Thoughts on Developing a Center of Excellence around Holistic Care

When contemplating the design, implementation and scope of what is to be a future endeavor no matter the institutional design it is an imperative to understand the meaning of words and their impact. So, let us begin with the definition of a Center of Excellence (COE). A COE is “A colloquial, jargonistic, and vastly overused term for any health care facility that is reputed, by means of public survey or in the opinion of the facility itself, to be superior in one or more ways to other such care facilities.” (Center of Excellence, 2012) 

Keeping this understanding in mind as it relates to what it means to the medical community it becomes an issue of public perception. People in the community drive every facet of the economy including medicine and playing into their understanding of reality and facilitating decision-making by-word choices is commonplace. Not to say that use of words that create the vision of distinction are always deceptive; they can be used in such ways. The use of the COE phrase in other words can be likened to an advertising gimmick whether true or false in relation to the institution it apparently represents.  

My hope and aspiration are to live a life of and build institutions of integrity that have a big impact on my family, community and the world. Though I do not feel the need to reinvent the wheel there are certainly improvements that can be made. Any improvement should deal in creating efficiency, optimization of the physician's, staff’s and patient’s performance by utilizing old tested principles and new innovative technologies. Paving the way for others to follow is never easy, often painful and usually filled with ridicule by peers and small-minded detractors that lack the capacity of vision and discernment. Our entire society has been held back from being literally an interstellar species by a relatively small group of people that have constructed a way of life that uses people to maintain their decadence instead of guiding people on a path to enlightenment. One small way I and my colleagues in healthcare can contribute to the advancement of humanity is by embracing new technologies, dealing in science not politics and conjecture and being willing to take calculated risks that will lead to a better future for everyone.  

It has been said that big things have small beginnings as the saying goes and a reasonable place to start in healthcare is by creating a COE that can serve as a model for others going forward. The year is 2020 and though we have not yet physically reached our nearest star system with a manned craft; this is a time of great advancement and change! The seemingly tumultuous times are an opportunity to create a better way of thinking and mold a better healthcare system one COE at a time. Even the greatest structure of our ancient civilizations had to be built one brick at a time; so too, that of which we seek in this purpose and describe in this paper. 

Much of my philosophy as with all people that are wise enough to acknowledge reality; has been molded by academia and experience. Influential people all have their initial conscious design built up by other people. After all it was Oscar Wilde who said “Most people are other people. Their thoughts are someone else's opinions, their lives a mimicry, their passions a quotation.” This is not to say, no one has unique thought but rather an observation of how we form our understanding of the world around us. It is, therefore, an absolute imperative we choose wisely the words we read, the media we expose ourselves and so called “leaders” we follow. Careful thought went into developing the board of directors each of whom represent one of the disciplines practiced in our facility. These people are thought leaders and revolutionary in their understanding of healthcare and how their art contributes to the betterment of all. I and the board of directors look for team members that share in my philosophy and drive for the health and well-being of the community. We do not look for bodies to fill positions we carefully seek out the right candidates and higher for long term employment, NOT job hoppers! 

According to Merriam-Webster.com dictionary wisdom by definition: 

1a: ability to discern inner qualities and relationships: INSIGHT b: good sense: JUDGMENT 

c: generally accepted belief challenges what has become accepted wisdom among many historians— Robert Darnton 

d: accumulated philosophical or scientific learning: KNOWLEDGE 

2: a wise attitude, belief, or course of action 

3: the teachings of the ancient wise men 

We must use all our cognitive abilities to root out the truth of things and by this we build a solid foundation upon which we create! 

To better understand the model, I am going to outline; let me provide you with three of the greatest influences in my current development and philosophical path. In The Book of Five Rings by Miyamoto Musashi (who was and is likely still the world's greatest swordsman and warriors) outlined the Ways. Everyone has their own path and must find their own Way, however the principles flow like a river and with predictability. In that, there are similarities between Ways, and we should study all things in detail and seek mastery of them so that it is possible for each of us to develop our own becoming leaders, teachers! Another, The Art of War by Sun Tzu which though primarily a military operations and best practices text also applies to business and personal mastery. Really the hierarchy is there to help build a strong force and in order to remain such must have the right leadership. Additionally, it is not enough to just have bodies filling roles. Everyone must be evaluated thoroughly for their aptitudes and abilities with roles assigned based on the skill of the person. Further, it is not enough to have a trained individual; it is an imperative they are well conditioned and have enough experience to be excellent at their craft. Therefore, for instance it is recommended by Sun Tzu to not utilize in battle any man that has not trained for at least seven years. Most importantly the Holy Bible is among the greatest foundational combinations of books written as it contains historical examples of philosophical reason and an understanding in the New Testament of the power that lies within each human being stemming from the basic loving tendencies accompanied by forgiveness, gratitude and a patient understanding of the imperfections innate to man. This philosophy of mastery and understanding of the human condition. I hope to create a model worth replicating.  

