Recording of the Call: https://www.dropbox.com/s/60tdn9kq7u9luxd/Charter%20Healthcare%20140826%20edit.mp3?dl=0
Facilitator: Dr. Elizabeth Rider, Director of Academic Programs at the Institute for Professionalism and Ethical Practice, Boston Children’s Hospital/ Harvard Medical School.
Elizabeth Rider: Will be giving a roadmap of the call. First, we will hear from Dr. Doty, then questions/answers, then breakout groups to discuss a couple of questions. The breakout group discussion will contribute to the Charter’s Community Toolbox. The Toolbox will assist the Compassionate Cities and Communities as well as all sectors/partners of the Charter. Following the breakout sessions, the whole group will come back together to discuss insights, etc.
Dr. Doty is our speaker. He will talk for about 15 min and then we will have about 15 min for questions/answers. Dr. Doty is the Founder and Director of CCARE. ccare.stanford.edu. which supports rigorous research on compassion. He collaborates with a number of scientists on the neurological basis of compassion. See his bio on the Charter website. Dr. Doty is member of the Global Advisory Council for the Charter.
When there is caring and concern and sincere authenticity, the severity and length and even occurrence of disease is positively impacted.
In terms of the Charter, how do we examine the issue of lack of access to healthcare in communities? To some degree, it turns into a political question. It is part of a deep examination of how a more compassionate attitude toward the citizenry will have a more positive impact. Creating the “Center for Compassionate Health Care” involves Dignity Health, CCARE, and the Stanford School of Medicine. The Center is creating a think tank--curator, aggregator, creator of tools in this domain, as well as doing research in this area with partners (other healthcare institutions). Also, the Center will act as convener of conferences in this domain.
Dr. Doty: CCARE does not have all the answers. Difficult to do. Can get agreement, but implementation is often another issue. Especially when it requires money. Institutions spend extraordinary amounts of money dealing with stress. Many physicians in training are on anti-depressants. He is just beginning to explore this--it is a work in progress. Cannot start an initiative like this alone--have to have buy-in from physicians and patients.
Alem Makonnen: Has worked in healthcare, education, and leadership. When examining access to healthcare--cultural issues come up. Need awareness, humility, and sensitivity where we have historically not done so well. Need to authentically care. Need representation of this awareness in the leadership roles. Cultural considerations are important. How can we include this issue more?
Dr. Doty: Excellent question. Needs to be buy-in to change from institutions. When it comes down to the bottom-line which translates to dollars, that’s when people start paying attention. Need research to demonstrate value of these interventions/programs. Healthcare companies and insurance companies understand the need for compassion but want the empiric evidence. Individuals on this call can be involved in this initiative. In regard to sensitivity to cultural issues and the poor, again, mayors in cities and governments are trying to figure out the best solutions to these issues. We see demoralized populations that have been living on the edge for generations. We all know the impact of childhood poverty. These are things we have to address in our society. US has not addressed childhood poverty. As we move forward looking at this domain, we have to speak to the issue of disenfranchisement--people who do not come to hospital due to lack of funds, access, etc. As we create a cohesive grassroots entity among healthcare providers that demand this, many providers are also at the end of their ropes. Providers are stressed by the political issues. We need to address the political issues as well.
Carol Paris: She is a physician in US. In countries where they have a national healthcare system, do providers have less burnout and more compassionate initiatives?
Dr. Doty: No, cannot say that is the case. If you were to “de novo” plan a healthcare system and even plan a society and address many of these issues, including healthcare for all, you could design a wonderful program. Unfortunately, we know there are countries that spend half of what US does and have better outcomes. Physicians often feel they don’t have adequate resources or time. In a capitalist country, profits are syphoned off and physicians become workers instead of professionals. Capital goes into pockets of companies, share holders, etc. In socialist countries, they have little money and physicians still have burnout. This is true of British and Canadian systems. Societies that are more culturally integrated into caring for all and also have a fair degree of wealth, e.g. Scandinavian countries, have better results. However, there is still cultural pressure not to stand out or complain which can be a downside as well. Question: how do you work in a political system to create a better world for all? Has to be participation by the healthcare workers, the administrators who work on the issue of caring for the patient. Stanford’s “Clinical Excellence Research Center” tries to reduce healthcare costs. How do we use informatics and data to improve healthcare? Also, how do we use technology? Dr. Doty wants them to incorporate a patient-centered healthcare approach.
