Implementing OHEs.

ow that we have reviewed the seven domains of an optimal healing en- vironment (OHE), how do we be- gin to implement and integrate these principles into the hospital setting? We have seen many examples of forward- thinking hospital leaders and clinicians who have taken bold steps to incorporate various components of a healing environment be- causetheybelieveitisboththerightthingto do and that it makes good business sense. It isn't easy, they will all agree, but can be done. The challenges to the development of OHEs are many. First, our current health- care system is set up to deliver a curative model that focuses on the management of physical disease. These interventions are made relatively late in the progression of the disease and primarily call for drugs, surgery, and expensive technologies. Our current system was developed at a time when acute illness and infectious disease dominatedthehealthcarefield.Despiteits high price tag, the curative model remains Another challenge arises from the com- plexity of healing-oriented models. Sup- porting a self-correcting and self-healing system rather than one that seeks to con- trol and correct each known variable re- quires a new paradigm to conceptualize the role and nature of healthcare. As an outcome of a complex system, healing re- quires that real-time information be captured andfedbackintothehealthcaresystematmul- tiple levels. Setting up environmental condi- tions and infrastructure to support emergent healing properties will largely depend on new ways of applying science in healthcare. Fourth, developing a science of healing requires reconceptualizing and expanding of the model of evidence-based medicine. Just as systems biology involves a reconceptu- alization of how we approach biological sci- ence, the science to support OHEs will result in a systems medicine. This type of science requires new approaches to the management, synthesis, and application of data, and new uses of information technology in healthcare. The ideal type of data for an evidence-based systems medicine is not group probabilities- derived from randomized, controlled trials, but rather based on dynamic, informational feedback from actual individuals occurring in real time. Perhaps the most difficult challenge is a shift to practice collaborative medicine. Historically, knowledge and skills have been vested in the physicians, who con- trolled their environment and delivered treatments to a passive patient disempow- ered by his or her disease. With the growth of easy access to large volumes of informa- tion—bothgoodandbad—patientsarebecom- ingsophisticatedconsumersandpurchasersof healthcare. Hence, medicine can no longer be physician centered; rather, it becomes a per- son-centered system in which the "avatar" of intelligent information management and the "advocate"ofthehealthcareteamworkintan- dem to empower the patient in his or her own choices and actions. True collaborative medi- cineinvolvesashiftofpowertothepatient,the