**Theme**: Better Health for a Nation or a Neighborhood
**Theme Statement** Community Reinvents Healthcare
**Title** Managing Our Health In Spite of Uncaring Institutions
**Topical Outline** * Preface * The Situation in 2000 * The Grant and its Origins * Local history of cooperation among doctors (vs. broad cooperation in Grand Junction, Colorado) * Patients * People * Doctors * Hospitals * Maximizing profit * Payers * Hospitals * Primary Care * Speciality Care * Clinical Care Specialists * Community Health Workers * Patient Activation and its Measure * System Dynamics Model * Decisions based solely on money and power * Technology (EMR - PHR) * Problem solving concepts, methods, and insights * Improvement vs. Transformation * Innovating with patients and technologists * Competition vs. Cooperation * Coordination vs. Cooperation * Misplaced Identification (institution vs. health) * Central role of families and neighborhoods
**Scenic Outline** * Presenting at St. Joe's Board Meeting * RWJ Site Visit * Patients interviewing applicants for clinical care specialist role * Meeting Göran Henriks * Mapping Chaos talk in Jönköping * Qulturum and it effect on me * State Health IT Committee and Health Testimony * Shared Care Plan presentation to all payers * Peter Neupert and MS HealthVault Failure of Clinical Care Specialist, HealthVault, Health Record Bank program, Shared Care Plan, HiNet, CHIC, WIDS. * Consulting shifting * Ashby's Law and shift to neighborhoods for health * Healthy Washington Plan minus Requisite Variety * Smart but not yet wise * Partisan politics
**Shape of Story**
Sequence below may repeat
**Desires** * Make a difference, have a meaningful life * Play with others in a meaningful way for each * Learn as much as possible about being human * Discover new answers to Why? Who? How? What? about the health system from direct interaction with the whole system--including patients with serious chronic diseases and their families.
**Characters** * Marc Pierson * John Hayward, Nancy Bitting * Carolyn Turkovich * Board members * Bill Lombard * Sisters * Dave Ford * Don Berwick * Bob Dunham * Bill Mahoney
**Complication** * Government that controls the regulation, legal penalties, and financial incentives was not involved.
**Frustration** * No institution will allow any change that potentially reduces the throughput or revenue. Meaning, no money or effort will be expended to reduce illness or support patients is self care and increasing their competence.
**Action** * Find influential institutions that benefit from increased patient / person wellbeing and work with them.
**Setting** * Bellingham, WA * Boston, MA * Jönköping County, Sweden * Anchorage, AK * Redmond, WA * Care Oregon, Portland, WA * Wash DC * Olympia, WA * Medford, OR
**Scene** * Meeting with CEO Jackson Care Connect * Conference room at university in Medford
**Consequences** * Collaborative inter-institutional process improved.
End of repeating sequence
**Crisis** * Physician and hospital greed and conflict derail further large scale cooperation.
**Climax** * We move on the Spokane and five counties in NE Washington.
**Defeat**
**Success**
**Resolution**
**Insight** 1. You cannot improve your way out of a fundamentally dysfunction structure where the parts are purposefully non-interacting and antagonistic. You have to disintermediate the senile system with new structures from the bottom. 2. All institutions have goals at odds with the needs of people living in neighborhoods. If health in America is to be restored, it will be done by neighbors in neighborhoods or it will not be done. Every other part of the system profits on illness and dependence.
**Denouement** * Patients, students, workers, parents are all pretty much on their own. They must re-conceive and reimagine and remake their ways of living because almost all the present institutions are predatory--using the citizen for their own cancerous growth with little regard to the wellbeing of the citizen. * Marc moved beyond the medical system and all similarly uncaring institutions with their truly intractable structural problems. He is presently exploring the latent and realized capabilities of neighbors, in the context of feasible management of social, technical, political, and ecological complexity across all scales. * There are millions of others on this same journey. I am optimistic that breakthroughs will come. Will they be in time. I don't know.