1. Collaborative Dialog: “Who is an expert in the doctor’s office?”
Relational Practices in Health and Healthcare:
Healing through Collaboration
November 10-12, 2016
Cleveland, Ohio
Victoria Lazareva MD, Ph.D.(c)
Nova Southeastern University

2. Dominant Discourse Traditional role Doctor’s order Patient education
Focus on disease
‘‘System of thoughts composed of ideas, attitudes, courses of action, beliefs, and practices that systematically construct the subjects and the worlds of which they speak’’ (Foucault, 1972)

3. Consumerism Consumer and patient rights movement 1960s-1970s
Patient focused and collaborative care

4. Health Care Quality Gap
The elements of patient-centered care, respect for individual beliefs and values, active listening to patients, involving patients as leaders and experts, family inclusion in care and decision-making

5. Shifting Relationships
Doctor-Patient Relationship
vs.
Patient-Doctor Relationship
Patient centered approach
Patient is an advocate
Difference between experiencing HC
vs. administering health care

6. Let’s Talk Technology

7. Technological Footprint
More than 10,000 health-related sites
70 million Americans seek health online
70% US adults track
21% use technology
5000 self-m apps in Apple store
activity tracker
- disease management tool
- self-care
- diagnostic tool
- doctor is advisor
“No one clinician can retain all the information
and act on the volume of relevant scientific literature”
(Richardson, et al., 2001)

8. Currently Available Trackers
FitBit features from simple step counting to continuous heart rate monitoring.
 Nike Fuelband
Garmin Vivo
Jawbone features activity, sleep, and heart rate
Xiamo Mi Band
(Hoy, 2016)

9. What is the Preferred Story?

10. Collaborative Relationship
Relational approach to health care because quality of healthcare depends on the quality of the relational practices in which we engage (Richardson, et al., 2001)
CHC = meaningful and healing relationships
CHC= healing narratives
CHC= new roles
Collaborative Inquiry

11. Outcomes Compliance Quality of HC Ethical consequences
Meaning of shared responsibilities

12. Continuing the Conversation
What is collaborative health care and what it looks like?
Who are the participants in the collaborative dialog about health care?
What are the roles of the participants in the dialog about quality of the health care?
Why is collaboration in health care matter?
How does the concept of collaboration in HC effect the relationships between participants?
Would a change in relationship between doctors and patients have any effect on the quality of the health care?
How relational approach to health care may effect the collaboration between doctors and patients?
How relational approach to health care can impact the conversation between doctors and patients about management of diseases?
How the issue of medication adherence and compliance could be seen differently when utilizing collaborative approach to health care?
What is the relationship between service quality and consumer satisfaction?
What is the role of the doctor and patient in the therapeutic meaning making narratives?

14. References
Akter, S., D'Ambra, J., Ray, P., & Hani, U. (2013). Modelling the impact of mHealth service quality on satisfaction, continuance and quality of life. Behaviour & Information Technology, 32(12),
Chung, C. F., Cook, J., Bales, E., Zia, J., & Munson, S. A. (2015). More than telemonitoring: Health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. Journal of medical Internet research, 17(8), e203.
Hoy, M. B. (2016). Personal activity trackers and the quantified self. Medical reference services quarterly, 35(1),
Piras, E. M., & Miele, F. (2016). Clinical self-tracking and monitoring technologies: negotiations in the ICT-mediated patient–provider relationship. Health Sociology Review, 1-16.
Richardson, W. C., Berwick, D. M., Bisgard, J. C., Bristow, L. R., Buck, C. R., & Cassel, C. K. (2001). Crossing the quality chasm: a new health system for the 21st century.