Work in Whatcom County, WA, that lead up to our participation dates back to about 1985 or earlier. The effects from Pursuing Perfection continue, but not necessarily in the mainstream as RWJF had hoped, and not in Whatcom County as I had hoped. Such is life.
Here I begin to graph out the story of Pursuing Perfection in Whatcom County. From 2000 until about 2007 Robert Wood Johnson Foundation (RWJF) provided significant funding and the Institute for Healthcare Improvement (IHI) controlled the use of those funds. The stated purpose of this collaboration was to redesign the US healthcare system, within three years.
Personally, I chose a new course in my life in 1986 or '87 when I decided to create something that did not exist, something deeply meaningful to me and for my community. I am an emergency medicine specialist. The concept and actualization of urban trauma systems was new at the time. I worked in a sophisticated but rural setting. There were no trauma systems in rural settings at that time. The way there were organized was prohibitively expensive. I figured out a way to do it and got the support and funding from our hospital and from the physicians. I had never had so much fun. I got paid about $17/hour for the work. Who cares. The fun and success of innovation in a community setting set the stage for the rest of my career.
digraph { rankdir=LR subgraph {rank=same CAlexander SBeer RAckoff RAshby} subgraph {rank=same; FedWiki VSMSurvey TheBrain Graphviz Neo4j OpenStreetMaps TomSawyerPerspectives PursuingPerfection} subgraph {rank=same; MarcPierson JonWalker AllennaLeonard AngelaEspinosa NoahWillimas WardCunningham CarlMcDaniels } subgraph {rank=same COMPLEXITY Visualization Pattern PatternLanguage Neighborhood LinkageMaps SharedCarePlan IdealizedDesign RequisiteVarity Homeostat Meta DSRP Distinctions LawsOfForm Perspectives NondestructiveDevelopment SysDynModCommunity MSHealthVault WAHealthRecordBank "Ripple ReThink Health"} subgraph {rank=same BogataColumbia ColumbiaValleyComm Conversations } Homeostat -> ViableSystemModel RequisiteVarity -> ViableSystemModel WardCunningham -> {Wiki FedWiki ObjectOrientedProgramming} Wiki Neo4j -> FedWiki Neo4j -> TheBrain ObjectOrientedProgramming Neighborhood -> {"Local Commons Coop" TheBrain ViableSystemModel VSMSurvey LinkageMaps ColumbiaValleyComm Conversations Graphviz OpenStreetMaps} Conversations -> {Action Speculation BohmianDialogue} LinkageMaps -> {Neo4j TomSawyerPerspectives TheBrain ColumbiaValleyComm BogataColumbia} MarcPierson -> JourneyCollectWisdom COMPLEXITY -> {ViableSystemModel LinkageMaps} ViableSystemModel [shape=ellipse style=filled fillcolor=lightgreen penwidth=5 color=black] ViableSystemModel -> IdealizedDesign BogataColumbia [shape=circle style=filled fillcolor=lightgreen penwidth=5 color=black] TheBrain -> BogataColumbia TheBrain -> ColumbiaValleyComm ColumbiaValleyComm [shape=circle style=filled fillcolor=lightgreen penwidth=5 color=black] LawsOfForm -> Distinctions ActiveWork -> {Conversations ColumbiaValleyComm BogataColumbia ViableSystemModel} Conversations [shape=oval style=filled fillcolor=lightgreen penwidth=5 color=black] ActiveWork [shape=oval style=filled fillcolor=Yellow penwidth=5 color=black] Action [shape=oval style=filled fillcolor=lightgreen penwidth=5 color=black] Speculation [shape=oval style=filled fillcolor=lightgreen penwidth=5 color=black] BohmianDialogue [shape=oval style=filled fillcolor=lightgreen penwidth=5 color=black] WISERnet JourneyCollectWisdom PropertyGraphDataBase COMPLEXITY -> Visualization JonWalker -> "Local Commons Coop" Visualization -> LinkageMaps Visualization -> OpenStreetMaps PropertyGraphDataBase -> Neo4j PropertyGraphDataBase -> TheBrain PropertyGraphDataBase -> COMPLEXITY "Local Commons Coop" [shape=oval style=filled fillcolor=lightgreen penwidth=5 color=black] ElinorOstrom -> "Local Commons Coop" WISERnet -> MarcPierson Mentors [shape=circle style=filled fillcolor=lightblue penwidth=5 color=black] Mentors -> {SBeer RAshby RAckoff ElinorOstrom DonellaMeadows CAlexander} RAshby [shape=circle style=filled fillcolor=lightblue penwidth=5 color=black] RAshby -> {SBeer RAckoff ElinorOstrom CAlexander DonellaMeadows} RAshby -> {Homeostat RequisiteVarity MarcPierson} SBeer [shape=circle style=filled fillcolor=lightblue penwidth=5 color=black] SBeer -> {Meta ViableSystemModel MarcPierson} RAckoff [shape=circle style=filled fillcolor=lightblue penwidth=5 color=black] RAckoff -> {IdealizedDesign MarcPierson} CAlexander [shape=circle style=filled fillcolor=lightblue penwidth=5 color=black] CAlexander -> {PatternLanguage NondestructiveDevelopment MarcPierson} CAlexander -> WardCunningham SBeer -> {AllennaLeonard