Synthesis and Simplification of the Eight Rules

There are two ideas here:

A) Power of local (neighbors’) personal relationships and the related Limited Span of Personal Relationship

  • This limitation calls for clearly defined (1) boundaries–of relationship ability.
  • Requirement for (8) nesting of CPR enterprises in order to manage inter-relationship between limited personally connected networks. This is done by creating an empowered (delegated power) network of super relaters.
  • (3) Collective choice arrangements–individuals have a say in local rules for balancing accumulation and withdrawal from the common pool.
  • (7) Outsiders with power over the community must not disallow local rule setting and management.

B) Balancing [(2)local congruence] the accumulation and withdrawal of common pool resources through personal relationships

  • (4) Local Monitoring
  • (5) Local Graduated Sanctions
  • (6) Local Conflict Resolution

Sofi meets Meadows

Some initial thoughts on how Sofi model might relate to Donella Meadow’s Leverage Points. Both frameworks have been very useful to me and I have just begun to wonder how to relate them, if at all.

1.   Interacting with Customers

2.   Staffing

3.   Infrastructure

10. The Structure of Material Stocks and Flows

11. The Sizes of Buffers and other Stabilizing Stocks.

4.   Sales & Marketing

5.   Learning & Development

4. The power to add, change, evolve, or self-organize system structure.  *

6.   Day-to-Day operations

12. Constraints, Parameters, and Numbers.

7.   Measurement & Resource Allocation

8.   Strategic Planning

7. The Gain around Positive Feedback Loops

8. The Strength of Negative Feedback Loops

9. The Lengths of Delays.

9.   Market Research

6. The Structure of Information Flows  *

10. Leading

3. The goals of the system.  *

4. The power to add, change, evolve, or self-organize system structure.  *

5. The Rules of the system.  *

11. Culture

1. The power to transcend paradigms.   *

2. The mindset out of which the system arises. *

We are all Drunks Under Nested Lamp Posts

Remember the old story of the drunk searching under a lamp post on his hands and knees? Being ask what he is doing, he replies that he is looking for the keys he dropped. He acknowledges that he dropped the keys in the dark but chooses to search where the light is better.

We are all in a similar situation. We try to solve problems, tinkering mechanically, in ways that we are comfortable (in the light), never venturing into the next level of darkness–the well explored world of unintended consequences, huge effects form small actions, and small or counter-intuitive effects from huge efforts–nonlinear system dynamics.

And yet there is a next deeper level darkness (ignorance or apathy) beyond the pale light of dynamics. This is the dimmer light that reveals  who does or does not have a voice and why the game is even being played.

There is yet a deeper darkness (lack of curiosity) than the conversations of participation and purpose. This dimmest of light  hides (or reveals)  beliefs as choices and culture. This final or original darkness challenges the very concept of our own identity. It completely unhinges hope for unchanging certainty.

Miraculously, beyond this is dimmest of light exists a strange light indeed, where there are no comforting facts and no certainty. In this strange space there is a different light, one of intuition, where new worlds open up, dimly, where new possibilities emerge gently, where  there exists the mere possibility of dissolving intractable problems. Beyond the deepest darkness or dimmest light exists a state of possibility, of deep curiosity, openness, sensitivity, awareness, and creation. Without this identity-less way of being and knowing, nothing else offers real hope for a better world. Outside this way of knowing we are in a trap of conviction, isolation, simplistic thinking, and ultimately ineffectual tinkering.

——————

MechanicsTinkering (the smallest radius,  brightest lamp light)

But if you don’t have the dynamics right, the mechanics won’t matter much.

DynamicsSystem Dynamics Thinking (the next larger radius, less bright lamp light)

But if you don’t have the right people in the right conversations, the dynamics won’t matter much.

ConversationsConversing, Social Complexity, Politics, Innovation (the next etc.)

But if you don’t have the right paradigm (cosmology, ontology, and epistemology) the conversations won’t matter much.

ParadigmBelieving, Knowing, Way of Being (the largest radius, dimmest lamp light)

But if you are not deeply awake to  your (owner) always  inadequate paradigm, it will inevitably determine or limit  everything else.

Deeply Awake to the Universe, to Self and to Possibility (a universal light of an often imperceptible wavelength)

Acceptance, solidarity, mystery, emergence, joy…

BEING before and over Knowing, Having, Consuming or Controlling.

 

NESTING (from bigger to smaller domains): Consciousness/Paradigms/Conversations/Dynamics/Mechanics. However, be aware that the smaller nested domains each have the potential of limiting the breadth of the next bigger domain whenever convenience trumps coherence.

 

Meadows

Meadows, Ostrum, and Rippel.

 

CPI (Consumer Price Index) Categories

What goods and services does the CPI cover?

