be called, by sharing their work (at a meeting in New York on 22 July 2014) the Collaborative suggested the following as the principles for creating health.

Let people define health

Let people decide what health means to them. And let’s not try to enforce any models on them, including the “life satisfaction” one above. Just let them speak and take it from there.

Set a long lead time

Some say the adoption curve is two and a half years; others say seven years. There are already projects in health with a 10 year timeline. Whatever you decide, don’t plan for less than five years if you want to create a sustainable system of health creation.

Give the community control

Once you understand the different parts of your community, establish a way for the community to be in control. There is every chance that clinical expertise is needed but that skill should be invited to the table as an equal partner, ensuring parity between local heuristics and professional knowledge.

Agree value before metrics

Agree what value you’re trying to create before you start assigning metrics. This is essential so that during evaluation you’re able to remember the direction you were heading in, rather than just the minutia of the journey.

Operate at individual and community levels

Interventions at the individual level are likely to be short term if the interconnectedness—or scaffold—of the community is not considered. Always ask yourself how something that acts on the individual can also either invest in or tell you something about the scaffold.

Accept failure, but fail fast

This is unchartered territory so it’s important to take risks. This means accepting the possibility of failure. Learn to evaluate early and make quick decisions, whether it be to continue, change, or stop a project. Embrace the idea that a unit of success is that you learn something—and ensure that all learnings are carefully documented, including the process that was followed.

Embrace complexity

There’s no getting away from it, creating health means trying to create change in a complex environment: embrace complexity; embrace the idea of emergence; focus less on things such as causality and attribution, and more on shared contribution; and learn to devise projects and programmes within these parameters.

Be open to unintended consequences

This is part of embracing complexity but it’s worth reiterating within the context of evaluation. Even if you focus on value before metrics, there is every chance that you’ll miss changes that are happening elsewhere as a result of your intervention. Find a way to be open to this possibility—there is every chance that new ideas lurk in these phenomena.

Meticulously record processes

How health is created will differ from community to community, but what may be the same is the process that’s followed. Be meticulous about recording how things are done and why. Transplanting and scaling good ideas will happen at the process level, not the intervention level.

Build a resilient team

Creating health will be difficult work: uncertainty will be the norm, failure will be common, and doubts will surface repeatedly. Your ability to deliver will be directly correlated to how resilient your team is, how much they understand that this is both unchartered territory and likely to be very difficult. Make team cohesion an important metric in your evaluations.

Invest carefully; err towards being lean

At the beginning, you may well require philanthropic capital but consider it only short term, seed funding. If creating health is to become the norm, it must stand on its own two feet—one of consumer defined value and the other of economic self-sufficiency.

Finally, embrace group attribution

Attributing causality to a single organisation, programme, or stakeholder is a red herring. Find ways to attribute value to the commons—whatever that means. This will be fundamental to long term relationships among the multiple stakeholders in a community.

There is no doubt that the idea of creating health is a difficult one to grasp. And yet, talk of healthcare’s unsustainability is decades old. We have to try something new and we have to build a community of practice that shares thinking, projects, and experiences in order for others to join in an experiment.

The report ends with what the Collaborative feels we need to work out next to make creating health the norm. It is currently seeking funding to continue its work. If you’d like to support us, please do get in touch.

The attendees of the Collaborative’s first meeting were (alphabetically, by first name): Bridget Kelly, senior program officer, Institute of Medicine; Gerry Greaney, designer/researcher, Center for Innovation, Mayo Clinic; Harry Burns, professor of global public health, Strathclyde University; Jamie Harvie, executive director, Institute for a Sustainable Future; Jeff Cohen, director, FSG; Leigh Carroll, associate program officer, Institute of Medicine; Oliver Smith, director of strategy & innovation, Guy’s and St Thomas’ Charity; Onil Bhattacharyya, Frigon Blau chair in family medicine research, Women’s College Hospital, University of Toronto; Prabhjot Singh, director of systems design, The Earth Institute; Pritpal S Tamber, founder, Creating Health Collaborative; Scott Liebman, partner, Loeb & Loeb; Seema Kara, program manager, US Community Health Systems, Earth Institute; Thomas Foels, chief medical officer, Independent Health and representing the Alliance of Community Health Plans.

Pritpal S Tamber is an explorer of the future of health and an adviser on transformative innovation in healthcare. His work is informed by his experience as the physician editor of TEDMED; the medical director of Map of Medicine, a company that helps clinicians improve the quality of care; and numerous roles in medical publishing, including at BioMed Central, the company that proved open access publishing was commercially sustainable. Pritpal honed his ideas through a movement called Wellthcare, in which he explored the idea of creating health through community. This work has led to the Creating Health Collaborative. Follow him on Twitter.

Competing interests: None declared.