[ 4] Social policy affects
health in many ways.
Health has several
prerequisites, including,
clean air and water,
food and shelter, physi-
cal and financial securi-
ty, and education. In the
early 20th century, water
and sewage treatment
hugely improved public
health; likewise laws
regulating toxins, pol-
lution, and safety also
improved public health.
Administering vaccines
has all but eliminated
some diseases, such
as polio and smallpox.
More recently, tobacco
smoking has declined.
See: “Beyond Health
Care: New Directions to
a Healthier America,”
Recommendations
from the Robert Wood
Johnson Foundation
Commission to Build
a Healthier America,
2009.

another way to reframe it. Kaiser and the Mayo
Clinic employ design innovation teams; UPMC
has teamed with CMU design students to reimag-
ine patient experiences [ 12].
Self-management also suggests setting goals
and measuring progress—the basis for managing
and improving quality. Individuals decide what’s
important to them, what well-being means,
what they want to work on. Individuals record
their actions; for example, meals eaten, exercise
completed, medications taken, hours slept, time
spent working or playing or commuting, and
perhaps even interactions with others and media
consumed (e.g., music played). Individuals also
measure results; for example, hard values such
as their weight, pulse, blood pressure, cholester-
ol, and blood glucose; and softer values such as
energy, stress, pain, happiness, or mood.
Then they repeat the cycle. If they’ve made
progress toward their goals, they may continue
the same course of action or even speed up. If
they’re diverging from their goals, they may
change course. Individuals find and maintain
a “healthy balance,” one that’s comfortable for
them. They take an active role in their body’s
process of homeostasis—including physical, emo-
tional, and social dimensions.
This process is directed trial and error—exper-
imenting, something like the Shewhart-Deming
PDCA cycle, a simple application of the scientific
method, a version of the design process.
Imagine patients as designers—conducting bil-
lions of tiny self-experiments, prototyping their
own well-being. That’s the essence of a self-man-
imagining the Frame of self-management
Foucault attributes “the birth of the clinic” to
the Enlightenment, when early versions of the
current healthcare paradigm displaced a medi-
eval paradigm [ 9]. The language of health had a
beginning; it was invented. And like other lan-
guages, it can evolve; we can reinvent it [ 10].
Imagine reframing health so that it includes
self-management.
Self-management suggests a fundamental shift
of responsibility. Patients reclaim their role as
adults responsible for their own well-being. The
relationship between HCP and patient becomes
more symmetric (at least outside of medical
emergencies). Issuing orders gives way to dis-
cussing and collaborating. HCPs become coaches
and assistants, shifting their stance from dis-
pensing knowledge to learning from patients. As
Melanie Swan reports, “a collaborative co-care
model is starting to evolve for healthcare deliv-
ery…the patient’s role may become one of active
participant, information sharer, peer leader
and self-tracker, while the physician’s role may
become one of care consultant, co-creator and
health collaborator” [ 11].
In the parlance of “design for service,” HCPs
begin to think of themselves as “co-producing”
health and well-being with their patients.
Imagining healthcare as a designed service is
Traditional health management
applies the tools of acute care to stabilizing chronic conditions
Traditional health-care
focuses on treating acute problems
our current healthcare system. Wellness is more
than absence of illness: It’s is a way of living.
Well-being requires its own language, its own
frame.

[ 5] First International Conference on Health Promotion. “The Ottawa Charter for Health Promotion.” World Health Organization. Ottawa, 1986.

[ 6] Kamani, P. and Mehta, R. “Zume Life Consumer Pilot Report 080701.” (Unpublished).

[ 7] American Heart Association. “Statistics You Need to Know.” http://www.american-heart.org/presenter. jhtml?identifier=107/ [ 8] Mills, K. “Bringing the ‘Social’ to Epidemiology: S. Leonard Syme, Ph.D.” U.C. Berkeley Public Health Magazine, Spring (2006). http://sph.berke-ley.edu/pubs/magazine/ mag_sp06/

Goals
Eliminate or minimize
acute diseases and infirmities
Goals

Eliminate or minimize
acute diseases and infirmities
Manage chronic conditions;
avoid or slow deterioration
leading to acute problems

May + June 2010

[ 9] Foucault, M. The Birth of the Clinic: an Archeology of Medical Perception. London: Tavistock, 1973.

interactions
[ 10] Geoghegan,
M., and Esmonde,
P. Notes on the
Role of Leadership
and Language
in Regenerating
Organizations.
Menlo Park, CA: Sun
Microsystems, 2002.

Means Medicine and other therapies
administered by HCPs
with patients’ consent;
patients have little say
in means
Means Medicine and other therapies
administered by HCPs
with patients’ consent;
patients have little say
in means
Medicine and other therapies
prescribed by physicians
and administered by patients,
who may have other priorities
or may reject means

 

• Figure 1. Traditional heathcare focuses on treating acute problems.

• Figure 2. Traditional health management applies the tools of acute care to stabilizing chronic conditions.