Visualizing complex systems is difficult. Trying to navigate without a map is also a perilous undertakinng. Two years ago we created a mathematical model of the system which made the potential winners and losers clear. We have not made as much progress toward our promises and goals as we would like--we have had a plan but not a map.
I have been talking about Jonkoping County, Sweden for more than a year. They have mapped their health care system in one county and begun the process of whole system improvement--a cross multiple organizations. Here is a presentation that I put together after the first trip to Jonkoping.
Finding ways for lots of folks to focus on improving a system is a challenge. API and the County Council of Jonkoping, Sweden have done that.
We have built upon the work done in Sweden. It is interesting that the API (Associates in Process Improvement) methodology called Quality as a Business Strategy (QBS) translates well to the national Baldrige Award quality framework. Here is a first pass at matching their approach with Baldrige. If you want to see our high level map in three parts here they are: Healthcare Processes, Support Processes, and Driver Processes. One can even map the Chronic Care/Planned Care model onto this high level framework. On can also view the "mainstay" or key processes as a Clinical Microsystem as developed at Dartmouth. The trick will then be to locate the processes in the system, link them and then improve them.
Whatcom County created a map of it's healthcare system last May. We are beginning to move this work forward in various ways that I will report on in this web log as we make progress. The most exciting part is creating the map of patient processes as the "mainstay" of their own clinical microsystem (their homes and support networks) with the rest of us in support roles. That may be a major part of the future system of chronic care. Stay tuned.
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