Myron Rogers Master Class 17th September -...

Myron Rogers Master Class 17th September

1

Leadership for Change Programme Master Class 1

Systems Thinking with Myron Rogers

Thursday 17th September 2015

Welcome!

Working the Whole System: Revealing the Dynamics that Create Enduring Capacity for Change

Myron Rogers

The Phillips Kay Partnership LTD

All slides copyright © Myron Rogers 2014 (and earlier);

Permission for non‐commercial use granted, with acknowledgment of source.


2

There is no theory of everything…

The universe is made up of stories, not atoms.

Muriel Rukeyser

The Three Commandments

• Know Thy Students

• Know Thy Practices

• Personalize Thy InstructionA History of Systems Theory.

in 15 minutes.


3

Cybernetics,Living Systems Theory

Socio technical systemsOpen systems

Group DynamicsAction Research

T‐groups

Macy Conferences

Lewin,Lippitt, et alNTL

Trist, Emery,Tavistock

Von Neumann, Wiener, Meade, Bateson, Shannon Forrester, et al

All of this and more in 1947?What was going on?

General Systems Dynamics:

Bertallanfy,

1920

The technology revolution

General Systems Theory; Cybernetics; Group Dynamics; Family Systems Theory; Living Systems Theory; Complex Adaptive Systems;Complexity Theory; Chaos Theory; Fractal Geometry; Socio-Technical Systems; Network Theory; Wave Theory; Self-Organizing Systems…

Chaos and complexity

Emergence

Cognition

Networks

Self-organisation

Working with Social Systems as Living Systems:

The Big Five


4

Maturana & Varela ‐ evolutionary biology

• Organisms, from single cells to eco‐systems have a variety of characteristics in common

• They have evolved to be in a perfect relationship with their environment

• It is a symbiotic relationship, the organism/organisation defines the environment and the environment defines the organism

• If there is an external source of perturbation the organism acts to kill it, be it internal or external.

• If the organism is held perturbed for sufficient time it adapts to this new condition.

• Organisms are self‐referencing, they act to preserve their own identity (autopoeisis)

• By cultural behaviour we mean the transgenerational stability of behavioural patterns ontogenically acquired in the communicative dynamics of a social environment.

Innovation occurs when ripe seeds fall on fertile ground. Instead of having a single cause, the great advances…came from a combination of capabilities, ideas and needs that coincided in multiple places…When these disparate practitioners and theoreticians came together, they learned how to find a common parlance to trade ideas and exchange information.

From: The Innovators:How a Group of Hackers, Geniuses and Geeks Created the digital Revolution.

‐‐Walter Isaacson

How do systems work?

How doesthis systemwork?


5

How do we workthe system?

How do I workin and with this system?

How do we know?


6

Culture eats strategy

“And I really don’t thinkthere is much we can doso it’s not really a factorduring the flight because there is not muchwe can do about it.”

Linda Ham, MMT Leader

What goes on

below the surface

affects the surface

Andy Goldsworthy


7

Culture is VORACIOUSIt eats…

• Structure• Policy• Procedure• Process• Purpose• Intent

• Oh, and… INNOVATION.

Why do good intentionsgenerate unintended consequences ?

VUCAVolatile Uncertain Complex Ambiguous


8

If you can find a path with no obstacles it probably doesn't lead anywhere.

The essential need is to seewho we are now based on whatwe do, not what we say about what we do.


9

What was our intent?

What really happened?

Why did it happen that way?

What have we learned?

What do we keep, create or abandon?

U.S. Army, AFTER ACTION REVIEWS

What are we trying to do?

How do we need to do it? How do we know?

And Who Needs to Do It?

