Presentation Transcript

1. Summer Institute 2013Community Medicine into Action

   F. Daniel Duffy, MD, MACP July 28, 2013
2. What is Community Medicine? A practice-based discipline that acts from the perspective of the health care ecosystem in a geographic region to … Learn new knowledge by improving the health care system and educating the next generation of professionals to do likewise Positively influence the healthcare system to enhance health for individuals and their communities…and Integrate human biology, economics, psychology, public health, and health care delivery science into the complex adaptive ecosystem that produces health
3. Summer Institute GoalsA five day immersion in Community Medicine Learn community medicine through stakeholder interviews to appreciate their part in the whole health care system Reflect on what we are called to do Co-create a prototype and business plan for something that brings part of better health care into being
4. The U Journey Discover Community Medicine
5. Theory U The way we look at or think about a situation determines how that situation unfolds. Principles and practices for collectively creating the future that needs us to emerge. Otto Sharmer, 2009
6. Summer Institute – The U Journey 1. COME TOGETHERListen to others and to what life calls us to do
7. Summer Institute – The U Journey 1. COME TOGETHERListen to others and to what life calls us to do 2. EXPERIENCEGo to community stakeholders and listen with our minds and hearts wide open
8. Summer Institute – The U Journey 1. COME TOGETHERListen to others and to what life calls us to do 2. EXPERIENCEGo to the places of most potential and listen with our minds and hearts wide open 3. REFLECT Retreat and reflect, on our moral and ethical calling
9. Summer Institute – The U Journey 1. COME TOGETHERListen to others and to what life calls us to do 2. EXPERIENCEGo to the places of most potential and listen with our minds and hearts wide open 4. CREATEPrototype a new product or service that meets health care need 3. REFLECTRetreat and reflect, allow our inner knowing to emerge
10. Summer Institute – The U Journey 1. COME TOGETHERListen to others and to what life calls us to do 5. EVOLVE COMMUNITY MEDICINEby acting from the emerging whole 2. EXPERIENCEGo to the places of most potential and listen with our minds and hearts wide open 4. CREATEPrototype a microcosm of the new to explore the future by doing 3.REFLECT Retreat and reflect, allow our inner knowing to emerge

11. What Have We Learned?

12. Health Death Rate Physical Illness Mental Illness
13. Poor Health & Healthcare Statistics
14. Health Care Determines 10% of Health Biology Environment 19% 20% HEALTH 10% 51% Health Care Lifestyle WHO Commission on Social Determinants of Health, final report, 2008.
15. Lifestyle Is Greatest Determinant Biology Environment HEALTH Social Advantage Health Behaviors Health Care Lifestyle WHO Commission on Social Determinants of Health, final report, 2008.
16. Environment & Lifestyle Change Genetics Biology Environment Hazards Change Genes HEALTH Adverse Childhood Experiences Health Care Lifestyle WHO Commission on Social Determinants of Health, final report, 2008.
17. Health Care is Interdisciplinary Medicine Nursing Pharmacy Allied Hlth Public Health Biology Environment HEALTH Social Work Health Care Lifestyle WHO Commission on Social Determinants of Health, final report, 2008.
18. “Anatomy” of Community Voice-Justice Basic Research Local Economy Drug Research Transportation Volunteer Health Organizations Environmental Hazards Academic Health Centers Crime Safe Housing Medical Care HEALTH Education Mental Health Tobacco, Alcohol, Drugs Job & Income Diet & Nutrition Health Insurance Sedentary Lifestyle Home Abuse & Violence Unprotected Sex
19. Voice-Justice Basic Research Local Economy Drug Research Transportation Poverty vs. Self Sufficiency Wage Volunteer Health Organizations Environmental Hazards Academic Health Centers Crime Safe Housing Medical Care HEALTH Health Insurance Education Mental Health Tobacco, Alcohol, Drugs Job & Income Diet & Nutrition Health Insurance Sedentary Lifestyle Home Abuse & Violence Unprotected Sex-
