http://www.cfha.net/forum_thread.php?t=50Recent posts in Bill Doherty: "Citizens of the Healthcare Home: A Concept and Plan for a Pilot"http://www.cfha.net/forum_thread.php?t=50#post278pbNameb maryanna hathawayppbEmailb bugrushaol.comppI am a registered nurse and a licensed professional counselor and I am interested in starting to open the eyes and the ears of a small conservative community in Northern Michigan.nbsp Does anyone have good ideas as to where to startphttp://www.cfha.net/forum_thread.php?t=50#post47pppI first caught wind of Bills citizenefforts at the Chaska conference.nbsp My first thought was I love the ideabut it seems impractical to make so much effort to include peoplepatients inthe start-up process.nbsp Now 5 years later its impressive to see how itsgrown from a few disease-specific programs to a community-wide project.ppnbspppI was most inspired by the plenary in Denver.nbsp I came home committed tohaving a patient representative at all my resident educationpresentations.nbsp It also led me to making patient feedback sessions a corepart of all my group medical appointments.ppnbspppAs for obstacles I do return to start-up time.nbsp I worry that theseprojects wont take flight outside an academic incubator.nbsp It is the ideal healthcare reform but will thesystem muster the patience to nurture it to fruitionphttp://www.cfha.net/forum_thread.php?t=50#post43p classMsoNormal stylemargin 0in 0in 0ptnbspstrongBasic Ideastrongnbsp The health care home idea which now focuses on changing the way professionals serve consumers can create pathways for consumers to become citizens of a health care home community.nbsp This citizenship has two levels personal and family responsibility for onersquos own health care in relationship with the professional team and opportunities for leadership within the health care home community.pp classMsoNormal stylemargin 0in 0in 0ptnbsppp classMsoNormal stylemargin 0in 0in 0ptstrongGoalstrongnbsp improved health outcomes for people connected to health care homes through stronger personal and collective ownership of their own health carepp classMsoNormal stylemargin 0in 0in 0ptnbsppp classMsoNormal stylemargin 0in 0in 0ptstrongThe Provider Pressure Pointstrongnbsp Primary care needs a new practice model or it will continue to erode and the health care home idea will not reach far enough if it does not transform how patients are engaged in their health care.nbsppp classMsoNormal stylemargin 0in 0in 0ptnbsppp classMsoNormal stylemargin 0in 0in 0ptstrongWhat the Citizen Health Care Model Offersstrongnbsp For a decade we have been developing a grass roots organic democratic way to involve people in tackling health care challenges in their communities.nbsp Up till now Citizen Health Care projects have focused on specific issues such as diabetes smoking and depression.nbsp But this community organizing process can be adapted to the development of citizenship in a health care home community.pp classMsoNormal stylemargin 0in 0in 0ptnbsppp classMsoNormal stylemargin 0in 0in 0ptstrongWhat a Citizen Project in a Health Care Home Might Look LikestrongnbspEvery patientfamily would be invited to take out citizenship papers in the clinic based on the framework develop by the leadership group.nbsp At the personalfamily level this might mean orientation sessions and an explicit social contract laying out expectations between citizen patients and the professionals in the clinic. The idea is to forge a more intentional approach to onersquos health care and onersquos relationships with providers.nbsp Patients and families who do not take out citizenship papers will continue to receive the same health care services just as the children of non-PTA parents receive the same teaching as children of PTA parents.nbsp However citizen patients are likely to benefit from deeper involvement with the health care home via special communications community gatherings and more collaborative relationships with providers.pp classMsoNormal stylemargin 0in 0in 0ptnbsppp classMsoNormal stylemargin 0in 0in 0ptstrongThe PilotnbspnbspstrongA large primary care clinic has volunteered to form a leadership team of professionals and citizen patients with leadership abilities to co-create a ldquoconstitutionrdquo for its health care home community and embark on the process of implementing it.nbsp I will lead the process over the next year as part of my work in the new Citizen Professional Center a hrefhttpwww.citizenprofessional.orgwww.CitizenProfessional.orga..pp classMsoNormal stylemargin 0in 0in 0pt 0.25innbsppp classMsoNormal stylemargin 0in 0in 0ptstrongThe Bold VisionnbspnbspstrongThe health care system can only be saved by we the people working democratically on personal and collective responsibility for the health of all. Deep citizen involvement at the grass roots level of health care can produce leaders to become part of the larger policy development.ppnbsppp classMsoNormal stylemargin 0in 0in 0pt text-align center aligncenterstrongENGAGING PATIENTS AND COMMUNITIES IN HEALTH CAREstrongpp classMsoNormal stylemargin 0in 0in 0ptstrongnbspstrongptable classMsoTableGrid stylemargin auto auto auto 0.2in border-collapse collapse border1 cellspacing0 cellpadding0tbodytr styleheight 17.1pttd styleborder-color ece9d8 padding 0in 5.4pt width 1in height 17.1pt background-color transparent width96 valigntopp classMsoNormal stylemargin 0in 0in 0ptnbspptdtd styleborder-color ece9d8 ece9d8 windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 436.5pt