This is Your Brain on Transformation

Sep 27, 2012, 10:45 AM, Posted by Michael Painter

Michael Painter Mike Painter

My recent journey to Mayo Clinic’s Transform 2012 began with a bike ride. I was up at 4:00 a.m. and drove for an hour to join hundreds of other cyclists in northern New Jersey for a 7:15 a.m. ride start. 107 miles and 7,600 feet of climbing later, I uploaded my ride stats to Strava, chatted some with colleagues, grabbed a bit of post-ride lunch, and blasted home. I made it to the Philadelphia airport just in time for my 7:00 p.m. flight. After a connection in Chicago, I arrived in Minneapolis around midnight, rented a car, and then drove 80 miles in the early morning hours across rural Minnesota, eventually arriving at my hotel in the town of Rochester.

Bright and early that morning at the meeting, feeling surprisingly bushy-tailed, I encountered a large gathering, almost like a mirage rising from the prairie, of curious, engaged people talking earnestly about how they were transforming American health care. But of course it wasn’t a mirage. It was real and impressive. Our national audacious effort to transform the health care colossus from its current state of dysfunction and inefficiency is impossibly complex and difficult. We know that. Nevertheless, my reaction to Transform 2012 was not simply because I found a large gathering focused on that health care transformation. No, the truly remarkable thing is that here was yet another of many large gatherings of engaged people working all over the United States to transform health care.

Think about it. There are meetings like Transform and TEDMED. There are long-term initiatives focused explicitly on helping communities transform care like RWJF’s Aligning Forces for Quality or the HHS Beacon Communities and Chartered Value Exchanges. There is an entire network of regional improvement initiatives called the Network for Regional Healthcare Improvement. CMMI improvement and payment initiatives are sprouting across the country. There is private sector innovation from Kaiser, Microsoft, GE, and others. There are interesting efforts like the Institute for Healthcare Improvement, the Thedacare Center for Healthcare Value in Wisconsin, and the Institute for Clinical Systems Improvement in Minnesota. There are HealthCamps and e-patient networks. There are private sector health care incubators and accelerators. There are groups focused hard on transformative payment reform like HCI3 and many related payment reform projects. There is an emerging national public-private health data consortium. There are organizations from Consumers Union to Castlight finding new ways to get information about health care to consumers in order to help drive transformation. And there are many more. Some of these burgeoning, hopeful efforts are connected to each other—most probably are not. If they are connected, that connection and weaving is happening slowly and organically. Many are still almost “one-off” or stand-alone efforts—almost as if they’re all happening in their own separate small towns in the corners of beautiful states.

At Transform 2012, meeting speakers and participants talked about the important design pieces of transformation like innovative delivery system models, payment reforms, and platforms for engaging patients and consumers. Some speakers like Laura Adams, Rhode Island Quality Institute, eloquently made the case for transformation—as if we still need to do that. Speaking movingly about her breast cancer diagnosis, Laura noted how our current system forces patients to manage their care including their records. For instance, she even had to hand-carry digital files of her images and records from specialist to specialist. On her way to one appointment, some of those files dropped under a car wheel—ruined. Seriously? Is this the best we can do in American health care? Obviously, it’s way past time for this transformation.

A number of Transform speakers focused on deep design issues important for transformation. Margaret Alrutz, Nurture by Steelcase, exhorted the transformers not to fall for the myth of the single future. There is a multiplicity of futures—and they’re happening right now. We need to understand that and embrace it. Use it. Others like Robert Fabricant, frog design, urged the audience to design ahead of the problem. He emphasized that design is in fact about connection. Even the technology that will enable health care transformation is really only important to the extent it enables people to connect. He and others urged the legions transforming health care to observe, connect with, and listen to people—especially patients and consumers. He noted one Humana consumer engagement effort.  In it all information was suspect to the consumers until Humana  was  able to give them  information they  wanted—and in that case it was information about cost.

Fabricant ended his talk urging us all to “look where other people aren’t.”  That admonishment made me think. On my drive back to the Minneapolis/St. Paul airport to head home, I started wondering again about all those other gatherings and efforts of engaged, brilliant people focused hard on this complex, strenuous, and at times, overwhelming task. What if instead of lots of groups working separately in this meeting and that initiative to transform care, we actively connected those various transformation nodes? In all likelihood that connection is slowly growing and happening anyway. What if these slowly growing networks are becoming or could become a sort of huge transformation brain? The pieces we’re observing could actually be developing nodes or neurons—neurons that will slowly develop synapses and connections. 

Here’s a crazy idea: what if we could accelerate the development of that slowly emerging health care transformation brain? What if we purposefully connected nodes like Mayo’s Transform, TEDMED, Aligning Forces for Quality, CMMI, Beacons, Charter Value Exchanges, the Dartmouth Atlas, AHRQ, IHI, private payer initiatives, private company innovation centers, and many others? Now, wouldn’t that be intelligent design?

My lasting impression of Transform 2012 was that it’s actually happening.  The transformation of health care is happening. It’s occurring all around us. You don’t have to bike a hundred miles, climb thousands of feet, and drive in the wee hours across rural Minnesota to find it. The transformation has more than begun. Unfortunately, that’s not enough. Now, we need to dig in and get really imaginative. It is time to accelerate—and to do that we’re going to have to figure out how to connect, learn, and accelerate together.

This commentary originally appeared on the RWJF Pioneering Ideas blog.