WIKI Sites



  1. Integrating Cooperation and Competition
  2. The Creative Power of Diverse Voices
  3. Overcoming our Initial Fear (of embarrassment) and Having Some Fun


  1. Thought Leaders and Though Partners
  2. Decision Making
  3. Durations of Intention (attention & resolve)


  1. In Dynamic Systems Timing (sequencing) Matters
  2. Navigating in the Sea of Community

EVALUATION / MEASUREMENT (at three levels of certainty and associated time scales)

  1. Simple
  2. Complicated
  3. Complex

Community-based Health Levers Wiki (Programs)

  1. Improve routine preventive and chronic physical illness care   ***
  2. Provide adherence support for routine care
  3. Improve care for chronic mental illness  **
  4. Coordinate health care ***
  5. Create medical homes **
  6. Expand the use of hospice care **
  7. Improve hospital efficiency
  8. Prevent hospital-acquired infections
  9. Improve post-discharge care to reduce hospital readmissions *
  10. Redesign primary care practices for efficiency
  11. Recruit primary care providers in private practice
  12. Recruit primary care providers for Safety Net clinics
  13. Enable healthier behaviors *****
  14. Reduce environmental hazards
  15. Reduce crime
  16. Create pathways to advantage ****
  17. Establish innovation fund  ***
  18. Capture savings ***
  19. Pay providers for performance (out of captured savings)  ***
  20. Insurance coverage expanded as a result of Federal mandate

Leverage Points (Donella Meadows)

  1. The power to transcend paradigms.   *
  2. The mindset out of which the system arises. *
  3. The goals of the system.  *
  4. The power to add, change, evolve, or self-organize system structure.  *
  5. The Rules of the system.  *
  6. The Structure of Information Flows  *
  7. The Gain around Positive Feedback Loops
  8. The Strength of Negative Feedback Loops
  9. The Lengths of Delays.
  10. The Structure of Material Stocks and Flows
  11. The sizes of Buffers and other Stabilizing Stocks.
  12. Constraints, Parameters, and Numbers.

Ostrom  and Governing the Health Commons

  1. Clearly defined boundaries
  2. Congruence between appropriation and provision rules and local conditions
  3. Collective-choice arrangements
  4. Monitoring
  5. Graduated sanctions
  6. Conflict-resolution mechanisms
  7. Minimal recognition of rights to organize
  8. Nested enterprises

Innovations in Governance for Community-based Accountable Care

Integrating Community Health Levers and Ostrom’s Governance Principles into Meadow’s Leverage PointsI

Conversational Practices of Innovation

  1. Sensing
  2. Envisioning
  3. Offering
  4. Adopting
  5. Executing
  6. Sustaining
  7. Leading
  8. Embodying

Grand Junction, CO

Participatory Action Research as Innovation

Whole Community Health Information Exchange— for successful and accountable care.

  1. Learning Layer: Sofi and Genomics; System Dynamics Modeling; Community Organizaing;
  2. Coaching and Support Layer: Answers Media
  3. Coordination Layer: Congral’s “Coordinators”
  4. Analytic Layer: MS Amalga
  5. Data Repository Layer: MS Amalga
  6. Place of Employment / School Layer: Answers Media + Congral’s SCP
  7. Patient and Family Layer: Congral’s SCP and MS HealthVault; Genomics
  8. Community-wide (Health System) Patient Portal Layer: MS SharePoint (Now an Amalga use case, previously HCC)
  9. Community-wide Provider Portal Layer: Health Unity
  10. Clinical Data Exchange Layer: Health Unity
  11. EMR Transaction Layer: Certified EMRs


Leave a Reply

Your email address will not be published. Required fields are marked *

Time limit is exhausted. Please reload CAPTCHA.