While improved care will decrease the fraction of the population needing emergency and hospital care it will never eliminate it. The decreased utilization and decreased funding available per capita puts pressure on hospitals. I think that the best innovation strategy for hospitals will be something like: “Sooner, Better, Cheaper”. Hospitals that can provide needed service sooner in your life or your schedule, with better cllinical and experiential outcome, at a significantly lower cost than competitors will flourish–at least in contrast to hospitals that are “Slower, Average, Expensive”. As systems accept risk for population outcomes at lower costs, higher quality and higher satisfaction–they will buy services that meet these requirements when they are unable to produce it themselves.

Innovation in a health system will be a concerted effort to create 1) the clinic of the future, now (P4Medicine) and 2) the hospital of the future, now (Sooner, Better, Cheaper).

Psychological resilience is important for every one. There are emerging programs to teach resilience to soldiers, their families and to school children. Here is a news clip from London. Here is a NPR transcript. Here is an HBR podcast and transcript. Comprehensive Army Fitness may be the most advanced model available to transform current employee wellness programs into employee wellbeing programs which should have a much bigger pay off, not just in health but in productivity and worker retention.

There is a lot going on in health care. I regularly feel the need to reorient myself. This morning I reflect back upon my own source of inspiration. In 2001 a group of patients in my community articulated what a redesigned health care system would have to accomplish from their perspective. They simplified the problem/solution considerably. The asked consistently for three things:

1. Navigator-Coaches,
2. Their own life long, sharable, personal health records and
3. Access to tailored knowledge, education, and training to have more self-caring capability.

I will continue to help this emerge in my community, my organization, my state, my country, and beyond.

• Certified EMRs
• Community connections between EMRs (HIE)
• Organizational portals for providers and families

Socio-technical support for the new (near term future) Triple Aim based health care system:

• Begins in earnest ONLY when financial reimbursement aligned with the community members–Triple Aim
• Data repository and analytics for early pattern detection of managing a network or system
• Care coordination (case management and beyond) that engages the patients
• Patient and family health engagement tools
• Engagement of people at work and at school (health, flourishing, and illness prevention)
• Broad based support whole community policy creation and action

I want the human experience of each person, patient, family member and provider to be respectful, connected and deeply meaningful. Only in such an environment can each person adopt the behaviors and practices that will lead to their highest wellbeing.

In this talk I suggest how can we support all the people in our communities making new choices and adopting new behaviors that support health and wellbeing.

Here is a condensed PDF of the slide deck :Consumer-Centric Models of Change

Leadership is supporting people’s capacity to see reality and act. Otto Scharmer, Theory U. I really like this.

My earlier thoughts on ten years of leading.

Innovation teams must:
Enjoy openness in uncertainty
Must develop skill in suspending judgement (knowing)
Must participate in group dialogue with all stakeholders in order to get beyond politeness, and beyond challenges and discussion in order to reach the previously unknowable wisdom of the whole and from there to discover our best future.

Socio-technical innovation is best conceived and conducted as participatory action science (learning).

Scrum (Scrum Alliance) methods provide complementary tools that fit the action science / action learning framework.

There is an essential order to planning and organizing community change:

FIRST: WHY & When

For the sake of what are we taking action. Out of what history and what historical mind set? Out of what belief system? At what scale? In what place(s)? For whom? Is this the time for a change of mind and direction?

Meadow’s first three “existential” leverage points address this first stage. The conversational methods for this stage must include dialogue and participatory action learning.

SECOND: WHO & When

Who has had a voice? What kind of a voice have they had? Who must have a voice? What kind of a voice must they have for the change to emerge? When will the conversation change?

Meadow’s 4, 5 & 6th “political” leverage points Address this next stage. The methods for this stage must include dialogue, participatory action learning, social organizing, and democratic political action.

THIRD: HOW & When

What are the nonlinear dynamics of this complex social system we are intervening in? What are the feed back loops, the delays, the unexpected consequences. What are the surprises that matter?

System dynamics modeling is the only way to understand this. Will we invest in this method or will we suffer the consequences. When do we need to create and update the model in order to have the necessary tool for policy design? Who will get to see and use the model? Will it be transparent to the whole community? If not, why not?

FOURTH: WHAT & When

What are the visible linear systems, the processes, the inventories, the investments, the adjustments? How do we manage, day-to-day, the system that has emerged from the more fundamental leverage points?

The conversations here are about process flow, hand offs, organizational structure for coordination and decision making. How will we operate within a hierarchy or command and control structure in a way that does not kill the engagement and creativity of the participants. How often will improvements be made? Who will be allowed to make improvements? Who will see the performance data?

Patients?
Customers?
Employees?

Choice?
Information?