marcpp News

Promises are the Key to Managing

Marcus Pierson — Sun, 06 May 2007 11:46:56 GMT

MANAGING through PROMISES

Humanizing the PDSA cycle

MANAGING BREAKDOWNS THROUGH VOLUNTARY, PERSONAL & PUBLIC PROMISES

Here is a picture of this framework.

The world comes to life through BREAKDOWNS.

One can choose to ask what kind of problem is it? I have choosen to use David Snowden's methods and Cognitive Edge software to make sense of complex and intractable problems. Each problem type has its own solution space with very different concepts, methods, tools and outcomes. Therefore, it is essential that one understand this and break complicated problems into their constituent problem/solution spaces:

Known

1 Sense, 2 Categorize, 2 Respond

Knowable (by experts)

1 Sense, 2 Analyze, 3 Respond

Complex

1 Probe (inquire), 2 Sense, 3 Respond

Chaotic

1 Act, 2 Sense, 3 Respond

Disorder (unclassifiable)

1 Reflect, 2 Sense, 3 Respond

In a certain way, organizational breakdowns represent our collective missing conversations. Organizations can get upstream of the inevitable crisis by discovering the missing conversations (unsafe circumstances) earlier. SOFI and TRIPOD are methods, frameworks, and software for doing just this. They help us make our organizations more resilient by discovery, thus preventing catastrophic breakdowns.

If we need others to help us with the breakdown, we prepare to seek their COMMITMENT / PROMISE to help with the breakdown. We can use CoThrive software to manage the linked promises that are our managing. Don Sull does a good job of explaining the importance and method of linked commitments in managing organizations. See www.donsull.com and watch his videos.

We may get CLEAR on what we care about and what conditions would satisfy us in the context of this breakdown. We may articulate our own CONDITIONS OF SATISFACTION.
Next we may ask others, whom we judge to be competent, to help and in the context of our concern, "What do YOU CARE ABOUT?" and "What is going on here?"
We then may have a CONVERSATION / DIALOGUE to find their concerns and the meaning they make of the situation.

We do this by listening, and speaking to their listening. Looking for common ground--SHARED MEANING.

We may make a REQUEST or and OFFER.
We may then ask for their COMMITMENT / PROMISE or offer our COMMTIMENT
Together we must NEGOTIATE to get clear on our ability to deliver on our shared CONDITIONS OF SATISFACTION including the TIME.
1. They can say no--REFUSE.
2. Than can say yes--COMMIT
3. They can give a conditional promise to GET BACK TO US with a response.
4. They can make a COUNTER OFFER to answer our concerns.
We may choose freely to COMMIT to each other.
Then a PLAN is generally produced, generally by the performer.
ACTIONS are taken.
RESULTS are produced.
1. Some results are SATISFACTORY to the customer (the requestor) while other results represent BREAKDOWNS
2. TRUSTING or CREATING TRUST is in the linguistic/speech acts of dealing with breakdowns.
If the results are satisfactory THANKS are given.
If the results are not satisfactory, a BREAKDOWN is asserted by the requestor/customer of the promise, shared concerns are explored again, and corrective plans are co-developed or the performer may choose to RENIG on the commitment. Alternatively the requestor may WITHDRAW the request at any time.b

John Kitzhaber - And other videos

Jack Foster Mancilla — Sat, 23 Dec 2006 20:03:46 GMT

Marc,

This is the link to the Washington State Blue Ribbon Commission on Health John Kitzhaber Video.

This is the link to the Washington State Blue Ribbon COmmission on Health Marc Pierson Video.

PBS and Bellingham Herald, update Pursuing Perfection in Whatcom County, WA

Marcus Pierson — Sun, 22 Oct 2006 14:44:22 GMT

Pilot health program saves lives and money
Documentary on PBS features county efforts
MARY LANE GALLAGHER
THE BELLINGHAM HERALD

Rebecca Bryson wasn't about to call the doctor because she felt tired. She lived with heart failure, diabetes and other severe illnesses - she always felt tired.

But Bryson did tell Nancy Stothart, a nurse who checked in with Bryson each day. Stothart, a clinical care specialist, served as a health coach, care manager and patient advocate to dozens of Whatcom County residents who, like Bryson, were juggling multiple illnesses, complicated medication regimens and long lists of doctors.

The job was part of a multimillion-dollar, grant-funded effort to improve the treatment of chronic illnesses. The effort caught national attention and saved thousands if not millions of dollars - and Bryson's life.

"I don't know what she heard (in my voice), but she knew I was in trouble," she said. "And I didn't."

Bryson was tired because she was so dehydrated she didn't have enough blood in her body. She ended up going to the hospital.

"I would not have survived the weekend," she said.

