Systems Thinking with Myron Rogers

Myron Rogers Master Class 17th September 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.
1
Myron Rogers Master Class 17th September 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
A History of Systems Theory.
• Personalize Thy Instruction
in 15 minutes.
2
Myron Rogers Master Class 17th September Cybernetics,
Living Systems Theory
General Systems Dynamics:
Bertallanfy,
Macy Conferences
1920
Von Neumann, Wiener, Meade, Bateson, Shannon Forrester, et al
Group Dynamics
Action Research
T‐groups
Lewin,
Lippitt, et al
NTL
The technology revolution
Trist, Emery,
Tavistock
Socio technical systems
Open systems
All of this and more in 1947?
What was going on?
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…
Working with Social Systems as Living Systems: The Big Five
Chaos and complexity
Emergence
Cognition
Networks
Self-organisation
3
Myron Rogers Master Class 17th September 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. From: The Innovators:
How a Group of Hackers, Geniuses and Geeks Created the digital Revolution.
‐‐Walter Isaacson
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.
How do
systems work?
How does
this system
work?
4
Myron Rogers Master Class 17th September How do we work
the system?
How do I work
in and with this system?
How do we know?
5
Myron Rogers Master Class 17th September Culture eats strategy
“And I really don’t think
there is much we can do
so it’s not really a factor
during the flight because
there is not much
we can do about it.”
Linda Ham, MMT Leader
What goes on
below the surface
affects the surface
Andy Goldsworthy
6
Myron Rogers Master Class 17th September Culture is VORACIOUS
It eats…
•
•
•
•
•
•
Structure
Policy
Procedure
Process
Purpose
Intent
• Oh, and… INNOVATION.
Why do good intentions
generate
unintended consequences ?
VUCA
Volatile Uncertain Complex Ambiguous
7
Myron Rogers Master Class 17th September If you can find a path with no obstacles it probably doesn't lead anywhere.
The essential need is to see
who we are now based on what
we do,
not what we say about
what we do.
8
Myron Rogers Master Class 17th September What was our intent?
U.S. Army, AFTER ACTION REVIEWS
What really happened?
Why did it happen that way?
What have we learned?
What do we keep, create or abandon?
What are we trying to do?
How do we know?
How do we need to do it?
And Who Needs to Do It?
The following courtesy of Professor Keith Grint, University of Warwick
9
Myron Rogers Master Class 17th September The NHS: ¼ century of change (AKA Restructuring)
1982: Abolition of Area Health Authorities
1982‐85: Introduction of general management
1985: Creation of NHS Board at the Dept of Health
1989‐93: Establishment of NHS Trusts
1989‐95: Creation of GP Fundholding & Commissioning
1989‐95: Setting up NHS Management Executive (later NHS Executive)
1990: Replacement of FPCs (Family Practitioner Clinic) by FHSAs 1991‐97: Reconfiguration of Health Authorities
1991: Restructuring of NHS Organisation Boards
1994: Reorganization of RHAs (Regional Health Authorities)
1994: Abolition of FHSAs & incorporation into Health Authorities
