Hope where we forgot to expect it

Dr. Jeffery Brenner, of “hotspotters” fame lights up the room at The White House meeting Tuesday with laser-sharp data about the illogical waste in the health system of Camden New Jersey (and pretty much everywhere). Katherine Gottlieb of the South Central Foundation (Nuka) in Alaska had just finished laying out that stunning model. Bobby Baker and Teresa Cutts opened the hopeful trifecta explaining the “Methodist Memphis Model of hundreds of community partners.”

At least 100 people–more than 20 of which were CEO’s of major health systems–crowded the room. I’ll post links to the extraordinary power points and summaries of the meeting when they are ready.

I had the privilege of giving opening comments in place of Gary Shorb, Methodist Healthcare CEO, whose mother had emergency surgery. Here are my comments:

We come to this White House aware of our many roles: we are citizens, believers, administrators, healers, sons of mothers, sisters, neighbors and, yes, even policy wonks. We will speak out of that complexity in different ways as together we try to catch a vision of what is practically possible and how we can help each other make the possible come quickly.

Why are we here? This is a mean and bitter time in public places; the poor and the sick resented by the powerful for making inconvenient claims of mercy. So it is curious that this Tuesday morning this small group of faith and community based hospitals meet with government partners at the White House to do some opportunity solving. The focus is on how to weave the extraordinary 21st century technologies with the tenacious capacities of the love-based, justice-seeking institutions still accountable to faith or community.

This is no time for happy talk, as health organizations and government face uncertainties too numerous to list. We usually forget that the most disruptive uncertainties are good news, not bad, including the most obvious; successful policies and partnerships have resulted in most of us living inconveniently long.

Technologies today let physicians see blockages in arteries in real time 3-D allowing robotic surgeries quite recently unimaginable. Every specialty rides a wave of technical innovation that propels it almost faster than can be described. The disruption comes because the technologies that change the possibilities also change the relationships between specialized roles rooted in the previous technologies, back when nothing was digital, everything on film or paper. This kind of positive disruption dominates the attention of Washington because it changes who gets paid by whom.

Let’s be clear what we are not doing: we are not pleading for our burden to be less; we want to be accountable for the effectiveness of our close working partnership with government so that together we bear the fruit we are intended to bear in health (Rev Dr Don Stiger of Brooklyn Lutheran not pleading…).

In Memphis, Methodist LeBonheur Healthcare reports $156 million dollars of “community benefit” including $104 million of the actual cost of charity care and another $21 million of cost for patients only partly covered by government. A similar amount goes to pay for training health professionals in partnership with publicly funded Universities in Memphis. We do not wish the amount to be less; we want it to be more effective.

All of the hospitals here today far exceed the level required by government. We are not trying to get around the system, we want to know how to form more powerful alignment between public, private and faith driven partners to generate more health.

Most of us are committed to do this in very tough communities, each of which we think is tougher than anyone else’s. Memphis is a vortex of snarly, intractable challenges of race, class and ill health. But it is not any tougher than Jacksonville, Alaska, East LA or Brooklyn. And, truth be told, we love Memphis; we are here on purpose; and we want it healthier. Just as you do your community. So we are not here to complain; we want to learn with other partners who can help us be the institutions our communities need.

The most profoundly positive disruption of all may be the new relationship possible between hospitals and neighborhoods, especially illuminated by the bright light of 21st century science. Most diagnoses are no longer death sentences; not even AIDS, cancer or CHF. We live with conditions that would have killed us only recently, but we live in greater dependence on a web of partners. We obviously still need healthcare: insurance, pharmaceuticals, physician, other providers and, from time to time, hospitals. But now the journey of life includes family, congregation, social services and a host of wellness-enhancing helpers including community health workers. These are brains on the ground, not just boots on the ground. Our communities are filled with answers and assets, which we can work with, if we become teachable by those we previously only saw as liabilities and needs.

In a time filled with swagger and spit, venom and vanity you will find this room filled with the cool breeze of humility and the refreshing tone of adults trying to act like adults (two of them, Joshua Dubois of the White House and Fred Smith of Wesley Seminary pictured). The result is not predesigned to be revealed at the end of the meeting. Nothing will happen today that we ourselves do not create. It will come out of our conversation with each other about how we could be together to help us do the right thing in our own community, informed transparently by others trying to do similar work. That would help us in Memphis, so we hope for some ongoing relationship, especially in the practical spirit embodied in the Partnership office’s work.

The quality of teachableness is what links three innovative health models held up like a lens: the way that Nuka in Alaska has built a highly efficient, broadly comprehensive system by listening with unfeigned respect to their native American members receiving their services; the radically useful intelligence Dr. Jeff Brenner discovered by following his most expensive patients home to the apartment buildings where they taught him the reality of their lives; the 376 covenant congregations of Memphis who are shifting outcomes data the hospital previously found inscrutable and intractable. These are disruptive models that decenter the hospital and drag the accountants outside the lines of their spreadsheets.

In a cynical time of diminished expectations from nearly everybody, hope simmers and bubbles as we ask, “How do we bring these disruptions to full bloom?” Innovation. Community scale. Faithful. Bold. Today.

////

– Posted on the journey