The "systems dynamics model" that you have built with two consultants is a breakthrough.  This model would be of help to every Pursuing Perfection site, and gives a new tool to the industry for exploration of the "business case for improvement."

How do we begin to see more clearly the importance of connections?

What mental models and physical models can help us see the connections and the connected actions that can link the parts and pieces of health care?

The Chasm report challenges us to focus on the separations and the need for linkages. The ten simple rules or ideas essential for crossing the chasm include: cooperation among clinicians, knowledge is shared and information flows freely, care is based on continuous healing relationships, the patient is the source of control, safety is a property of the system, transparency is necessary, needs are anticipated, and waste is continuously decreased.

Simple yet compelling metaphors are needed. Bridges may be such a simple strong image that can help us change the culture to focus on the gaps and barriers that prevent the system from working on the patient's behalf. These same gaps constantly frustrate and demoralize health care workers. Can we begin to see ourselves and our organizations as islands that the patient must get to and from? Our patients may be swimming in cold water between our islands. If we can see ourselves as islands then we may be able to begin to see the bridges, or land fills, or boats that can connect the patient to us and each of us to the other island that patients must navigate to and from. I believe that the patient frequently must carry the cargo from island to island, since it does not reliably get across the gulf or chasm consistently in any other way. How shall we assist our patients as the journey from our island to other islands?