I believe prevention is the weakest link in American healthcare. But what exactly is prevention? Mirriam Webster defines prevention as “The act of preventing. Effectual hindrance.” It defines prevent as “to be in readiness for…to go or arrive before…to keep from happening or existing...to hold or keep back.” The key to these definitions is that prevention is an active process. Ironically, it is almost an active process of creating hindrances.
In regards to healthcare, even the terminology of prevention has been difficult. The Institute of Medicine (IOM) in 2009 stated “The definition of ‘prevention’ is itself a problem. Since the release of the 1994 IOM report, the IOM has emphasized the need for clear definition to guide the field.” In fact, there was even a Preventions Definitions Project sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) created in 2009.
The SAMHSA definition of prevention is as follows. “Prevention is a proactive process that empowers individuals and systems to meet the challenges of life events and transitions by creating and reinforcing conditions that promote healthy behaviors and lifestyles.”
Breaking down this definition of prevention into its component parts displays a systems oriented approach for the individual and communal structures to create healthy behavior. Firstly, prevention is a “proactive process” meaning that we as individuals and communities must actively engage in health oriented activities (or actively avoid unhealthy ones) to create a meaningful result. This system based approach seeks to create an effective response to the various events that can occur. A common saying among those that are systems oriented is “it’s the process not the person.” If the system is not producing the desired outcome, then change can be made to the system to produce a desired outcome. If one has a sharp and clear image of a desired end product, and the system is failing to produce that end result, then a reworking of the system must be performed. As the old computer saying goes “Garbage In, Garbage Out.”
Secondly, it “empowers individuals and systems” that is, it strengthens and gives resources to individuals and systems to promote a healthy outcome. This section alludes to the responsibility of the system and the individual to promote a healthy outcome. Responsibility in this respect does not refer to individual blame, or fault. Rather it refers to the individuals and systems “ability to respond.” Both the individual and the system must be able to respond to various threats which the individual may encounter.
Thirdly, “to meet the challenges and life events by creating and reinforcing conditions that promote healthy behavior and lifestyles.” . This in itself is a continual, ongoing process to always achieve the desired end result. Further, the system must be dynamic in its ability to respond to ongoing challenges.
In short, prevention is a systems based process that can empower the individual to ably respond to the contingencies of life and life events to promote a healthier outcome. This occurs by the individual using effective system based tools and the individual him/herself being part of a systems’ based process to promote effective change.
The next step is to create a personal quality prevention system.
The IOM defines healthcare quality “as the extent to which health services provided to individuals and patient populations improve desired health outcomes. The care should be based on the strongest clinical evidence and provided in a technically and culturally competent manner with good communication and shared decision making.
Total quality is best defined as an attitude, an orientation that permeates an entire organization, the way in which that organization performs its internal and external business. People who work in organizations dedicated to the concept of total quality constantly strive for excellence and continuous quality improvement in all that they do.“
Although the IOM report refers to healthcare systems, I believe that this definition can be extrapolated for the individual as well. Quality is based on the best clinical evidence. From an individual’s perspective it is based on education and knowledge of what treatment works, why it works, what its risks are and what are its benefits. From a quality standpoint each decision is made with these questions in mind. Once the decision is made, the next step required is often the hardest – implementation.
The next step of implementation requires ruthless honesty. Once we are aware of our situation, we must then take the sobering step of acknowledging it, and, if necessary, changing it. In a systems oriented approach this is often described as a Root Cause Analysis.
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