summer institute 2010 deep dive into community f. daniel duffy, md, macp july 31, 2010
Post on 19-Dec-2015
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TRANSCRIPT
Why are we here?
Present Future
School of Community Medicine
OK
Access for all Coordinated care Complete information Good communication Highest quality Affordable costs Altruism in care
How do we do it?
OK
Access for all Coordinated care Complete information Good communication Highest quality Affordable costs Altruism in care
Plan & design
Present Future
School of Community Medicine
YES, BUT…Community Medicine Moves from isolated and self-interested silos
to connectedness and care for the whole
Shifts from problems to be solved to our community’s positive potential
Encourages collaboration in creating the future that cares for the whole
Theory U
The way in which we attend to a situation determines how a situation unfolds: I attend this way, therefore it emerges that way.
Principles and practices for collectively creating the future that wants to emerge.
Otto Sharmer, 2009
How does the “U” Journey Work?
LISTEN to others and to what life
calls us to do
SENSE Go to the places of most potential, observe and listen with our minds, hearts and wills wide open
CREATE Prototype a microcosm of the new to explore the future by
doing
EVOLVE ecosystems by acting from
the emerging whole
PRESENCE Retreat and reflect to allow inner knowing to emerge
Present Future
Social activities Anchoring lectures Stakeholder dialogues World-Café: discover the whole Professional meaning groups Prototyping the future Evolving Community Medicine
Co-Sensing: Listen, Discover, Connect
Dialogue GroupsDialogue Groups
Appreciative InquiryAppreciative Inquiry
Shadowing PatientsShadowing Patients
Poverty Simulation Poverty Simulation
PhotoVoicePhotoVoice
Observe, observe, observe; suspend voice of judgment, cynicism, fear
Dialogue, listen deeply, connect with mind, heart, and will wide open
Allow the system to see itself
Learning journeys into community
World Café World Café
Anchoring LecturesAnchoring Lectures Learning from the past
Appreciative Inquiry Interviews
Dialogue focuses on the individual’s or group's most positive potential – not on problems!
We inquire to learn with an open mind, open heart and open will.
Our conversations appreciate rather than criticize and judge
World Café practice Hospitable Café-like
setting Hosts Travelers
Meaningful questions Everyone contributes
Cross pollination Diverse perspectives
Listen together for deeper insights
Harvest discoveries
Co-Presencing: Professional Meaning
Professional Meaning “Presencing” Conversations
The call to service, to give ourselves to something larger than ourselves, and to become what we were meant to become.
Our public self is shaped by life experiences and masks the authentic self beneath rationalizations, excuses, and resentments that stem from fear, blame, and sorrow in our relationships with each other.
Our authentic self is in touch with truth, generosity, and love and is the source of inspiration, compassion, and creativity
Co-Creating: Prototype 0.8
Create prototype 0.8 microcosms
Explore the future by doing rather than by analyzing
Quickly build an experiential microcosm of the future that needs you to come into being
Present ideas or work in progress before they are fully developed
Get feedback to improve it and make it useful
Co-Evolving: Act as Ecosystem Part Grow innovation
ecosystems by seeing and acting from the
emerging whole
Systems governed by: Markets Hierarchy (regulation) Networking
New governing system: Seeing from “presencing”
the emerging whole Acting from our crystallized
vision of the future
Summer Institutes2008
Rationale & Vision for School of Community Medicine
Plight of Uninsured Vulnerable people need us Developing knowledge Moral imperative
2009 Dr. Clancy’s story Health & community structure Determinants of health Behavior change Ethics & social justice Crystallize a better future
Tulsa’s history full of violence and community separation Social agencies are eager to help – but are uncoordinated Low density, separated, low social capital, auto, poor air, accidents Poverty is not a choice, can happen suddenly, is a hard lifestyle Health care institutions somewhat isolated from community needs Uninsured patients appreciate access to low cost care
Prototypes 0.82008
Take it to the streets Electronic portal Center for behavioral health Connecting care – Tulsa HIE Fewer patient more
professionals Go forth and multiply No senior left aside Community research
infrastructure Science of cultural
competency
2009 Yo-Yo 96 Frequent flyer – ER clinic CANDLe3 HUB Spanish Immersion Healthy Hornets CHAMP Service-Share Foundation AH-AH i-Volunteer app Life Skills – you can do it Shock Aah, Hugs
Healthcare Ecosystem
Complex adaptive system integrating human biology economics, socio-political organization, psychological factors, and health care delivery to produce health.
