In "Healing Healthcare", Cherri Jacobs Pruitt interviews Teddie Potter, University of Minnesota’s School of Nursing’s Director of Planetary Health and Specialty Coordinator Doctor of Nursing Practice in Health Innovation and Leadership. Dr. Potter and Dr. Riane Eisler co-authored Transforming Interprofessional Partnerships: A New Framework for Nursing and Partnership-Based Health Care (published in 2014). This episode unwraps the insidious persistence of Domination-based values and illustrates how adopting Partnership-based practices are ushering in a healthcare revolution that is promoting health and wellbeing for all.
Center for Partnership Systems
Transforming Interprofessional Partnerships: A New Framework for Nursing and Partnership-Based Health Care, Teddie Potter and Riane Eisler
The Chalice and the Blade: Our History, Our Future, Riane Eisler
The Power of Partnership: Seven Relationships that will Change Your Life, Riane Eisler
Interdisciplinary Journal of Partnership Studies: https://pubs.lib.umn.edu/index.php/ijps/index
center@partnershipway.org
Resilience, Rising Appalachia
In "Healing Healthcare", Cherri Jacobs Pruitt interviews Teddie Potter, University of Minnesota’s School of Nursing’s Director of Planetary Health and Specialty Coordinator Doctor of Nursing Practice in Health Innovation and Leadership. Dr. Potter and Dr. Riane Eisler co-authored Transforming Interprofessional Partnerships: A New Framework for Nursing and Partnership-Based Health Care (published in 2014). This episode unwraps the insidious persistence of Domination-based values and illustrates how adopting Partnership-based practices are ushering in a healthcare revolution that is promoting health and wellbeing for all.
Center for Partnership Systems
Transforming Interprofessional Partnerships: A New Framework for Nursing and Partnership-Based Health Care, Teddie Potter and Riane Eisler
The Chalice and the Blade: Our History, Our Future, Riane Eisler
The Power of Partnership: Seven Relationships that will Change Your Life, Riane Eisler
Interdisciplinary Journal of Partnership Studies: https://pubs.lib.umn.edu/index.php/ijps/index
center@partnershipway.org
Resilience, Rising Appalachia
Welcome to the Power of Partnership podcast. I'm Rianne Eisler, president of the Center for Partnership Systems. This podcast brings you voices from the partnership movement People using partnership practices to build a world that values caring nature and shared prosperity. The Power of Partnership podcast is hosted by Cherry Jacobs Pruitt, a health policy and partnership scholar. Today, cherry interviews Teddy Potter on how partnership-based practices are healing our healthcare system. Teddy and I co-wrote and published the Transforming Interprofessional Partnerships colon, a new framework for nursing and partnership healthcare book. It was published in 2014 and now on to the POP podcast showing how we can create a healthcare system that supports health and wellness for all.
Speaker 3:Teddy, can you begin by sharing how you first learned about Rianne Eisler and how her work has impacted and influenced you both personally and professionally?
Speaker 4:I first came across Rianne's work shortly after she published the Chalice in the Blade. I can't remember what led me to read that work, but I was very fascinated in cultures and culture changes. I had been in healthcare for maybe five years, 10 years, when I picked up her work and when I read it I thought, oh my gosh, this is game-changing, absolutely game-changing, because what drove me out of the hospital system and into the community care system was that the hospitals were so hierarchical and really based in a domination structure. I didn't know why I couldn't stand it. I didn't know why I was so frustrated and angry. I didn't know why I felt we were leaving patients behind and not delivering on our promises. But the language of that book helped me see what was going on. So what happened was I read the book and did further studies in the area and it really created a paradigm shift for me. I now had a language and like a mental map to explain the world that I was experiencing, and once you understand that world and once you see it for what it is, you can't go back. I see domination all over the place and I see wonderful examples of partnership all over the place that I want to lift up as well. So it's been highly significant in my life and formed the basis of everything I do.
Speaker 3:So I want to set the stage a bit for this next question by reminding our listeners of the partnership domination continuum that Rion has developed as a framework to help us understand patterns that we see in society. So, on the domination end of that continuum, we see hierarchies of power that are often maintained by fear or violence, along with rigid stereotypes of genders and devaluation of traits that are defined as feminines, such as caring and caregiving, while on the partnership end we see the opposite. So hierarchies of actualization and power with, or power to be creative versus power over, with equality, cooperation and mutual respect among individuals and groups valued. So, teddy, can you provide a picture for us of how domination values play out in the healthcare system before we dig deeper into what a healthcare system based on partnership principles looks like?
