Crystalizing Healthcare in a Community?
April 3, 2010 by marc
Upon what can the parts of health care come together into a coherent whole. No metaphor works well if extended very far; certainly not inorganic crystals. But let’s play with this for a moment to get some use from it. There are a lot of parts of health care swirling in the community. How can they come together into something that can be used? There is talk of Accountable Care Organizations (ACOs). What will come together in an ACO? For what (who’s) purpose and benefit will ACOs function? In the reorganization of healthcare we have a moment in history to have the parts and players come together differently and more effectively and more for the benefit of the people who’s health is at stake.
Do you think it can be organized around or by hospitals? Physicians? Payer/Insurers? Government? Something entirely new? Who will have a voice? Who should have a voice? Who can have a voice? Can the voices blend or will strident voices (or pressure to silence voices) prevent anything useful from coming into being? What is the desired use and shape of this possible crystal? Will it be strong or brittle? Beautiful or ugly? Useful or not so useful?
Dave Ford, of Care Oregon gave me a book to read–Governing the Commons, by Nobel Prize winner Elinor Ostrom. She has me thinking. That was Dave’s goal I believe. How did those successful instances of well managed COMMONS come about? How can we begin to see health as a “common pool resource” and manage it well over the long term–ourselves, as communities of appropriators–appropriators from the common pool of health resources? This is a question worth serious reflection and design.
3 Responses to “Crystalizing Healthcare in a Community?”
Marc-
I think most definitely hospitals are the logical place from which to organize such an approach. If you map the processes of care in a community, the organization that can view emergence in all of the component pieces the best is the hospital. It is the “connector” of physicians, nurses, other providers, payers, business leaders, local govt. and educational forces. There are tensions, to be sure. Hospitals have been primarily geared for episodic care, but so has everyone else.
The ideal situation from which to start is a location with a single, visionary institution–say Bellingham (
). Santa Fe or Durango have a similar single dominant institution, so risk could at least be ameliorated in attempting “safe fail” probes. The CJI has certainly taken the lead in pointing what can be done.
The frustration is that “blind spot” that John Kenagy talks about. As an ophthalmologist, I find that exceedingly interesting! Enlargement of the blind spot in glaucoma is often not noticed by the patient, until it is too late. Screening helps bring that to the attention of the patient. How can we introduce similar “screening” to the stakeholders of health care in general?
David Logan, in “Tribal Leadership”, describes the “aha moment” in the life of a Level 3 leader when s(he) realizes that productivity is limited by the current processes. Health care is filled with Level 3 leaders. Logan describes the concentration on shared values and a job too big to accomplish without cooperation and movement to Level 4.
Even though health care leaders are fossilized at Level 3, successful business people can move to Level 4. Perhaps the point of intervention should be with controlling Boards, as they are more likely to understand what we are talking about than our colleagues.
Russ,
Dave Snowden taught me that people all have multiple identities which are situational. Our colleagues, physicians, each have identities other than their role as physician/expert–parent, sports team member, spouse, organizational member or leader, etc. It is from some of these non-expert perspectives that physicians will have the ah ha moments that lead to a new way of participating with their community members and designing the next better way of providing and receiving expert care as well as staying healthy together.
That said, Russ, I do think that organizations are key to successful community collaboration and one of the key roles of business leaders and NGO leaders is to have their organizations show up as community citizens.
Marc-
Your comments regarding the multiple identities are right on the mark. The concepts of “communities of practice” need to be expanded beyond the primary product of patient care into the “secondary” product of organizational action. That expert identity has served us well in the complicated aspects of what we do, but we need a community of practice in the complex realm. The hospital governing board is one institution that could supply that insight, as it is made up of the type of perspective that allows the differing viewpoint you mention. Bellingham has the advantage of already “getting it”. In many other (most?) locations, this is all new stuff. Using the governing board as a portal of influence could offer advantages.