Salutogenesis: The Defining Concept for a New Healthcare System

Abstract

A decade ago, we published several articles that \rdescribed our definitions of healing and of healing-ori-\rented practice and environments (HOPE) and how they \rare organized to create an optimal healing environ-\rment (OHE) as they apply to healthcare. We also pro-\rvided a description of the seven domains and their ele-\rments that constitute an OHE.\r1 \rIn the ensuing years, \rthe accumulation of scientific evidence and the chang-\res in healthcare delivery brought on by health reform \rhave reinforced the importance of an OHE as the pre-\rferred clinical approach to patient care by individual \rhealth practitioners and healthcare institutions. Some \relements in our OHE definition have been incorporat-\red into the operations and best practices of several \rmedical institutions and into large systems in their \rattempts to transform from disease treatment to health \rand healing.\r2\r However, in our field studies and evalua-\rtion of the literature, we have not found a complete \rprototype of an optimal healing environment that ful-\rfills our definition and criteria. This is not a criticism. \rRather, it is a comment on the reality and exigencies \rthat exist when medical organizations take on the task \rof changing their culture and philosophy of care. To \rhelp healthcare organizations move toward becoming \rOHEs, we have developed research and educational \rtools for making a culture change toward institutional-\rizing healing as a way of practice. \rIn this article, we present an updated and expanded \rversion of the OHE definition based on published data \rand solicited input from a large number of scientists, \rproviders, and patients. We bring to the forefront the \rconcept of “salutogenesis” as the foundational principle \rfor producing healing and well-being in healthcare and \rprovide further clarification of the domains of an OHE \rwith examples of clinical and economic outcomes from \rapproaches used successfully in each domain