The Theory and Action of Running a Breakthrough Collaborative: Using a Network-Centric Approach Framed Using Doug Engelbart's Idea of Networked Improvement Communities

1. 1 Ahmed Calvo
The Theory and Action of Running aThe Theory and Action of Running a
Breakthrough Collaborative:Breakthrough Collaborative:
Using a Network-Centric ApproachUsing a Network-Centric Approach
Framed Using Doug Engelbart’s Idea ofFramed Using Doug Engelbart’s Idea of
Networked Improvement CommunitiesNetworked Improvement Communities
June 2, 2017
Ahmed Calvo, MD, MPH, Director,
National Health Leadership and Public Service Fellowship
Haas Center for Public Service, Stanford University
Fellow, Thought Leadership and Innovation Foundation
Medical Officer, Health Resources and Services Administration
U.S. Department of Health and Human Services

2. Questions-to-run-on
Ahmed Calvo 2
• What is the one most interesting idea that
popped into your brain as you heard this?
• How do you activate a “whole-of-nation”
effort with action at the local community?
• How can the government (and you) connect
up with private sector activity taking place?
(“Culture of Health” effort and related work)

3. Presentation Messages
• Going from healthcare to health is critical
to improve population health outcomes
• A wicked problem requires partnerships –
cannot be resolved by a single organization
• A network-centric approach of influence
(meta-leadership) shows promise for the
success of private-public-partnerships – in
active action at the local community level

4. Wicked Problems
Ahmed Calvo 4
Cannot be solved by a single entity alone (or by a
single agency) – requires partnerships, sharing, and
collaboration – and evolve at the speed of trust.
A “Community of Solution”* as a going concern can
own the disruptive innovation as much as business.
The key is not have it be a government initiative.
To go to scale is going to require meta-leadership –
working via non-traditional network-approaches.
* “Communities of Solution: The Folsom Report Revisited,”
The Folsom Group, doi: 10,1370/afm.1350 Ann Fam Med
May/June 2012 vol 10 no 3-250-260

5. Scaling-Up Communities of Solution
Typical community activity
Pilots/Demos
Products
Community Going Concern
(something already owned
by the community of action)
- trying to go from A to point B
USG
Contracts and Grants
(Cooperative Agreements)
$$$$ (and specifications)
Owned by government
Government
Is Authorized To Help
The Community Achieve Goal
(By assisting the community)A
B
Time
Metric

6. Scaling-Up Communities of Solution
Typical community activity
Pilots/Demos
Products
Community Going Concern
(something already owned
by the community of solution)
- trying to go from A to point B
USG
Contracts – Grants
(Cooperative Agreements)
$$$$ (and specifications)
Owned by government
Government
Is Authorized To Help
The Community Achieve Goal
(By assisting the community)
- But it does not become solely
owned by USG – can scale up
A
B
Time
Metric

7. 7 Ahmed Calvo
HRSA Health Disparities Collaboratives:HRSA Health Disparities Collaboratives:
Framed Using Doug Engelbart’s Idea ofFramed Using Doug Engelbart’s Idea of
Networked Improvement CommunitiesNetworked Improvement Communities
In the context of striving for the “Digital Dividends for All” PCI Effort
For Wiser Use of Information-Communications-Technology (ICT)
And leveraging lessons learned from the experience of national QI work
over the last two decades – going forward the activity needs to be done at
the local community level (owned by the community as a going concern)
that can be supported by US Government, State and Tribal Govs.
And counties, cities, and local citizen entities - such as associations –
leveraging insights of Alexis deTocqueville (cf: Democracy in America).

8. Ahmed Calvo 8
Breakthrough Series (BTS) Collaborative Model
Drawing on a napkin by Paul Batalden over 20 years ago –
from Don Berwick, Institute for Healthcare Improvement (IHI)

9. Ahmed Calvo 9
HRSA Health Disparities Collaboratives
added ICT support to learning process
– as key needed infrastructure (1998)
Select
Topic
Planning
Group
Identify
Change
Concepts
Participants
Pre-work
LS 1
P
S
A D
P
S
A D
LS 3LS 2
Rudimentary ICT Supports
E-mail Visits
Phone Assessments Senior Leader Reports
Time for setting aims, allocating resources, preparing
baseline data leading to the first 2 day meeting.
Action period 1: Adapt
and test the ideas for
improved system of care
Action period 2: further develop the
system of care at the pilot site and
spread the system to other sites

