Online Program

Microdemocracy: A new starting point for shared decision-making and democratic action

Tuesday, November 5, 2013 : 5:30 p.m. - 5:50 p.m.

Dan Rothstein, Ed.D., The Right Question Institute, Cambridge, MA
Each year, Medicaid-insured patients have over fifty million encounters with healthcare services. Those encounters frequently do not include the active participation of patients in shared decision-making and they also are the endpoints of their engagement with the public sector. Those same encounters could, however, become new starting points for both improving health care outcomes and increasing participation in democracy. We will share lessons about the challenges patients face when they do not know how to ask their own questions or focus effectively on decisions. This prevents participation in health care and in democracy. Our research and experience in many fields and communities details how to build new capacity for action by deliberately teaching patients the skills to focus effectively on decisions and ask their own questions. We will share lessons from how patients in low-income communities can learn the skills as part of their on-going relationships with community health workers, frontline staff and healthcare providers. Their actions, once they put the skills into practice, illustrate a new concept that we call Microdemocracy. We will present the evolution of- the idea of Microdemocracy, an argument that individual encounters with health care providers can become opportunities to learn both essential health advocacy skills and essential democratic skills. In each of these settings, as patients learn to participate in decisions, they are also demonstrating the habits and practices of a citizen in a democracy. We will examine the democratic implications of experiences at the “micro” level of health care institutions.

Learning Areas:

Administer health education strategies, interventions and programs
Advocacy for health and health education
Assessment of individual and community needs for health education
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Analyze connections between a new idea, Microdemocracy, and improving healthcare outcomes. Name the implications of building patients’ skills for participation in decisions at all levels. List a variety of encounters in healthcare and beyond where patients can learn to participate in decisions. Name the importance Microdemocracy for patients and for their work.

Keyword(s): Self-sufficiency and Empowerment, Decision-Making

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the co-director of an educational organization that focuses on designing effective ways to build the capacity of people in low-income communities to think and act on their own behalf. I am the co-author of a book published by Harvard Education Press on teaching students to ask their own questions. I have extensive experience designing community-based educational programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.