Innovation Invocation

Every quarter the top 500 leaders of Methodist Healthcare gather to see how we are doing and where we are going. We call this the "quarterly business review," but it is really a mission review. Today we gathered in 8 locations linked by video broadcast from the Innovation Studio in the Center of Excellence. We were sobered by the stunning images of the wrecked hospital in Joplin, so I opened with the following prayer.

God of every past, you have drawn 10,000 of us together from Arkansas and Mississippi and every part of Memphis, but also Pakistan, Scotland, India, Africa and every part of the United States. What a wondrous thing you have woven from so many different pasts!

We see the shattered hospital in Joplin and ache at what people just like us are struggling with at this very minute. Give them strength beyond their own strength to do their labor. We cannot know what the day will ask of us. But whether we are asked for courage or quiet diligence, we thank you for bringing us into others' lives as agents of your healing.

God of what comes next, give us the spirit of curiosity about you have not yet revealed, not yet done. As we are accountable to the past, let us be accountable to the future, too. So we offer up our best without pride as the seed of something better. Revealing God, honor our earnest search for innovation so that your love and justice might flow into the lives of the patients and families and neighbors you have given us to serve. Break down our fear, break loose our imagination and break through our satisfaction with "good enough." Fulfill Ezekiel's prayer that you replace a heart of stone, with a heart of flesh. And now tune our hearts to each other as we listen for the common heartbeat of a common mission.

We know you are already saying yes, even as we offer up our prayers. So with confidence we say Amen.

- Posted on the journey

God's Economy

There are no weeds in the economy of God. There are, however, a lot of things we don't know how to work with. So, fifty of us met in Simsbury, Connecticut (which has this week nearly as much water falling from the sky as Memphis). We were "converged" by Criterion Ventures, led by Joy Anderson, one of the most creative people in whole world (top 100, according to Fast Company Magazine). In her presence, everybody gets about ten notches more creative, too.


Patrick Duggan helped us move to understand the "church as an economic being" with some asking, "where is the cash stuffed away in all the nooks and crannies of denominational structure?" Others asked baldly, "what is the value proposition of the local church?" Others, also practically, "how do we find a workable business model for seminaries," and "how do we find and form the next generation of leaders who can lead these spiritual/economic beings?" Andy McCarrol and I came curious about whether there were new models that might help us expand our Memphis congregational health strategies to scale.


There is no shortage of anxiety in the church today, but I share little of it. Church structures are certain to dramatically shed structure and form like our auto companies have done in humbling fashion. But humility is appropriate after decades of serving as the complicit center for a culture that is among the most wasteful in the history of the species. Does anybody think the church deserve a reward for our performance any more than Chrysler?

So we'll have fewer full time "learned" clergy, a lot fewer seminaries and way less gothic boxes on corners. No big loss to the Kingdom of God. The astonishing thing is that we (I am an ordained part of it) have billions of dollars of liquid and material assets that are fungible enough to realign in service of what God might have in mind next.

We still have thousands of people laying their life on the line through churches doing all sorts of useful things. Some are young and crackling smart like Tom Daniel of Atlanta, or Tim Soerens of the Parish Collective in Seattle, Dan Senter of California and Cynthia Rasmussen in Rochester. How much more talent does God need?

And there are plenty of the "older young"--people in the 50's-70's who have seasoned talent and staying power: Jim Bennett of Church of the Savior, Steve Monti in North Carolina, and on and on. And some way smart veteran denominational mechanics: Phyllis Anderson, Greg Black of the UCC, Woody Bedell, who knows all there is to know about clergy health. How much talent does God need?


So too at the root. Last Thursday I witnessed the miracle of another class graduating from our CHN training, filled with power and encouraged by the practical knowledge. Every seven weeks another 60 or 100 goes through another flight of learning. How much talent does God need to get going?

There is startling number of faithful people who know how money works, and how to get it into the service of real change. The Investors' Circle, Village Capital, Praxis, Imago Dei Fund, OikoCredit, Equilibrium Capital Group, e3bank--and the whole wild ecology of others found at SOCAP. How much money does God need?