The following courtesy of

Professor Keith Grint, University of Warwick


10

The NHS: ¼ century of change (AKA Restructuring)1982: Abolition of Area Health Authorities1982‐85: Introduction of general management1985: Creation of NHS Board at the Dept of Health1989‐93: Establishment of NHS Trusts1989‐95: Creation of GP Fundholding & Commissioning1989‐95: Setting up NHS Management Executive (later NHS Executive)1990: Replacement of FPCs (Family Practitioner Clinic) by FHSAs 1991‐97: Reconfiguration of Health Authorities1991: Restructuring of NHS Organisation Boards1994: Reorganization of RHAs (Regional Health Authorities)1994: Abolition of FHSAs & incorporation into Health Authorities1995: Reconfiguration of Acute Services & Trusts1996: Abolition of RHAs, incorporation into NHS Executive1997: Abolition of GP fundholding, replacement with PCGs (Primary Care Group)2000: Abolition of NHS Executive, incorporation into the Dept. of Health2001: Abolition of NHS Executive Regional Offices, move to Regional DHSCs

(Directorate of Health & Social Care) at Dept of Health 2001: Replacement of larger health authorities with SHAs (Strategic Health Authorities)2001: Replacement of PCGs with PCTs (Primary Care Trusts)2002: Creation of Foundation NHS Trusts2002: Creation of Health and Social Care Trusts2005: Merger of 300 PCTs into 100 larger PCTs2005: Merger of 28 SHAs into 10 larger SHAs2006: Reorganization of Dept of Health to split NHS and DH responsibilities

Major inquiries and the main legislation affecting policing 1960‐20081960 Establishment of the Royal Commission on the Police1964 Police Act – establishment of the Tri‐Partite Structure for policing1967 Home Office circular encouraging unit beat Policing1968 Lord Denning ruling1976 Police Act1977 Fisher Report1980 Home Affairs Select Committee Report on Sus Laws1981 Royal Commission on Criminal Procedure, Byford Inquiry – The Yorkshire Ripper1983 Home Office circular 114/83 (Financial Management Initiative)1984 Police and Criminal Evidence Act1988 Home Office Circular 106/88 (new management strategies for Police)1989 Publication of the Operational Policing Review1989 Taylor Report on the Hillsborough Stadium Disaster1991 Royal Commission on Criminal Justice1993 Audit Commission publishes Helping with Enquiries1993 White Paper on Police Reform1993 Publication of the Sheehy Inquiry report1994 Police and Magistrates Court Act1994 Audit Commission publishes Cheques and Balances1995 Core and Ancillary Tasks Review – Final Report1996 Final Report on the Cassels Inquiry, Audit Commission publishes Streetwise, Police Act1997 Police Act – Creates PITO and NCIS1998 Crime and Disorder Act1999 Stephen Lawrence Inquiry report1999 Patten Report – future of Policing in Northern Ireland2000 Regulation of Investigatory Powers Act2001 Criminal Justice and Police Act, Cantle Report, Clarke Report, 2001 Home Office White Paper – Policing a New Century, Private Security Industry Act2002 Police Reform Act‐National Policing Plan, PCSO’s introduced IPCC established2003 Bichard Inquiry, HO Green Paper‐ Policing: Building Safer Communities together, Anti‐Social Behaviour Act2004 National Policing Plan 2005‐20082005 HMIC report on workplace modernization, HO report – Neighbourhood Policing2005 Prevention of Terrorism Act, Serious and Organized Crime and Police Act2006 Terrorism Act, Police and Justice Act (Establishes the NPIA)2008 Flanagan Report2008 Policing Green Paper

Other New Bureaucracies

22 1 4 1 2, 35 09 , 5 101 ,

1 0 1 0 4 , 1 02 2 1 ,1 0 3 3 4 , 10 4 1 3 ,

1 0 50 1

Other New Demonstration

& Pilot Programs

26 1 20 1 , 27 0 4 , 2 70 5 , 2 7 06 , 2 7 0 7 , 3 02 3 , 3 0 2 4 , 3 1 1 3 , 3 1 4 0 , 4 20 4 , 4 2 0 6 , 5 3 0 4 ,

5 5 09 , 6 1 1 2 , 6 1 1 4 , 10 2 1 2 , 1 0 2 21 , 10 3 1 5 , 1 0 32 3 , 10 3 2 6 , 1 0 50 4 ,