Speaker 4:Sure. So I would make a joke and say, how much time do you have? Because I see these playing out through the entire system and, as you mentioned, the book that Rion and I co-authored walks people through the entire system and where we see it and how it forms the foundation of our health system. I have to again contextualize this, that I'm commenting on healthcare in the United States. I'm commenting on what my experience was in the 1980s, early 90s. I think there's been a huge amount of improvement, but some of the old patterns still exist and we need to see them and call them out. So some real, tangible examples. I remember I worked on a cancer unit. I was caring for a patient. They had just been informed that their treatments were no longer working and that they were going to have to move into a hospice setting, a hospice focus. I was holding the patient's hand and listening deeply and then I heard somebody come in the room and clear their throat, and it was the physician and it was excuse me, when the captain of the ship arrives, the crew stands. Now that's a couple decades ago, but some of that is still there. A little more over. Back then you had to kind of get up out of your chair if a physician wanted to chart, wanted to sit there. If they needed the chart, it didn't matter if you were part way through it, you had to hand it to them. I mean the whole structure was set up with hierarchy. Another example I read the order of physician, went in, took care of the patient, read the thing and came out, wrote the order in the chart and it was. They had done foot care for the patient and it was nursed to remove toenails from bed. Well, come on, if you're doing care, remove the toenails. I mean you don't let them sit there and do this hierarchical junk of really treating somebody with so little respect. And there's example after example after example of just those messages and the way that was conveyed. I think we've made a lot of headway in the area of interprofessionalism, but I will still say that there's a lot of ranking and there's ranking within every profession and everybody knows where that ranking is that if you are like a flight nurse or on a flight squad and you're coming out on the helicopters and you're in the emergency room or emergency department and you're in ICU and CCU, you have more of a rank than somebody who works with children, works with women, works with elders. There's this ranking long-term care is ranked less than acute care, community care is ranked less than other more intensive care. And so this exists. It just exists in our system and it needs to be called out. And so I did see this, and what always bothered me was the, if you look at it as a ladder, who's on this hierarchical ladder? The people that are not even on the lowest rung of the ladder are the patients in communities we serve. They weren't even called by name. They were somebody in room 764 or the gallbladder down the East Wing. It was so dehumanizing. And then we use language and it still gets said now and then about they're not compliant, they're non-compliant, and listen to the language. They're non-compliant with my orders. It wasn't even language that supported a partnership, or language that said we've come to an agreement on how we're going to approach this person's health and this is what we've agreed on, and someone is not able to adhere to the plan because of various challenges and crises in their life. Let's see if we can work together to renegotiate the plan to bring them to a higher level of health and wellness. That's very different than this person's not compliant with following my orders. It's so I would love to say you don't see much of it. It's kind of everywhere in healthcare in the United States.
Speaker 3:So, related to this ranking, where does public health fall?
Speaker 4:That's a great question, because it used to be that public health was really deeply respected and honored and we had plans and seatbelts becoming part of the norm and standards around helmets for kids, we were riding bicycles and now we've just pivoted more towards domination of well. That system can't be trusted. They don't know what they're doing, their communications terrible. So we've actually gone backwards in our relationship with public health as an understanding of how we move a health system forward. I think it's, quite frankly, a narrative shift. It's really looking at our narrative and unpacking our narrative as just that. It's a. It's a paradigm that we've bought, a narrative that we bought and it is not serving us well. So one of the aspects of the narrative is we have become an illness care system rather than a health care system. We need to call that out and say is that who we want to be as a society, that we focus on illness rather than health and wellness? If that is, then we're doing it. Right now, we're focusing on waiting till people basically reach the 11th hour and need rescue medicine. But if we really feel that it's more compassionate and even if you're not worried about compassion it's more cost effective to be involved in health and wellness for our citizens. It's it's it makes more sense. It's just a better, more effective system than we need to pivot. Where we put our focus, our dollars, our training, our emphasis, our public outreach, all of that needs to shift. And then we also as far as as public health. Public health will not work as long as we have a hierarchical structure of who in our society counts and who doesn't count. If we come at our society and understanding, all people count, everybody counts, everybody matters and therefore the health and wellness of every single person matters. Now, what are the threats to that health and wellness of people? What are the barriers to that health and wellness for people? If my starting point is every single person matters, I will be looking at those structures, those determinants that impact the health and wellness of the members of my nation. We're all in this together. Everyone counts and even, furthermore, to take it further, the people with the the even less voice, a less influence, is the children yet to come, the people that are unborn. So if we value them as also being part of our beloved community, we will be investing in women's health. We will be supporting families and the health of women in making decisions about their bodies.
