You can learn a lot crawling on the floor with a nine-month old about how we humans learn. Charlie (okay, “Charles Isaac Gunderson Wolfe”) approaches everything with hands-on curiosity —full body tactile learning. He crawls into the toy box, doesn’t just select from it. So he learns fast, laughs a lot and sometimes bumps his head in the process. At this point he mainly needs skills to alert his servants as to his desires. At some point he’ll need skills to learn what others need, so he’ll be able to play his role in the complex human systems that are his life.
Maybe a couple decades along, he’ll need some theory and abstraction so that the team or tribe he finds himself among—perhaps even leading—can use what it knows to face a challenge or opportunity. Teams need theory and true stories to do anything beyond dumb repetition.
Healthcare systems, like infants learning to crawl, are finding our way out of our crib-like buildings into the wildly complicated neighborhoods. We bring the simple assumptions that worked in the crib, but now holding, turning, playing with the tools and toys we find outside. We call this “population health management,” but we are only grasping the objects, not yet learning our way into the relationships. Inside the hospital, we get paid a lot of money to achieve some positive short term results one organ system at a time. How could we not think that way outside? But outside, it is rare to achieve anything, even in the short term, without relating to the humans, at least one person at a time. This is more than simply tuning up our computers with more predictive analytics and linking them to call-centers and texting reminders of clinical appointments. We will need a more advanced—at least 9 month-old quality—approach to learning: fully present and curious about the new terrain and the people we find there.
We have to use all three pounds of brain and all our senses. We can’t just imitate or replicate; we have to understand what we’re touching, so that we can make it relevant to our own social body and local reality.
I’ve seen this as we and many others have tried to replicate the success of Memphis. Until you’ve seen the Congregational Health Network in Memphis, it is almost impossible to grasp its scale, energy, intelligence and raw power. It is unlike any other relationship a community has to any hospital I’ve ever seen. Watching it is a bit like watching a baby that knows how to crawl watching a young child walking. So that’s what the legs are for! Hundreds of people from all over the world have come—and continue to come—to Memphis to see it. So that’s what partnership can be! But it is very difficult for them to go home and replicate what they’ve seen. Many try, even duplicating the covenant and connectional apparatus that has grown up in the past 10 years. But it is very hard to adapt those processes to one’s own crazy town without grasping the theory and logic that lies behind the Memphis Model. You have to have Know Why, not just know how (…it works there).
To get the “know-why” of Beale Street you have to look to the learning group that grew up out of Memphis, Stakeholder Health. That’s the moveable learning feast that will next touch down in Chicago in a couple of weeks and is in the process of intensive collaborative writing that will result in a new “Collaborative Learning Document” that will emerge next Spring (with a little help from the midwives at Robert Wood Johnson Foundation). Know-why is a team sport that demands, in addition to curiosity, humility and lots of listening. It’s not for babies.
Is all this learning really necessary? Surely we can just “spread best practices and scale them up.” Do we even have time to learn? I was recently in Burgundy where the hills and fields have been iconically productive for millennia. You can get more food quicker with a boxcar of nitrogen fertilizer, machines and hybrid corn seed. But you can’t get Burgundy. For that, you need wise humans adapted to their land, thinking of the next several generations.
The innovations or adaptations that matter most involve the practices of teams of humans, not the implementation of their new technical tools, whether they be software or remote monitoring technology. On the way out to see Charlie I was reading “Humans are Underrated” by Geoff Colvin: “As machines rapidly take over the largely mechanical, nonsocial elements of work, our most valuable roles become more intensely social. We’ve seen that we are most fundamentally social creatures—that we evolved into creatures that cannot survive or approach happiness or be productive without social relationships. Empathy is the first element of how all that happens, the basis of every significant relationship.” He told a tale of two doctors achieving very different outcomes using the same techniques to show that “empathy is harder than it may seem, and it frequently doesn’t seem all that easy to begin with.” (p71). How do we learn that precious thing that matters most?
Winston-Salem is one place where you can come and see an intensive process of adaptation of the Memphis Model. You’ll see less imitation and more blending with the local assets, intelligence, history and opportunities. We are long accustomed here to reflection on practice, having nearly invented clinical pastoral education just a few months after Boissen beat us to the reflection in Chicago. In Winston-Salem we have reflected much on Memphis, but also our own peculiar history. Some of that includes the banal arrogance of corporate, academic and medical privilege that results in young minority pregnant women afraid to get prenatal care for fear they’ll be sterilized. Some of what we are reflecting on is the extraordinary array of social, church and philanthropic assets we have yet to get aligned to produce the change it obviously could achieve, but hasn’t, yet. And some of what we are reflecting on is the right-side-up power of the Supporters of Health who are having an astonishing effect on outcomes and cost of our most indigent, vulnerable and complex patients. They are the embodiment of “proactive mercy” and they are proving that doing the right fast—is smart.
We are adapting our structure, budget, partnerships, job descriptions, evaluation methods, messaging, field practices and clinical teams radically and in real time. We are challenging everything illuminated by the reflection on what is happening. It’s not a grope in the dark or a plunge into the toy box. It’s a reflection illuminated by theory that gives us an idea what to reflect on and what the new story means. We don’t have a “model” anything as finished as the Memphis Model. But we may have something as valuable for you to visit and see for yourself, “a teachable hospital” living in learning partnerships. We are learning fast, smart and in the open, informed by a voracious appetite for everything on the Stakeholder Health menu and deep reflection on our local reality. And, yes, we have a lot of theory to turn on the light (the whole FaithHealth library, in fact, especially Deeply Woven Roots, Boundary Leadership and Leading Causes of Life).
If you want to see all that live, join us on Monday, October 12th as we pause to reflect on what’s going on. By bringing your learning edge, we’ll all be smarter, faster. I personally hope you’ll come in the night before so we can spend some social time together (Winston is actually a pretty cool little city) and then have a rich day of collaborative learning on Monday.
It may not be as raw a pleasure as a box of toys, but we can promise a “three pound thrill”.
(Marisa Jensen is a long friend and development expert from The Carter Center, now helping lead AARP. Her husband once had a band named, Three Pound Thrill, best name ever! Thanks for letting me borrow the title.)