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I want to tell you a story of a strange little journey, high into the mountains of abstraction, and then we will return to sea level. For about 18 years I was a member of a sea level executive team in a hospital with a local monopoly. Team work was in short supply. As it […]

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Reposting for the third time in fifteen years: Albert Camus on Community, Hope and Creativity October 21, 2003 by Marc Pierson “Great ideas come into the world as quietly as doves. Perhaps then , if we listen attentively we shall hear, among the uproar of empires and nations, the faint fluttering of wings, the gentle […]

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It’s important to diagnose the type of problem you have. Better said, it’s important to know the type of cause for problem you have–not only it’s symptoms. What I see happening is very bright and well intentioned people are grabing whatever tool they are used to using and applying it to every problem. I see […]

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Warranty Work?

Neighborhoods produce health. Many neighborhoods are failing as health generating systems they are meant to be. If we choose to ignore the health generating capacity of our neighborhoods, our efforts a population health will simply be warranty work–trying to make up for failed neighborhoods. Quality of life begins and exists in our neighborhoods, not in our medical […]

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Don’t get in the way of Cheap Talk

Community (as a Commons) must scale up from a foundation of face-to-face interactions (Ostrom’s “cheap talk”)–without imposed middle men and their inevitable attendant costs, delays and misunderstanding. Experts and other resources must stand to the side of the primary relationships, not between them. The primary dyad is only temporarily a triad including the expert, not […]

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CONTEXT for Accountable Communities of Health

Money and policies are being marshaled at the federal and state level to improve population health at a reduced per capita cost. However health and wellbeing are emergent properties of all the face-to-face and local experiences individuals have. Medical and social services are adjuncts to our day-to-day experiences in neighborhoods. They are not the primary […]

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Notes on the Second Amendment

The best protection for democracy is the practice of democracy itself. The need to use guns or arms to protect oneself again central government maybe a case of putting one’s head in the sand. The main reason that the problem would arise is because the population has not participated in decision-making at all levels. Democracy […]

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Guns in America

Many Americans sense something is terribly wrong. There is a group who believes that the current situation between the government and those governed still resembles the situation at the time our Constitution was written. That was a time at which illigetimate governmental control could plausibly be resisted with marshall force. Thus the insistence at the time on […]

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Compete or Organize?

Compete or work together in an organized way? When to play competitive games and when to play cooperative games? I have a personal bias toward cooperative games, though I don’t hesitate to compete. It seems that things work out better for me when the systems in my body cooperate and when the members of my family cooperate. We often choose competition rather […]

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ACH’s: Organizing to Decrease Overwhelm

Shared purpose is not enough to fuel partnerships. Most institutions and their leaders are in states of near overwhelm. Having one institution ask another to take on and solve any more problems is not helpful. However; if we approach their problems and our problems together and create ways which reduce one another’s overwhelm–such as only giving them […]

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Should we cooperate?

1) Are there mutual benefits from working together that exceed what we could do alone? 2) Do the benefits from cooperating exceed the cost of cooperating? 3) Is there some purpose that we share? 4) How can we avoid hurting each other needlessly and accidentally? 5) Is it important to work together, to stick together?

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Grow or Die? Is there another choice?

I am responding to a Boston Globe column by Joan Vennochi  speculating that Partners HealthCare’s two flagship hospitals, Massachusetts General and Brigham and Women’s, might become independent again. The Vennochi column, headlined “Breaking up is hard to do,”  starts with the sentence: “GROW OR DIE. It’s the choice facing any business — including the health care […]

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Our Systems of Neglected Ownership

In social systems, you are the system and the system is you. There is no escaping it. Our challenge is to discover how our systems’ intended  beneficiaries can find their way back into decision-making positions. All systems ultimately serve the decision makers. When control shifts from those who created the enterprise to solve their problems into […]

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Are Insecurity and Betrayal of Trust ever Good Things?

  Are Insecurity and Betrayal of Trust ever Good Things? We can create a better shared future by embracing insecurity and choosing to trust one another. I conceptualize the dynamics of trusting start from sensing “we are in this together” and “hoping”, followed by caring and conversing (see the figure below). This diagram captures my lessons […]

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Expedience or Effectivness

Russell Ackoff along with Aristotle claim that the components noted in this diagram are the necessary and sufficient components or aspects of every social system. (see prior post) I suggest that design directionality matters a lot if we care what kind of social systems and business institutions result from the interactions among these parts. It seems […]

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Economic Constriction

Aristotle and Ackoff base quality of life and the quality of enterprises upon a  set of foundational concerns. They recommend that we balance these aspects of living. Ackoff claims that this set is a system and that its parts are necessary and sufficient. It  is not hard to imagine that each part is necessary. The claim of sufficiency […]

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A forced march?

No singing? No dancing?  Who would join?  Why would you, other than fear?  And what can come from joyless effort? Reconsider.

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When there is Resistance

Participation is in the balance Pay attention. It is a signal. Something important is at hand. Understand everything you can. Turn toward it. Open up. Dig deeper. Don’t turn away from resistance. Participation is in the balance.

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In the Long Run

I have begun to like this expression. The idea feels like an old friend. How long can you and your partners run? Are you sprinters? Is the race a short race? I look to see if people are preparing for marathons. I look to see whether they are running at measured paces, clear about the […]

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Approximation not Revolution

The Arab Spring vividly reminds us that removal of problems is not the same thing as improving the system. Things can actually get worse. So how do we change complex situations for the better? How do we design something better rather than only reacting against things. Destruction and tearing down are much easier than design and building up. […]

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Necessary and SUFFICIENT

The question that captivates me is “What parts and interactions are both necessary and sufficient for population health?” I get excited, most of us get excited when we discover a new and necessary piece of a puzzle. Understandably so. But we must curb our enthusiasm and understand the whole system in which this new part fits. Then get excited! So often we […]

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More than hubris and bandaids are needed

The architect, philosopher, and systems designer left us an important and essential legacy. We all need to study Russell Ackoff’s approach to “Interactive Planning and Idealized Design.” And apply it at the whole community level.

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Population Health–where cats get out of the bag

The triple aim, obviously has three parts. One part is revolutionary–population health. We all understand that population health is mostly determined by social determinants and personal behaviors–which we know are also mostly socially determined. So… The medical service provider–client relationship cannot solve the problem. In other words business as usually, even when strengthened and generously funded, […]

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“Help them find their voice.”

In 2005 I attended the US Patient Safety Conference where I heard Dr. Mamphela Ramphele draw uncomfortable parallels between US health care and South African experience with Apartheid in her talk, “Lessons for Health Care from Apartheid to Post-Apartheid South Africa Leadership.” At the end of her compelling talk I ask her quietly, what is the […]

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Bringing forth Identities

“Setting the context” is another way of understanding the idea of calling forth identities appropriate to the occasion. How do we, how can we set context? Art. Songs, sounds, smells, movements, images and stories all  have the power to set the scene for me. Cooperation requires some sense of community, some sense of being in the […]

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