1995: Reconfiguration of Acute Services & Trusts
1996: Abolition of RHAs, incorporation into NHS Executive
1997: Abolition of GP fundholding, replacement with PCGs (Primary Care Group)
2000: Abolition of NHS Executive, incorporation into the Dept. of Health
2001: 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 Trusts
2002: Creation of Health and Social Care Trusts
2005: Merger of 300 PCTs into 100 larger PCTs
2005: Merger of 28 SHAs into 10 larger SHAs
2006: Reorganization of Dept of Health to split NHS and DH responsibilities
Major inquiries and the main legislation affecting policing 1960‐2008
1960 Establishment of the Royal Commission on the Police
1964 Police Act – establishment of the Tri‐Partite Structure for policing
1967 Home Office circular encouraging unit beat Policing
1968 Lord Denning ruling
1976 Police Act
1977 Fisher Report
1980 Home Affairs Select Committee Report on Sus Laws
1981 Royal Commission on Criminal Procedure, Byford Inquiry – The Yorkshire Ripper
1983 Home Office circular 114/83 (Financial Management Initiative)
1984 Police and Criminal Evidence Act
1988 Home Office Circular 106/88 (new management strategies for Police)
1989 Publication of the Operational Policing Review
1989 Taylor Report on the Hillsborough Stadium Disaster
1991 Royal Commission on Criminal Justice
1993 Audit Commission publishes Helping with Enquiries
1993 White Paper on Police Reform
1993 Publication of the Sheehy Inquiry report
1994 Police and Magistrates Court Act
1994 Audit Commission publishes Cheques and Balances
1995 Core and Ancillary Tasks Review – Final Report
1996 Final Report on the Cassels Inquiry, Audit Commission publishes Streetwise, Police Act
1997 Police Act – Creates PITO and NCIS
1998 Crime and Disorder Act
1999 Stephen Lawrence Inquiry report
1999 Patten Report – future of Policing in Northern Ireland
2000 Regulation of Investigatory Powers Act
2001 Criminal Justice and Police Act, Cantle Report, Clarke Report, 2001 Home Office White Paper – Policing a New Century, Private Security Industry Act
2002 Police Reform Act‐National Policing Plan, PCSO’s introduced IPCC established
2003 Bichard Inquiry, HO Green Paper‐ Policing: Building Safer Communities together, Anti‐Social Behaviour Act
2004 National Policing Plan 2005‐2008
2005 HMIC report on workplace modernization, HO report – Neighbourhood Policing
2005 Prevention of Terrorism Act, Serious and Organized Crime and Police Act
2006 Terrorism Act, Police and Justice Act (Establishes the NPIA)
2008 Flanagan Report
2008 Policing Green Paper §§1501, 10106; HCER A §§1002, 1004
Your New Health Care System
§3021
§5605
§3403, 10320
§6301
§6301
§8002
§1411
§4002
§1411
§8002
§8002
§8002
§§1311, 10104
§§1311, 10104
§§1341, 10104
US
Territories
§1323; HCERA: §1204
§1323; HCERA §1204
§1323; HCER A: §1204
§1001
§1322
§1313, 10104
§1313, 10104
§1322, 10104
Private
Purchasing
Council
§1322
Internet
Portal
§1311
§§1201, 1301,1302, 1311, 1312, 1313,
1321, 1323, 1334, 1411, 1413, 10104;
HCERA §1204
§1561
§2602
§1001, 10101
§1311
§1311
MEWA
Health Plans
§§1201, 1301
§1511
§1512
§1311