1 0 6 07

Other NewGrant Programs

59 1 00 2 , 100 3 , 1311 , 13 22 ,

1 5 61 , 29 5 2, 2 9 53 , 3 50 1 -6 , 3 5 0 8, 41 0 1, 4 1 08 , 4 20 1 ,

4 2 02 , 4 30 4 , 5 1 02 , 5 20 6 , 52 0 8 , 5 30 1 -5 3 03 , 5 30 5,

53 0 6 , 5 3 0 9, 5 31 3 , 5 31 5 , 5 4 05 , 5 50 7 -8 ,

5 6 0 4, 6 70 3 ,

10 3 01

10 32 3 , 10 3 33 ,

10 40 8 -1 0 , 10 41 3 , 10 50 1 , 10 5 03

Loan Repayment

& Forgiveness Programs

4 5 2 0 3 , 52 0 4 , 5 20 5 ,

5 31 1

Other New Regulatory Programs

4 1104, 6102, 610 3

Special Interest

Provisions

19 110 2, 1201, 200 6, 3 137, 3201 , 330 1,

6 001, 900 1, 90 10, 90 14, 9 023 , 1020 1, 1 0317 , 10 323, 1 0324, 105 02, 10601 ,

1 0901 , 10905; H CERA 1 101, 1103 ,1 106, 120 3, 14 06

BENEFIC IARIES: Mut ual of Omaha (N E);Dru g C os; NJ D ru g C os;

AARP ; Libby Monta na ns;P hy sicia n-Own ed Ho spitals;Univ . of CT; Me digapP lan s;L ongsho re man He alt h Plans;

Me dic aid: HI , LA, MA, TN , V T; Me dic are : CT , FL , MI, MT, N D

New Government

AGI: Adjusted Gross IncomeAHRQ: Agency for Healthcare Research and QualityCDC: Centers for Disease Control & PreventionCHIP: Children’s Health Insurance ProgramCLASS: Community Living Assistance Services & SupportsCMS: Centers for Medicare & Medicaid ServicesCO-OP: Consumer Operated & Oriented ProgramFFS: Fee-for-ServiceFSA: Flexible Spending ArrangementGAO: Government Accountability OfficeHCERA: Health Care & Education Reconciliation ActHHS: Health & Human Services Department

HSA: Health Savings AccountIPAB: Independent Payment Advisory BoardIRS: Internal Revenue ServiceMA-PD: Medicare Advantage Prescription DrugMedPAC: Medicare Payment Advisory CommissionMERD: Medical Early Risk DetectionEALORS: Executive Auxiliary Linked Office Regional Systems MEWA: Multiple Employer Welfare ArrangementNAIC: National Association of Insurance CommissionersNIH: National Institutes of HealthPCORI: Patient-Centered Outcomes Research InstitutePPS: Prospective Payment System

§§3001, 10335

§3011

§2602

§5605

§4302

§2602

§2602

§3013

§1411

§§1333, 10104

§§1341, 10104

§1311

§1411

§3006

§2602

§§3403, 10320

§3011

§5605

§6301

§6301

§6703

§6703

§4004

§3403, 10320

§3011

§3311

§8002

§8002

§3001

§1001

§1001

§3403

§3012

§1302

§§9004, 9005; HC

ERA

§1402

§§1401, 1412, 10105; HCERA §§1001, 1004

§§1513, 10106; HC

ERA: §1003

§1421, 10105

§§9001, 10901; HC

ERA §1401

§§9010, 10905; HC

ERA §1406

§4002

§6703

§6301 §6301

§4002

§1341, 10104

§1331, 10104

§§1001, 10101

§3004

§4004

§6301

§6301

§1323; HCERA: §1204

§3026

§3026

§§1311, 10104

§8002

§8002

§§9001, 10901; HCERA §1401

§§9009, 10904; HC

ERA §1405

§9008; HCER

A §1404

§3005

§§9015, 10906; HC

ERA

§1402

§1311

§1322

§3403

§1323; HCERA: §1204

§§1311, 10104

§1313, 10104

§§1331, 10104

§§1401, 10105

§1322

§6703

§§3403, 10320

§10407

§3001

§1331, 10104

§1313, 10104

§3011

§3013

§8002

§§3006, 10301

§§1501, 10106; HC

ERA

§§1002, 1004

§§1402, 1412; HC

ERA §1001

§§1402, 1 412; HCERA §1001

Prepared by: Joint Economic Committee, Republican StaffCongressman Kevin Brady, Senior House RepublicanSenator Sam Brownback, Ranking Member