Beverly Tannon: In NY state. She is a breast cancer survivor. Resource is the “patient-centered outcome research institute”. Website: www.PCORI.org
Will have facilitators. Discussing and brainstorming the following questions:
- What questions do people need to ask in order to assure that all members of their communities receive adequate healthcare?
- What are some examples of programs, organizations and processes that you can share with others in our healthcare sector?
The Charter is creating a Community Tool Box that can be used by the entire Charter community in finding tools (i.e., assessments, techniques, evaluations, measurements, surveys, guidelines, etc.), especially the city/community initiatives, to support the work in which they are involved.
Shared Session - Follow-Up to Breakout Sessions
Lesa Warlker: Appreciated all the input from the group. One discussion point stood out. Louisa Hext brought up forgiveness. Forgiveness is a key issue for compassion and health care.
Sahid from Ashville, NC: Likes the model in Santa Monica. He is working in the hospice movement. The Santa Monica model of community outreach is wonderful. The calls are very helpful and timely for networking.
Florence Harvey: Moved by the similarities with her own family issues and the work she is doing. She created a website and was able to share it with others. Also, issue of “compassionate cooperation” struck a chord. Needs forgiveness and compassion to help in her own circumstance. Wants the book on compassionate cooperation.
Margo Lalich: Tied in with forgiveness is how we approach the individual. Telling the personal story is important. Compassion is about love. Difference between self-less love and selfish love. Are we making choices, intervening, and acting through self-less love?
Zoe Muntaner: Santa Monica. Mary brought up the question of who is not at the table. She is planning to design a volunteer ambassador group to design a way to connect with those who are not able to tap into technology. Santa Monica has a large homeless population. www.CompassionateSantaMonica.org .
Grace Cerrone: In our group there was discussion of research being done on healthcare that was relevant. Talked about demographics. She can contribute by advocating and getting people involved. “Mydemocracy” is a platform for people to speak to legislators. They are listening and holding people accountable. She has been inspired by the “Hamilton Project”- part of Brookings Institute. She has created a group: “Bipartisan Support of Rising Youth Out of Poverty.” There are a ton of healthcare issues around bringing youth out of poverty. She would like to mobilize people around this. Please contact her if you want to collaborate.
Barbara Kaufmann: Discussion of aging population. How to meet healthcare needs especially in rural areas. Might be a cross-country database developed where people could exchange services in communities other than their own. If one’s parents are distant, how can you best find help for them from afar?
Florence Harvey: National resource: “Timebank USA”- volunteer effort- people offer their time and can take time back. Trying to coordinate roles that people can take on neighbor to neighbor. You can find out if there is a “Timebank” locally. Another model where timebanking has been used for Medicaid purposes is used in Lehigh Valley Medical- called “Neighbor to Neighbor Care.”
Andrew Himes: He appreciated the conference call and heard a lot of wonderful dialogue. The Charter has launched a membership campaign. Inviting everyone to be a member and to contribute time, energy, attention and finances (optional). Go to Charter website and click on “Join” in the menu bar. Most of the revenue to support the Charter has come from small donors who join the movement.
Marilyn: Reminders: November- Compassion Week in San Francisco- hopes everyone reads the Charter newsletter and registers for the events. Also, there is a second event in the Netherlands. Thank you to Drs. Doty and Rider for a wonderful call.
Luskin, Frederic. Forgive For Good: A Proven Prescription for Health and Happiness (Harper Collins Publishers, 2001)
Based on scientific research, this groundbreaking study from the frontiers of psychology and medicine offers startling new insight into the healing powers and medical benefits of forgiveness. Through vivid examples (including his work with victims from both sides of Northern Ireland’s civil war), Dr. Fred Luskin offers a proven nine-step forgiveness method that makes it possible to move beyond being a victim to a life of improved health and contentment.
www.thepowerofforgiveness.com explores recent research into the psychological and physical effects of forgiveness on individuals and within relationships under a wide variety of conditions and translates it into a popular, accessible documentary film for national public television. This includes feature stories on the Amish, the 9/11 tragedy and peace-building in Northern Ireland, along with interviews with renowned Buddhist teacher Thich Nhat Hanh, Nobel Laureate Elie Wiesel, best-selling authors Thomas Moore and Marianne Williamson and others. The film also explores the role forgiveness holds in various faiths traditions. It provides an honest look at the intensity of anger and grief that human nature is heir to. We see in the film that there are transgressions people find themselves unwilling or unable to forgive. Through character-driven stories the film shows the role forgiveness can play in alleviating anger and grief and the physical, mental and spiritual benefits that come with it.
