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.

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.

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.

From this website http://azer.com/aiweb/categories/topics/Quotes/quote_camus.html one sees this attribution for the quote. I have not read this autobiography. Thank you.

Albert Camus (1913-1960), renowned novelist and thinker from Algeria, writing in his autobiography, “The Artist and His Time”.

If you would be so kind to advise the source of this great quotation from Albert Camus ” Great ideas, it has been said, come into the world as gently as doves…” I would be incredibly grateful to you !!

Thanks a million & very best regards

Stefanie