Innovation in Primary Care

One of our focus areas includes improving primary care. We embrace ways to measure wellness and thriving in communities and re-envisioning primary care to maximize its capacity to recognize and, to a greater extent, address the myriad factors that impact a person’s health. 

Evaluating the State of Primary Care During Covid-19

Nova Institute Visioning Visionary Dr. Rebecca Etz’s work aims to grow and articulate the intellectual foundations and guiding principles for the next generation of primary care. During the COVID-19 pandemic, Rebecca’s work with the Larry A. Green Center is highlighting the fact that systemic neglect of primary care in the United States has left this critical national resource unstable and overwhelmed.

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In response to the fact that no one organization, federal funder, or national dataset speaks to the on-the-ground realities of primary care practice, Rebecca and her team’s “Quick COVID-19 Primary Care Survey” is gathering data regularly from primary care practitioners across the country. National and state policy is now being informed about the strains on this system. Read about this work in a Washington Post article from May 14, 2020.

A New Vision for Primary Care 

In Summer 2020, Rebecca and her team convened the seven largest primary care clinician organizations to discuss the situation of primary care and the need for a unified voice and vision. This was the first time these organizations had ever met together. The group worked through a theoretical discussion and posted a vision of a new paradigm for primary care, “Primary Care Speaks as One.” More than 2,000 individuals and 50 organizations have signed this call to action. 

Rebecca was also a contributor to an important report released by the National Academies of Science, Engineering, and Medicine: Implementing High Quality: Primary Care Report: Rebuilding the Foundation of Health Care on May 4, 2021. On May 21, 2021, the Larry A. Green Center sent a letter to the Secretary and Assistant Secretary of Health and Human Services urging the implementation of one of the report’s highest recommendations, to create an HHS Secretary’s Council on Primary Care.  

Stay tuned for more updates and publications about Rebecca’s important and groundbreaking work. 

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Developing safety, persistence, trust

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Acquiring Resources

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
    • “I think I kept trying to convince him I was crazy. And he kept saying, ‘No, you’re not crazy.’ […] You wouldn’t necessarily say a Vietnam Vet was crazy. You’d say they are responding like you’d expect to extraordinary circumstances.”
    • “I’m not the only one who have [sic] this problem. A lots, millions of people, you know. […] They don’t have nothing to do with that. I guess I have to live.”
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
    “You need a lot of energy and a lot of work … it takes a lot of work. It doesn’t just happen. It’s not like a magic wand.” This patient understood that they had to actively participate in the healing process.
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

Helping Relationships

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) “When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. Healing, in this sense, does not mean cured—none of the study participants were cured of their ailments—”but all developed a sense of integrity and wholeness despite ongoing pain or other symptoms.” In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” When we begin to heal, we find increased capacity for hope, renewed motivation to help others, and are more able to accept ourselves as we are.

Suffering

Suffering is the ongoing pain from wounding. There is debate about whether or not one actually needs to experience suffering on the path to healing.

Wounding

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. “The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”