Overview

Individuals
While medical research has made remarkable strides in understanding the underlying biological mechanisms of the disorder, it is the patient who is responsible for daily self-care and decision making. Our focus has been on the cognitive aspects of self-care, including problem identification, sensemaking, planning, and decision making. These macrocognitive functions are necessary for patient adherence, but they are not well addressed by most current programs.

An example can be seen in diabetes management. Medical science understands the physiological mechanisms of diabetes, pharmaceutical companies produce effective medications, and product designers have produced state-of-the-art equipment. Despite all this, about 2/3rds of all type 2 diabetics fail to control their blood glucose levels. Many practitioners are clueless as to why so many of their patients with diabetes fail.

Our research has found that much of the failure is not because patients lack discipline, or will power, or knowledge of physiology. They don’t need more lectures about how the pancreas works. We found that most patients simply don’t understand what they must do to regulate their glucose levels.

The medical model contributes to the problem by taking control away from patients. Health care providers have patients collect and bring in test results, but they don’t use the finding of cognitive science and naturalistic decision making research to guide patients in interpreting results, discovering and correcting anomalies, and planning/replanning future choices. Patients are not learning to make their own discoveries about how they are driving blood glucose levels up and down through diet, exercise, stress, and medication, and how these variables interrelate. We use a dynamic control model to convey these critical skills.

Organizations
Health care organizations also must continually monitor their operations to reflect changes in patients served, medical advances, legal and fiscal constraints, and professional availability. Here, the focus must be on continual attention to the whole health care system. Organizations must detect changes early, make sense of their potential impact, plan for anticipated changes, and make timely and astute decisions. While we can address specific challenges, our real interest is in building the competence for ongoing adaptive capacity in organizations.