The CPI represents all goods and services purchased for consumption by the reference population (U or W) BLS has classified all expenditure items into more than 200 categories, arranged into eight major groups. Major groups and examples of categories in each are as follows:

  • FOOD AND BEVERAGES (breakfast cereal, milk, coffee, chicken, wine, full service meals, snacks)
  • HOUSING (rent of primary residence, owners’ equivalent rent, fuel oil, bedroom furniture)
  • APPAREL (men’s shirts and sweaters, women’s dresses, jewelry)
  • TRANSPORTATION (new vehicles, airline fares, gasoline, motor vehicle insurance)
  • MEDICAL CARE (prescription drugs and medical supplies, physicians’ services, eyeglasses and eye care, hospital services)
  • RECREATION (televisions, toys, pets and pet products, sports equipment, admissions);
  • EDUCATION AND COMMUNICATION (college tuition, postage, telephone services, computer software and accessories);
  • OTHER GOODS AND SERVICES (tobacco and smoking products, haircuts and other personal services, funeral expenses).

Also included within these major groups are various government-charged user fees, such as water and sewerage charges, auto registration fees, and vehicle tolls. In addition, the CPI includes taxes (such as sales and excise taxes) that are directly associated with the prices of specific goods and services. However, the CPI excludes taxes (such as income and Social Security taxes) not directly associated with the purchase of consumer goods and services.

The CPI does not include investment items, such as stocks, bonds, real estate, and life insurance. (These items relate to savings and not to day-to-day consumption expenses.)

Whatcom County Estimated Initiative Costs

The ReThink Health model not only estimates the health and economic effects of simulated interventions, but also the cost of implementing each selected initiative over time. Below are cumulative program spending estimates for in the first five simulated years (2012‐2017).

These figures account for size and composition of the local health system. They are based on scenarios in which each initiative was simulated individually at its 100% lever setting (i.e., with the maximum plausible reach and effectiveness). Program costs vary with different lever settings and may differ in scenarios with multiple initiatives due to interactions. Default unit costs may be adjusted, as needed.

ReThink Health – Whatcom County, Washington Reference Data Summary

Each local configuration of the ReThink Health model draws from a variety of data sources to create a broad and balanced profile of the health and health care system in a particular region. Data for the Whatcom County Health Service Area currently addresses:

  • Population composition, divided by 10 subgroups according to age, insurance status, and income, and projections for aging and overall growth through 2040;
  • Population health status, including the prevalence of physical and mental illness (by population subgroup);
  • Health risks, including fractions of the population with high risk behaviors, environmental hazards, and high crime (by population subgroup);
  • Provider resources, including office-based primary care providers (private and safety net) and specialists, and acute care hospital beds;
  • Health care utilization, including PCP visits and available slots for the indigent, ER visits urgent and non-urgent, inpatient stays and readmissions and discharge destinations, and people in nursing facilities or using home health care;
  • Health care costs, including nearly every category in the “personal healthcare expenditures” portion of the National Health Expenditures tracking system.

Some of the main sources for understanding conditions in the Whatcom County region are:

  • Office of Financial Management, Vital Statistics
  • Washington Department of Health
  • WhatcomAlliance.com
  • Hospicehelp.com
  • Local data from hospital representatives
  • U.S. Census 2010 (American Community Survey)
  • In addition, certain estimates were either calculated or cross-checked using local adjustments from national sources such as:
  • National Ambulatory Medical Care Survey (NAMCS)
  • National Hospital Ambulatory Medical Care Survey (NHAMCS)
  • National Survey of Children’s Health (NSCH)
  • National Nursing Home Survey (NNHS)
  • National Home Health Care Survey (NHHCS)
  • National Health Expenditure Accounts
  • National Health Interview Survey (NHIS)
  • National Health and Nutrition Examination Survey (NHANES)
  • Medical Expenditure Panel Survey (MEPS)

Whatcom County-specific Data Sources by Topic

POPULATION

  • Population by age group–U.S. Census 2010
  • Population projection by age group–Office of Financial Management – State of Washington
  • Disadvantaged fractions by age group–American Communities Survey – Public Use Micro-area
  • Insured fractions by age/income–American Communities Survey – Public Use Micro-area
  • Births, Deaths, Net Migration–Office of Financial Management–State of Washington

