H4 – What If We Tried for Health? Donald M. Berwick, MD, MPP 19th Annual International Forum on Quality and Safety in Healthcare This presenter has nothing to disclose April,

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“Health is a state of complete physical, mental, and social well- being, and not merely the absence of disease or infirmity.” —WHO 4

Royal Observatory 5

Prime Meridian

Dava Sobel’s Longitude

Cloudesley Shovell Shipwreck

John Harrison

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H2 11

H3 12

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Harrison’s Clocks 15 H1H2H3H4

Richie Davidson

Davidson’s Findings Meditation cultivates emotional well-being, empathy, and compassion. Mindfulness reduces stress, and reducing stress reduces inflammation. Adversity and stress negatively impact brain structure and function, which can be reversed by stress-reducing interventions.

Jon Kabat-Zinn

Wayne Jonas

Salutogenesis 20 The process of healing and health creation

Optimal Healing Environment 21 Facilitate healing processes that focus on people’s resources and capacity to create health. Three goals: – Preventive – Restorative – Palliative

Four Pillars of Human Flourishing Psychological resilience Social support and cohesion Exercise movement and sleep Healthy exposure to substances in the diet and environment

23 HEALTHY ENVIRONMENT Mind-body Skills & Psychological Resilience HEALTHY CULTURE Social Support & Cohesion Exercise Movement & Sleep Optimum Nutrition & Substance Use PURPOSE & MEANING

Placebo Effect 24 Real surgery vs. sham surgery for angina No difference in outcomes Pain relief in 70% - 80% of patients in both groups

Placebo Effect 25 Real vs. sham laser myocardial revascularization No difference in outcomes – 60% of patients in both groups improved by an entire functional class Benefits lasted over six months

Access Research and Learn More About the Science of Healing Contact Kim Adelman or

Dan Buettner

Characteristics of “Blue Zone” Communities 28

Characteristics of “Blue Zone” Communities Move naturally Know your purpose – have a reason for waking up Kick back – shed stress Eat less Eat less meat Drink in moderation Have faith Power of love – family first Stay social

Dean Ornish

Ornish’s Program 31 10% fat vegetarian diet Moderate aerobic exercise Stress management training Smoking cessation Group psychosocial support

Ornish’s Results 32 Experimental group: – 8% less stenosis in coronary arteries Control Group: – 28% more stenosis in coronary arteries – Cardiac events occurred 2.5 times more frequently

Themes Embrace a positive view of health Resources to support positive health reach beyond current boundaries of health care Significant effect sizes from wellness efforts Systemic designs that change how we live Connectedness and interpersonal interactions Loving kindness

Stanley Milgram 35

Milgram Experiment 36

Milgram Experiment Prod 1: Please continue. Prod 2: The experiment requires you to continue. Prod 3: It is absolutely essential that you continue. Prod 4: You have no other choice but to continue.

Health Effects of Prosocial Behavior Prosocial behavior leads to lower stress and sense of well-being. Giving correlates with happiness in 88% of countries surveyed. Even children are happier when giving. People who give are happier and have lower cortisol levels than those who keep money. Older adults who help others live longer. Giving to charity is associated with improved grip strength.

“The benefits of prosocial spending are evident in givers old and young in countries around the world, and extend not only to subjective well- being, but to objective health.” —Elizabeth Dunn

What can you do? 1. Reconsider your own concept of health. 2. Reconsider the form and function of your piece of the health care system. 3. Take account of healing tools you and your patients have that lie outside the boundaries of the health care system. 4. Bring systems thinking to the pursuit of well-being. 5. Re-establish your faith in and use of connectedness and interpersonal relationships. 6. Remember, embrace, and celebrate that kindness is inseparable from healing and good health.

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