Patient Protection & Affordable Care Act, P.L. 111-148;Health Care & Education Reconciliation Act, P.L. 111-152

§3004

§1421, 10105

Rationing Potential

Taxes & Monetary Fees/Penalties/Cuts

Other Expansions

Involvement in Health Insurance Market

Represents Bundles of Additional Entities

Mandates

Trust Fund(Rationing Potential)

Other New Trust Funds/Monetary Benefits

Expanded GovernmentGovernment with Expanded Authority/ Responsibility

Government Financial Entity with New Inflows/Outflows

State/Territory with Expanded Authority/Responsibility

New RelationshipsRegulations/Requirements/MandatesReporting Requirements

Oversight

Money FlowsConsultation/Advisory/Info Sharing

Structural Connections (Includes Existing)

Private

Unchanged Private Entity

Private Entity with New Mandates/Regulations/Responsibilities

Special Interest Provisions

§3301; HCERA §1101

§3013§6301

§§1401, 1412, 10105; HC

ERA

§§1001, 1004

§§1331, 10104

Small Business Health Options

Program§1311

NAIC§§1333, 1341,

10104

§3007

HC

ERA

§1402

§1001, 10101

§3311

§2701

§2703

§5605

§2701

§2602

§2703

§3012

§§1513, 10106; H CERA §1003

§1334, 10104

§8002

§6301

§§3004, 3005

§1513, 10106

§6703

§4102

§§1341, 10104

§10407

§10407

§2701

§1334, 10104

§§3022, 10307

§3004§3004

§8002

§§1301, 10104

§1333, 10104

§§1341, 10104

§§1201, 1301, 1304

§§12 01, 1301, 1304

§1342

§1301

§1001

§§1201, 1301, 1302

§1331, 10104

§1302

§§1311, 10104

§1342

§1511

§3004

§1561

§1411

§1342

§3012

§4004

§4004

§4004

§4002

§10409

§1311

§6703

§6703

§3012

§4001

§1512

§1511

§3403, 10320

§4003

§8002

§8002

§8002

§8002

§§9001, 10901; HCERA §1401 §§9001, 10901; HCERA §1401

§§1001, 10101

§9004

§9003

§§9009, 10904

§9008; HCERA §1404

§§9010, 10905; HCERA §1406

§9002

§§9005, 10902; HCERA §1403

§1501

§§1311, 10 104

§§3103, 10320

§1334, 10104

§§1322, 10104

§1333, 10104

§1312

§6301

§3005

§3011

§§3021, 10305, 10306

§3026

§4001

§§3006, 10301

§1411

§4305

§1001

§§1201, 1301, 1302

§1331, 10104

§1341, 10104

§8002

§1513, 10106

§6605

§§2001-2004

§§9017, 10907

§§1501, 10106; HCERA §§1002, 1004

§§9015, 10906; HCERA §1402 §9013

§1511

§1511

§§1201, 1301

§1312

Tit le I II

§§3201, 10318; HCERA §1102

§8002

§§3001, 10335

§6301

§§1311

§§1514, 10106

§1321

§2703

§5605

§§1311, 10104

§6301

§4001

§9002

§8002

§1414

§1411

§2701

§3403, 10320

§6703

§1331, 10104

§2602

§3403, 10320

§1512

§§1514, 10106

§1411

§1411

§§3001, 10335

§3004§3004

§3011

§3021

§3022, 10307

§3026

§2701

§2701

§2701

§2703

§4001

§4302

§3013

§1411

§4004

§6301

§6301

§6703

§3011

§4305

§10409

§3311

§3311

§3021

§3011

§3012

§8002

§3311

§§1311, 1413

§3005

§3004

§1411

§1313, 10104

§§1001, 10101

§5605

§1512

§5605

Qualified HealthPlans

§§1301, 1302,1311, 10104

HealthCare Choice

Compacts§§1333, 10104

Reinsurance Program§§1341, 10104

Value-Based Insurance Design

& Coverage of Preventive Health

Services§1001

Optional Basic Health

Program§§1331, 10104

GAO§§1401, 3001, 3403, 6301,

10105, 10320

Comptroller General§§1313, 1322MedPAC

§2602

States§§1311,1331,

1333,1341, 10104, 10407

State Surveyors

§6703

Vital Statistics Agencies

§10407

US Territories§1323; HCERA §1204

KeyNational

Indicator System Implementation

Institute§5605

Commission on Key

Indicators§5605

National Academy of Sciences

§5605

CongressMembers

& Personal Staff Mandate:

