Cooperating for better care.

Marc Pierson

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An Ore. county maps its way out of healthcare ‘chaos’

Leaders from four of Jackson County, Oregon’s health institutions asked Cambridge Management Group (CMG) to help them formalize a community-wide collaborative approach to health-system improvement. Before starting, the sponsors rated the chances of success at “less than 50 percent”. Upon hearing this assessment, Marc Pierson. M.D., a member of the CMG team, pointed out that the strength and duration of leaders’ commitment would trump probability projections.

The CMG team  also included Bob Harrington and Annie Merkle. (Biographical sketches of all CMG staff members may be found at this link to the CMG Web site’s “Professional Staff” page.)

Participation and commitment grew as members of 13 institutions, along with 6 patients, documented the key parts of their county’s healthcare system. As they went along, they noted where and how they could improve the connections among their organizations—for stronger operational efficiencies as well as to better serve their shared patients.

These collaborating clinicians, administrators and patients developed a clearer understanding of the opportunities to work together to improve patients’ journeys among emergency rooms, inpatient hospitals, post-acute outpatient care and social-service agencies. It became clear to all that these improvements would help achieve the “Triple Aim’’ goals — better care, lower cost and improved care experience.

In the second joint meeting they prioritized a set of improvements and defined the criteria for measuring success. The collaborative two-day process of mapping the county’s healthcare-related parts and connections, priority-setting and defining specific improvement programs was a new experience. But as participants saw the emerging picture and practical opportunities, they became optimistic and committed to proceed with improving their institutional interactions. “People were delighted when they saw the practical work they could do together,’’ Dr. Pierson said.

Jackson Care Connect, a not-for-profit regional insurance organization, thus took the opportunity to invest some of the savings from the preceding year’s improvements (One such improvement was to improve the efficiency of “handoffs’’ – when patients move from one healthcare institution or clinician to the next).

This community program began with in-depth listening by CMG to the perspectives of institutional stakeholders and patients who would be participating in the system mapping and program definition. Midway through the project, 30 institutional leaders and 6 patients met for a day to map the community’s overall system and note the key linkages and interactions that support patients and institutional operations. This information was organized, shared, clarified and used to define seven initial system-improvement programs.

By explaining the linkages through a “system and process lens,’’ CMG helped them make order out of the seeming “chaos’’ of the community health environment.

Here’s a poster describing the linkages of Jackson County’s healthcare entities and related information: OHA Summit 2015 Jackson Poster am.ppt (PowerPoint file will download).

A report, with graphics, on the findings and recommendations of the CMG engagement is linked here (PDF) and appendix here. (PDF)

For  a look at this ambitious project by  Jennifer Lind,  Jackson Care Connect’s chief executive, hit this link















Marc Pierson: Escaping ‘Economic Constriction’


Read Cambridge Management Group Senior Adviser (and healthcare visionary) Marc Pierson, M.D.,’s piece, linked here, on “Economic Constriction,” which includes both text and graphics.

He writes at the end:

“{T}here is now a very  strong cultural drumbeat calling each of us to begin with the creation of an Enterprise, a business, or simply employment and from there it is all to easy to adopt an expedient style of Power Over others (in exchange from money or career advancement rather than inclusion into beauty). This path narrows Knowledge to what is useful for the enterprise and discards wisdom. This path reduces Ethics to legal maneuvering to ensure that the penalties are economically manageable or sufficiently delayed. This path reduces Aesthetics to entertainment. There you have much of the current situation fueled by a culture that accepts the primacy of business and money. What remains of our lives is a shaky derivative of Economically guided and unbalanced approach to living. We are reduced to producers and consumers, much less than the people we hoped to be.”

“It is a simple matter to step away from the  awkwardness of our culturally biased economic perspective back to a more human and participatory way of being that stays forever connected to what we personally care about. From there a easy sense of fairness, a curiosity which leads toward wisdom, toward a way of associating with others and into shared enterprises arise.

“Nothing very human flows when economics is the starting place.

“Love of something is the best starting place.”

Video: Simple rules for a complex world


Clinicians and administrators trying to cope in an increasingly complicated healthcare sector will find guidance — and entertainment — in watching this video in which Donald Sull, of MIT and the London Business School, discusses “Simple Rules: How to Thrive in a Complex World”.

We thank  CMG team member Marc Pierson, M.D., for spotting this.

Healthcare for the old via mail-service people



St. Helier Harbor, in Jersey.

Now here’s something for healthcare experts (such as Cambridge Management Group senior adviser Marc Pierson, M.D.) seeking to created accountable communities of health in the United States to look at.

As the Commonwealth Fund notes here in a story and wonderful slide show:

“Having recently explored The Palo Alto Medical Foundation’s LinkAges program, which encourages communities to check-in and offer help to its older citizens, we now turn our attention to the Jersey Post’s ‘Call and Check’ program. This program, run by the postal service on Jersey, an island  (part of the United Kingdom} nestled between England and France, offers a creative approach to providing care to the frail elderly.”

Using mail-delivery people, “Call and Check” offers frail elders such services as check-ins, appointment reminders and prescription drop-offs twice a week at low cost.


Wash. State as giant health-reform demonstration project


Seattle at dusk.

This item caught our attention in part because Cambridge Management Group has done a great deal of work on population-health and social-determinants-of-health in Washington State and Oregon, led by our senior adviser Marc Pierson, M.D.

Jarrad Aguirre, an M.D. and MBA student, writes in HealthAffairs that the Bill & Melinda Gates Foundation has a huge opportunity  to use Washington State, its home, as a giant demonstration project  to  address the social determinants of health by building Accountable Communities of Health  (ACHs) that improve community engagement, encourage multi-sector participation and use  “transformation projects”  that look beyond investments in the most expensive adults and invest in upstream social determinants and in children.

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