Medicare
Beneficiaries
State/Territory with
Expanded Authority/
Responsibility
Money Flows
Consultation/Advisory/
Info Sharing
Structural Connections
(Includes Existing)
Special Interest
Provisions
Oversight
§§1421,
10105
10%
Tax On
Indoor Tanning
Services:
§1512
§§9017, 10907
§§9017,
10907
§9013
Flexible Spending
Arrangement
§9005, 10902; HCERA §1403
§§9005, 10902; HCER A §1403
FSA
Contribution
Limit: $2,500
§§9005, 10902;
HCERA§1403
Patients
Only
Medical Expenses
Above 10% of Income
(AGI) are Tax
Deductible
§§9010, 10905; HCERA §1406
Other New Trust Funds/
Monetary Benefits
Unchanged
Private Entity
§1512
§§9015, 10906;
HCERA §1402
§1421, 10105
§9003
Small
Business
Health Insurance
Tax Credit
Small Business
Employees
Individuals
Mandates, Regulations,
& Taxes
§§1311, 1411, 1501, 9003-9005, 9013,
9015, 9017, 10106, 10902, 10906, 10907;
HCERA §§1002, 1004, 1402, 1403
New Relationships
Regulations/
Requirements/Mandates
Reporting Requirements
§9002
Represents Bundles of
Additional Entities
Government Financial
Entity with New Inflows/
Outflows
Private
Private Entity with
New Mandates/
Regulations/
Responsibilities
§§1304, 1311, 1421, 1512,
10105
§1501
Other Expansions
Trust Fund
(Rationing Potential)
Government with
Expanded Authority/
Responsibility
§1511
HCERA §1402
§§9015, 10906; HCERA §1402
§3311
Expanded Government
§1513, 10106
§1512
Taxes & Monetary Fees/
Penalties/Cuts
Small Employers
§§1511, 1512, 1513, 9001, 9002,
10106, 10901; HCERA §§1003, 1401
§1511, 1512
3.8%
Investment
Income Tax
§9004
Medicare
Payroll Tax
Increase: 0.9%
§1301
Mandates, Regulations,
& Taxes
Large Business
Employees
§§1501, 10106;
HCERA §§1002, 1004
§3311
Mandates
Involvement in Health
Insurance Market
§§1514, 10106
Misuse of
HSA Funds
§3004
§3004
§3004
New Government
Rationing Potential
§§1513, 10106; HCERA: §1003
§1511
Individual
Mandate:
Buy Health
Insurance
§§9001, 10901;
HCERA §1401
§§1001, 10101
§9004
§3311
§3311
§3004
Health Insurance
Policy Holder
§§9003, 9004
§§1001, 10101
HSA
Use Restriction
Self-Insured
Health Plans
Employers
§§9001, 10901; HCERA §1401
“Cadillac
Plans” Tax
Health Savings
Accounts
“Excessive
Profits”
Premium
Tax Credit
Subsidies
§§1401, 1412, 10105;
HCERA §§1001,
1004
§9002
§1511
§§9001, 10901; HCER A §1401
§§1001, 10101
HCERA §1402
§2701
§3301; HCERA
§1101
§§1402, 1412;
HCERA
§1001
§§1304, 1511, 1512, 1513,
1514, 10106
§1411
§2701
Medicaid
Quality
Measurement
Program
Subsidy:
Medicare Part D
Drug Program
“Donut Hole”
§3007
§3004
§3004
§3004
§3004
§3004
§1342
§3301; HCERA §1101
Subsidies:
Out-of-Pocket
Expenses
§9003
§§3201, 10318; HCERA
§1102; CBO Cost
Estimate,
3/20/10
§3311
§§9010, 10905;
HCERA §1406
W2
Health
Insurance
Disclosure
§§1513, 10106;
HCERA §1003
Large Employers
§§1201, 1301, 1511
Mandates, Regulations,
Required Benefits, &
Taxes
§§1001, 1201, 1252, 1301, 1334, 1341,
3311, 9001, 9010, 10101, 10104, 10901,
10905; HCERA §§1401, 1406
§§1001, 10101
Medicare
Prescription Drug
and MA-PD
Complaint System
§2701
§3004, 3005
§2701
§2701
Title III;
CBO Cost Estimate,
3/20/10
Medicare
Advantage
Cuts: $205.9bn
Hospital
Quality
Reporting
Program
Annual Fee
