There is a grand opportunity to shape massive healthcare systems that support patients seeking wellness, clinicians delivering care, and providers eager to reduce costs, while increasing the quality of care. Big Data analytic tools could provide insights at every level, which could be shared with relevant stakeholders, but producing meaningful changes in such massive systems remains a challenge. Bottom-up strategies could propel patient and clinician participation, while top-down governance is needed to set policies, cope with malicious actors, and guide continuous improvement. How can a set of guiding principles, vision statements, and governance structures shape the next 30-50 years for the evolutionary development of the learning health system (LHS)? What creative embryonic ideas can grow into a safe and effective LHS that is plastic enough to accommodate change, yet sturdy enough to be reliable and predictable? What models can we draw on from biology, arts, urban planning, or genomic assembly? What lessons from socio-technical systems design can be applied to get the best combination of bottom-up initiatives and top-down leadership? What blend of quantitative Big Data and qualitative ethnographies can provide guidance for managers, so they can adjust the game theoretic mechanisms that govern motivation for patients, providers, and insurers? In short, how can we design a caring healthcare system?
Sydney Devine, NAKFI Science Writing Scholar
University of Georgia
The relationship between doctors and patients in the United States has been changing for the past decade or more, as patients ask for more say in their care, and physicians, hospitals, and health insurers encourage them to take charge of their own well-being. Thousands of smart phone apps and online programs exist so you can count your steps, track your heart rate, diet, and sleep, or call a nurse 24 hours a day. Each is intended to generally encourage well-being. The group on healthcare proposed the development of an app that it believes will be even better than existing apps such as MyFitnessPal, which help individuals track their daily calories, or the ever-so-popular FitBit, which counts your steps and encourages you to increase your daily exercise. No two people are identical, however, and each person’s health goal is different from the next. The group has developed an app that will combine these features and more, by giving app “players” the chance to compete against others in a wellness game—the final prize being the achievement of what is currently known about a healthier life.
To accomplish this, the team focuses what it calls “wellness motivation.” How can the team build something that will make people motivated not only about their health, but also their wellness as a whole? An individual’s wellness can be sliced into seven different dimensions: physical, emotional, intellectual, spiritual, occupational, social, and environmental. Team members refer to these seven parts as the “wheel of wellness,” and they presented the seven types in a spinning color wheel that encompasses their idea of well-being for the whole person. “Each of these different dimensions plays a key role in an individual’s life and how an individual feels every day. Wellness depends on how you relate to others, how you interact each day, how you feel when you wake up in the morning. It’s how you engage with life.”
Although people want to be healthy, that’s often easier said than done, as daily life gets in the way of maintaining good diets and exercise routines. New technology has only added to everyday distractions that have existed before. Understanding the strong influence that technology has on our lives today, the group decided to design a plan that is supported by technology.
The group asked whether it could improve an app that reminds people to stop and meditate for 1 minute each night, or whether it could make a
better app to allow real or online friends to “challenge” you to get 1 extra hour of sleep. Could the team develop a better way to remind people to work out and accompany that reminder with helpful tips on what to do? Also, in an ideal world that same app would help people eat right, while offering guidelines and recipes about food, making it simple. And what if the health-conscious app user, in the end, could track these changes and see where they’ve improved? The “Wellness Game” the group imagines builds on the idea that games can be addictive. Games hook people into playing. There will be winning, losing, challenges, and even teams.
Thinking about the different types of games that are popular today, the team decided it was a good idea to choose something as a model for their particular wellness game. The issue with games, however, is oftentimes the players involved become frustrated or bored with the content and give up—therefore, a recurring element of surprise is an important element.
The game to model the plan after needed to be something that has been wildly popular and successful. Finally, a team member came forward explaining that there are more than 57 million users on the popular game Fantasy Football, a game that drops the player into a virtual world of sports, where they serve as the coach and the littlest change could blow the game. It involves the player selecting his or her own team from the National Football League roster. After drafting your choice of players, you compete against other football team owners. The players then compete using their football skills and knowledge to win the championship. The competition keeps the game alive.
Learning how to play is simple and millions are involved, so the team decided “Why not?” Why not make a Fantasy Wellness version, mirroring it after the ever-so-popular game. The team then mapped out the basics of their new game. Players would begin by creating a profile that would include data from some sort of screening process, through which individuals would insert health information about themselves. Perhaps they’d also set goals—what parts of the seven dimensions of wellness from the colorful wheel mean the most to them and where do they want to see themselves improving.
Next is drafting your team. Players of the game could pair up with friends, family, co-workers, and even strangers to play on their team. Each team player would contribute to the team by reaching wellness goals—each person will have her own set of goals based on needs and lifestyles. Goals could be anywhere from Player A wanting to lose 2 pounds per week to Player B wanting to complete a 5K by the end of the month.
Teams will compete against each other. Players are motivated by the competition and motivated by their other team members. The ultimate goal is to remain engaged and to improve wellness overall.
After some of the more important details were decided, the team finally chose a name for their game: Human Race. Human Race will make wellness an everyday part of life. It will make health interesting for those involved and encourage players to complete wellness goals—giving them a healthier lifestyle and shaping the current healthcare system into a better, holistic one. Technology constantly forces its users to think about the next awesome, innovative device to come.
The group ended its discussion and presentation of the new game with “imagine.” They asked the audience to imagine the possibilities of their game. Imagine what the game would do to the healthcare system—saving costs, improving health, motivating consumers. Imagine who would use the game, and what this game would save. Imagine future wellness games to come: Calorie Crush, with similar rules as Candy Crush, or Family Fit Feud, mirrored after the well-known Family Feud television show, or Mindfulness Craft, to mock the addictive video game Minecraft. Just imagine the wheel of wellness shaping the world of wellness into a better, more effective system.