When it Comes to Health Our Environment and Surroundings Make Difference

Over the New Year holiday my family and I went on a road trip to southern California. We spent a day on the beach and a couple days at Disneyland. We got to the park when it opened, and with the exception of an hour or two break in the late afternoon, we were on the move all day to try and get the most out of our experience. After the two days I looked at my phone and was amazed to see I had walked 59,226 steps, which equated to around 29 miles! Normally, I set daily goals to try and achieve a high number of steps and often find it difficult to reach a third of that amount. As I reflected on the experience, I decided the surrounding environment was key to reaching this high number of steps. The difference is I was with my family in a visually stimulating and fun place, and my motivation to keep moving was higher.

As health care quality professionals, we are trained to look at process, identify failure points and then redesign the process for improvement. Often the surrounding environment or culture is forgotten. The broader view should not be overlooked and may contain the secret ingredient to make our improvement efforts successful. Some questions to consider asking to help explore this include:

• Are there any surrounding processes or systems that will hinder the improvement?
• Does the culture promote, foster, or accept change and improvement?
• What surroundings could be augmented to promote the change or improvement?
• What are the underlying motivations for the team?

Once we have a feel for the environment and motivations we can create a better redesigned system that looks more holistically at the process.

Recently in health care circles we have begun embracing Social Determinants of Health (SDoH). The SDoH are the conditions in which people are born, grow, live, work and age. In comparing two patients who on the outside look identical in diagnosis yet have stark differences in their SDoH , research is showing their health outcomes are completely different and that SDoH have a lot more influence on health than the health care system (see the article Using Social Determinants of Health Data to Generate Value). In addition, some have viewed SDoH efforts too narrowly as a way to meet social needs of patients but not the broader environmental needs (see Meeting Individual Social Needs Falls Short of Addressing Social Determinants of Health). At Qualis Health and HealthInsight, as we work up stream in preventive medicine, addressing the opioid epidemic, promoting behavioral health integration and working on chronic diseases, we are broadening our look to include all SDoH.

Whether it be in personal and family improvement, process/system improvement, or SDoH, addressing the environment and surroundings will set us up for greater effectiveness. If we can take off the narrow-siloed blinders that so often limit us, we’ll be able to see the broader holistic picture and make a greater impact in our communities.