5% of the population accounts for 50% of overall health care spending.     http://www.nihcm.org

25% of the United States community population have one or more of the following:

• Mood disorder
• Diabetes
• Heart Disease
• Asthma
• Hypertension

https://archive.ahqr.gov/research/findings/factsheets/costs/expriach/#mostexpensive

I have spent my professional career attempting to become an expert at caring for this population. I believed that if I followed the rules/guidelines/best practices/gold standards developed by the ‘experts’, I would be successful at keeping the population that I was responsible for as healthy as possible. This was true for my personal life as well. If I could just figure out the rules (as defined by the experts), I could be happy.

When my job involved my teaching others how to keep the population as healthy as possible because we were financially responsible for the health of the population, I crumbled. So many rules, so many experts all saying different things. Who could we trust?

I took a six month sabbatical to focus on  a piece of this work that I have always been passionate about and that is self-determination. How do you teach the value of self-determination to caregivers that are trying to follow the rules and ‘do it right’?

I have had many great teachers, many of whom probably don’t even know how influential they were to me. One day I was complaining about work and this fella who I had just met said “you are giving all your power away”.

I had no idea what that meant. I ruminated over this idea for weeks. I was feeling powerless. How could I give away something I didn’t even feel like I had in the first place? I started to research the concept of power.

As a nurse, when I reflected on the concept of self-determination, I felt that it threatened my power over the plan for the population that I was responsible for. How could the individual possibly know what was best when I was the one with all the correct information?

I like to be correct.

The next teacher was a consultant that my company hired to help leadership get a handle on the discord felt by the team members. This consultant told me that I was not allowing myself to be vulnerable. Team members didn’t trust me because  I was not generous with giving them the benefit of the doubt with how they did their job. I was critical.

My core beliefs (which are simply thoughts you keep thinking) were being challenged.  My sister was diagnosed at age 38 years with breast cancer that metastasized to her lung, bones and brain had recently died at 44 years suffering what I felt was a horrible end of life experience.  I played a significant role in her treatment decisions. We followed the rules as explained to us by experts yet she suffered most days. Do you know when she suffered least? When we would play golf (which she loved) or when we had family time, or when she was doing things that she was most passionate about.

The next teacher, probably the one that has influenced me the most was Don Berwick. Don was the President and CEO of IHI (Institute for Health Care Improvement) and the administrator at CMS (Center for Medicare and Medicaid Services) until 2011. Don was giving the keynote address at the IHI annual conference in Florida in December of 2013. In his talk he shared a story of an experience that he had on the drive that he and his wife were taking to New Hampshire to visit his beloved 4 year old grandchild, Kaleb. He described this feeling that he had in his body with a level of anticipation and excitement as a state of complete wellbeing. He said that for him, this was the feeling of health.

Suddenly, I got it. Everyone’s feeling of health is different. What makes you have a sense of wellbeing could be different than everyone else. Even those that you are closest to and love most dearly may have beliefs and experiences that have a profoundly different impact on your sense of wellbeing. I had finally learned what self-determination actually meant and how it could be taught and adopted to help address population health.

IHI has a statement that they encourage practitioners to consider: instead of asking “what’s the matter with you?” ask “what matters to you?”. When you know what matters to the individual, you then craft a treatment plan that allows the individual to focus changes on why they would be driven to make the change. Knowing what matters is the key. Knowing what matters is the key to Person-Centered Care Planning.