Speaker 3:So let's broaden now beyond public health to our health care delivery system. What changes need to take place to move us to a partnership based system in the delivery of health care services?
Speaker 4:Well, much of our current thought process is that health reimbursement is attached to employment, and so if you are not employed, or you're underemployed or you're you're working within your home context or you're you're you know, fill in the blank. There's other reasons you can't attach your health to employment. We have a problem because we have citizens that can't be employed or are unable to be employed, or are underemployed. So we need to really look at it and say is the purpose of coverage to help our workers stay healthy, to feed our economic model, or is our purpose to ensure that all people have health as a basic human right? We need to question that, because then the model ends up being very different. The model ends up being a Medicare for all model or something like that, where you know Medicare works, the VA system works. Why can't we have that be the model for all people, that health is a right? Not because it gets me back on the assembly line, but because I'm a human being and that's the starting point for being a member of society. You see, though, that it brings into question. Do I want to live in a society where people's basic rights aren't acknowledged, where they don't have health care? No, that's a setup for a very ill society, a lot of human suffering. That's absolutely preventable.
Speaker 3:So, teddy, talk us through the process of you writing the book Transforming Interprofessional Partnerships a new framework for nursing and partnership-based health care that you wrote with Rian. How was that process? How was it being used? What are your hopes for the future About?
Speaker 4:the book Right. So I really give so much credit to Rian for the organizational framework of how you move a culture from a domination culture to a partnership culture, and that's all in her cultural transformation theory. So I did not come up with a brand new theory. What I did was I applied her theory in an area that had not previously been applied to, and I really looked under the covers and took my flashlight out and looked at all the shadow spots because I wanted to see how are we socialized not only nurses but also all health professionals to become part of and support this domination-based health care system that we have in place. How is that happening? Because I know so many fine nurses, pharmacists, physicians, dietitians, physical therapists, et cetera, but they are just incredible humanitarians and somehow, along the way they are shaped, pushed, shoved, drilled into them to be basically cogs in a system, and that's this illness-based system, and so I really wanted to figure that out. How is this done? And I first looked at education. How are we educated? How are our curriculum content and the textbooks that we're exposed to and the exam questions that we take for licensure? How does all of that start to shift and shape us towards being part of the system that most of us acknowledge we don't want to be a part of. And then, once we're in that system, how does this ranking work? Over and over again, to keep us separate from each other and working together and keep us with one type of knowledge is more important than another type of knowledge, that if you dispense medicines, that's the highest contribution to health care and if you teach or if you exercise a limb, that's less important than dispensing a pharmaceutical. How did that happen? How does that work? And how is this perpetuating the system? How is it perpetuating in the way we treat patients, families, communities? I also did a whole chapter on our relationship with nature. The former paradigm is that nature is something that we're separate from. It's something, in many respects, to be feared. We need to control it. It is the source of illness, instead of flipping the nature and say, hey, we are nature, we're part of nature, we're part of this giant ecosystem and, quite frankly, we're causing more harm to nature than nature is causing us. So let's look at that narrative and call it out for being flawed and faulty. So it was really unpacking all of this to move us into a healthier place and I can. My dream would be every health professional would take a look at this and look at their own, being caught up in the system. And what can change? I think, because of COVID and what's happened is we might be approaching a tipping point. There is such a huge healthcare worker shortage right now massive amounts of depression, people leaving the field even after a year or two in the field, suicides of health professionals that I think we're going to have to examine the source, the root cause of these problems. It wasn't the virus, was not the root cause. It is being part of a domination system. So, teddy, can you talk about?
Speaker 3:how you're using your book with your students or the professors that you work with at the University of Minnesota and the nursing school there, and if you know if there's other universities or academic institutions using the book.
Speaker 4:At the University of Minnesota. We use it as a required textbook in our specialty area because ours is the system's leaders and thinkers and we want our students to graduate thinking differently. We have built into our system a core principle of partnership, so it is called right out we are preparing you to be leaders of a partnership based system. It has been adopted by a local hospital system as the nursing professional practice model, so they all understand partnership and why we're orienting towards that way and ensuring that we're moving in that direction Around the country. I would love to say it's a New York time bestseller but it isn't, so hopefully the podcast will spark people's interest of what is this about. But I can say that the journal, the Interprofessional Journal of Partnership Studies, is also a home base for this way of thinking and this way of exploration. I thread partnership into just about every public talk that I give and really help people very quickly with role modeling. What is a partnership way of being look like? What is a domination way of being look like? I can talk to faculty and say, okay, if you're a domination faculty, this is what it looks like. If you're a partnership faculty, this is what it looks like. I have got examples for just about every field that people are in, and once they hear that they're like, ah, that makes so much sense.