20. Who is Poor? Income for Family of 3 in Tulsa County 2012 Economics & Employment Value of TANF, SNAP & WIC
21. How Old Are the Poor in Tulsa?
22. Who are Uninsured in Tulsa? Employer, Individual, or Medicare Uninsured Not Poor Medicaid Uninsured Poor
23. Obamacare - Insurance for Nearly All Insurance Exchange + Low income Tax Subsidy Medicaid Expansion
24. Community Interviews
25. Social Service Interviews YMCA - YWCA Tulsa County Health Department - Prevention Tulsa Parks Day Center for Homeless Salvation Army Mental Health Association Ronald MacDonald House 211-HotLine Poverty Simulation Trinity Episcopal Services Life Senior Services Catholic Charities Emergency Infant Services Children’s Justice Center DIVIS Tulsa CARES (HIV/AIDS) OATH – Human Trafficking KIPP Academy Crosstown Learning Tulsa Educare TPS – Mark Twain Safe Housing Schools Healthy Habits Library Internet Social Services Job Business Food Market Poverty Lunch Akins Health Foods Community Food Bank Iron Gate Meals on Wheels Morningside Library Tulsa Public Library Goodwill Industries Tulsa Job Corps
26. Public Service Interviews Voice & Justice Tulsa PhotoVoice Gerry Gustafson Douglas Fox Legal Aid of Oklahoma Greenwood Chamber Elder Law Attorney Healthcare Law Attorney Tulsa County Medical Society Bus Roadway Public Health Fire & Police Neighbor-hoods Safe Housing Schools Tulsa Transit Authority Morton Transportation Healthy Habits Library Internet Tulsa Police Department Tulsa Fire Department Emergency Medical Services Social Services Job Business THD – Children First THD – TFIMR Infant Mortality THD – STD Clinic THD – Disease Surveillance THD – Food safety Food Market Neighborhood Associations Tulsa Parks & Recreation US Postal Service
27. Research & Education Interviews Voice & Justice LIBR Community Service Council Tulsa Health Department Comprehensive Primary Care Beacon Community MyHealth Access Network Sooner Health Access Network Bus Roadway Research Public Health Profession Education Fire & Police Public Information Neighbor-hoods Alzheimer's Association America Diabetes Association America Heart Association America Lung Association Autism Center of Tulsa Mended Little Hearts National Multiple Sclerosis Society Susan G. Komen Foundation Safe Housing Schools OSU Medical School OU College of Allied Health OU College of Dentistry OU College of Medicine SCM OU College of Nursing OU College of Public Health Tulsa Community College Tulsa Technology Center TU Nursing School Healthy Habits Library Internet Social Services Job Business Food Market
28. Health Care Interviews - Providers Bedlam Longitudinal CHC (FQHC) Morton (FQHC) Indian Resource (FQHC) OSU Physicians OU Physicians OU Fostering Hope In His Image FP Planned Parenthood Omni Medical Group Utica Park Warren Clinic TCSS – Recycle Pharm All Saints Med Equip OU Pharmacy PAP Bedlam - Discount Voice & Justice Bedlam Evening Neighbor for Neigh Xavier Clinic Good Samaritan Bus Roadway Research Public Health Profession Education Pharmacy DME Fire & Police Public Information Lab, Path, Imaging Neighbor-hoods Walk-in & Free Clinic Medical Home Safe Housing OSU Radiology Schools Brookhaven Center for Behavioral Hlth Family & Children Services OU Social Work OU SCM IMPACT program Healthy Habits Procedures Consults Library Internet Psychiatry Social Services Job Business Food Market Addiction Treatment SFH Genetic Services Newborn Specialists OK Spine and Brain Inst Surgical Hospital SFHS Breast Center TU Speech & Hearing 12 & 12 Treatment Counseling & Recovery Svs Drug Court Women in Recovery Dentist IHRC Dental Service
29. Health Care Interviews - Institutions Hillcrest Main Hillcrest South OSU Medical Center Saint John Health System Saint Francis Health System Saint Francis Broken Arrow Surgical Hospital Voice & Justice Bus Roadway Research Public Health Profession Education Pharmacy DME Fire & Police Hospital Public Information Lab, Path, Imaging Neighbor-hoods Walk-in & Free Clinic Intensive Care Emergency Medical Services Medical Home Safe Housing ER EMS 911 The Cottage Skilled Nursing Schools Healthy Habits Procedures Consults Skilled Nursing Library Internet St. Simeons Zarrow Jewish Center Inverness Village Montereau Psychiatry Social Services Job Business Long Term Care Home Health Food Market Addiction Treatment Freedom Hospice OU Palliative Care Hospice Dentist SJ Home Health SJ Wound Care
30. Health Care Financing Voice & Justice Public Insurance Private Insurance Charity – Free Care VA-HIS-Gov HC Bus Roadway Research Public Health Medicaid Medicare Dual Medicaid-Medicare Profession Education Pharmacy DME Fire & Police Hospital Public Information Lab, Path, Imaging Neighbor-hoods Walk-in & Free Clinic Blue Cross Blue Shield Community Care Corporate Self-Insurance Intensive Care Medical Home Safe Housing ER EMS 911 Schools Healthy Habits Procedures Consults Skilled Nursing George Kaiser Family Foundation Saint John Foundation (MAP) Chapman-St John Free Clinics Voluntary Health Associations Physician Pro-Bono Care Hospital Charity Care Program Library Internet Psychiatry US Dept of VA US Dept of Defense (TriCare) Okla Dept of Mental Health US Indian Health Services Indian Nation Health Systems Social Services Job Business Long Term Care Home Health Food Market Addiction Treatment Hospice Dentist
31. Health Care Financing Voice & Justice Public Insurance Private Insurance Charity – Free Care VA-HIS-Gov HC Bus Roadway Research Public Health Premiums Co-Pay Gifts Pro Bono Taxes Taxes Profession Education Pharmacy DME Fire & Police Hospital Public Information Lab, Path, Imaging Neighbor-hoods Walk-in & Free Clinic Intensive Care Medical Home Safe Housing ER EMS 911 Schools Healthy Habits Procedures Consults Skilled Nursing Library Internet Psychiatry Social Services Job Business Long Term Care Home Health Food Market Addiction Treatment Hospice Dentist
32. Health Care Information Voice & Justice Public Insurance Private Insurance Charity – Free Care VA-HIS-Gov HC Bus Roadway Research Health Information Exchange Public Health Profession Education Pharmacy DME Fire & Police Hospital Public Information Lab, Path, Imaging Neighbor-hoods Walk-in & Free Clinic Intensive Care Medical Home Safe Housing ER EMS 911 Schools Healthy Habits Procedures Consults Skilled Nursing Library Internet Psychiatry Social Services Job Business Home Health Long Term Care Food Market Addiction Treatment Hospice Dentist