Only Exchange Coverage

§1312

NationalTraining Institute for Federal and State Surveyors

§6703

AHRQ§3012, 3013, 6031

EssentialHealth Benefits

Package§§1001,1201, 1301,

1302 PlatinumBronze

Silver Gold

Government Health Benefit

Exchanges§§1201, 1301,1302, 1311, 1312, 1313, 1321, 1323, 1334, 1411, 1413, 10104;

HCERA §1204

Internet Portal§1311

Data Collection

§1311

HHS Inspector General

§1313, 8002,10104

Eligibility Determinations

§1411

Privacy Study

§1411SecretaryHealth & Human

Services

HealthInsurance

CO-OP§§1322, 10104

CO-OP Advisory

Board§1322, 10104

Private Purchasing

Council§1322

USPreventive

Services Task Force

§1001

Health Savings Accounts§§9003, 9004

Medicare Beneficiaries

§3311

Health Insurance Policy Holder

§§1001, 10101

Small Employers§§1304, 1311, 1421, 1512,

10105

Large Employers§§1304, 1511, 1512, 1513,

1514, 10106

MedicarePart C & Part D

Insurers§3311

Large Group Market

§§1201, 1301, 1511

PremiumTax Credit Subsidies

§§1401, 1412, 10105; HCERA §§1001,

1004

Annual Fee§§9010, 10905; HCERA §1406

3.8% Investment Income Tax

HCERA §1402

HSAUse Restriction

§9003

Misuse ofHSA Funds

§9004

“CadillacPlans” Tax§§9001, 10901; HCERA §1401

Subsidies:Out-of-Pocket

Expenses§§1402, 1412;

HCERA§1001

Individuals

Mandates, Regulations,& Taxes

§§1311, 1411, 1501, 9003-9005, 9013, 9015, 9017, 10106, 10902, 10906, 10907;

HCERA §§1002, 1004, 1402, 1403

“Excessive Profits”

§§1001, 10101

Patients

MedicarePayroll Tax

Increase: 0.9%§§9015, 10906; HCERA §1402

Flexible Spending Arrangement

§9005, 10902; HCERA §1403

Only Medical Expenses

Above 10% of Income (AGI) are Tax

Deductible§9013

FSA ContributionLimit: $2,500

§§9005, 10902; HCERA§1403

RiskCorridors

§1342

Large Business Employees

§1511, 1512

Small Business Employees

§1512

MEWAHealth Plans

§§1301, 6605

Self-Insured Health Plans

§1301

Small Group Market

§1301, 1304, 1342Individual Market§1201, 1301, 1304, 1342

10% Tax On

Indoor Tanning Services:

§§9017, 10907

W2 Health

InsuranceDisclosure

§9002

Individual Mandate: Buy Health Insurance

§§1501, 10106;HCERA §§1002, 1004

Employer Mandate:

