closing dialogue
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Matt: Let’s focus on issues on similarities, barriers, drivers, issues. What are we hearing? What about the similarities and key drivers we captured in the scribing? Is there anything missing?

Key drivers:

Technology is improving.

Each of the tiles had something about the need for more integration and cadence of the small changes.

Culture issues were in most of the teams.

The feedback from economics is contrary.

Community, is it a key driver or barrier? Key driver.

Patient-centered is a key driver.

Metrics are important for change. Need measurability for a foundation.

Barriers:

Leapfrog has arbitrary regulations and is too prescriptive. It helps you report if you have certain tools in place. It is hard to measure. Outcome data can be very helpful, but there are drivers already chosen. It is a heavy hammer. We need the stuff it does, but Leapfrog may not the first thing we need to do.

Leapfrog creates sound bites to draw attention to problem areas, so we can work on items to change. How do we do sensible things in a hot spot environment?

Matt: Fuzzy logic allows for multiple states—yes, no or some combination. It is not about compiling or non-compiling, but it would give you some measures in-between. Might be a better concept.

Outcomes are not a satisfactory way to drive. They are largely un-actionable.

We need structural process.

We need to capture this in a breakthrough bucket.

We need to engage the consumer.

Matt: The person who wrote the book on Fuzzy logic, said he wished he had never called it "fuzzy" because it is very precise and consumers got another idea. Either/Or logic does not give you good feedback loops.

Sound bites are useful. We need tools to teach the patients value systems.

Matt: It is a context sensitive system, so you have to be careful to frame your request for feedback. It puts a finger on a tremendous opportunity.

We need meaningful models.

We don’t want to teach all our consumers, and then send them to something like Leapfrog.

Matt: How can we move to honest reporting? Honest takes the hit. There is not a tolerance and tool for improvement in place today. Creating the structure of process and communication is critical.

Leapfrog as a barrier measures three things that are not intended to be the end of the trail, but the head. There have been no suggestions for alternatives—try to come up with the structure, process, outcome you thing would be preferable.

Matt: It shows the transformational nature. Riding a bicycle downhill while building it. Everything is in change at the same time.

We have defined the issue nicely.

Leadership, this is a different kind of leadership more organic.

Matt: With tech systems, it seems there is more of a top down structure, but the self-select creates a different kind of leadership.

We need to be anticipating the environment we will grow up in.

Matt: Educators are creating a product that will emerge 20 years into the future. Anything else?

Set up for tomorrow.

In Washington, there is an effort to re-education of the consumer. There are som unrealistic expectations out there.

Matt: If we put the consumer in systems terms, we could see some of the problems we have there. It is probably one of the most broken, disconnected pieces of the system with multiple third parties in-between.

We like to work late into the evenings, so you don’t usually get to go home until after dark, but since this is your first time, we will go easy. We do however have some homework for you.

Take whatever context you want, but something that is you. This is the process of shifting from focus to act. All of the work today is about the system—somebody else. The next work is what you are going to do. What is the current trajectory and what is the gap? Come in with that tomorrow.

Is it the narrower focus or bigger issues?

It is something you, personally, are in control or influence of. It has to be actionable. It is relatively easy to thing abstract thoughts, but saying who does what and when is harder. Think of the ideal state is what you thing you could achieve in three years. The current trajectory is what you think is going to happen and the gap is what you see.

See you in the morning.

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