33. What Is the Stakeholder “Pain” in the present system? What Stakeholder “Gain” is Possible? World Cafe
34. Stakeholder “Pain” or “Gain” Patients Providers Social Services Health Care Public Services
35. Stakeholder “Pains” and “Gains”
36. What Small Piece of a Future Health Care System Can we Co-Create with Prototypes?
37. Co-Create the Emerging Future Experience Pain & Possible Gain Idea ? Summer Institute Prototype
38. Productivity & Equity Risk Health Care Costs Capacity Innovations Payment Schemes Innovation Fund Cost Savings
39. Productivity & Equity Risk Health Care Costs Environment Lifestyle Job & Life Skills Training Public Education – Library Capacity Health Education in Schools Safe Housing for Homeless Safe Healthy Neighborhoods Health-Career Pipeline Innovations Connect to Social Services Community Gardens Payment Schemes Innovation Fund Cost Savings
40. Informatics Productivity & Equity Online (App) to Find Social Services MyHealth Information Exchange Low cost cell phones & text reminders Online Specialty Consultations Risk Health Care Costs Patient Portal for Self-Care Bedlam Registry for proactive care Capacity Health Care AIDS in Older People Waiting-Room health information cart Social Service Screening & Referral Diabetes Prevention Design Lab Reports for patient education Bedlam Patient Advisory Board Innovations Post ED Follow-up Clinic Simplify med list & visit summary Mobile clinic for prevention Payment Schemes Innovation Fund Cost Savings Breast Feeding support Redesign patient education handouts Clinic bus & in transit health videos
41. Productivity & Equity Productivity & Equity Health Care Community Health Workers Risk Health Care Costs Pharm & Occu. Med Students Volunteers to Work in Clinic Capacity Research & Education Innovations Curriculum in Cultural Competency Community Research Infrastructure – Geo-Plot Services Orientation to Community Medicine for All @ OUT Payment Schemes Innovation Fund Cost Savings Spanish Immersion Course Summer Institute-type Interdisciplinary Curriculum Conference for awareness of Tulsa social services
42. Productivity & Equity Risk Health Care Costs NO Prototypes Addressed “Cost” or “Funding! Capacity Innovations Payment Schemes Innovation Fund Cost Savings
43. Oklahoma Spends Plenty for Poor Quality
44. Can We Cut Waste, Save Cost and Reinvest to Fund Improvements? http://resources.iom.edu/widgets/vsrt/healthcare-waste.html
45. Scenario 1A
46. Scenario 1B
47. Scenario 2A
48. Scenario 2B
49. Scenario 3A
50. Scenario 3B
51. Scenario 4A
52. Scenario 4B
53. Co-Create the Emerging Future Experience Pain & Possible Gain Idea Iterate with Customer Feedback Prototype & Business Model
54. Business Model Canvas
55. Business Model Canvas Partners & Suppliers (#7) Activities (#8) Value Proposition (#1) What Pain or Gain does the product or service address? Customer Relations (#4) Customer Segments (#2) Who needs and will buy the product or service? Resources (#6) Channel for Delivery (#3) Cost (#9) Revenue Stream (#5)
56. Business Model Canvas Partners & Suppliers (#7) Activities (#8) Value Proposition (#1) What Pain or Gain does the product or service address? Customer Relations (#4) Customer Segments (#2) Who needs and will buy the product or service? opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp Resources (#6) Channel for Delivery (#3) opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp opoiuppoipoippppppp Cost (#9) Revenue Stream (#5) opoiuppoipoippppppp
57. Challenge for 2013 Summer Institute Be personally transformed by the U Journey that takesus from competitive self-reliance to belonging and impacting the health care ecosystem in Tulsa, Oklahoma Inquire to appreciate our community as it is Think from the perspective of the whole community Reflect on what your heart and values call you to do Prototype a change today that will improve the future Act from understanding that you shape the whole