Provide Health Insurance

§§1513, 10106; HCERA §1003

Mandatory Worker Auto-

Enrollment§1511

Small Business

Health Insurance Tax Credit

§§1421, 10105

Insurance Mandates

§§1001, 1101, 1201, 1251, 10101, 10103; HCERA §2301

17

Health Insurance Companies

Mandates, Regulations, Required Benefits, &

Taxes§§1001, 1201, 1252, 1301, 1334, 1341,

3311, 9001, 9010, 10101, 10104, 10901, 10905; HCERA §§1401, 1406

Employers

Mandates, Regulations, & Taxes

§§1511, 1512, 1513, 9001, 9002, 10106, 10901; HCERA §§1003, 1401

Demonstra-tion Program

§3001Public Data Disclosure

System§3006, 10301

FFS Accountable

Care Organizations

Program§§3022, 10307

Community-Based Care Transitions Program

§3026

Hospital Quality

Reporting Program§3004, 3005

Medicaid Health Home

Program§2703

Federal Coordinated Health Care

Office§2602

Medicaid Quality

Measurement Program

§2701

State-Specific Adult Health Quality

Measures§2701

Medicaid Expansion: +16 million

§§2001-2004CBO Cost Estimate,

3/20/10

State Medicaid Agencies§§2602, 2701, 2703,

3011

MedicareCuts: $528.9bn(includes MA cuts)

Title III; CBO Cost Estimate,

3/20/10

Medicare Advantage

Cuts: $205.9bn§§3201, 10318; HCERA

§1102; CBO Cost Estimate, 3/20/10

Subsidy: Medicare Part D Drug Program “Donut Hole”

§3301; HCERA §1101

Hospital Compare Website

§3001

HospitalValue-Based Purchasing

Program§§3001, 10335

Centerfor Medicare& Medicaid Innovation

§§3021, 10305, 10306

Physician Value-Based

Payment Modifier

§§3007

Annual Fee§9008; HCERA

§1404

Hospitals§§1311, 3001, 10335

Skilled Nursing Facilities§§3006, 10310

§§3006, 10301

Ambulatory Surgical Centers

§§3006, 10301

Home Health Agencies

§3006

Medical Device Manufacturers

§§9009, 10904; HCERA §1405

Pharmaceutical Companies

§9008; HCERA §1404

Inpatient Rehabilitation

Facilities§3004

Hospice Programs

§3004

PPS-Exempt Cancer Hospitals

§3005

Medicare Administrative

Contractors§3311

Health Industry

Mandates, Regulations, Taxes, & Payment Cuts

§§1311, 3001-3006, 3311, 9008, 9009, 10327, 10331, 10335, 10904; HCERA

§§1404, 1405

Long-TermCare Hospitals

§3004

Medical Device

Excise Tax§§9009, 10904;

