Summer Institute 2011
Deep Dive into Community
F. Daniel Duffy, MD, MACP
July 31, 2011
Why Community Medicine
Present
Why are we here?
Present
Future
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Access for all
Coordinated care
Complete information
Good communication
Highest quality
Affordable costs
Altruism in care
How might we do it?
School of Community Medicine
Present
Future
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Access for all
Coordinated care
Complete information
Good communication
Highest quality
Affordable costs
Altruism in care
How do we build it?
School of Community Medicine
Present
Future
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Plan &
design
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Access for all
Coordinated care
Complete information
Good communication
Highest quality
Affordable costs
Altruism in service
Community Medicine is a Movement
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Moves from isolated and self-interested silos
to connectedness and care for the whole
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Shifts from problems to be solved to our
community’s positive potential
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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 see it this
way, therefore it emerges that
way.
Principles and practices for collectively
creating the future that needs us to emerge.
Otto Sharmer, 2009
How does the “U” Journey Work?
Present
Future
LISTEN
EVOLVE
to others and to what life
calls us to do
ecosystems by acting from
the emerging whole
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
PRESENCE
Retreat and reflect to allow
inner knowing to emerge
Co-Sensing: Listen, Discover, Connect
Anchoring Lectures
Dialogue Groups
Appreciative Inquiry
Windshield Survey
Poverty Simulation
Shadowing Patients
World Café
Learning from the past
Go out and see the community
Dialogue, listen deeply, connect
with mind, heart, and will wide open
Observe, observe, observe; suspend
voice of judgment, cynicism, fear
Harvest the themes of the whole
system
Appreciative Inquiry Interviews
We use Dialogue to
focus on the
individual’s or group's
most positive potential
– not on their
problems!
We inquire in order to
appreciate another’s
experience with an open mind,
open heart and open will.
Our conversations
appreciate rather than
criticize and judge
Patient Dialogue
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Challenges you face with
your health
Works well to help you
Someone we should
recognize for helping
you?
Other people or things
that have helped you
Just one thing that would
make the healthcare you
receive better
Windshield Survey
Provider Dialogue
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Describe team’s
observations from patient
How you and your practice
team help patients cope
What works well
Someone we should
recognize for their help
Challenges you face
Community agencies or
services enlisted to help
Just one thing that might
improve healthcare
Social, Healthcare, & Public Services
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Describe team’s
observations about
challenges and successes
How you or your agency
help patients and providers
What works well
Someone we should
recognize for good work
Challenges you face
One thing you would change
to improve your service
Experiencing Others’ Lives
Poverty Simulation
Shadowing Patients
World Café
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Hospitable Café-like
setting
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Answer meaningful
questions about
healthcare ecosystem
Everyone contributes
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Hosts
Travelers
Cross pollination
Diverse perspectives
Create a summary
Harvest themes about the
whole system
Patient, Provider, Social, Healthcare &
Public Service Agency Observations
Team
Health Challenges
Services Provided
Works
Well
Recognize
Challenges
Just One
Thing
Themes about the Whole System
INTERVIEW
Patient
Provider
Social Services
Healthcare Services
Public Services
Unifying Theme
MAJOR THEME
Co-Presencing Professional Calling
What are we collectively sensing about the
professionals we being called to become?
What service that is larger than ourselves are we
being called upon to freely give ourselves to?
How have we been moved by our travel into our
community and our dialogue with patients, providers,
social, healthcare, and public services?
Reflection on Professional
Calling for our Lives
Wednesday Noon Start UP the U
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Observe prototypes of
community-based
participatory action
research
World Café
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What did you learn
from the research?
What do agencies
need from us in
healthcare ecosystem?
Co-Creating: Prototype 0.8
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Quickly build an experiential
microcosm of the future that
needs you to come into being
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Present work in progress
before being fully developed
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Get feedback to improve it
and make it more useful
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Explore the future by doing
rather than thinking about it
Create prototype
0.8 microcosms
How will we build Prototypes 0.8?
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Marketplace of ideas
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Group builds prototype
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Self selected groups
attracted to an idea
Develop a prototype
microcosm of the future that
prevents the problems of
the present
Stakeholder feedback
Select prototypes with
greatest potential
Prototype 0.8 Solution Poster
Issue: Patient repeats history multiple
times
Title: Patient INFO to
Team: JB.CD.
EMR Quickly
RK. SW. FG HO
Future Condition
Patient
generated
form
Background/Measures
• Patient survey 50% poor history
• Nurse/doctor delays, patient waits
Current Condition
Repeated
questions
Root Cause Analysis
Why? – Tradition
Why? – Training students
Why? – Habit of practice
Why? – Forms in EMR
Why? – No time to
develop
Countermeasures: Patient Questionnaire
Implementation Plan:
Task
Who
When
Outcome
Forms J.B.
EMR
C.D.
Training RK
8/1
8/15
8/30
New form
Template
“can do”
Cost
Benefit Save time
$600
Rapid Cycle Test of Change
IM Clinic Team 1, SW, 9/1-10
Follow-up – Expected Measure
Patient wait time drops 50%
Prototype Feedback Rating Form
CATEGORY
QUESTION
Rate 1 (lowest) to 10 (highest)
Issue
Is the issue statement clear?
Background/Measures
Do background data or measures describe issue?
Current Condition
How easily can you grasp the current condition?
Root Cause Analysis
Has analysis identified the root cause of the issue?
Title and Bylines
Is the Prototype titled, with authors &date created?
Future Condition
How quickly can you grasp the future condition?
Implementation Plan
Are tasks for “bringing to market” specified?