ILLNESS & RISK

  • Chronic mild and severe physical illness prevalence by pop segment–WA Dept. Of Health BRFSS Internet Query system: General Health Status (mild=“good”; severe=“fair or poor”)
  • Chronic mental illness prevalence by pop segment–For youth, scaled national data from the National Survey of Children’s Health: yes responses to “Does child have any kind of emotional, developmental, or behavioral problem for which [he/she] needs treatment or counseling?” For adults WA Dept. Of Health BRFSS Internet Query system: 7+ days as a response to: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”
  • Risky behavior prevalence by pop segment–Youth: NSCH 2007 for WA state. Overweight or obese|no activity|smoker in the house|oral health problems
    Adults: BRFSS WA statewide data: obese|no activity|current smoker|binge drinking 2+ times per month|missing 6+ permanent teeth

PROVIDERS

  • Primary care physicians and physician- equivalents (private, safety net)–WhatcomAlliance.org; Hospicehelp.org; Office of Financial Management, State of WA
  • Specialist physicians— WhatcomAlliance.org
  • Acute Care Hospital Beds–Noreen Fassler (per Elya’s spreadsheet)

UTILIZATION

  • Visits to safety net PCPs, and visit capacity per safety net PCP–Awaiting data from SeaMar and Interfaith safety net clinics
  • Fraction of safety net PCP slots available to poor uninsured–Awaiting data from SeaMar and Interfaith safety net clinics
  • Fraction of private PCP slots available (1) to Medicaid, (2) to poor uninsured–Estimate based on experience at other RTH sites
  • ER visits in local & outside hospitals–St. Joseph’s data; assumption that ER utilization within and outside county by county residents follows same pattern as inpatient admissions
  • Non-urgent fraction of ER visits–Estimate based on pattern of ER utilization by population segment from St. Joseph’s and RTH methodology that reflects proportion of ambulatory sensitive conditions coming to the ER
  • Inpatient stays in local & outside hospital–Utilization by segment based on St. Joseph’s data; total utilization by Whatcom County residents from Washington Department of Health patient origin data; inflated St. Joseph’s data to reflect larger number of patients coming from county (SJMC has 87% share of county admissions)
  • Fraction of hospital discharges to SNF/rehab facility or home care agency–St. Joseph’s data on discharge status, assumed to hold true for entire county given SJMC’s large share
  • Nursing home population–Assume 90% Occupancy of 786 beds in 9 SNF’s in county

COSTS

  • Average charge per ER visit–Net revenue from St. Joseph’s data
  • Average charge per inpatient stay–Net revenue from St. Joseph’s data

UPENN Questionnaires

Questionnaires Center

These questionnaires measure character strengths and aspects of happiness. All are yours to use at no charge. For each one, you’ll immediately receive your score and see how it compares to the scores of others who have used this website. We’ll keep a record of your scores, so that you can return later and see how far you’ve progressed. To see your earlier scores, log in and choose the Test Center link.

You must complete our free registration form to use the questionnaires. Once you are registered, you may log in whenever you like to use them again or view your scores.

Your responses to these questionnaires will be used in research about happiness, but your e-mail address, name, and password will not be included with them. We use them only to give you access to your own records and to send information about the website, if you agree to receive our e-mails.

Featured Questionnaire:

Compassionate Love Scale
Measures your tendency to support, help, and understand other people
Source: Sprecher, S. & Fehr, B. (2005). Compassionate love for close others and humanity. Journal of Social and Personal Relationships, 22, 629-652. Used with permission of Susan Sprecher. ©2005 Susan Sprecher and Beverly Fehr

Emotion Questionnaires:

Authentic Happiness Inventory Questionnaire
Measures Overall Happiness
Questionnaire is © 2005 Chris Peterson, University of Michigan. Used with permission.

CES-D Questionnaire
Measures Depression Symptoms
The Center for Epidemiological Studies-Depression Scale (CES-D) was developed by L.S. Radloff, National Institute of Mental Health.

Fordyce Emotions Questionnaire
Measures Current Happiness
From Authentic Happiness, Chapter 1 – Positive Feeling and Positive Character Questionnaire copyright Dr. Michael W. Fordyce. Used with permission.

General Happiness Questionnaire
Assesses Enduring Happiness
From Authentic Happiness, Chapter 4 – Can You Make Yourself Lastingly Happier? Questionnaire developed by Lyubomirsky & Lepper (1999). Used with permission.

PANAS Questionnaire
Measures Positive and Negative Affect
From Authentic Happiness, Chapter 3 – Why Bother to Be Happy? Positive Affectivity and Negative Affectivity Scale-Momentary Feedback questionnaire developed by David Watson and Lee Anna Clark, University of Iowa, and Auke Tellegen, University of Minnesota. Used with permission.

Engagement Questionnaires:

Brief Strengths Test
Measures 24 Character Strengths
Questionnaire is the work of Chris Peterson, University of Michigan. Used with permission.

Gratitude Questionnaire
Measures Appreciation about the Past
From Authentic Happiness, Chapter 5 – Satisfaction about the Past Questionnaire developed by Michael McCullough and Robert Emmons. Used with permission.

