Providers must abandon paternalism and treat patients like partners in the decision-making process when drawing up care plans, according to Chris Waugh, Sutter Health's chief design and innovation officer. Instead of prescribing a major lifestyle overhaul without considering a patient's unique life circumstances, providers should "recognize that it's about the tiny things and the accumulation of marginal gains,” he said.
By KATIE ADAMS

Historically, healthcare providers have had a reputation of paternalism — as one might guess, this type of approach doesn’t support patient engagement or care plan adherence.
Like many other innovators in the industry, Chris Waugh — Sutter Health’s chief design and innovation officer, believes providers need to abandon paternalism and pivot toward collaboration. They must start treating patients like partners in the decision-making process when drawing up care plans, he said during an interview last week at the Reuters Total Health conference in Chicago.
“We’re often asking people to make such dramatic changes — often a complete overhaul of their lifestyle. There’s often this long list of changes they need to make, but asking anyone to even make a micro change to their health is a lot. Healthcare needs to recognize that it’s about the tiny things and the accumulation of marginal gains. All these little things are going to add up — but who is going to nudge those little things in the right direction every day?” Waugh explained.
Rather than imposing a set of prescribed changes, providers should inform patients that they may need to make some difficult lifestyle adjustments and communicate that the care team is committed to figuring out how to best implement those plans, he said.
It’s important to have an open dialogue when creating care plans for patients — without this, providers could be making decisions on behalf of the patient without understanding the unique circumstances of their life. For instance, a doctor may mistakenly assume that cutting salt out of the diet is a reasonable intervention for one of their patients with high blood pressure, Waugh pointed out
“Patients come from various cultures. What if we tell someone to take salt out of their diet when that is counter to everything that their culture stands for? What if their family meals always have salt? Now we’re not only asking the person to change, but their whole ecosystem has to change with them. You have to bring the whole ecosystem along, which sounds daunting, but the truth is that this is where design is really fun, because these are different ways to engage different people,” he declared.
The healthcare industry doesn’t have the best track record when it comes to being there for patients for all the small decisions and tiny moments that make up the picture of their health, Waugh noted. However, he is excited about the rise of digital health coaching, as various platforms have emerged in recent years that seek to engage patients and keep them connected to their health journeys in a convenient and non-intimidating manner.
One example is Scout by Sutter Health, an app that the health system launched last month. The app — which is free for users across the country — was launched to help teens and young adults manage their everyday mental health needs, but user feedback has shown that adults of all ages can benefit from using the platform, Waugh remarked.
The app doesn’t provide care — it’s not a platform for therapy or counseling. Rather, Scout is a resource people use to conveniently manage their difficult emotions, daily challenges and mental health stressors. The app serves as a tool people can use to check in with their mental wellbeing while they’re waiting for the bus or the water to boil, Waugh explained.
“It turns out that the hour Scout is used most is 11 at night. That’s the most common time when the service is needed, and it’s not a handy clinical time,” he said during his presentation at the conference. “We’re not going to solve the mental health crisis with an app, but it’s a super helpful tool that’s competing with TikTok and the doom scrolling and everything else that’s happening. We figure as long as you’re on your phone, we may as well try to use it for good.”
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