JonWalker AlnglaEspinosa MarcPierson} DonellaMeadows [shape=circle style=filled fillcolor=lightblue penwidth=5 color=black] ElinorOstrom [shape=circle style=filled fillcolor=lightblue penwidth=5 color=black] ElinorOstrom -> MarcPierson DonellaMeadows -> MarcPierson Tools [shape=box3d style=filled fillcolor=lightblue penwidth=5 color=black] Tools -> {Neo4j TomSawyerPerspectives OpenStreetMaps VSMSurvey Graphviz FedWiki TheBrain} Neo4j [shape=box3d style=filled fillcolor=lightblue penwidth=5 color=black] TomSawyerPerspectives [shape=box3d style=filled fillcolor=lightblue penwidth=5 color=black] Graphviz [shape=box3d style=filled fillcolor=lightblue penwidth=5 color=black] OpenStreetMaps [shape=box3d style=filled fillcolor=lightblue penwidth=5 color=black] VSMSurvey [shape=box3d style=filled fillcolor=lightblue penwidth=5 color=black] TheBrain [shape=box3d style=filled fillcolor=lightblue penwidth=5 color=black] FedWiki [shape=box3d style=filled fillcolor=lightblue penwidth=5 color=black] FedWiki -> {Graphviz OpenStreetMaps Neighborhood VSMSurvey TheBrain} CriticalConcepts [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] CriticalConcepts -> { Meta RequisiteVarity Homeostat Pattern Distinctions IdealizedDesign Perspectives LinkageMaps Visualization COMPLEXITY SharedCarePlan Neighborhood DSRP Perspectives Distinctions PatternLanguage LawsOfForm NondestructiveDevelopment} Pattern [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] Meta [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] Homeostat [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] NondestructiveDevelopment [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] PatternLanguage [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] DSRP [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] DSRP -> {Distinctions Perspectives} Distinctions [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] Perspectives [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] LawsOfForm [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] Visualization [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] RequisiteVarity [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] IdealizedDesign [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] COMPLEXITY [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] CurrentActors [shape=circle style=filled fillcolor=pink penwidth=5 color=black] CurrentActors -> {CarlMcDaniels WardCunningham JonWalker AngelaEspinosa AllennaLeonard MarcPierson NoahWillimas KerryTurner} WardCunningham [shape=box style=filled fillcolor=pink penwidth=5 color=black] JonWalker [shape=box style=filled fillcolor=pink penwidth=5 color=yellow] AllennaLeonard [shape=box style=filled fillcolor=pink penwidth=5 color=yellow] AngelaEspinosa [shape=box style=filled fillcolor=pink penwidth=5 color=yellow] KerryTurner [shape=box style=filled fillcolor=pink penwidth=5 color=yellow] CarlMcDaniels [shape=box style=filled fillcolor=pink penwidth=5 color=black] MarcPierson [shape=box style=filled fillcolor=pink penwidth=5 color=yellow] NoahWillimas [shape=box style=filled fillcolor=pink penwidth=5 color=yellow] WISERnet -> {JonWalker AllennaLeonard KerryTurner AngelaEspinosa MarcPierson NoahWillimas} WISERnet [shape=circle style=filled fillcolor=Yellow penwidth=5 color=black] PursuingPerfection [shape=ellipse style=filled fillcolor=red penwidth=5 color=black] PursuingPerfection -> {Patients SharedCarePlan LinkageMaps NavigatorCoachCHW SysDynModCommunity MSHealthVault WAHealthRecordBank PtActMeasure} [penwidth=5 color=red] NavigatorCoachCHW [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] Patients [shape=ellipse style=filled fillcolor=red penwidth=5 color=black] Patients -> {Neighborhood SharedCarePlan NavigatorCoachCHW PtActMeasure} [penwidth=5 color=red] SharedCarePlan -> {MSHealthVault WAHealthRecordBank} SharedCarePlan [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] LinkageMaps [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] Neighborhood [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] MSHealthVault -> WAHealthRecordBank WAHealthRecordBank [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] MSHealthVault [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] SysDynModCommunity [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] SysDynModCommunity -> "Ripple ReThink Health" "Ripple ReThink Health" [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] PtActMeasure [shape=diamond style=filled fillcolor=yellow penwidth=5 color=black] }
This complex graph is further broken up into some subgraphs and sub plots in the story. They include:
PursuingPerfection especially the results and effects.