Grit Survey
Measures the Character Strength of Perserverance
The Grit Survey was developed by Angela L. Duckworth, Seligman Research Alliance, University of Pennsylvania. Used with permission.

Optimism Test
Measures Optimism About the Future
From Authentic Happiness, Chapter 6 – Optimism about the Future

Transgression Motivations Questionnaire
Measures Forgiveness
From Authentic Happiness, Chapter 5 – Satisfaction about the Past Transgression-Related Interpersonal Motivations Inventory developed by Michael McCullough and colleagues. Used with permission.

VIA Signature Strengths Questionnaire
Measures 24 Character Strengths

VIA Strength Survey for Children
Measures 24 Character Strengths for Children
From Authentic Happiness, Chapter 12 – Raising Children Questionnaire and classification of strengths are the work of Nansook Park, University of Rhode Island, through the VIA Institute on Character, under the direction of Drs. Martin E. P. Seligman and Chris Peterson, and funding for this work has been provided by the Manuel D. and Rhoda Mayerson Foundation. © 2003 VIA Institute on Character. Used with permission

Work-Life Questionnaire
Measures Work-Life Satisfaction
From Authentic Happiness, Chapter 10 – Work and Personal Satisfaction Questionnaire developed by Amy Wrzesniewski. Used with permission.

Meaning Questionnaires:

Close Relationships Questionnaire
Measures Attachment Style
From Authentic Happiness, Chapter 11 – Love Questionnaire developed by R. Chris Fraley, Niels G. Waller, & Kelly A. Brennan. Used with permission.

Compassionate Love Scale
Measures your tendency to support, help, and understand other people
Source: Sprecher, S. & Fehr, B. (2005). Compassionate love for close others and humanity. Journal of Social and Personal Relationships, 22, 629-652. Used with permission of Susan Sprecher. ©2005 Susan Sprecher and Beverly Fehr

Meaning in Life Questionnaire
Measures Meaningfulness
The Meaning in Life Questionnaire (MLQ-10) was developed by M. F. Steger, P. Frazier, & S. Oishi. Used with permission.

Life Satisfaction Questionnaires:

Approaches to Happiness Questionnaire
Measures Three Routes to Happiness
Questionnaire is the work of Chris Peterson, University of Michigan. Used with permission.

Satisfaction with Life Scale
Measures Life Satisfaction
From Authentic Happiness, Chapter 5 – Satisfaction about the Past Scale developed by Ed Diener, University of Illinois at Urbana-Champaign. Used with permission.

RESEARCH AGENDA FOR FLOURISHING & TRIPLE AIM OUTCOMES

(Notes from Bill Mahoney, PhD)

I will start at the end of the causal path and work backward. The end is health outcomes at the individual level (which aggregated = population health). We are starting with the fact that a large proportion of the variability across individuals in health outcomes is explained by behavioral factors. It is the “behavioral factors” we are explaining in this logic.

Why do less than optimum health outcomes from behavior happen? I think the answer is summarized in activation and the voluminous research showing the relationship between activation and health.

  • Believing that health is my responsibility not that of health care professionals.  Not believing this reflects being socialized to believe that health is dependent upon health professionals.
  • Knowledge. Must know things such as what lipids are, why they are important, what your lipid numbers are, why they are that, what is your recommended weight, etc. The most important piece of knowledge is knowing the truth about health care and health care professionals and that they are not all knowing and do make mistakes and are generally far too busy to have an all encompassing focus on you and your health situation.
  • Confidence that one can know and do.
  • Doing. Actually taking behavioral change steps such as diet, exercise.
  • Doing in difficult times. This is having resilience to the deactivating effects of stress and set backs; being able to stay the course when sliding back to old patterns would seem easier.

For most people improving their health management behavior in almost any way involves adopting a new way of thinking about health and health care. This change can be close to a transformational change that is needed. From this change in thinking comes change in behavior.

How does this change come about? It comes about when people flourish and it cannot come about when they do not flourish. The reason for this is that the more positive the affect ratio people are/have the:

  • More likely they are to be open to new ideas.
  • More likely they are to be open to changing behavior.
  • More interested they are in learning new things.
  • Better able they are to learn and learn more and more quickly.
  • More open they are to interaction with and connection to other people (enhancing flourishing spurs network creation).
  • More confident in their ability to manage their health.
  • Physiological states that directly, biologically, enhance health and healing.

So the pathway to health outcomes starts with increasing flourishing because this leads to the possibility and probability of behavioral change. Trying to create behavior change without flourishing as the focus (e.g., education alone) is simply a waste of time .

———-

Cognitive Behavioral Therapy

Mindfulness-based Cognitive Therapy