This morning I walked through the drizzle to an abandoned field behind the hotel. Some pine trees were quietly starting over in their busy and awkward way. And down at the root of what I thought were just weeds are gorgeous little red flowers. How much beauty do we need?

When we release our fears just a second, we notice assets and human capacities sufficient not just for the day, but for all that may be required of us. If God has enough (which seems to be the case) perhaps we do, too.

Surely, we have at least enough to take the next right steps on the path. What we could use more of is clarity of vision. That deserves some prayer, discernment, deep dialogue and, maybe even silence. What exactly do we need to do next?

The question has an edge when we know we have enough to start.

- Posted on the journey

Quiet, massive. The Mississippi

The Mississippi flows across the land and carves it path this way and that. The picture is from Reelfoot museum, mapping in different colors the many different courses across the years.For the last hundred years or so it has been contained within earthworks that among the largest humanly constructions on the planet. For the most part they look like they will hold the river in once again, except the lowest-lying neighborhoods where the poor live. There are a lot of poor in Memphis, so this is not a small number who will lose--once again--everything.


What is surprising to me--and might be surprising to those reading from a distance about the raging river and it wrath-- is that massive flow is actually quiet. It is hard to imagine tens of millions of gallons of muddy water moving in silence. It boils and rolls, carrying trees and clutter from upriver. But it doesn't seem wrathful, or particularly emotional.


It just does what rivers do, dangerous only to humans who take it personally and fail to respect its ways.

- Posted on the journey

Be a whirlwind of love

It is still raining out my window as it is up and down the Mississippi. There is justified awe and fear of the power of that great river, which channels the flow from 31 states. A very great deal of that brown water goes past beneath the Memphis bluffs and it is rising to levels not seen since 1937. One of my sunday school class members told yesterday of that great flood which covered much of eastern Arkansas. He was 17 at the time and remembers his high school closing so that it could be converted to emergency shelter for people driven off their land by the water.

On saturday I road in a fundraising bike ride for diabetes (the tour de cure). The 35 mile route wound from riverfront splendour though industrial grit and then in neighborhoods on the edge. Their homes were financially "under water" with lots of foreclosure signs block after block. And now non-metaphorical water rising up the walls of the mobile homes in the bottoms, heading for the streets nearby. Humans are vulnerable people, needing each other to make it in ways and means that we don't expect.

The radio and TV shows know they can draw a crowd with bombast and mean-spirited silliness about individual responsibility replacing government. But in real life where it rains, floods and ever now now and then swirls with F5 tornado force, it takes all kinds of responsiblity--personal, social, faithful and government.

Collins Dillard is an artist of abnormal sense and sensitivity. The picture is a poster he did for our little United Methodist Church, St. John's, to tell us how to send money where it will help somebody immediately and efficiently. The United Methodist Committee On Relief (UMCOR) has a stellar record moving fast and smart with compassion and competence. Just google UMCOR Advance 30021326. Send money. And prayers of gratitude that we are made to connect.

The other pictures are of a kind of sculpture Collins did that went along with the poster. The bent wire spirals up out of a stone toward a heart. We were encouraged to come, pray, place a paper heart at the base signalling the prayer and the intention to help.

Do it.

Gary

(Thank you Collins, for quietly reminding us that art gives us the coherence to find our toward each other.)

Predicaments of trees and turtles

A week of profound passages: Heather Ion convened sparkling minds exploring "the epidemic of health," KD's 90th, my 60th and Jesus rose again, too. Too much to think about, so I am mulling on the predicament of trees (in real forests) and turtles (crossing actual roads). The tree first.

Walking down the gravel road alongside Fighting Town Creek, we passed under a young oak bent a perfect arch. One of the pines killed by the bark beetles a couple years ago fell in the heavy spring storm, tangled with the oak, weighing it low, caught.


I thought all day about the improbable things that happen to real trees, so unlike the pictures we paint. In real forests (and neighborhoods) anything physically possible just might happen no matter what the predictions based on averages might expect. I was intrigued by the tangle off the ground that held the bent tree captive to the fallen on and even walked back later near dusk to find the predicament more improbable than I thought. The pine didn't just topple over, it snapped in the wind, caught its upper branches in the young strong oak, which bent but held the severed trunk a foot off the ground like a grey ghost might hold a troubled mind. The things that happen to trees ... and people.

