Your external environment is where you live, work and play. Having great experiences in these places requires a bit of creativity. Perhaps you change the color of the walls in your home, or decorate your workplace with greenery. Maybe in your backyard, you plant flowers that give off a wonderful aroma. All of these originally normal spaces become healing spaces when you use your creativity to make them your own. Continue reading “Creating the Optimal External Healing Space” »
Tag Archives: Optimal Healing Environments
It is often stated that “actions have consequences,” but when it comes to your health, it is much deeper than that. The behavioral environment is defined by Samueli Institute’s experts as actions executed to prevent illness, improve health and engage in self-care. Continue reading “Behavioral Environment: What You Do Matters For Your Health” »
It’s time we got rid of the SOAP note.
The SOAP note is the subjective-objective-assessment and plan around which every medical encounter in the country is framed. The priority is to identify the disease, measure it to confirm that it is a disease, and develop a treatment plan to try to control and eliminate it. This disease-based approach frames everything that goes on in health care.
It works well when a cause of a disease is easily identified and eliminated. However it works poorly for the factors that are now seen to impact most of health— prevention, lifestyle and holistic practices.
We now know that 80 percent of health care actually comes from outside of the clinic, and it won’t fit into that particular diagnostic plan that we create with SOAP. Patient’s goals and their decision-making are crucial for the creation of health and healing, even more so than the specific treatments of disease medical professionals sometimes provide.
Putting all encounters into a framework of subjective-objective-assessment and plan, around a specific diagnosis and verification of treatment, is no longer the model needed in the health care box.
From SOAP to HOPE
We need a new model for structuring the visits within the health care system. To achieve patient-centered care this new model must include the factors that change behavior and create health. These include social determinants of disease, holistic and integrative medicine, the importance of lifestyle, as well as the key role of purpose and meaning in the patient’s life.
In this new Healing Oriented Practices and Environments (HOPE) model, the patient and their own goals in life would be part of the diagnosis and the plan – all components that don’t currently fit into a standard SOAP note. Expectations and beliefs are a key part of healing, and so are social support and the relationships that are essential for recovery and the optimization of any kind of treatment. Thus, the social components must be part of the note.
What would a medical encounter look like if we were focused on Healing Oriented Practices and Environments (HOPE) in health care?
I propose it would consist of four components that are essential to creating health. These would be in addition to the areas already included in the traditional medical assessment called SOAP, which are the subjective-objective-assessment and plan assessment that come in making a traditional medical diagnosis and treatment.
The four components of HOPE are reflected in the following questions:
1. What is your goal and intention for your healing? What do you want to heal?
- This may be a certain percentage less pain, ability to climb stairs or play with a grandchild
- Rate your health and what you expect can happen (1-10)
- Why are you here in life? What is meaningful for you? What is your purpose?
This addresses a person’s the inner environment — their desires, their beliefs, and their needs—their reason for getting up in the morning, their purpose in life—what’s meaningful for them? What gives them a sense of wellness and motivation?
Sometimes a simple thing such as spending time in the woods, or with family, is the primary avenue into treating their pain. Sometimes the goal of being able to play with their grandchildren will generate the physical activity necessary to prevent a future illness or disease that could impair them. Sometimes it’s the desire to serve their country, or their God.
2. What are your connections and relationships?
- Do you have family, friends, live alone, have hobbies, and have fun? Can you get rides to airport?
- Tell me about yourself. Tell me about your traumas. Do you have a best friend? Are you part of a group? A club? How often do you meet?
So often the reason and process for healing has to do with social relationships — with family, friends, communities and colleagues. Therefore, after we finish putting lines around the box of the diagnosis and the treatment, let’s capture the social components and the interpersonal components that drive an individual in their daily life.
3. What do you do during the day? What is your lifestyle like?
- Do you smoke or drink? What about diet, exercise, sleep and water?
- What do you do for stress management? How do you relax, reflect and recreate?
- What is your CAM use (supplements, herbs, other practitioners)?
Lifestyle and behavior can impact up to 60-70 percent of chronic illnesses; therefore these behaviors are essential for creating health.
4. What is your home like? Your work environment? Do you get out in nature?
- This includes light, noise, clutter, colors, plants, walls.
The communities, the work sites, the schools and the environment in which our patients live, often dictate what they’re able to do, what happens, how long they live, and how well flourish, and how well they function. The physical environment, then, needs to be explored.
Let’s make asking these questions a routine part of medical care.
The HOPE note is one powerful component in transforming your practice into an Optimal Healing Environment. To learn more about Samueli Institute’s research into Optimal Healing Environments, visit SamueliInstitute.org.
On September 15, Bonnie Sakallaris, PhD, RN, explored the role of an Optimal Healing Environment (OHE) in the context of advanced illness care in an hour-long webinar available for public viewing. The presentation was part of the Veterans Health Administration Employee Education System and included more than 120 participants including VA physicians, chaplains, nurses, and social workers. Continue reading “Creating Optimal Healing Environments for Patients with Advanced Illness” »