The new National Center offers the possibility of remaking healthcare to improve the health and well-being of our most vulnerable, neglected, and forgotten. To do so in a completely whole-person, whole-system way. Motivated by love and compassion, with the deep respect, non-judgement, and desire to learn and understand, to afford everyone – “patient” and “provider” – the dignity to fail. To fail, but never relent on the path to success. To be courageous warriors together. To stop at nothing. That was the overwhelming feeling that hundreds, from diverse backgrounds and roles, gathered at this conference were sharing. Not as an abstraction, but as evidenced by the heroes and pioneering models of care delivery achieving incredible health outcomes, that were present in the room - irrefutable proof that this is possible.
I attempt to share with the audience the crucial next steps I believe the new Center must consider to move toward this audacious aim. First, we must always remember the deepest and truest source of what motivates us – love. Second, as Einstein observed, “We cannot solve our problems at the level of thinking we created them.” We need a new level of thinking. We need to examine the assumptions, biases, preconceptions, and rigid mental models that paralyze our current level of thinking. We must probe, dissect, and take them apart … in preparation of creating something new.
It is critical that we fully understand how much this will require of us – and that we don’t try to shortcut or ignore that reality. Open-hearted listening to those with whom we partner and serve, must be translated into new models. Robust models. Faithfully executed models. Measurable models. We need master designer/model builders – and many of the best were at the conference.
Once we design the models we must implement them with fidelity. Because these models are new, complex, and multifaceted, they are not easy to implement reliably. But they must be implemented reliably or they won’t work. We need new management systems, driven by data captured from the field and patients, analytics providing new measures of service reliability and team performance, and a team-based learning culture. We need master implementers and there were many at the conference.
Once designed, implemented, and honed these new models must then be scaled and rigorously evaluated. Not every program need be formally evaluated in robust longitudinal studies like randomized trials, but larger implementations should be. These two steps; scaling and rigorously evaluating are vital and interdependent. Without sufficient numbers of people served across different settings, it’s impossible to credibly evaluate new models. To avoid the sins of the unfettered medical-industrial complex - selling us vast amounts of costly health services, but not more health - we must demonstrate the benefit our models bring to society. Our approach of person-centered, prevention-oriented, highly disciplined, whole-system redesign promises to yield far better health at lower cost than our current approach – but we must prove it.
For models that are well-designed, well-implemented and proven effective in rigorous studies we must find better ways to disseminate their use. The use of knowledge purveyors and change agents alone is not sufficient to spread these more complex, whole-system designs. The field of dissemination is now ripe for new thinking, applied R&D, and innovation.
But none of these ideas are coming out of my mouth clearly or completely. The fact that only a handful of intensely dedicated programs have successfully fought their way through all phases of this long and arduous life cycle of maturation is testimony to how challenging the work ahead is for the National Center. But all the pieces are here. The will is here. We can do this. We just need a plan. A design.
I’m trying to convey how we must embrace, organize, and integrate the broad range of talents and expertise needed to undertake all elements of this work – listening, designing, implementing, scaling, evaluating, disseminating, policy advocacy, and funding – with an appreciation of the long timelines needed to fail before succeeding, taking a whole-person, whole-systems approach, and always working in direct partnership with those we serve. But instead, I feel I am muttering – overwhelmed by the memory of the testimonies of consumers - suddenly realizing that many of those we serve love us too. Not in a sentimental way, but in the most deeply human way – by giving us their trust – turning to us for hope - courageously baring their most intimate violations, pains, and sufferings in hope that we will respond with kindness, compassion, respect, understanding, and help.
Afterwards Jeff and colleagues are gracious and kind with their feedback. Themselves knowing full well that this work is a marathon, not a sprint. That missteps are the norm, not the exception. That the perfect articulation of the work is nearly impossible. And that ultimately the aim will be achieved by being constant to our purpose and working together. Thoughtfully, skillfully, compassionately. Let’s roll.
Note: MANY of the ideas as well as some terms and phrases included in this post were expressed by several speakers and participants at the Putting Care at the Center conference. Their use here is a reflection of what I gratefully took away from that experience. I apologize for any failure on my part to specifically cite any individual contributor where that might have been more appropriate.