Guiding Principles
As population-based healthcare increases, it is less possible to tailor delivery systems to a single, standard population. Racism, diversity, and cultural sensitivity are front line and bottom line issues in the design of delivery systems.
For example, the healthcare system currently has not been able to stem the worsening of the overall health of African Americans. The result has been continued negative impact for the patients as well as the system that struggles inadequately to serve them. For this to change, there is a critical need to adapt systems to cultural, social and economic realities of different ethnic populations.
Failure to tailor delivery systems to the particular communities they aim to serve will become even more costly as the healthcare system undertakes responsibility for the health of all as opposed to the sickness of some. Among the principles guiding the organization in responding to this core need are the following:
- All clinical events always occur at biological, psychological and social levels.
- At the extremes, presentation may be simple and single level (accidental laceration, viral URI,) or complex and multi-level (self laceration, AIDS infection.)
- Mixed and ambiguous presentations are commonplace. (70% of primary care presentations are without a demonstrable organic basis.)
- Financing shifts, from fee-for-service to capitation, shift the economic interest of the healthcare industry from service delivery to prevention.
- The increased complexity of treatment protocols puts a greater premium on integration of the multiple healthcare disciplines involved in the care of a patient.
- Numerous factors associated with the advances of biomedicine implicate ever-increasing involvement of families in healthcare. Among these are complex chemotherapy protocols, heroic interventions such as bone marrow transplant, or family stressors such as the survival of newborns at risk for chronic disabling conditions.
- Reduction in duration of inpatient hospital stay as a cost control measure also increases burdens on families.
- Increasing awareness of the ethical dimensions of healthcare (prenatal decisions, end of life decisions, DNR orders) inevitably involves families.
- Advances in diagnostic capability (molecular medicine) lead to complex ethical and life pattern decisions. For example, diagnosis of an untreatable condition might pose a question of whether to initiate or terminate a pregnancy.
- There is increased awareness of family systems relevance to lifestyle health-related activities (smoking, other addictions, accidents, suicide.)
- There are many studies indicating a relationship between adhering to biomedical treatment (non-compliance) and family and other psychosocial factors.