Nathan Wolfe, a virologist Jonas Salk would have liked a lot, joined Heather's exploration of viral metaphor by phone. Nathan is named by Time Magazine this week as one of the 100 most influential people in the world (and on a much shorter list of influences on my daughter). Sparked by Heather Ion, he noted that virus are instructive for humans in how they "generate novelty" by combining and recombining genetic information constantly and promiscuously. Novelties (innovations) are tested against reality--also constantly--and those that work better stick long enough to generate more novelty. That's how viral life works, with some clues for us mammals.

I'll wait for a fuller posting on this until Heather has a chance to edit the transcripts. But you can see why it matters in the real neighborhood where you live.


Humans mash ideas together constantly, too, because we face not just threats but opportunities. As technology and knowlege move, it turns out that reality holds more possibilities for life than we had known. We are not contained by what has been possible yesterday, or even this morning. We can generate novelty, too. Indeed, the lives of all we love depend on the adaptive innovations that come from how our lives combine with others'.

Less than a month ago I was measuring my steps against geological phenomenon, noticing that I lived barely longer than one of Nathan's virus. Better generate novelty fast, for life is quickly passed on to others. The thoughtful community philanthropist behind our "epidemic" meeting passed on just last night. But Richard Cornuelle knew his ideas had combined with those of Jonas Salk (who passed on a handful of years ago himself). Lives are good when they leave a vital process more alive.

In the meantime, notice that turtles (and people) have predicaments that can be helped now and in very straightforward ways.


This is the patch of clutter where I moved a box turtle from his precarious rest two thirds of the way across a gravel road. Safe in his armored skin, he probably thought this an unnecessary novelty. But he didn't know about cars and I did, so I moved him unasked. He did not tarry to thank me and was long gone when I walked past again 45 minutes later. I thought of Loren Eisley's "star-thrower", walking the beach at dawn chucking stranded starfish back in the surf. Turtles are less poetic, but probably a lot more alive.

In Rock Hill to celebrate KD's 90th, I noticed an off-brand Baptist church announcing "Jesus stripped, shamed, tortured, killed...for you!!!" (Happy Easter). The ultimate Vital Novelty lost amid the violence. What wondrous life is this, asked the song, more helpfully astonished at the combination of divine and human. I wonder what it would look like if we believed it?

I thought of Bobby Baker, his Navigators and Liaisons intervening in the lives of hundreds of people (mostly moving slowly as turtles) every month getting them to where they need to be to have a better shot at health. Many of those lives are as unlikely as the tangled tree and many just as obviously exposed as the turtle in the road. Their hope is the novelty of competent compassion--hundreds of mundane but creative acts of vitality done quietly and a system that puts people in positions for life giving novelty.

- Posted on the journey

Ready... aim, aim, aim...

Boston is a city of revolutions past--and maybe future. Sometimes revolutions are simply things that just need to happen and are overdue. This is certainly the case with the "triple aim."

Among health wonks nothing is more obviously righteous as "the triple aim"-- lowering cost, improving quality and improving population health. Originally advanced by the Institute for Healthcare Improvement under Dr. Don Berwick, the triple aim is embedded at the very root of the current federal health care reform legislation. It also pops up at state levels such as Oregon (http://www.oregon.gov/OHA/action-plan/).


Just beyond the water over yonder is Bunker Hill; to the left behind the glass towers, Boston Commons. A more wonkish revolution is under way now, which is why a group from Memphis was here for a couple days. We were drinking deeply of the IHI / triple aim cup along with a hundred or more other folks from around the country. Representing both major hospitals in Memphis, the Med and The Church Health Center we listened to how these goals were being reached at large scale in upper Wisconsin and Oregon.

Of course the new triple aim is a footnote to the original one in Micah 6: "you know what the Lord requires already (some 2,600 years ago): do justice, love mercy and walk humbly." If we had done that, we would not need the new triple aim. The new triple aim is related to Micah a bit like the plumbing is related to Amos' prophecy that justice will role down like mighty river. Don't take plumbing lightly. Just because it depends on gravity, doesn't mean it is easy or obvious to get it to work. Same with health care.

