What Is an “Upstreamist” in Health Care?

Rishi Manchanda, MD, MPH, Founder, HealthBegins

Have trouble viewing this video? Read the transcript.

Learning Objectives: At the end of this activity, you will be able to:
  • Define “upstreamist” as it relates to health care.
  • Contrast an “upstreamist” model of health care with traditional models of health care.
  • Identify at least two “upstream” factors that affect patients.

Description: “There are three friends who come to a river …”

So begins a parable from Rishi Manchanda, MD, MPH, who has a different view of our health care system. Health care, Manchanda says, has rescuers and raft builders to save people from drowning, but it doesn’t have nearly enough people looking for the root causes to the problems that plague patients every day.

In this IHI Open School short, Manchanda creatively explains why he’s an “upstreamist” — and why the health care workforce is still swimming against the current.

Discussion Questions:

  1. How would you define an “upstreamist” in health care?
  2. Can you think of any fields of study that encourage people to be “upstreamists”?
  3. Why might an “upstreamist” mindset be helpful to the future of health care?
  4. If you’re currently in a patient care role, which of the three friends are you most like? Why?
  5. Do you think it’s challenging to think like an “upstreamist”? Why or why not
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