height 17.1pt background-color transparent colspan3 width582 valigntopp classMsoNormal stylemargin 0in 0in 0pt text-align center aligncenterstrongThe level of the task and the manner of engagementstrongptdtrtr styleheight 31pttd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 1in height 31pt background-color transparent width96 valigntopp classMsoNormal stylemargin 0in 0in 0ptnbspptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 135pt height 31pt background-color transparent width180 valigntopp classMsoNormal stylemargin 0in 0in 0pt text-align center aligncenterstrongThe Personal taskstrongpp classMsoNormal stylemargin 0in 0in 0pt text-align center aligncenterThe ldquoIrdquoptdtd styleborder-color windowtext windowtext windowtext ece9d8 border-top 1pt solid windowtext border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 162.65pt height 31pt background-color transparent width217 valigntopp classMsoNormal stylemargin 0in 0in 0pt text-align center aligncenterstrongThe Clinic and Community task strongpp classMsoNormal stylemargin 0in 0in 0pt text-align center aligncenterThe ldquowerdquoptdtd styleborder-color windowtext windowtext windowtext ece9d8 border-top 1pt solid windowtext border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 138.85pt height 31pt background-color transparent width185 valigntopp classMsoNormal stylemargin 0in 0in 0pt text-align center aligncenterstrongThe larger societal taskstrongpp classMsoNormal stylemargin 0in 0in 0pt text-align center aligncenterThe ldquoall of usrdquoptdtrtrtd styleborder-color ece9d8 windowtext windowtext border-left 1pt solid windowtext border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 1in background-color transparent width96 valigntopp classMsoNormal stylemargin 0in 0in 0ptstrongTraditional medical consumer modelstrongpp classMsoNormal stylemargin 0in 0in 0ptnbspptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 135pt background-color transparent width180 valigntopp classMsoNormal stylemargin 0in 0in 6pt 7.9pt text-indent -7.9ptmiddotnbspnbsp The professional as expert provider and teacherpp classMsoNormal stylemargin 0in 0in 0pt 8.1pt text-indent -8.1ptmiddotnbspnbsp The patient as receptive consumer and learnerpp classMsoNormal stylemargin 0in 0in 0ptnbspptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 162.65pt background-color transparent width217 valigntopp classMsoNormal stylemargin 0in 0in 3pt 11.5pt text-indent -11.5ptmiddotnbspnbspnbspnbsp Education outreach professionals teach and intervene patients community members learn and changepp classMsoNormal stylemargin 0in 0in 0pt 11.7pt text-indent -11.7ptmiddotnbspnbspnbspnbsp Advice input professionals learn from patientscommunity members in selected areas patients community members provide useful consumer feedbackptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 138.85pt background-color transparent width185 valigntopp classMsoNormal stylemargin 0in 0in 6pt 12.25pt text-indent -12.25ptmiddotnbspnbspnbspnbsp Professionals educate public officials and payers on policy issuespp classMsoNormal stylemargin 0in 0in 0pt 11.95pt text-indent -11.95ptmiddotnbspnbspnbspnbsp Professionals advocate to public officials and payerspp classMsoNormal stylemargin 0in 0in 0ptnbspptdtrtrtd styleborder-color ece9d8 windowtext windowtext border-left 1pt solid windowtext border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 1in background-color transparent width96 valigntopp classMsoNormal stylemargin 0in 0in 0pt text-align right alignrightWell-suited forptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 135pt background-color transparent width180 valigntopp classMsoNormal stylemargin 0in 0in 0ptMinor and major acute problems trauma surgical emergenciesptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 162.65pt background-color transparent width217 valigntopp classMsoNormal stylemargin 0in 0in 0ptRoutine prevention and self-care provider-initiated changes such as new prevention or practice guidelinesnbspptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 138.85pt background-color transparent width185 valigntopp classMsoNormal stylemargin 0in 0in 0ptDelivering an organized professional opinion on policy issues such as access and reimbursementptdtrtrtd styleborder-color ece9d8 windowtext windowtext border-left 1pt solid windowtext border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 1in background-color transparent width96 valigntopp classMsoNormal stylemargin 0in 0in 0pt text-align right alignrightNot so well-suited forptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 135pt background-color transparent width180 valigntopp classMsoNormal stylemargin 0in 0in 0ptPrevention self-care family care giving chronic illnesses uncertain diagnoses and treatment options end of lifeptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 162.65pt background-color transparent width217 valigntopp classMsoNormal stylemargin 0in 0in 0ptHealth behaviors that are difficult to change cultural differences areas where patients donrsquot have access to enough information to give useful feedback to the clinicptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 138.85pt background-color transparent width185 valigntopp classMsoNormal stylemargin 0in 0in 0ptEngaging the public in changing the culture and practice of personal and professionally-delivered health careptdtrtr styleheight 16.15pttd styleborder-color ece9d8 ece9d8 windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 1in height 