It would be easy to give you the details and miss the sense of it' Social sensemaking is retrospecti

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It would be easy to give you the details and miss
the sense of it. Social sensemaking is
retrospective. So this is a personal
retrospective where I try as much to make sense
of it as I try to give you the facts.
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COMMUNITY

• From Getting Along
• To
• Co-creating Our Futures

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• Who is We?
• Where is Home?
• What are our deepest aspirations?

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Isabella Sofia
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IOM

• Not an indictment of physicians, nurses, or,
  indeed any of the people who give or lead care.
• futile to seek the improvement by further
  burdening an overstressed health care workforce
  or by exhorting committed professionals to try
  harder.
• A redesigned health care system can offer the
  health care workforce what it wantsa better
  opportunity to provide high-quality care.

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PURSUING PERFECTION

• RWJF APPROACH Complex Adaptive Systems
• For situations too complex for control or even
  classic business planning
• Rules for optimizing a CAS
• Agreement upon clear aims
• (patient-centered, safe, equitable, etc.)
• Follow a few simple rules
• (cooperation, relationship, transparency, etc.)
• Ensure effective communication among the
  agents/parts
• (the trick is effective)
• Provide opportunities and resources for
  experiments
• (fertilizing and watering)
• Pruning
• (removing resources from experiments that fail to
  move the system closer to the aims)

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It Takes a Community
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PURSUING PERFECTION

• WHO
• Patients with Heart Failure and/or Diabetes
• As participants, team members and system
  designers
• Family practice group
• Community health clinic
• Senior Center, of hospital
• Cardiology group
• Hospital
• Three payorsGHC, CHPW, Regence
• Facilitators for teams and processes,
  sociologist, psychometrician/statistician, data
  analysts, educators, org. dev. experts, system
  dynamics modelers
• IHI technical support and 12 other organizations
  in 12 other communities or countries

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Lead up to Pursuing Perfection in Whatcom County

• Trauma Program 1987
• Our children were dieing needlessly
• Proof of concept, cooperation is possible through
  conversations and relationship
• Not through representation to defend the status
  quo
• Community Vision 1990
• Seamless care, with best outcomes in the state by
  2000
• WA managed care, 1993
• Whatcom Integrated Delivery System (WIDS)
• There is a will, but not a way
• If you focus first on ...
• Relationship is the true currency of healthcare,
  not money. Marc Pierson
• To create a system doctors need their office
  managers
• Community Health Record Whatcom Health
  Information Network
• Payor, hospital, and providers
• After 3 years WIDS dies and CHIC is
  hatchedCommunity Health Improvement Consortium
  for Whatcom County
• Providers, hospital, public health dept., and
  payers
• 12 spend a month in Salt Lake City at
  Intermountain Health Care learning quality
  improvement
• Work on Diabetes, Tobacco cessation, Pediatric
  Immunizations, and Mammograms
• Community chronic disease registry

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PURSUING PERFECTION

• WHAT
• Make public promises to patients make good on
  the promises
• Began with Wagner Chronic Care Model
• Created a local dynamic model of outcomes,
  winners and losers
• Interoperable EMRs
• Substituted by patient designed Personal Health
  Record
• IDCOP
• Substituted by clinical care specialists role
• Activated patients
• Not alone but supported by clinical care
  specialists (CCS)
• Lifeguard, System Navigator, Care Coach,
  Interpreter
• Community
• Whatcom Alliance for Healthcare Access (WAHA)
  working on access
• Exploring patient action committees

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What is Pursuing Perfection P2 ?
We are building a patient-centered community wide
chronic care management system in Whatcom County
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Involving Patients in the Process
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Patient Action Advisory Committee
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How to Invite Patients

• Simply have prospective team members ask patients
  that they or their friends know will fit the team
• Caution
• Avoid inviting patient advocates
• Forgiveness and compassion are not theirs to
  choose
• Avoid asking healthcare workers who are also
  patients

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PATIENTS EXPERIENCE
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PURSUING PERFECTION

• CLINICAL CARE SPECIALISTS
• Lifeguard
• System navigator
• Care coach
• Translator
• Results
• A missing role
• Needs fundingcommunity resource, helps everyone
  involved
• Needs leveraging
• Final pathway to MD in a sparse radial network
• Needs lay networks, e.g. parish nurses

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The Surprising Shared Care Plan

• A Patient Self-Management Tool
• Facilitates information flow across org.
  boundaries and care team members
• Has generated intense positive interest
• Improved safety and accuracy between
  patient/healthcare team
• Improvised through iterative use/feedback

• Like a developing blue-print between the owner
  and architect and builders
• More Discussion
• More Design
• More Learning
• More Expertise
• More Involvement of family members
• Much more than a record, a symbol and artifact
  for cooperation and shared responsibilityPatients
  and Providers as PARTNERS

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Information--or Partnering Conversations for New
Behaviors

• The focus shifts
• from EMR (organization specific business medical
  records)
• to include PHR (personal health records)
• Think more of conversation generating
  artifactsprinted PAPERthan electronic databases

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PURSUING PERFECTION

• GLOBAL PARTNERS
• Six USA peers
• They worked on hospitals or vertically integrated
  single business. Little progress between the
  silos, the space where patients live and die.
• London, England
• Community based nurses
• Like clinical care specialists
• Jonkoping County, Sweden
• CEO of whole county health care resources
• Leaders who understand teams (Swedish National
  Womens Basketball coach)
• Deming system map of whole system
• Started system map of Whatcom County
• Central meeting place for learning and research
• WWU institute in planning stages

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First Meeting, May 04Patients, Hospital,
Providers of Many Types, Government Leaders and
Agencies, Businesses, Insurers, etc.
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APIs Cliff Norman
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Organizations as a System?
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A System Supporting the Re-Socialization of
Chronic Conditions

• With and by patients
• They have a network of supporters
• They have capacity
• They have ideas, they can lead
• A return from the over medicalization of life
• BMJ article, Too Much Medicine, suggesting
  balance is possible

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Expand The FocusChange the Game

• Move beyond the profession and institutions
• The current impasse came about with the current
  players.
• Just trying harder or trying to renegotiate among
  the current players is not so likely to be a
  breakthrough
• Include community
• There are not enough doctors and nurses in the
  pipeline for the coming demographic budge
• Re-socialize health where reasonable
• Include homes, patients and their social support
  networks

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LEADING COALITIONS

• A few ideas about leading community coalitions
• -It is about shared values--creating, unearthing
  and polishing them.
• -We don't know. We are improvising. In fact, the
  key is probably improvisation.
• -A recommendation find at least one person that
  is or will become consumed by the opportunities.
• -Here are ten ideas we seem to be using in
  Whatcom County as we pursue perfection in health
  care delivery across a community.
• Bring the outside in.
• Hire and empower successful revolutionaries as
  leaders.
• Become a story junky.
• Revert to common values. Technique will not work
  here (yet?).
• Make it up as you go.
• Appreciative Engagement.
• Systems thinking must trump liner, simplistic
  planning.
• Get committed, publicly.
• It's about LOVE, FAITH, and FORGIVENESS.
• Give away (through stories) all the success.
• http//www.wwpp.org/users/0000002/2003/04/30.html
  a399

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THANK YOU

• These presentations and other materials can be
  found on my weblog
• Google Marc Pierson