Cost Benefit Analysis
How realistic is the cost & benefit analysis?
Follow-UP
How effective is prototype as a microcosm of a
future health care system?
Overall Design
How well designed & user friendly is the prototype?
Prototype Poster
Prototype Poster Presentation
Co-Evolving: Act as Part of Ecosystem
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Systems governed by:
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Markets
Hierarchy (regulation)
Networking
Added governing force:
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Seeing from “presencing”
the emerging whole
Acting from our crystallized
vision of the future
Grow innovation
ecosystems by seeing
and acting from the
emerging whole
What Have We Learned from
Summer Institutes?
2008
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OU-Tulsa committed to improving health & healthcare
Government leaders need our help in making wise policy
Everyone can become vulnerable and need help from others
OU-Tulsa can focus its discovery on the health of community
The helping professions have a moral imperative to service
2009
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Dr. Clancy told of taking psych care from hospital to street
The structure of community profoundly influences its health
Social determinants of health change our genes
Personal health habits cause disease and can be changed
Market driven healthcare conflicts with ethics & social justice
We can crystallize a vision for a future healthcare ecosystem
2010
Concepts from Anchoring Lectures
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Early childhood education & trauma impact adult health
Research is both innovation & system improvement
Change in laws may change the healthcare ecosystem
Successful collaboration yields healthcare results
Lessons from Community Dialogues
 Tulsa’s history full of violence and community separation
 Social agencies eager to help – but disconnected from primary care
 Poverty is not a choice, can happen suddenly, is a hard lifestyle
 Health care institutions seem to be isolated from community needs
 Uninsured patients appreciate access to affordable care
Collaboration changes health and healthcare
 We find it hard to appreciatively listen to each other
 Photovoice gives the silent members of our community a voice
 Moving from idea to prototype to system change is very hard work
Interdisciplinary education, care, and research
Healthcare Policy – Medicaid
Sooner HAN, Diabetes Bridge Clinic – coordination of care
Patient Centered Medical Home – pay for coordination
Community-wide Health Information Exchange – MyHealth
Prototype 0.8 2008
Take it to the streets
– Put a Bedlam clinic
at KIIPP Academy and
use Community
Advocate to build trust
Connecting Care –
Develop a Tulsa
Health Information
Exchange to “wire”
Tulsa healthcare
services
No Senior Left Aside
- Community-based
education in early
dementia with referral
to services for help
Electronic Patient
Portal – Improve
access to care for
Bedlam patient with a
patient portal to be
used for online visits
Fewer Patients More
Professionals – High
School Health &
Health Career
Development
Community
Research
Infrastructure Faculty
development and
resource tools and
pilot project funding
Center for
Behavioral Health –
Coordinate services
for health behavioral
change, education
andGo
research
in field
Forth and
Multiply – Create a
center for Geographic
Information Systems
to geo plot services
across community
Science of Cultural
Competency–
Develop a curriculum
in cultural competence
for OU Tulsa
Prototype 0.8 2009
YO-YO 96 –
Community education
program that helps
people prepare for self
sufficiency in a
HUB – Program to
disaster
build neighborhood
trust, through schoolbased clinic, health
education,
CHAMP–and
out safe
of
school play
enrichment
activities, leadership
development and
community renewal for
iVolunteer
kids.
APP – An
iPHONE application
like UrbanSpoon that
selects opportunities
for volunteering &
rating them
Frequent Flyer ER
Clinic –
Interdisciplinary team
clinic for care
coordination of
Spanish
frequentImmersion
ED users –
Plan for elective in
conversational
medical Spanish for
students
andShare
residents
Service
Foundation – Web
based activity that
connects persons with
social services
Life Skills – You Can
Do It Implementation
at Bedlam the N4N
program that teaches
life skills to the poor
CANDLe3 –
Interdisciplinary team
helps vulnerable
neighborhoods learn
how to improve
Healthy Hornets –
School-based medical
clinic and health
education in high
AH AH school
– Web-based
social service agency
contact database and
opportunities to
volunteer
Shock, Aha, Hugs –
Day-long course for
students, residents,
faculty, & staff to
understand the lives of
patients served
Prototype 0.8 2010
Create Jobs in North
Tulsa – Partner to
create economic
opporutnities in North
Tulsa
Filling the Gap –
Mobile (1 stop) clinic
provides preventive
care
for children
Lay
Health
Liaisons
corrects inefficiencies
of knowledge silos in
the medical model &
encourage community
OKIEcollaboration
Oklahoma
Knowledge Is
Empowerment:
Health education &
literacy program
through libraries
Tulsans Teaching
Tulsans Conduct
Community Forums to
spreads knowledge
about community
services
OU-Bedlam
Patient
Portal - Virtual
Bedlam & Blog e.g.
implement
“DocVia” in
Tulsa Community
Bedlam –
Connection
Program for helping
people find social
service in their
neighborhood
Y
R Bus –
transportation
resources to visits with
videos & information
on Bus – team with
OKIE
OU
Soonergy – BedlamE patients get social
service screening,
referral, SW follow-up
Breast Feeding is
Best – Provide prenatal and post-natal
education and support
in OUProviders
Clinics –
Healthy
Partner with providers,
staff, and patients to
develop role models
for healthy living
Immerse Yourself in
Tulsa – Implement a
program to engage
faculty, staff, students
in volunteerism in
Tulsa
Healthcare Ecosystem
Complex adaptive system integrating
human biology economics, socio-political
organization, psychological factors, and
health care delivery to produce health.
PhotoVoice – Celebrating Community
Enjoy your
deep dive into
shaping the
future of
community
medicine