§2701
StateSpecific Adult
Health Quality
Measures
(includes MA cuts)
Tit le I II
§§3201, 10318; HCERA §1102
Title III, §2602
§3311
§§9010, 10905; HCER A §1406
§§1401, 1412, 10105; HCERA §§1001, 1004
§§3007
§§2602, 2701, 2703,
3011
Medicare
Cuts: $528.9bn
§2701
Medicare
Hospital
Compare
Website
§3001
Physician
Value-Based
Payment
Modifier
§§3007
Medicare
Part C & Part D
Insurers
§2701
Physician
Quality
Reporting
System
§§3002, 10327,
10331
§§2001-2004
CBO Cost Estimate,
3/20/10
§3022, 10307
Employer
Mandate:
Provide Health
Insurance
§1511
Large Group
Market
Health Insurance
Companies
§3311
State
Medicaid
Agencies
§2701
§3005
§3005
§3005
§3004
§2602
§3005
Long-Term
Care Hospitals
§3004
§§3002, 10327, 10331
§§3002, 10327, 10331
§§3004, 3005
§§3001, 10335
PPS-Exempt
Cancer Hospitals
§3004
Inpatient
Rehabilitation
Facilities
§§1311, 3002, 3003, 10327, 10331
§2703
§2703
Medicaid
Expansion:
+16 million
§§3022, 10307
§3001
§3311
Hospice
Programs
§3007
Physicians
§§3006, 10301
Public Data
Disclosure
System
§3006,
10301
§3006
Hospital
Value-Based
Purchasing
Program
Title II; §§1413, 3011
§§12 01, 1301, 1304
Mandatory
Worker AutoEnrollment
§1301, 1304, 1342
§§1514, 10106
§§1402, 1412; H CER A §1001
§§3001, 10335
§§3001, 10335
Medicare
Administrative
Contractors
§§1311
Demonstration Program
§3001
§§3001, 10335
Hospitals
§§1311, 3001, 10335
Medicaid/
CHIP
FFS
Accountable
Care
Organizations
Program
§§1301, 6605
Small Group
Market
§1201, 1301, 1304, 1342
§2703
Health Industry
Mandates, Regulations,
Taxes, & Payment Cuts
§§1311, 3001-3006, 3311, 9008, 9009,
10327, 10331, 10335, 10904; HCERA
§§1404, 1405
Medicaid
Health Home
Program
§2602
§§2001-2004
NonHospital
Value-Based
Purchasing
Program
§§3006, 10301
§§3006, 10301
§§3006, 10301
§1341, 10104
§§3021, 10305,
10306
§§3006, 10310
§1334, 10104
Skilled Nursing
Facilities
§§3013, 3021, 3026,
3403, 10305, 10306,
10320
Individual Market
§6605
17
§§1201, 1301, 1304
§2703
§§3006, 10301
Medical Device
Manufacturers
CMS
§3021
§2602
§§3022, 10307
§9008; HCER A §1404
§§9009, 10904
§§9009, 10904; HCERA §1405
Ambulatory
Surgical Centers
Center
for Medicare
& Medicaid
Innovation
§2602
§§1311, 1413
4
§3403
Insurance
Mandates
§§1001, 1101,
1201, 1251,
10101,
10103;
HCERA
§2301
§§1001, 10101
Medical
Device
Excise Tax
§§1331, 3403, 10104
§3026
§2602
§2703
5 2 0 3 , 52 0 4 , 5 20 5 ,
5 31 1
§3026
§§3403, 10320
§3403, 10320
Federal
Coordinated
Health Care
Office
CMS
Actuary
CommunityBased Care
Transitions
Program
§3011
§§3021, 10305, 10306
§§9015, 10906; HCERA §1402
Loa n
Re payme nt
& Forgivene ss
Programs
§1342
§3013
§3026
§3026, 6301
§§9001, 10901; HCERA §1401
§1342
Small Business
Health Options
Program
Data
Collection
§1334, 10104
§1513, 10106
Risk
Corridors
§1342
§1411
§3026
Medicare
Part B Trust
Fund
IPAB
Consumer
Advisory
Council
§§3403, 10320
§1321
§§1322, 10104
§1421, 10105
§1411
§1313, 8002,
10104
Health
Insurance
CO-OP
§1322
§1411
Government
Health Benefit
Exchanges
§§1341, 10104
§1001
§1411
§§1501, 10106; H CER A §§1002, 1004
CO-OP
Advisory
Board
§§1322, 10104
§1411
§1411
Eligibility
Determinations
§3001
§§1401, 10105
§§1311, 10104
