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1. DESIGNING HEALTHCARE
THAT HEALS
Leland R. Kaiser, Ph.D.
Kaiser Institute

2. Our Challenge
• We have to go beyond the redesign of our
medical care delivery system.
• We have to go beyond the issues of access,
cost and quality, as important as they are.

3. Our Challenge
• We have to go further upstream.
• We must begin designing out disease.
• We must begin designing for health.

4. Our Challenge
• Much of what we have to do is go outside what is
normally considered to be a legitimate interest of
the healthcare system.
• We will be working in everyone else’s backyard to
accomplish total environmental design.
• This means overcoming immense social, political
and economic resistance to this kind of approach.

5. Challenge
• We have to do nothing less than change the
way people live.
• The challenge is total design.

6. My Belief
• Design is the ultimate human science and
art.
• Design is the end stage of human evolution
• To promote health and longevity, any race
of sentient creatures anywhere in the
universe will eventually have to re-design
both their genes and their habitat.

7. The Five Most Important Design
Dimensions
• Designing for health
• Designing out disease
• Redesigning the human genome
• Redesigning the human habitat

8. Our Preferred Future
• Redesign requires us to envision our
preferred health future.
• I suggest this is the highest level of heath
and wellbeing attainable for our population.
• This definition takes us well beyond where
we currently are in health planning and
health services delivery in our country.

9. Basic Concepts of the Future
• Our future is not fixed.
• Our future may be invented or prevented.
• Our future is not something that happens to
us – it is something we happen to.

10. Basic Concepts of the Future
• Imagination is our most powerful tool for
redesign.
• We must imagine what we want to see
happen in our country.
• Then, we must act to make our imagination
a reality.

11. The Futures Mindset
• To achieve a better design we will need to
adopt a new mindset that takes us from
treatment to prevention, potentiation and
design.
• This is the futures design mindset.

12. The Design Mindset
• Good health happens when everything else
works.
• The best design goes the furthest upstream
so disease can be designed out rather than
treated.
• This requires genetic design and
environmental design.

13. The Design Mindset
• This is the design century.
• As healthcare professionals we should view
ourselves as designers of America’s health

14. A New Perspective
• When we talk about health we are usually
referring to something we do to the person.
• We now are beginning to realize the
importance of also working on the person’s
environment as well.
• This is called habitat design.

15. The Design Formula
• Health is a function of the transaction of the
person and the environment.
• H=f (P.E)
• In other words you can change a person’s
health by changing his/her habitat.
• Healthy environments create healthy
people.

16. Design Environments
• Physical
• Social
• Cultural
• Economic
• Political
• Housing
• Work
• Spiritual

17. Simple Examples
• Start removing toxins from the air, water and food.
• Improve the health of selected neighborhoods in
our urban areas
• Create model tribal villages
• Design out work stressors
• Help people exit damaging personal relationships
• Design out hazards in the home

18. Simple Examples
• Design homes you can live in for an entire
lifetime
• Re-design dangerous traffic intersections

19. Healthy Human Habitats
• Good nutrition
• Physical exercise
• Clean air and water
• Adequate housing
• Adequate clothing
• Good medical care
• Convenient transportation

20. Healthy Human Habitats
• Diverse recreational experiences
• A safe physical environment
• An empowering educational system
• Opportunity for employment
• Presence of a nurturing mentor
• Opportunity for spiritual development

21. Healthy Human Habitats
• Opportunity for self expression
• Opportunity for ego enhancement
• Meaningful activity to fill the hours
• Incentives for continued self development
• A feeling of begin needed
• A sense of accomplishment

22. Healthy Human Habitats
• Opportunity for membership in social
groups
• Opportunity to make friends
• Acquisition of life goals and a sense of
direction
• A measure of control over one’s destiny
• Development of skills and abilities

23. Healthy Human Habitats
• Development of an interest in other people
• Opportunity to give and receive love
• Support and reassurance
• Variety and change
• Stable and predictable life situation

24. Healthy Human Habitats
• Development of confidence and ego
strength
• Opportunity to redefine one’s self
• Freedom to try on new life styles
• Reinforcement of desirable social behavior
• Abundance of cognitive sensory stimulation
• Opportunity to be depended upon by others

25. Healthy Human Habitats
• Opportunity for further education
• Opportunity for leisure
• Opportunity for healthy physical
development
• Competence models for emulation
• Exploration of the world

26. What We Must Do
• We have all the pieces we need to build a
healthy people, but we do not know how to
put them together.
• We need to build bridges among the many
contributing disciplines.
• We need someone responsible for the
finished product.

27. What We Must Do
• Convene – involve an array of habitat
specialists
• Converge – bring these specialties together
in an overall community design structure.
• Test the design on demonstration villages
and urban neighborhoods

28. Questions We Should Be Asking
• Who are the underserved in our nation?
• What health needs are going unmet?
• What can we do to best improve the health
status of our communities?
• What is special and unique about our
nation?

29. Questions We Should Be Asking
• How can we be a better partner with our
health care providers?
• What can we do to reduce waste and better
conserve our limited resources?
• What new resources should we seek to
develop in our nation?

30. America’s New Healthcare
• Development of a coherent national health
policy
• Increasing the healthcare GNP
• Movement toward universal health
insurance coverage
• Adoption of a holistic health model with
CAM modalities

31. America’s New Healthcare
• Tremendous expansion of primary care
capability
• Healthcare becomes innovation driven
• Race to become world class in all that we
do

32. Summary
• What kind of a future do we want to
precipitate?
• What can we do today to begin moving
toward that future?
• Who can help us along the way?