What Are the 10 Domains of Contextualization?

Friends,

I’ve listened to this podcast multiple times, in preparation for this write-up.  Each time I listen, I learn something new and continue to be blown away by what the visionary folks at Laguna Health are doing and building. The bottom line here is that our healthcare system is not designed to identify and address the contextual [life] barriers of care. As a result, patients and their families suffer, health outcomes are worse, and the jobs of providers and their teams are made much more difficult. Laguna Health is reversing that by creating a much more contextualized and personalized healthcare approach. 

In this interview we distill decades of patient-centered research that Dr. Saul Weiner and Dr. Alan Schwartz have conducted and are now embedding within the Laguna Health approach. It is the most significant and impactful applied research I have ever encountered in terms of understanding how the context of people’s lives impact their healthcare and their health outcomes. And, importantly, how clinicians, clinical teams and healthcare systems can identify barriers to care and address them as an integral part of the healthcare experience.  The magic, however, doesn’t stop here.  Laguna Health has taken this extraordinarily empathetic approach and combined it with the most advanced digital technologies to create an ecosystem of care that supports the provider-patient relationship and promotes a humanistic form of healthcare. This is in stark contrast to what most patients and providers have to endure – which is an underlying technologic platform and system of care that makes it difficult for providers to really listen to and understand their patients, and makes it very difficult for patients and their families to navigate healthcare within the larger context of their daily lives. 
The majority of the interview was conducted with Dr. Weiner and Dr. Schwartz, who literally wrote the book on ‘Contextualizing Care’. We were also fortunate to have Dr. Spiro (Chief Medical Officer) as well as Yoni Shtein (co-founder and CEO) on the line to provide some brilliant commentary in what was one of the most engaging and awe-inspiring conversations I’ve had on this podcast. 

Dr. Weiner is co-founder of the Institute for Practice and Provider Performance Improvement. Dr. Weiner is a professor of medicine, pediatrics and medical education at the University of Illinois at Chicago, and deputy director of the research Center of Innovation for Complex Chronic Health Care at the Veterans Health Administration. He graduated from the Geisel School of Medicine at Dartmouth, completed his residency in Internal Medicine at the University of Chicago and is a former Robert Wood Johnson Foundation Generalist Physician Faculty Scholar.

Dr. Schwartz is also a co-founder of the Institute for Practice and Provider Performance Improvement. He is the Michael Reese endowed professor of medical education, and research professor of pediatrics at the University of Illinois at Chicago. Dr. Schwartz received his PhD in cognitive psychology and Masters in business at the University of California, Berkeley. He is currently enrolled in the JD program at the University of Illinois at Chicago School of Law.

Dr. Alan Schwartz & Dr. Saul Weiner co-authored the book on contextualized care – Listening for What Matters: Avoiding Contextual Errors in Health Care.   

In this interview, we’ll hear:

1. What contextualizing care actually means – from the physician and medical researcher who have been studying this topic for over 20 years, and who have taught it to thousands of doctors and healthcare teams.
2. How critically important contextualizing care is in delivering optimal healthcare outcomes, and how frequently it is ignored in clinical practice.
3. The difference between empathetic care and contextualized care. Contextualized care is not the same thing as good bedside manner!
4. The twelve domains of contextualizing care that Dr. Weiner and Dr. Schwartz have discerned from intensely & rigorously studying over 5000 patient-provider encounters.
5. Which one of the twelve barrier domains these experts emphasized as being grossly missed in healthcare delivery.  

What I love about the Laguna Health story is that these visionary leaders are operationalizing and technologizing – automating – a humanistic form of healthcare delivery that is almost the inverse of mainstream healthcare. They are literally contextualizing care for each and every patient and their families by embedding it in the process and embedding it in the tech platforms.  Most providers would agree that the current legacy electronic health records as well as workflows make it more difficult to understand the context of patients’ lives and its impacts on healthcare. What Laguna is building is quite the opposite – creating a tech platform and a system of care that literally has personalized care built into it, at every step of the way – from assisting the provider teams in identifying barriers to healthcare, to supporting their inquiry of those barriers, to eliciting actionable responses from patients, to identifying and implementing a plan of action to overcome these contextual barriers.  

The team at Laguna Health is taking Dr. Weiner and Dr. Schwart’s profound work and putting it on steroids, enabling it with state-of-the-art data analytics and machine learning, natural language processing and voice analytic technologies, as well as embedding it within their team structure, their training and their workflows.  I could literally feel the energy and enthusiasm in speaking with Dr. Weiner and Dr. Schwartz – the realization that their decades of research and teaching were being taken to a whole different level. 

As I listened to these leaders from Laguna Health, I could not help but realize that they are, in fact, creating a new, better and more humanistic healthcare system. I also could not help but think that they are doing nothing less than creating a new standard of care. It is breathtaking and inspiring – and I encourage you to listen to this episode more than once. You will be better for it. 

Until Next Time,
Be Well

Zeev Neuwirth, MD