§§1341, 10104
§§1341, 10104
§§1333, 10104
§§1333, 10104
Reinsurance
Program
§§1301, 10104
Privacy
Study
§1311
HHS
Inspector
General
§1313, 10104
Health
Care Choice
Compacts
NAIC
§§1333, 1341,
10104
§§9004, 9005; HCER A §1402
States
§§1301, 1302,
1311, 10104
§1301
§1411
§8002
§1561
§1331, 10104
§1001
§1001
§1001
Health
IT Policy
Committee
§4302
§1331, 10104
§§1201, 1301, 1302
§1411
§3011
§3013
§§1311, 10104
§6703
§6703
§4302
§3011
§§3013, 10304
§§9001, 10901; HCERA §1401
§1333, 10104
Qualified
Health
Plans
§3026
§3026, 3403,
6301,9015
§§1331, 10104
§1331, 10104
§3011
§3403
Medicare
Part A Trust
Fund
§10407
§§1311,1331,
1333,1341, 10104,
10407
Platinum
§§1401, 3001, 3403, 6301,
10105, 10320
Vital
Statistics
Agencies
§6703
Gold
Value-Based
Insurance Design
& Coverage of
Preventive Health
Services
§1001
§§3011, 3012
National
Health Disparities
Data Collection &
Reporting
System
National
Health Strategy
& Priorities
Office
§3013
Public
Health Quality &
Efficiency Measures
Development
Program
Health
Care Quality
Website
Silver
§1341, 10104
§1331, 10104
§6703
§6703
§4004
§4002
§3011
US
Preventive
Services
Task Force
Health & Human
Services
§3011
§4302
§3011
§§1001,1201, 1301,
1302
Bronze
State
Surveyors
§§1201, 1301, 1302
Secretary
Website
“Transparency
in Government”
§1552
Public
Health
Service
§§3011, 4002, 4302
§4001
§§3403, 10320
§9008; HCERA §1404
§10407
§4305
Advisory
Group on
Prevention, Health
Promotion, and
Integrative and
Public Health
§4305
§3011
§3403, 10320
§9008; HCERA
§1404
§4004
§4001
§430 5
§6301
§6301
Interagency
Pain Research
Coordinating
Committee
4
§4001
§9008; HCERA §1404
Prevention
Website
§4004
§3011
§4001
Other New
Regulatory
Programs
1 1 0 4 , 61 0 2 , 6 10 3
Pharmaceutical
Companies
AHRQ
§4001
§4002
§§1001, 1302, 1311, 1511, 1512,
1513, 6605, 10101, 10106
Rules for
Insurance
Claims Appeals
§§9009, 10904;
HCERA §1405
§3012
§§1331, 10104
Essential
Health Benefits
Package
§3012, 3013, 6031
22
§§1313, 1322
GAO
§1302
§1311
Surgeon
General
§4001
§1001, 10101
Annual Fee
§10407
§4004
§6301
§6703
§4002
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
§4001
Comptroller
General
MedPAC
§2602
Optional
Basic Health
Program
§1331, 10104
§§1311, 10 104
§6703
§6703
§6301
§3012
§3012
§3006
26
§4004
Other New
Bureaucracies
Labor
Department
Home
Health Agencies
§4102
§4004
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
Elder
Justice
Coordinating
Council
Elder Abuse,
Neglect, &
Exploitation
Forensic Centers
§6703
§10407
§1302
§1556
§§9009, 10904;
HCERA
§1405
§1312
§3311
§10407
§2602
§3013
National
Prevention,
Health Promotion,
& Public Health
Council
Prevention
& Public
Health Fund
1 1 0 1 , 1 10 3 ,
§1333, 10104
National
Diabetes Mortality
Statistics Education
Training Program
§§1001, 4003, 4004,
4102, 10407
§1312
1 1 0 2 , 1 2 0 1 , 2 0 0 6 ,3 1 3 7 , 3 20 1 , 3 3 0 1 ,
6 0 0 1 , 9 0 0 1 , 9 0 1 0 , 9 0 14 , 9 0 2 3 , 1 0 2 0 1 ,
1 0317 , 10 323, 1 0324, 105 02, 10601 ,
1 09 0 1 , 1 0 9 0 5 ; H CERA
1 106, 120 3, 14 06
§5605
§8002
Other New
Demonstration
& Pilot Programs
National
Training Institute
for Federal and
State Surveyors
§6703
§4102