Some reasons why this is considered a COE: 

• For the unique approach to problem solving on behalf of the patients we serve  
• Go above and beyond literally in comparison to our counterparts.  
• Focus on evidence-based medicine/practice   
• Utilization of the best historical medicines and the most advanced technologies available 
• Use case studies to publish in house research for peer review to set new standards and lead the healthcare community forward. 
• Seek out ways to perfect healthcare and NEVER settle for good enough 
• Suggest this must become a teaching institution for the community and practitioners  
• This facility would utilize the best that traditional and modern medicine has to offer creating a truly one of a kind healing environment 
• Multiple options for care patients can choose from 
• Actively apply for grants and seek donors to help subsidize the cost of care for the patients 
• Cannot just claim to be a COE the facility must be open to third party certifications 

I believe this model is what will be necessary to maximize the potential of what healthcare can and should be especially for the most vulnerable among us! This is a hospital like facility but really, more similar to the holistic health sanitoriums of old. In my studies I came across a chiropractor and naturopath by the name of Bernard Jensen and he is also the practitioner that brought iridology to America and he ran several centers such Altadena Ranch where he used natural therapies to help restore health to his patients that would come from all over the world. (BJF, 2020) 

My mission in the context of this paper is to create a contemporary holistic, comprehensive, healing atmosphere that the entire community will benefit from. To become the “GOLD STANDARD” of how healthcare is delivered and prove efficacy through outcomes!  

There is the saying commonly made that “the proof is in the pudding” and that is part of what sets us apart. We have accountability measures put in place to ensure patient results and satisfaction. It is important to us that we keep this vision about the patient. Money is important as we all need to make a living but our why is patient care! 

 This grand vision is ambitious and one that will likely take decades to fulfill; absolutely worth the investment because of the impact it will have! This clinic is for everyone’s benefit treating the acute, chronic and terminal with the intention of providing the best care possible no matter what condition the person is in. Understanding that we cannot be all things to all people, but we can be a lot of things to a lot of people! Our goal is to be as comprehensive as possible and limit the cost to the patient along the way. Everyone in need of care should be able to get it! Keeping that in mind the initial setup will be as a 501c3 Non-Profit that will work primarily from government grants and civilian donations. Subsequent ventures depending upon sustainability will be for profit organizations dealing with insurance and cash fee for service. 

Every hospital and nursing home is technically a multidisciplinary facility and therefore competition; however, we stand out because of our philosophy of holism and commitment to optimizing the human condition, not just disease management! In that there is a lot of competition yet really there is very little in the space we occupy given the comprehensiveness of our scope. Many hospitals and extended care facilities operate off outdated models and principles that are no longer valid in the modern landscape. These facilities are filled with academics and practitioners with a narrow vision of healthcare perpetuated by the academic institutions from which they rise. Many of these institutions of higher learning are driven by research grants rather than reason and in that way as one author put it, we may be witnessing the “Death of the Scientific Method.” (Rozner, 2020) 

This facility would operate in the space of medical and holistic intervention through a collaborative multidisciplinary philosophy of patient centered care! Holistic health careers are on the rise in the US and it is wise to take advantage of this momentum and contribute to the development of best practices. Millions of people use complementary and alternative medicine (CAM) every year to the tune of $30 Billion out of pocket which means this is a growing segment of the nation's GDP and if we can provide a better combination of services there is a perfect opportunity to help our community and expand rapidly. (Rivera, 2016) 

clearly presents significant competitive advantages and effectively analyzes their impacts on organizational success.  

This facility will have several professionals working within the COE to create the optimal environment and opportunity for healing: 

1. Medical providers (MD/DO) have a broad what is called unlimited scope and thereby can prescribe and recommend a much larger range of services as compared to most others in the health professions. They also have a much better relationship with insurance companies improving the likelihood of reimbursement for services. Only open and holistically minded medical practitioners will be hired into this facility to reduce infighting so that we can focus on problem solving. 
2. Within the realm of chiropractic lay a wide range of services that fall within their purview and expertise. Because it is not just about hiring doctors it's about hiring the right doctors there will be strong requirements for those hired. They should be DC’s that are certified in or have advanced degrees in nutrition and Acupuncture/Oriental Med/ Herbalism at minimum. 
3. Psychological services to help patients improve their overall outlook and detrimental thinking patterns or trauma that may be a hindrance to health and healing. 
4. Holistic Dentistry to address Temporomandibular Joint Disease (TMJD) and oral disease from a more natural perspective 
5. Physical Therapy to perform rehabilitative services and direct personal trainers in patient care 
6. Personal Training/ Yoga to help build strong foundations in exercise and physical activity 
7. Massage Therapy to address the muscular component of care in a more comprehensive way 
8. Meditation using binaural beats to help improve the depth and impact of each session (Raghaven, 2017) 

Procedural: 