HCERA §1405

IPAB§3403, 10320

IPAB Consumer Advisory Council§§3403, 10320

Medicare Part A Trust

Fund§3026, 3403, 6301,9015

Medicare Part B Trust

Fund§3026, 6301

PublicHealth Quality &

Efficiency Measures Development

Program§§3013, 10304

Hours of Service Determination for Calculating

Employer Mandate Penalty

§§1513, 10106

Rules for Insurance

Claims Appeals§1001, 10101

Health IT Policy

Committee§1561

Office of Personnel

Management§§1334, 10104

President§§ 3012, 3024, 3403, 4001,

8002, 10320

Cures Acceleration

Network Review Board

§10409

National Diabetes

Report Card Program§10407

CLASS Independence

Benefit Plan§8002

CDC§§1001, 4003, 4004,

4102, 10407

NIH§§4305, 6301,

10409

National Partnership on Prevention &

Health Promotion

§4004

National Public Education

Campaign on Prevention & Health

Promotion§4004

Community Preventive

Services Task Force§4003

National Oral Health Public

Education Campaign

§4102

Cures Acceleration

Network§10409

CLASS Independence Fund Board of

Trustees§8002

Life Independence

Accounts§8002

National Diabetes Mortality Statistics Education Training Program

§10407

Eligibility Assessment

System§8002

PersonalCare Attendants

Workforce Advisory Panel

§8002

CLASS Independence

Fund§8002

CLASS Independence

Advisory Council

§8002

Black Lung Benefits Act

§1556

Office of Multi-State Qualified

Health Plans§1334, 10104

PublicHealth

Service§§3011, 4002, 4302

Surgeon General

§4001

AdvisoryGroup on

Prevention, Health Promotion, and Integrative and Public Health

§4001

PCORI Expert

Advisory Panels

§6301

PCORI Methodology

Committee§6301

PCORI Board of Governors

§6301

PCORIWebsite

§6301

State Protection & Advocacy Systems

§8002

Justice Department

§6703

National Prevention,

Health Promotion, & Public Health

Council§4001

Prevention Website

§4004

Website“Transparency

in Government”§1552

Prevention& Public

Health Fund§4002

Interagency Working Group on Health Care

Quality§3012

PCORITrust Fund

§6301

PCORI§§6301, 10602

SocialSecurity

Administration§1411

Homeland Security

Department§1411

Labor Department

§§1001, 1302, 1311, 1511, 1512, 1513, 6605, 10101, 10106

CLASS Program

§8002

Officeof Tax

Analysis§§1331, 10104

Elder Justice

Coordinating Council

§6703

AdvisoryBoard on Elder

Abuse, Neglect, & Exploitation

§6703

Multi-Disciplinary

Panels on Improving Long-

Term Care§6703

Elder Abuse, Neglect, &

Exploitation Forensic Centers

§6703

IRS§§1401, 1402, 1411, 1412 1414,

1421, 1501, 9004, 9005,10105, 10901; HCERA

§§1401, 1402

Treasury Department

§§1311, 1331, 4002, 8002, 10104

National Health Disparities Data Collection &

Reporting System

§4302

HealthCare Quality

Website§§3011, 3012

Interagency Pain Research Coordinating

Committee§4305

NationalHealth Strategy

& PrioritiesOffice

§3011

Medicaid/CHIP

Title II; §§1413, 3011

MedicareTitle III, §2602

CMS§§3013, 3021, 3026, 3403, 10305, 10306,

10320

Medicare Prescription Drug

and MA-PD Complaint System

§3311

CMS Actuary

§§1331, 3403, 10104

Your New Health Care System

Congress§§1312, 1411, 3311, 5605, 8002

Non-Hospital

Value-Based Purchasing

Program§§3006, 10301

§3004

§§3002, 10327, 10331

§§3002, 10327, 10331

§3007

§§3007

Physician Quality

Reporting System

§§3002, 10327, 10331

Physicians§§1311, 3002, 3003, 10327, 10331


11

Structure

We trained hard, but it seemed that every time we were beginning to form into teams we would be reorganised. I was to learn later in life that we tend to meet any new situation by reorganisation; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralization.

—Caius Petronius*, AD 66 *Ordered by Nero to commit suicide for being a troublemaker


12

Dupont, Belle, West Virginia a.k.a., CHEMICAL VALLEY

NIMBY

What is the

sourceof safety?


13

A living systempreserves its identity.

It will change in order to preserve it.

© Myron Rogers, Margaret Wheatley, 1998

A living systempreserves its pattern of organization…its network of relationships

The Phenomena of Organization:

Structure

ProceduresPolicy

© Myron Rogers, Margaret Wheatley, 1997, 2002, 2010.


14

Identity

RelationshipsInformation

Emerge from the Dynamics of Organizing:


Which create the capacity for change and organization

Meaning

TrustAction


Identity

RelationshipsInformation

Structure

ProcessesSystems

Meaning

TrustAction


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IdentityActions are congruent with identity

Every change is a change in meaning

Human creativity is unstoppable

Shared significance is essential

© Myron Rogers Margaret Wheatley 2005

Information

Everyone has access to all information

People act on the information they have

Everyone is an expert about their own context

There is no hierarchy to information

© Myron Rogers, Margaret Wheatley 2005

Relationships

•Everyone has access to anyone

•Create health by creating more connections

•Clear agreements are essential

•Trust emerges



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People own what they help create

Real change happens in real work

Those who do the work do the change

Start anywhere, follow it everywhere

Connect the system to more of itself

Creating the capacity for change

Myron’s Maxims

Thus the work is to enter into a world of shared significance.

Francisco Varela,neurobiologist

© Myron Rogers, 2005


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For inquiring minds:

What are the conditions we need to create?

How can we create them?

Who needs to create them?

…to create the capacityfor people to do for themselvesmost of what has beendone to them.

© Myron Rogers

The Three Commandments

• Know Thy Students

• Know Thy Practices

• Personalize Thy Instruction


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Our action research project…

How do we create the capacity for

collective change?


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Myron Rogers Master Class 17th September -...

Documents

Transcript of Myron Rogers Master Class 17th September -...