Reversing History

Most weeks going to the White House for an all day meeting would be pretty much the biggest part of the week. This week it is at least arguable that being part of a plenary panel for 1,500 wonks 10 miles North of 1600 Pennsylvania Avenue may be more significant. The panel kicks off the annual meeting of the Agency for Healthcare Research and Quality, a federal unit which sets much of the agenda about what and how the government measures what matters in health organizations. This year the focus is on how innovation and collaboration in healthcare can change disparities, access and quality of care.(ahrq.capconcorp/ahrq)

Not very long ago Memphis would be the negative case study because we get all three of those wrong so often. In recent years our quality inside the walls has gotten pretty respectable. But our patients don't live inside our walls; they live outside most of the time. And when they step one foot onto the sidewalk they can be back, not ten or fifteen, but 150 years, when race and class created vast differences in life expectancy and unnecessary suffering. Unraveling the mystery of why could take the full-time career of all 1,500 of my fellow-wonks.


Hospitals were rarely equitable in their healing effect on the community, since they were largely created out of the power and largess of the dominant political and philanthropic culture, which in Memphis was largely white. Employment, privileges to practice and basic access where unequal, even among the faith-based hospitals like Methodist Healthcare. We have worked very, very hard to reverse that history, but it does not help to deny it. (The picture is of Nelson Mandela's sleeping mat in his cell on Roben Island.)

The hope of healthcare is to for the powerful instituions to become teachable, not just by battalions of wonks and researchers, but by the mothers, brothers and neighbors who know the other part of what we need to understand about life in our tough city. They may not know the detailed etiology of diabetes, but they know about the lives in which that disease must be lived. The most powerful gain from our covenant with 376 congregations is to bring the hospital into an appropriate relationship where we can be taught and guided by them. Not all are "minority" (should be called majority in Memphis). But the blend of cultures and class is rich in wisdom and practical tactical insight. We all become teachable so that the blend of intelligence comes alive.




Not many data wonks will thrill at the previous paragraph. What measures and metrics? Gathered with what assurance of objective credibility? Translated exactly how across the different cultures? With what clinical processes administered by what credentialed individuals taught by who? Albert Einstein said that " if we knew what we were doing, we wouldn't call it research." I'm with Albert on this. But all the research questions must be pursued and answered and tested. That is how these organizations move, change and, eventually, change the bitter history into something that looks more like what God had in mind.

- Posted on the journey