• Minor surgery 
• Nutritional therapies and programs 
• Class IV laser therapy, which is used to improve circulation, cellular healing, lymphatic flow and tissue repair. Depending on function can also be used for weight loss (Harrington, 2020) 
• Pulsed Electromagnetic Radiation (PEMF) is a tool used to improve the magnetic polarity of the body. In this therapy greater circulation, lymph flow and a reduction in inflammation takes place (Shupack, 2003) 
• IV nutraceuticals to get higher doses to of nutrients to patients that need specific interventions 
• Fit Body Wrap infrared technology that helps to improve circulation, decrease inflammation and helps with weight management (Vatansever, 2012) 
• Vibration Plates improve circulation, decrease inflammation, improve lymphatic flow, build bone density, improve muscle tone and help with weight management. (Prisby, 2008) 

In conclusion having covered a great deal of information and in detail outlined my vision of what a COE and what all health centers going forward should be, we now reach the climax. I am not claiming that what I have designed for is the absolute best without need of addition. It is however in my estimation a way forward that allows us an opportunity to be better servants to our communities. Now a time of decision making for my audience has come, as this is a paper for all future leaders in healthcare. Be they physicians, therapists, administrators, CEO’s or presidents. This design proposal will impact everyone involved in the healthcare system should they take note of my advice. Sometimes you must cut against the grain to create a desired effect, one in this case that may affect the entire world. We must be strong in our pursuit and wise enough to pick our battles especially when some ideas go in direct opposition to the foundation upon which our healthcare system is governed. Some ideas are not popular. Unpopular ideas are not always bad ideas; in truth most often, they are the best. These notions are likely in disfavor of our medical leadership because they call into question the status quo and shed light on their inadequacies, iniquities and culpability! A COE must truly live up to the name if it wishes to have credibility and be an influencer of public perception and administrative policy. The future lay at our feet, it is on us to create. What path shall you choose? The old way or something better?! 

References: 

Bernard Jensen Foundation (BJF). (2020) The Legacy of Bernard Jensen. https://bernardjensen.org/blog/f/altadena-ranch-in-california 

Brainy Quotes. (2020). Oscar Wilde.  

Center of excellence. (n.d.) Medical Dictionary for the Health Professions and Nursing. (2012). Retrieved June 4 2020 from https://medical-dictionary.thefreedictionary.com/center+of+excellence 

 https://www.brainyquote.com/quotes/oscar_wilde_104275 

Gabby, A. R. (2002) Intravenous Nutrient Therapy: the “Myers’ Cocktail.” Alternative Medicine Review. https://e-csa.com/ichikawa_pdf/bib%237%20Gaby.pdf 

Harrington, P., Vickers, J. (2020)Class IV Therapy Lasers Maximize Primary Biostimulative Effects. PPM. https://www.practicalpainmanagement.com/treatments/complementary/lasers/class-iv-therapy-lasers-maximize-primary-biostimulative-effects 

Merriam-Webster. (n.d.). Wisdom. In Merriam-Webster.com dictionary. Retrieved June 4, 2020, from https://www.merriam-webster.com/dictionary/wisdom 

Miyamoto, M. (2012) The Book of Five Rings Wilson Scott Wilson Translation. SHAMBHALA PUBLICATIONS. ISBN: 9781590309841 

Prisby, D. R. et al. (2008) Effects of whole body vibration on the skeleton and other organ systems in man and animal models: What we know and what we need to know. https://doi.org/10.1016/j.arr.2008.07.004 

Shupak, N. M., Prato, F. S. and Thomas, A. W. (2003). "Therapeutic uses of pulsed magnetic-field exposure: A review," in URSI Radio Science Bulletin, vol. 2003, no. 307, pp. 9-32, Dec. 2003, doi: 10.23919/URSIRSB.2003.7909506. 

Raghaven, S. (2017) Benefits of binaural beats and how it can heal your mind and body. https://www.thehealthsite.com/diseases-conditions/benefits-of-binaural-beats-and-how-it-can-heal-your-mind-and-body-k0217-473882/ 

Rivera, A. (2016) Why Holistic Health Careers Are On The Rise. https://www.amcollege.edu/blog/why-holistic-health-careers-are-on-the-rise 

Rozner, G. (2020) The Death of the Scientific Method. https://www.theaustralian.com.au/inquirer/the-death-of-the-scientific-method/news-story/511d5a6bb47757e27e10385a8da3ffa4?fbclid=IwAR2U5GPlU3Yncs9x01zaYtmMisDNvkMkwmrSi6VCTkOzumsoVOuR29JL8ts 

Sun Tzu. (2020). The Art of War https://suntzusaid.com/ 

Vatansever, F., & Hamblin, M. R. (2012). Far infrared radiation (FIR): Its biological effects and medical applications, Photonics & Lasers in Medicine, 1(4), 255-266. doi: https://doi.org/10.1515/plm-2012-0034