The structure and function of community government and services
affects the health of everyone
SafetyLaw & Order TransportationAgenciesCitizenship UtilitiesPublic Health
An individual’s genetics, family, culture, education and society affect health
Spiritual
School
Friends
Family
Money
Home Food
SafetyLaw & Order TransportationAgenciesCitizenship UtilitiesPublic Health
Personal Lifestyle choices and access to healthy options affects everyone’s health
Spiritual
School
Friends
Family
Money
Home FoodChild Care
Leisure Yoga
Fitness
Fat
Habits
Support
SafetyLaw & Order TransportationAgenciesCitizenship UtilitiesPublic Health
Health care begins with a Medical Home
Spiritual
School
Friends
Family
Money
Home FoodChild Care
Leisure Yoga
Fitness
Fat
Habits
Support
Medical Home
SafetyLaw & Order TransportationAgenciesCitizenship UtilitiesPublic Health
…and a network of services
Spiritual
School
Friends
Family
Money
Home FoodChild Care
Leisure Yoga
Fitness
Fat
Habits
Support
Medical Home Pharmacy
Specialist
Lab Tests
X-Ray
SafetyLaw & Order TransportationAgenciesCitizenship UtilitiesPublic Health
…and more services
Spiritual
School
Friends
Family
Money
Home FoodChild Care
Leisure Yoga
Fitness
Fat
Habits
Support
Medical Home Pharmacy
Specialist
Lab Tests
X-RayHospitalNursing Home Surgery
SafetyLaw & Order TransportationAgenciesCitizenship UtilitiesPublic Health
Spiritual
School
Friends
Family
Money
Home FoodChild Care
Leisure Yoga
Fitness
Fat
Habits
Support
Medical Home Pharmacy
Specialist
Lab Tests
X-RayHospitalNursing Home Surgery
Emergency
Rehab
SafetyLaw & Order TransportationAgenciesCitizenship UtilitiesPublic Health
Spiritual
School
Friends
Family
Money
Home FoodChild Care
Leisure Yoga
Fitness
Fat
Habits
Support
Medical Home Pharmacy
Specialist
Lab Tests
X-RayHospitalNursing Home Surgery
Emergency
Rehab
SafetyLaw & Order TransportationAgenciesCitizenship UtilitiesPublic Health
Spiritual
School
Friends
Family
Money
Home FoodChild Care
Leisure Yoga
Fitness
Fat
Habits
Support
Medical Home Pharmacy
Specialist
Lab Tests
X-RayHospitalNursing Home Surgery
Emergency
Rehab
Research
SafetyLaw & Order TransportationAgenciesCitizenship UtilitiesPublic Health
Disruptive Technology (LEAN) Disruption – makes simpler and more
affordable Technology – a way of combining inputs of
materials, components, information, labor and energy into outputs of greater value.
Business Model – work that creates value someone will buy
Value Stream MapValue to Patient
Check-In1.-------2,-------3.-------
Nurse1.-------2,-------3.-------
Clinician1.-------2,-------3.-------
Wrap-Up1.-------2,-------3.-------
Scheduler1.-------2,-------
Report1.-------2,-------
Triage1.-------2,-------
Check-In1.-------2,-------3.-------
Nurse1.-------2,-------3.-------
Clinician1.-------2,-------3.-------
Wrap-Up1.-------2,-------3.-------
Triage1.-------2,-------
Scheduler1.-------2,-------
Report1.-------2,-------
Check-In1.-------2,-------3.-------
Nurse1.-------2,-------3.-------
Clinician1.-------2,-------3.-------
Wrap-Up1.-------2,-------3.-------
Triage1.-------2,-------
Scheduler1.-------2,-------
Report1.-------2,-------
Process Step That Can Be
Improved
Check-In1.-------2,-------3.-------
Nurse1.-------2,-------3.-------
Clinician1.-------2,-------3.-------
Wrap-Up1.-------2,-------3.-------
Triage1.-------2,-------
Scheduler1.-------2,-------
Report1.-------2,-------
Bright Idea For Improvement or Innovation in a
Process Step In the Work
Prototype 0.8 Solution PosterIssue: Patient repeats history multiple times
Background/Measures• Patient survey 50% poor history• Nurse/doctor delays, patient waits
Root Cause AnalysisWhy? – Tradition Why? – Training students
Why? – Habit of practiceWhy? – Forms in EMR Why? – No time to
develop
Repeated questions
Current Condition
Future ConditionPatient
generated form
Title: Patient INFO to EMR Quickly
Team: JB.CD. RK. SW. FG HO
Countermeasures: Patient Questionnaire
Implementation Plan:Task Who When OutcomeForms J.B. 8/1 New formEMR C.D. 8/15 TemplateTraining RK 8/30 “can do”
Cost $600 Benefit Save time
Rapid Cycle Test of ChangeIM Clinic Team 1, SW, 9/1-10
Follow-up – Expected MeasurePatient wait time drops 50%