Presentation on theme: "Frank deGruy, MD, MSFM Chicago, IL June 22, 2011."— Presentation transcript:
Frank deGruy, MD, MSFM Chicago, IL June 22, 2011
From the Vantage of Primary Care The Nature of the Fragmentation The Range of Integrated Solutions The Fundamental Policy Problem How to Work Together Clinical Integration Vertical Integration
Population served Diversity of patients By problems By payer Diversity of practice forms Press of practice & competing demands PCMH & team-based care External collaborations
For PCPs with single or simple payer mixes For private practices Consultations and referrals according to matrix Upgrade in-house resources IPA-type solutions Other Fast success, fast failure
Guidelines Implementation Sustainability
What do we pay for? Office visits Procedures For only some problems What should we pay for? Health! Health care Collaboration, integration Innovation
Measure health, healthcare, and cost outcomes Pay for good healthwithin limits Pay for quality care Pay patients for participating Pay for partners to practice together Stop paying for bad care That is fragmented & redundant Stop paying for too much care Health Plans are architects: try new designs
Clinical integration Professional culture & practice style Communication Team-based care Operating principles adopted by ICSI Independence of thought Diversity of opinion Decentralization of authority Ability to aggregate & share learnings
Vertical integration The role of the convener Adaptive vs. technical problem Solutions for complex problems & Theory U
Loose connections Mapping (linking) Passion Emotional intelligence Trust in process Inspiration Tolerance of ambiguity Hands off approach Receding Backing away as work advances Adapted from The Starfish and the Spider (Ori Brafman) And--pointing at the pole star
Adaptive Challenge is complex Need to address & change deeply held beliefs & values Loss is an inherent part of process Cant be achieved within present systempeople must acquire new capabilities Technical Problem is well defined Answer can be found within present systemrequires application of abilities already in it Implementation is clear
C. Otto Scharmer (2007); Theory U Thanks to Gary Oftedahl for the Theory U diagram A new group wants to jump to solutions But a wise convener leads them through the U To a realistic shared solution
Productive Range Threshold of learning Limit of tolerance Time Tension of change Productive levels of distress in human systems Based on Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
Productive Range Threshold of learning Limit of tolerance Technical challenge Time Technical vs. Adaptive Work Adaptive Challenge Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg Tension of change
Keep in mind the social geography of your project!