Distribution of “self pay” (no pay) patients in Winston-Salem.

I’ve been a church-going American citizen my whole life. So I know that if you need a genius, don’t look first in either the church or government. Exceptions pop to mind, such as Drs. King and Rauschenbusch or Mr. Jefferson and Franklin.  Nobody currently active came to mind. So it was curiously encouraging last week to learn from two geniuses that we we don’t need geniuses very often. Sometimes all we need are grow-ups with grit and love for a particular place.

Angela Duckworth received the first MacArthur award. She is a school teacher (who ended up with a PhD) who actually paid attention to the ragged ensemble she was trying to teach. Which ones were likely to succeed? I also taught a hapless group of middle school students for what I would swear was 9 years, but was really only 4 months (I’m sure it seemed way longer for the students). Duckworth, being smarter and more tenacious than me, paid closer attention and noticed that the the major variable predicting success of students was no intelligence or capacity pass standardized tests. Rather, it was “grit.” (She is from Pennsylvania so she means the singular adjective, not the plural noun we eat in the South).

Grit is a composite of will (volition) and discipline, or tenacity. There are smart gritty people and dumb ones (as Maria Popova of Brainpickings.com notes). Duckworth’s 12 point grit scale is simple but powerful (and free: http://www.authentichappiness.sas.upenn.edu/Entry.aspx?rurl=http://www.authentichappiness.sas.upenn.edu/tests/SameAnswers_t.aspx?id=1246  ). I recommend that any church committee take it to see if they are qualified to take on the tough streets and towns around them. But so should any group of academics wishing to be relevant to adolescent violence or the metabolic syndrome. Important work takes grit even more than raw intelligence.

To review: genius #1 says it takes time to do most things worth doing. Stick.

Jeff Brenner (Genuius #2) says to focus that grit on specific neighborhoods–in his case the extremely unattractive ones across the river from Philadelphia. Jeff Brenner is a primary care physician who followed his patients home to where they live, which is smart if you want to help them heal. His genius is that he mapped all the highest utilizing, most demanding and complex patients in town and noticed they cluster in highly concentrated “hot” spots. Simple arithmetic took it from there to the “holy crap!!!!” insight about how much money it was costing to wait for such folks to inevitably present themselves for treatment at the most expensive possible places of treatment–the emergency room. The prescription for Camden–or any tough town–is to get out in the neighborhood and show some grit. He shared this powerpoint with our Stakeholderhealth learning group two years ago at the White House: http://www.methodisthealth.org/dotAsset/43ffb6f6-1971-478c-b9d9-c5068913420a.pdf .

This is genius that works! Here is the map of highest utilizing patients who could not pay their bills at Wake Forest Baptist Medical Center last year. Last year’s map and the one before that would be almost exactly the same, although the individual patients would not. Focus on the place, the neighborhood and the possibilities begin to be clear. It’s still really hard and complex. Of course it is! We’re talking about human beings not reptiles and we humans can be a complicated.

Medical people talk about “socially complex patients” as if all complexity was problematic. The opposite of pathology–generativity–is even more complex. All human creativity and adaptivity is possible because we are complex and capable of creating complex networks and relationships. It helps to notice that the most critical human associations such as hospitals, government, educational institutions and congregations are highly complex with intelligence, but often even more simple gritty tenacity in their spirit of service for the places they serve.

That is the work of grown-ups, not genius. Even churches and government have them.