November 24, 2015

These 5 Simple Rules Could Apply to our Network

Posted in Uncategorized at 3:30 pm by chads

See this link:  Fostering Systems Change

November 23, 2015

11/23 BYU Meeting

Posted in Uncategorized at 12:46 pm by chads

Thanks, Tom!  Here it is.

November 20, 2015

Fee for service in a complex health system

Posted in Uncategorized at 6:40 am by chads

A student recently sent me an email about fee-for-service, pay-for-performance, and unintended consequences. I thought that was a question that would be best answered in a blog post, so here it is.


The first thing to keep in mind is that considering issues such as payment reform through a a complex systems lens is very, well, complex. As such, I do think it will take months or even years for one to make a shift in thinking, and grasp the concept adequately to understand this issue. I still feel like I’m on that journey.


A key concept when considering  complex systems is that “context is king.”  Every clinic, community, hospital system,  district, nation, etc. has a unique history, culture, political environment,  set of policies and social norms, etc.  As such, there is rarely a “one-size fits all” approach.  There are an almost limitless number of payment options (salary, salary with incentives, fee for service, pay for performance, bundled payments, global payments, capitated payments, any combination of the above, etc).  What works in one context may backfire in another.


Another important point is the idea of leverage points that can lead to phase transitions.  Within any system, there are decisions, policies, or ideas that – if implemented or applied – could lead to significant, enduring changes.  In my view, changing fee for service is a significant leverage point in the US Healthcare System.  An even greater leverage point is shifting our mindset to include more complex social systems thinking.  But I could be wrong…


I do think that it’s safe to say that the more incentives are aligned with a shared vision, the “stronger” the system will be.  Perhaps the “triple aim” is emerging as a shared vision in the United States??


Here are some organizations and networks where you might be able to learn more and/or connect with people that are interested in change in payment strategies:  ReThink Health, IHI, and Beyond Flexnor.  (There are lots more).  I hope that helps!

November 19, 2015

Shift in Focus

Posted in Uncategorized at 9:51 am by chads

Given some unexpected (yet welcome for the long-term network!) developments (see the recent blog posts on academic co-authors, and the number of students that I will likely hire), preference will be given to proposals that contribute to the academic papers.  If interested, please come to the meetings and/or review the blog posts that summarize the meetings.  I won’t likely have time to discuss the specifics of this opportunity individually.

(This development, by the way, is a prime example of emergence, a key complex systems concept: unexpected, sometimes surprising relationships, opportunities, roles, developments, etc that arise without central control)

November 18, 2015

UVU Meeting Notes

Posted in Uncategorized at 2:58 pm by chads

• What type of proposals am I looking for?
o Current problems – what are problems with health and healthcare?
 Cost or efficiency – are we getting what we pay for?
 Identifying need for healthcare
 Preventative medicine – see link on slide for health affairs
 Patient satisfaction/ citizen satisfaction
 Paperwork/ administrative burden
o Contributing factors
 Tradition
 What role people should play
 Accountability of healthcare providers, students, citizens, etc..
 Biomedical reductionism – increasing sense of studying and applying scientific method, which led to a narrow view of healthcare
 Aligning incentives with what we really want – paying to number of patients seen rather than making patients better
o What would a learning health network look like in 20 years?
 Integrated in education
 Improving the way we educate the market
 Responding to data and feedback
• Doctors receive little to no feedback upon graduation
 Be able to prove the benefits
 Communication across disciplines and fields
o What can you do as an undergraduate to contribute?
 Networking with influential or powerful people
 New perspective and we are not invested in one particular way of thinking
 Experience in places

***Another Set of Notes for Same Meeting***

Current Problems
– Cost
– Efficiency
– Education to identify need for healthcare
– Preventative Medicine/ Environment
– Patient satisfaction/Citizen satisfaction
– Paperwork/ administrative burden

Underlying Contributing Factors
– Tradition / Past dependence
– Roles NP’s & PA’s play in patient care
– Patient Accountability / Provider Accountability/Education, etc..
– Biomedical Reductionism
– Aligning incentives with what we really want

