These are the effects of Whatcom County's involvement in the multi year Pursuing Perfection international collaboration.
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{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 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//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] Neighborhood [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 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Pursuing Perfection was a multiyear, multisite design experiment funded by Robert Wood Johnson Foundation from 2000 until 2007. The stated goal was to redesign US Health System. It was the largest grant they had awarded to date. Don Berwick and the Institute for Health Care Improvement (IHI) were the grant administrators.
This experiment followed upon two books published by the Institute of Medicine--To Err is Human, and Crossing the Quality Chasm. The hope was that six or more communities and business might break out of the incremental improvement mode and create a new way of providing medical care and supporting healthy behaviors in the population--a way that would be: Patient Centered, Effective, Safe, Timely, Equitable, and Efficient.
Most of the effort at most of the sites was directed toward timeliness and efficiency.
Very little was done to move toward patient centeredness, effectiveness, safety, or equity. Of course all of these variables extend beyond the walls of any particular institution--they are each and all interactive dynamic emergent properties of the system made up of quite a few parts, some of which are overtly competitive with one another.
To some extent timeliness and efficiency can be addressed within parts--but even this is from the point of view of the part, not the patient nor the other parts of the system.
The whole thing was asystematic. Not overtly anti-systematic but economically and politically non-systematic. A huge failure dressed up to look like some kind of success.
My personal and continuing after action review has provided the direction for my curiosity and work ever sense. The undertaking needed. The learning was rich. The only question is how can we now move dramatically toward the six aims? Maybe I will share some of my ongoing journey with you. I will offer that three of these six are much more important than the remainder. Patient Centered, Safe and Effective are primary--do no harm and do some good for the patient.
Equity is a cultural, political, economic ideal that this nation has moved further and further from since 2000. You cannot hope to have an equitable health system in a profoundly inequitable economic, political and social milieu.
Without Equity, there is no possibility for Patient Centeredness--on the whole.
Effective care begins with science and technology but is highly dependent upon Equitable, Timely, and Safe care.
So you begin to see that these six are a tightly intertwined set and they cannot be moves unless they all are moved simultaneously and that requires a level of cooperation rarely found in the rough and tumble of making money on sick people. 18% of the US GDP! Quite a disincentive for solving this puzzle.
At the Neighborhood Scale all of this can be addressed. But neighbors must assume full responsibility. Outsiders are looking to maximize their profits--they are often legally bound to do so.