Speaker 3:Can you talk us through a sample in the book where you're actually walking nurses through an example? So, for instance, the example you used of a doctor walking in and, ahem, why aren't you standing up when I enter how to support nurses in making that shift, both personally in that moment, but also more broadly for the system they're working within?
Speaker 4:So let's use that as example. We started the story that way For 10 times sitting holding the hand of a cancer patient that's been informed that they're dying, my physician walks in, clears their throat, says you know, when the physician, the captainship arrives, the crew stands as a as part of the domination system. I would stand up, say, oh I'm so sorry, I will. Do you need anything else? I'm gonna leave the room right now. That would be part of buying in and supporting the domination system. It would be acknowledging that this other person, this other professional with different skills, abilities and purposes, has a more important right to Be present with what's going on as a partner. I in somebody cleared their throat, you know I'm. You know, when the captain ship arrives, crew stands as a partner. I might say you know what? I'm so glad you're here, because the captain of the ship is actually in the bed and Just got a terrible message and they just learned that their, their cancer has returned. That's, the treatments aren't working and we as a crew are going to do our best To keep them comfortable and help them understand the choices they have ahead and how they can, you know, have this. The time that remains be quality time. We are the crew that will be serving this, this person, through them, the time that's that's remaining, and so I'm going to stay in the room as you talk to this, to the most Important person in the room, so that I can reinforce what I hear, so that I can ask questions that they might have voiced to me, and that I can be present as we wrap our care Around this person. One example from education yes, I will say a dominant teacher would say you know, welcome to nursing 101. Take a look at the person on your right. Take a person, look at the person on the left. Four years from now, when you're ready to graduate, only one of you are going to be here. This is a really tough program. It's very rigorous and I expect you to study Really really hard and I don't want to hear any Silly or inappropriate questions. That's a domination teacher. On the other hand, a teacher might say you know, welcome to the first class in nursing. Take a look at the person on your left. Take a look at the person on the right. These are your beloved colleagues. They're the ones that you're going to turn to in the middle of a night shift and ask them for their opinions and or help or work together to rescue someone. You want to make sure that they understand content and they'll be making sure that you understand content and take down content and together all of you will graduate and all of you will become incredible healers of our broken system. I Want questions. I want you to ask me questions, because we can never be master of all knowledge. Knowledge is constantly being created, and so I want to invite you to be a lifelong learner. Ask and questions anytime something doesn't seem right. You hear that pivot.
Speaker 3:Beautifully so. My final question for you, teddy, is inspired by your book that you co-authored with Rion. You point out in the introduction that the word medicine derives from the latin word Medicina. That can be translated into the art of healing. What are some healing words, or simply a message that you want to communicate to health care workers today?
Speaker 4:Giving this message right to you and right to your hearts, and that is that the problem with the current system is not your fault. No matter how good you are or how hard you work, the results will be the same because the system is designed to get these results. It's absolutely possible, however, to work together to redesign the system to get different results. We're not stuck here, we're not trapped here. There are models all over the world of highly effective health care For everyone. It's delivered to everyone, and we just need to say you know what? It's time to have that be a basic right here in this nation as well. Absolutely possible. It's not your fault. Let's get going and change it.
Speaker 3:Thank you so much, teddy. Before we close, I want to make sure our listeners know that you can find a link to purchase Teddy and Rianne's Transforming interprofessional partnership book, as well as numerous other resources that are included in the power of partnership book on health care, on our pop podcast website, and we also hope you join us for future episodes featuring teddy where she shares her work on planetary health with us, thank you. Thank you for listening to the power of partnership podcast. We're grateful to Rising Appalachia for the use of resilience as our power of partnership theme music. If you would like us to feature your partnership story or if you would like to be a proud sponsor of the power of partnership podcast, please contact us at center at partnershipwayorg. We hope you enjoyed this episode and will leave us a review on your favorite podcast channel, and don't forget to subscribe to be notified when new episodes are released. Every other Tuesday I'm cherry Jacobs Pruitt. See you next time on the power of partnership podcast.