16.15pt background-color transparent width96 valigntopp classMsoNormal stylemargin 0in 0in 0ptnbspptdtd styleborder-color ece9d8 ece9d8 windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 135pt height 16.15pt background-color transparent width180 valigntopp classMsoNormal stylemargin 0in 0in 0ptnbspptdtd styleborder-color ece9d8 ece9d8 windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 162.65pt height 16.15pt background-color transparent width217 valigntopp classMsoNormal stylemargin 0in 0in 0ptnbspptdtd styleborder-color ece9d8 ece9d8 windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 138.85pt height 16.15pt background-color transparent width185 valigntopp classMsoNormal stylemargin 0in 0in 0ptnbspptdtrtr styleheight 151.6pttd styleborder-color ece9d8 windowtext windowtext border-left 1pt solid windowtext border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 1in height 151.6pt background-color transparent width96 valigntopp classMsoNormal stylemargin 0in 0in 0ptstrongCitizen Health Care modelstrongptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 135pt height 151.6pt background-color transparent width180 valigntopp classMsoNormal stylemargin 0in 0in 6pt 7.9pt text-indent -7.9ptmiddotnbspnbsp The professional as competent collaborative provider and partnerpp classMsoNormal stylemargin 0in 0in 0pt 8.1pt text-indent -8.1ptmiddotnbspnbsp The patientfamily as partner astrongnd responsible agent of own healthstrongpp classMsoNormal stylemargin 0in 0in 0ptstrongnbspstrongptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 162.65pt height 151.6pt background-color transparent width217 valigntopp classMsoNormal stylemargin 0in 0in 3pt 12.95pt text-indent -12.95ptstrongmiddotnbspnbspnbspnbspnbsp Citizen professionals and citizen patients co-create ldquoconstitutional frameworkrdquo for patient and community involvement in the health care practice homestrongpp classMsoNormal stylemargin 0in 0in 3pt 12.95pt text-indent -12.95ptstrongmiddotnbspnbspnbspnbspnbsp Agreed-upon practices to foster citizen patient engagement at the personal levelstrongpp classMsoNormal stylemargin 0in 0in 0pt 12.6pt text-indent -12.6ptstrongmiddotnbspnbspnbspnbspnbsp Opportunities for patients to become citizens and leaders in their health care communitystrongptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 138.85pt height 151.6pt background-color transparent width185 valigntopp classMsoNormal stylemargin 0in 0in 6pt 12.25pt text-indent -12.25ptstrongmiddotnbspnbspnbspnbsp Citizen professionals and citizen patient leaders who emerge from the local level educate and advocate with public official and payersstrongpp classMsoNormal stylemargin 0in 0in 0pt 11.95pt text-indent -11.95ptstrongmiddotnbspnbspnbspnbsp Citizen professionals and citizen patient leaders engage the larger public in solving health care problemsstrongptdtrtrtd styleborder-color ece9d8 windowtext windowtext border-left 1pt solid windowtext border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 1in background-color transparent width96 valigntopp classMsoNormal stylemargin 0in 0in 0pt text-align right alignrightstrongWell-suited forstrongptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 135pt background-color transparent width180 valigntopp classMsoNormal stylemargin 0in 0in 0ptstrongAny area where active patientfamily self-responsibility and engagement are importantstrongptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 162.65pt background-color transparent width217 valigntopp classMsoNormal stylemargin 0in 0in 0ptstrongClinics that desire deep engagement and community building with their own clinics and want to focus health challenges that frustrate providers and concern patients and communitiesstrongptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 138.85pt background-color transparent width185 valigntopp classMsoNormal stylemargin 0in 0in 0ptstrongEngaging ldquowe the peoplerdquo in systemic and personal change creating policies that build community capacity for healthstrongptdtrtrtd styleborder-color ece9d8 windowtext windowtext border-left 1pt solid windowtext border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 1in background-color transparent width96 valigntopp classMsoNormal stylemargin 0in 0in 0pt text-align right alignrightstrongNot so well-suited forstrongptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 135pt background-color transparent width180 valigntopp classMsoNormal stylemargin 0in 0in 0ptstrongWhen patientfamily are not able or willing to actively engagestrongptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 162.65pt background-color transparent width217 valigntopp classMsoNormal stylemargin 0in 0in 0ptstrongClinics focused on survival or confident in the traditional model patients and community disengaged from the clinicstrongptdtd styleborder-color ece9d8 windowtext windowtext ece9d8 border-right 1pt solid windowtext border-bottom 1pt solid windowtext padding 0in 5.4pt width 138.85pt background-color transparent width185 valigntopp classMsoNormal stylemargin 0in 0in 0ptstrongThe technical dimensions of policy implementationstrongptdtrtbodytablep classMsoNormal stylemargin 0in 0in 0ptstrongnbspstrongppstrong 1 What clinics in your community might be open to a citizen initiativelike the one describedstrongppnbspppstrong 2 Few policy makers seems to be talking about mobilizing communities totackle the challenges in health care.nbsp What are the implications ofCitizen Health Care for health care reformstrongp