10. Ahmed Calvo 10
Evolved Perspective of the HRSA Health
Disparities Collaboratives as a National
Framework for Change (1998-2008)
Establish
National
Agenda
National
FACULTY
Identify
Measures,
Priorities
Evidence-Base
Developed by
Partners
Pilots
Evolved ICT Infrastructure
www.healthdisparities.net ° Regional Infrastructure ° www.hdnr.org
° Phone TA ° Monthly Measures and Senior Leader Reports
° National Faculty Consultants ° Topical Conference Calls/Webinars
Small scale pilots for the purpose of developing
the change package to facilitate rapid deployment
of a new evidence-base
Adapting
Evidence
Base-- BTS,
Care Model,
Model for
Improvement
Supporting
National
Learning
Community
For Best
Practices
Population
Health
Mgt.
•Registry
•Reporting
Executing
National
Health
Policy
•Partnerships
National
Vision For
Healthcare
Transformation

11. Ahmed Calvo 11
ICT and Policy Change Infrastructure at
HHS for ACA Implementation – a National
Collaborative Framework (2009-2016)
ACA Passed
(Affordable
Care Act)
Networked
National
FACULTY
Identify
Measures,
Priorities
(NQF
Contract)
Evidence-Base
Developed by Partners
(e.g. PCORI)
CMS Pilots
Further Adapted ICT Infrastructure
° National Leadership Network shifted to CMS ° State Infrastructure °
www.heathycommunities.org ° Link with QIOs ° National Measures
Massive use of Webinars – and maybe shifting to MOOCs
Small scale pilots and demonstrations for the
purpose of developing the change package to
facilitate rapid deployment of a new evidence-
base and massive scale-up via CMMI at CMS
Community
Adapting
Evidence
Base-- via
foundations
(private $$)
Supporting
National
Learning
Communities
(Partnership
for Patients)
EHRs-HIEs
Pop
Health
Mgt.
•Registries
•Reporting
•Analytics
Nation’s
NQS &
NPS –
With ONC
Standards
Incentives
Going from
Healthcare
To Health
- as a Vision

12. Practical Lessons Learned
Ahmed Calvo 12
• Front office receptionists community of practice in
a 24/7 beehive of communication (without having
to ask permission of their CEOs to share/question)
• Transparency of data and analysis: posting results
in the front waiting area for patients to see; studies
on the doctors by the front office; studies on the
back office medical records by billing staff; etc.
• Tiered help-desk and ICT support (peer to peer;
subject matter experts; national subject experts)

13. Insights Learned
Ahmed Calvo 13
• Experience no longer valuable only to the safety
net (i.e. the FQHCs with which we first started: 5
CHCs – then thousands of FQHCs – with millions
of patients) – there now was real interest from
mainstream medicine – Medicare/Medicaid, etc.
• Interestingly, Don Berwick named Administrator
of CMS to implement the Affordable Care Act
(ACA) led to massive change of culture within
CMS – and HHS – and ultimately with DOD, VA,
etc. etc.

14. Culture of Health
Ahmed Calvo 14
New entities exist that are working in private sector:
•100 Million Healthier Lives Campaign
•Communities Joined in Action (CJA)
•Practical Playbook Initiative
•New Breakthrough Collaboratives (Foundations)
•Healthy Communities Collaborative for America,
the AIMM Collaborative, and PCI
•Wellbeing in the Nation (WIN) Initiative
•Creating Wellbeing Leadership Group
•Collaborate.org

15. Questions-to-run-on
Ahmed Calvo 15
• What is the one most interesting idea that
popped into your brain as you heard this?
• How do you activate a “whole-of-nation”
effort with action at the local community?
• How can the government (and you) connect
up with private sector activity taking place?
(“Culture of Health” effort and related work)

16. Ahmed Calvo 16
Envisioning Collaboration via the PCI --
A Collaborative NIC Framework (2017)
Topic: Health –
in a digital age
Planning
Group: US
Citizenship
Change
Concepts:
Community
Action
Evidence-Base Developed
by Digitally Native Citizen-
Partners (using: PCI,
smart phones, apps, etc.)
Pilots
Further Adapted (Decentralized) ICT Infrastructure
° Evolved Leadership Network ° Evolved Infrastructure °
° New Metrics ° Massive use of Webinars – and MOOCs °
Small scale pilots and demonstrations for the
purpose of developing detailed change package to
facilitate rapid deployment of a new evidence-
base in anticipation of massive scale-up
Community
Adapting
Evidence
Base-- via
foundations
(private $$)
Supporting
Learning
Communities
-- as “going
concerns”
-- already
in action
Better ICT:
- PCI
- Collaborate
- EHRs
•Registries
•Reporting
•Analytics
US Gov
“Grand
Strategy”
Going from
Healthcare
To Health
- in context of
new realities

17. Closing Question
Ahmed Calvo 17
• How do you want to connect up with the
massive private-public activity taking place?
(as part of the Culture of Health initiative) –
a different type of disruptive innovation
happening all around you now – focused on
group process using new ICT – and in play
regardless of what happens in the USG.

18. Offer for Follow-Up
Marianne McPherson, PhD, MS
mmcpherson@ihi.org
Director, Implementation
100 Million Lives
100MLives.org