But these days, the only way Bryson will see a clinical care specialist is by watching a television documentary airing Sunday. "Remaking American Medicine: The Stealth Epidemic" highlights model efforts around the country that have saved money and lives by changing the way health care is delivered.

The clinical care specialists were funded through an international, $30 million grant from the Robert Wood Johnson Foundation that ended this summer.

The documentary also illustrates another Whatcom County project funded by the grant, the Shared Care Plan, an online record-keeping system that helps patients track their own medical histories and goals. That program remains.

And while funding from Congress helped extend the life of the clinical care specialists from two to four years, there was no easy place to pay for a program in a health care financing system based on paying for what the specialists worked to avoid - visits to the doctor and nights in the hospital.

A small study of 40 of the patients who had clinical care specialists showed their hospital bills dropped by an average of $3,033 annually, said Marc Pierson, a vice president at St. Joseph Hospital who helped coordinate the grant, called Pursuing Perfection.

Another study estimated the program saved more than $2 million annually in Medicare dollars alone, he said.

"It saved lives and it saved money. But there's no billing code for it." Pierson said. "If you want to redesign health care, if you want to redesign anything that's a business, you have to redesign what you get paid for."

While the clinical care specialists have moved on to other jobs or retired, the results of their work feed the growing interest in how to improve the care of people with chronic health problems, particularly as baby boomers get older.

For example, Northwest Regional Council officials have been talking with Stothart about her clinical care experiences. The council administers Medicaid funds for chronically ill people who get in-home care. Forty of the most severely ill, whose annual care tops $10,000, will join a state pilot project to provide intensive care management services.

"We were able to see how supporting people with chronic illnesses, and kind of coaching them in their own self-management and their interaction with the health care system, could be effective - and possible - if we had enough time to do it," said Victoria Doerper, the council's executive director.

The state pilot program started in Yakima and Pierce counties, said Candy Goehring, a program manager for the Aging and Disability Services Administration of the Department of Social and Health Services. By working with a small number of clients, case managers have more time to get to know them and their families and learn about their health needs, Goehring said.

"You just can't get that kind of experience unless you're with them in ways we are with our clients," she said.

The goal is to help prevent medical emergencies - and unnecessary hospital bills. The test cases in Pierce and Yakima counties showed $3 saved for each dollar spent, Goehring said.

After her experience working with clinical care manager Stothart, Bryson feels more confident managing her own illnesses. But she worries about others in the community who are now as sick as she used to be. And there are still days when she wishes she could call Stothart and ask a quick question.

But Bryson, who served on the patient advisory board for the grant and helped shape the clinical care managers' job, is optimistic that others are beginning to see the importance of more coordinated care for chronic illnesses.

"We just didn't reach the tipping point of the payers seeing the value in a way that they would take it over and continue it," she said. "But I think that will come."

Navigating Complex Systems of Care.

Jack Foster Mancilla — Fri, 07 Apr 2006 05:03:37 GMT

This is the link to the video for Navigating Complex Systems of Care.
This video is in two 10 minute segements. The first describes the state of healthcare before Pursuing Perfection project in Whatcom County. The second describes the innovations and the changed experiences of care and care giving.

Washington Health Foundation Talk

Marcus Pierson — Fri, 04 Feb 2005 15:27:05 GMT

Nancy Stothart and I gave a talk in Seattle at the Washington Health Foundation meeting.

Here is a link. When you click on it a fairly large Microsoft PowerPoint file will download into your browser.

http://www.wwpp.org/static/gems/wwppDiscuss/PatientCenteredProcesses.ppt

Switching from Userland's Radio to Manila

Marcus Pierson — Sat, 21 Aug 2004 19:06:19 GMT

In order to make it easier for more folks to easily write about their explorations into improved healthcare we are going to make the switch from a PC-based application to a web-base application.

This is my first post in a long while and it is in a server-based, web-based application--Userland's Manila, running their Frontier server software. We have been using this software in the backgroud for several years but will now have the end users write in it. We will use SocialDynamx's FMRadio/Manila front end to make the experience easier for end users.

This photo is me standing in front of a replica of the Valsa in Stockholm.

My oldest

Marcus Pierson — Sat, 21 Aug 2004 18:42:31 GMT

Isn't health about family and friends and community?

Of Chasms and Bridges

Marcus Pierson — Sat, 08 Jun 2002 22:26:21 GMT

How to "see" the problem and the solutions...

Trying Harder will not work for this!

Marcus Pierson — Sun, 26 May 2002 08:20:06 GMT

Robert Wood Johnson Foundation take the Institute of Medicine seriously.

Patient-centered? Yes or No? You decide?

Marcus Pierson — Sun, 26 May 2002 07:50:26 GMT

Rebecca's story tells it all.