We learned about CareOregon, a managed care organization for the poor that actually manages and actually cares. With tenacious decency, they use data like a righteous sword to carve waste and silliness from the lives of their members and providers. The result is dramatically more efficient services that are proactive, comprehensive, quick and responsive to what people really need. It passes for brilliance these days to notice that the most expensive patients needing the most medical services can be predicted by asking simple questions about substance use and family problems. And it passes for innovation when you do something non-medical about non-medical issues. Micah knew that would help, but did not need the cost savings to justify it.



Rebecca Ramsey, of CareOregon, shared how the basic revolutionary idea came from the SouthCentral Foundation in Alaska, which has built a large health services network on the highly participatory wisdom of the Native people. They (the people!) turn out to be pretty smart about the way people's health is connected to their families, community, decency and ... spirituality. The Native spirituality got left out of the story but the moral commitment to decency sure didn't. The key is that the embrace of those with the most complex conditions (almost often involving the snarly mix of substances, interpersonal violence and mental issues) is way cheaper than pretending the complexity isn't there. Mercy is cheaper; justice even more so.

These lessons are crucial for Memphis where we sit on a never-ending well of wicked disparities and poverty. We could be tempted to think we can't face the inherent complexity of multi-generational cascade of race and class. "We'll just do what we can; we can't afford world peace." Actually, IHI, Oregon and Wisconsin seem to say that world peace--taking it all on--is cheaper and more managing than trying to operate a hospital blind to the quiet violence of our patients' lives. We are way off the national curve for unneeded hospitalization that can be effectively managed only by getting involved in the complexity of those who have no real alternative. We are even further off the curve for expensive and futile care at the last months of life; that can be managed not by harshness, but by the gentle-kindness Micah aimed at. We're in a world war; why not work on world peace?

In the meantime, we can at least do a lot better. Micah thought he was only asking for what was obvious and doable: "you already know what God asks.....". IHI lives on the wonk-ish side, finding a buzz from the data and flowcharts. But they are talking about the same mercy, same justice and, ironically, the same humble seeking for what is possible on this earth.

- Posted on the journey

Adults behaving badly

In what appeared to be one its last actions before closing down in the fact of stampeding Vandals, the White House Office on Partnerships posted an article about "the Memphis Model" on its website. The Vandals thundered past to no affect, but may return at the walls next week, so you might go quickly to http://www.hhs.gov/fbci/resources/newsletter/040711.html#feature
to read the brief piece by Mara Vanderslice.

You've read the basics here before: hundreds of congregations connected to the big three faith-based treatment systems (Methodist LeBonheur Healthcare, Church Health Center and Christ Community Health Services) and pretty much anyone in town that wants to partner.

This would seem to be a fragile model for such wild oscillations in public policy. I could fill pages with simply lists of fundamental variables affecting the choices of all institutions involved. Given our 330 covenant congregations and these 3 key partners, there are at least 333 long lists of unknowns with big upsides and downsides that raise uncertainty to the 333rd power.

So we do the best we can on most days to consider the limits of what is possible to imagine and try to move that way with whoever we can do so that day. We try to respect each other and expect the best of all involved, and we are usually right. It is not pretty, but real.

However, we are not naive. We do not expect all the adults to behave well or to be able to keep to their best intentions, sometimes not even to keep their promises. In other words, it fits the times in DC and Memphis.

We muddle, which is what is possible for humans to do in complex and uncertain times. But we muddle while talking constantly to each other, making every incremental good choice we possibly can. It is not all that might be possible in the abstract, but all that are possible on this small and wild planet.

Sometimes the stars offer up an opportunity to move in big leaps. We are considering trying to become a model city for application of the Institute for Healthcare Improvement "triple aim." But that model seems to think that we could and should get all the powerful and smart people to agree, first, then act. The "memphis model" that appeals to the White House is more untidy and yet more ambitious. The heart of the Memphis model is to take advantage of every opportunity to bend the arc of justice in the right direction. It might work. And it might not. We continuously improve our aim and never give up.

In a week when we are told to be grateful our government employees are even going to be allowed to come to work, that seems pretty good.






- Posted on the journey