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Citizens of the Healthcare Home: A Conept and Plan for a Pilot

Posted By Bill Doherty, Monday, August 31, 2009
Updated: Wednesday, June 1, 2011

Basic Idea: 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. This citizenship has two levels: personal and family responsibility for one’s own health care in relationship with the professional team, and opportunities for leadership within the health care home community.

Goal: improved health outcomes for people connected to health care homes through stronger personal and collective ownership of their own health care

The Provider Pressure Point: 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.

What the Citizen Health Care Model Offers: For a decade we have been developing a grass roots, organic, democratic way to involve people in tackling health care challenges in their communities. Up till now, Citizen Health Care projects have focused on specific issues such as diabetes, smoking, and depression. But this community organizing process can be adapted to the development of citizenship in a health care home community.

What a Citizen Project in a Health Care Home Might Look Like:Every patient/family would be invited to take out "citizenship papers" in the clinic, based on the framework develop by the leadership group. At the personal/family 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 one’s health care and one’s relationships with providers. 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. 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.

The Pilot:A large primary care clinic has volunteered to form a leadership team of professionals and citizen patients with leadership abilities to co-create a "constitution” for its health care home community and embark on the process of implementing it. I will lead the process over the next year as part of my work in the new Citizen Professional Center (

The Bold Vision:The 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.


The level of the task and the manner of engagement

The Personal task

(The "I”)

The Clinic and Community task

(The "we”)

The larger societal task

(The "all of us”)

Traditional medical / consumer model

· The professional as expert provider and teacher

· The patient as receptive consumer and learner

· Education / outreach: professionals teach and intervene, patients / community members learn and change

· Advice / input: professionals learn from patients/community members in selected areas, patients / community members provide useful consumer feedback

· Professionals educate public officials and payers on policy issues

· Professionals advocate to public officials and payers

Well-suited for

Minor and major acute problems, trauma, surgical emergencies

Routine prevention and self-care; provider-initiated changes such as new prevention or practice guidelines;

Delivering an organized professional opinion on policy issues such as access and reimbursement

Not so well-suited for

Prevention, self-care, family care giving, chronic illnesses, uncertain diagnoses and treatment options, end of life

Health behaviors that are difficult to change; cultural differences; areas where patients don’t have access to enough information to give useful feedback to the clinic

Engaging the public in changing the culture and practice of personal and professionally-delivered health care

Citizen Health Care model

· The professional as competent, collaborative provider and partner

· The patient/family as partner and responsible agent of own health

· Citizen professionals and citizen patients co-create "constitutional framework” for patient and community involvement in the health care practice / home

· Agreed-upon practices to foster citizen patient engagement at the personal level

· Opportunities for patients to become citizens and leaders in their health care community

· Citizen professionals and citizen patient leaders (who emerge from the local level) educate and advocate with public official and payers

· Citizen professionals and citizen patient leaders engage the larger public in solving health care problems

Well-suited for

Any area where active patient/family self-responsibility and engagement are important

Clinics that desire deep engagement and community building with their own clinics, and want to focus health challenges that frustrate providers and concern patients and communities

Engaging "we the people” in systemic and personal change; creating policies that build community capacity for health

Not so well-suited for

When patient/family are not able or willing to actively engage

Clinics focused on survival or confident in the traditional model; patients and community disengaged from the clinic

The technical dimensions of policy implementation

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