www.theforgivenessproject.com The Forgiveness Project is a UK based charity that uses storytelling to explore how ideas around forgiveness, reconciliation and conflict resolution can be used to impact positively on people’s lives, through the personal testimonies of both victims and perpetrators of crime and violence. Our aim is to provide tools that facilitate conflict resolution and promote behavioural change. Central to the work is our commitment to work with ex-offenders and victims of crime as a way of modeling a restorative process.
www.glide.org “Glide Health Services” in San Francisco- provides compassionate care. Partners with St. Francis Memorial Hospital.
www.PCORI.org The Patient-Centered Outcomes Research Institute (PCORI) helps people make informed healthcare decisions, and improves healthcare delivery and outcomes, by producing and promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the broader healthcare community.
We mobilize, strategize and organize Compassionate Action in Santa Monica, CA. by bringing our City Council, Mayor, other City Officials and the private sector together to to sign the Charter for Compassion and develop a resolution as an effective means of effecting compassionate policies, change to our community and lead by example. We actively participate in the Global Movement established by the Charter for Compassion and participated in the 2013 Compassionate Games from September 11 to September 21, around the globe. The movement is gaining momentum and transcending geographical divide. The vision and mission is to make it a sustainable movement at a local level through horizontal leadership and community building. Collectively we want to prevent events and tragedies that plague our community.
Empowering Patients, http://www.carebrigade.com/ (their families and friends) in knowing, from the beginning, what medical, spiritual, and practical support Patients are likely to need to facilitate a full recovery, and how to help them rally a "just in case" team of on-call supporters. This Web site suggests ways for friends and family to provide support, even before the Patient knows exactly what they need.
Often a newly diagnosed Patient facing a life-threatening disease with a frightening prognosis is asked by friends and family "What can I do for you?" Unfortunately at that moment the Patient has no more idea of what will be needed than the person asking the question. Once treatment has begun we all know Meals and Drivers may be needed. However, this web site rallys emotional support for the Patient as well through what can be the most emotionally stressful part: the "what if" of a disease like cancer. It suggests Volunteer Patient Advocate Roles friends can play to support the Patient in dealing with many medical specialists and confusing terminology. Lastly these Advocates can provide the Patient a supportive listener and a sounding board for asking questions about and choosing among scary treatment options (surgery, chemo, radiation, etc).
Timebanking, www.timebanks.org TimeBanking is a way of giving and receiving to build supportive networks and strong communities. One hour helping another earns one TimeBank Hour (also called time credits, service credits or time dollars.) TimeBanking builds on the magic of “pay it forward,” one good turn leading to another and another.
A TimeBank is formed whenever individuals or organizations agree to earn and spend TimeBank Hours to meet the needs of friends, neighbors, and the larger community.
TimeBanks range from Small (15 – 20 members) to large (2,000 or more). They can connect with other Timebanks too.
Each TimeBank is unique reflection of its members, who they are, the dreams they have for their community, and what they choose to offer and receive.
Here is how it works: I earn a time credit by doing something for you. It doesn’t matter what that “something” is. You turnaround and earn a time credit doing something for someone else in your TimeBank Community. For example, an hour of gardening equals an hour of child-care equals an hour of dentistry equals an hour of home repair equals an hour of teaching someone to play chess. The possibilities are endless. Visit the website to learn more
Stacen Keating shared a paper, offered here as a PDF in this report. From the abstract of the Report: Barriers to care contribute to health inequities for immigrant populations. Although inadequate health insurance is a known barrier, other factors impact the issue. Few instruments exist to specifically measure these other barriers. The purpose of this study was to test the Immigrant Barriers to Health Care Scale – Hispanic Version. It was first pilot-tested in southern California with a Mexican population. After refinement, the instrument was tested in a north-eastern sample of diverse Hispanic adults. The data were analyzed using exploratory factor analysis. Factor loadings and communalities were used to assess the adequacy of the scale’s items. Six items were deleted due to ambiguous factor loadings. The final 11 items loaded onto four factors and explained 54.58% of the variance. The coefficient alpha was 0.81 for the instrument. The Immigrant Barriers to Health Care Scale is a reliable and valid tool. Its further use and reporting with other socially and economically disadvantaged groups is advised.