Tom Lloyd
Welcome to the Vanderbilt Center for Better Health (VCBH). I am the Director of the Innovation Center at the VCBH. We appreciate you being here and hope these next couple of days will be valuable for you. Let’s begin with a word from our sponsor
Mark Frisse
Good morning and thanks for coming. I want to let you know how this project started and where we’re going to go in the next few days.
First, we started off knowing privacy and confidentially are about establishing pubic trust and we must address current health care privacy concerns as well as future possibilities. We want to start a process of ensuring our efforts gain the public trust.
We’re doing this in part because we have funding from Agency for Healthcare Research and Quality (AHRQ). Through a contract with the State of Tennessee manged by Vanderbilt University, we are conducting a regional demonstration project in three counties in southwest Tennessee. This project is designed to understand the critical factors that must be addressed to create an infrastructure that enables the best possible health care for our communities. Although we are operating a real-world data exchange effort, our major focus is on making sure we are asking the right questions and, as a community and a state, seeking the right answers. Our contract calls for meetings such as this to explore thesequestions. How we will ensure the security and confidentiality of health care information is certainly the kind of question we need to ask early in the process. We believe our Design Shop is the right way to start seeking answers.
In this session we will accomplish three things:
How are we going to accomplish these things? We’re going to put people in teams and tackle the issues. All teams will create reports which will be delivered back to the main group. We will then iterate the output until we arrive at a design. We will talk about principles, processes, and then implementation.
We’ve assigned everyone an alternate identity and have made up some fictional communities to which each of you will be assigned. For example, David Goetz will will step out of his normal role and look at the issues from the perspective of a 25-person stand-alone interventionalal cardiology practice.
We will put you through a number of exercises today. Tomorrow we will begin discussing how you can develop an action plan for your temporary community. The days will be full and quick. Please maintain your role and try looking at these problems through different eyes to expand your perspective.
I’d like to introduce Commissioner Goetz who has been leading our AHRQ-funded initiative.
David Goetz
Thank you all for coming. With all that we have going on currently in Tennessee, this project has been very important to Governor Bredesen. We have been through some difficult decisions regarding healthcare in Tennessee. None of them have been by choice—we feel we had to make all of them if we were going to continue to operate. We’re now trying to push our way out to some other health initiatives that we hope will broaden health coverage.
A recent study by the State showed there are 585,000 people without any coverage at all (including TennCare) in this state. We are hoping to encourage them to find health coverage. This is a serious problem. We have begun defining models to help people access healthcare. In many ways, the concept of insurance has been broken. People used to be willing to buy insurance against some future risk. Instead, today they look for an immediate benefit at the time they make those payments. That leaves us with people who will continue to be disassociated from these mechanisms. How do we go about improving the coverage and health for those people? People don’t have the relationships with primary care physicians that they used to have. How do we keep people from starting down the diabetes slope in the first place? These are all part of the Governor’s aspirations.
A project trying to help the Med in Memphis got married with some of the work Vanderbilt has done and out of it came the Memphis community's eHealth project. Memphis’ response has been powerful, and that has been a real achievement.
We also have the CareSpark project in the Tri-Cities area. CareSpark has been a bottom up project, growing out of the communities. Now they are one of the leading projects in the country in that respect.
We have other projects coming up in Knoxville and in the Nashville area. We also have SharedHealth which is a statewide initiative built out of TennCare's roots.
In Tennessee we have many different projects which are national models. They are very different in how they were created and in their outcomes. We need them all to succeed.
We recognize the need for a statewide governance structure for these projects. We will be pulling people together, creating a planning group to help plan what a governance structure could look like. We must be able to rationalize the different approaches of all the entities here. It’s our job to make sure the state’s money is spent well.
I deeply appreciate everything you are doing. These projects will have tremendous impact on the healthcare of Tennessee. I look forward to participating.
Tom Lloyd
I’ve been working in centers like this around the world for 12 years. This place was created to accomplish something that has recently been written about by Jared Diamond in his book “Collapse”. Chapter 14 focuses on how group processes fail. It is about ancient civilizations and how they grow and collapse. One thousand years ago, Easter Island had no big statues on it and it was covered in trees. There are no trees today. He discusses how a society can fail to make the decisions they need to make and the book gives a roadmap for that. Let’s walk through that roadmap.
We all have in common the desire to do the right thing.
First, a group fails to anticipate something. In his class, a person asked “what do you think the person thought that cut down the last tree?” Didn’t they anticipate they might run out of trees?
Second, when a problem does arise, the group or society fails to perceive it. There are problems no one can predict. The music industry did not understand what MP3’s would do to them. Xerox used to give tours and a guy named Bill Gates saw something called Windows and computers hooked together into a network—Xerox said “it doesn’t help us make copies”.
Being removed from a problem creates an issue referred to as creeping normalcy or landscape amnesia. That’s when things change so slowly you don’t see them coming. If you do see it coming, what if you fail to act?
Third, when communities do perceive a problem, they may fail to attempt to solve it. Here’s where organizations have clashes of interest which come in two types: Rational clashes of interest (prisoner’s dilemma and death of the commons); and irrational behaviors (traditions, crowd psychology, and denial).
Last, sometimes communities act, but fail to solve the problem. Eventually Easter Island couldn’t sustain life so they had to leave.
Matt and Gail Taylor, when they created this place, examined the work environment and how it drives behavior. This place recreates the habits of creative people. Some key concepts are: iteration of work, having a diverse group look at problems, and applying knowledge.
If you’ve every watched how a Disney movie is created, they get very real. In the Lion King, they put the artist in a room with a lion. We want to get real in this session, as well. We have access to databases and libraries. If a question comes up over the next two days, let us help you find the answer. There are 8 or 10 of us here available to help you.
Another thing creative people do is work without stopping or structured breaks. There are no scheduled breaks in the agenda. We have tried to create a process allowing you to work on problems in a real time way. Please do as much as you can to manage to our time. Take care of yourself and break as you need to, but please try to stick to the schedules we give you.
Please set your “personal attention getters” to vibrate or turn them off. If you need someone to reach you, please give them this phone number: 615-322-6599. It is manned and we will find you based on the urgency indicated by the requester.