What would a learning health network look like in 20 years?
– Integrated in education
– Improving the way we educate and market
– Responding to data and feedback
– Be able to prove the benefits
– Cross disciplines/professions/sectors
What can you do to contribute?
– Develop a network
– New perspective
– Experience in places that relate

Probable Decrease in the Number of Students

Posted in Uncategorized at 9:16 am by chads

I initially advertised that I would be hiring 1-5 students.  I’ve always planned on hiring about 5, but I knew that things might come up.  For years, I’ve considered business and academic opportunities.  Well, it looks like something came up.  So, while I’m not sure, it seems more likely that I will only be hiring 1-2 students on Jan 1.  I will continue the weekly meetings on campus as long as there is interest, and I will continue working with as many volunteer students as are interested.

11-17 BYU Meeting

Posted in Uncategorized at 8:52 am by chads

***These summaries are drafted by students.  While I briefly read over them for accuracy, they do not provide perfect information***

Meeting Introduction

Matt has been doing this for a while.
Blog – make sure that you read this for a quick guidebook

Going to the calendar to check when the next meetings will be:

Hiring an Administrative Assistant – 2-5 hours a week
20$ an hour.

1. If there is a person that is organizing something geared towards this
2. What is it that he does that you like
3. What can he do better?

Looking at the Teleological Questions of why aren’t we being educated in a way that we know the key drivers of the health system.

When designing your questions and programs, go back to the second slide, to “Catalyze or contribute to a premier health learning and collective impact collaborative network in the world over the next 20 years.

“Suboptimization” – Maximizing what we can do at the expense of the greater system.

Delineating the Fluffy cloud – what does this mean?
Problems – Suicide, Rx abuse, Low exercise
Biomedical Reductionism – Solving these problems by disconnecting them and solving them as parts of a whole.
Underlying Problems – what are they?

Information Transparency + A holistic Approach to solving medical problems
Developing Principles that govern our
Command and Control doesn’t work with more top-down and less vision for the future.
Example – what are some simple rules that contribute to…
Facilitating and environment for self-organization which leads to the emergence of roles and processes to solve the problems.
This is why it needs to be a network. This happens when interactions happen

Complex systems have to be trans-disciplinary, -practice, -sector.
The more there is work across sectors and disciplines,

The best way to approach this:
Where are we now, where will we be in 20 years and how can I contribute to that vision?

He’s not after a solution to obesity. There are millions of people working on that. He’s after a change in mindset, which complements Biomedical Reductionism with a holistic approach

2-3 years ago there was a conference in italy with global health professionals.
City health department head
Who is supporting what you are doing?
Here are funds – Do what you need.

Meta-analysis of the papers that have been published
Seperate paper on bibliography, Etc

How is what you want to mobilize around going to contribute to this vision that you have in 20 years?
Eg. Changing curriculum – Leaving with a lense of complexity. In order to do that, you have to understand the theory, then have the paradigm shift (it takes a while to get it). Do alot of reading from his blog and the movies he put

Tom is working on “white papers” pictures, bullet points, etc.

November 16, 2015

Co-authorship in Academic Journal

Posted in Uncategorized at 2:03 pm by chads

I just learned of some opportunities to publish on systems thinking and health.  One opportunity involves the categorization of systems thinking articles in health.  There might be a couple of other opportunities.  If you are interested, share your interest in your proposal.  Also include a writing sample.  Questions?  Email me and/or come to the meetings.

Volunteer Help Wanted

Posted in Uncategorized at 1:59 pm by chads

I’m looking for someone to help update the blog, etc.  I’m thinking an hour or 2 a week max until the new year.  No pay, just volunteer.  Interested?  Email me with a brief (less than 5 sentences) statement of interest.  Include a CV.  I’ll likely decide on someone before Thursday unless no one is interested.

November 13, 2015

Next Weeks’ Meetings

Posted in Uncategorized at 7:23 am by chads

Comment below if you have requests or suggestions for next weeks’ meetings.  We’ve decided to imagine possibilities for proposals at UVU.  If you have further questions about the meetings, see the FAQ page.

Next page