CDC
19
Congress
§§1312, 1411, 3311, 5605, 8002
§6703
MultiDisciplinary
Panels on
Improving LongTerm Care
§6703
§6301
§6301
PCORI
Expert
Advisory
Panels
§6301
Hours of Service
Determination
for Calculating
Employer Mandate
Penalty
§5605
Office
of Tax
Analysis
§6703
Advisory
Board on Elder
Abuse, Neglect,
& Exploitation
§6703
§6301
PCORI
Trust Fund
§6301
IPAB
§4004
§§4305, 6301,
10409
§4004
§1334, 10104
NIH
§10409
§6301
§6703
Black Lung
Benefits Act
§§1513, 10106
National
Partnership on
Prevention &
Health
Promotion
§10409
PCORI
Methodology
Committee
§§6301, 10602
Justice
Department
§4003
§3012
PCORI
§1334, 10104
§3012
§4003
§10409
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
§§1331, 10104
National
Diabetes
Report Card
Program
§10407
National Oral
Health Public
Education
Campaign
§4004
Cures
Acceleration
Network
§6301
Interagency
Working Group
on Health Care
Quality
§8002
§6301
§6301
Congress
Members
& Personal Staff
Mandate:
Only Exchange
Coverage
Special
Interest
Provisions
§5605
§§1331, 10104
§6703
National
Public Education
Campaign on
Prevention & Health
Promotion
Commission
on Key
Indicators
Key
National
Indicator System
Implementation
Institute
§§1401, 1402, 1411, 1412 1414,
1421, 1501, 9004, 9005,
10105, 10901; HCERA
§§1401, 1402
§§1311, 1331, 4002,
8002, 10104
§8002
§8002
Cures
Acceleration
Network
Review Board
§10409
PCORI
Website
§6301
§6301
Treasury
Department
§§1513, 10106; H CER A §1003
§9002
§3012
§6301
PCORI Board
of Governors
10 32 3 , 10 3 33 ,
10 40 8 -1 0 , 10 41 3 ,
10 50 1 , 10 5 03
CLASS
Independence
Benefit Plan
§8002
Community
Preventive
Services Task
Force
§8002
Office of
Multi-State
Qualified
Health Plans
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
§5605
§§3103, 10320
§3403, 10320
CLASS
Program
§8002
CLASS
Independence
Fund Board of
Trustees
§8002
Personal
Care Attendants
Workforce
Advisory Panel
§8002
§8002
§8002
§8002
4 2 02 , 4 30 4 , 5 1 02 , 5 20 6 ,
§8002
§8002
§8002
§8002
§1411
§§1334, 10104
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 ,
§8002
§8002
CLASS
Independence
Fund
§3403, 10320
State
Protection &
Advocacy
Systems
Social
Security
Administration
Office of
Personnel
Management
IRS
Other New
Grant Programs
§5605
§§ 3012, 3024, 3403, 4001,
8002, 10320
Eligibility
Assessment
System
CLASS
Independence
Advisory
Council
Life
Independence
Accounts
§5605
§5605
National Academy
of Sciences
§1414
§1411
§1312
President
§5605
§8002
Homeland
Security
Department
§9013
§§1401, 1412, 10105; HCERA §§1001, 1004
AGI: Adjusted Gross Income
AHRQ: Agency for Healthcare Research and Quality
CDC: Centers for Disease Control & Prevention
CHIP: Children’s Health Insurance Program
CLASS: Community Living Assistance Services & Supports
CMS: Centers for Medicare & Medicaid Services
CO-OP: Consumer Operated & Oriented Program
FFS: Fee-for-Service
FSA: Flexible Spending Arrangement
GAO: Government Accountability Office
HCERA: Health Care & Education Reconciliation Act
HHS: Health & Human Services Department
HSA: Health Savings Account
IPAB: Independent Payment Advisory Board
IRS: Internal Revenue Service
MA-PD: Medicare Advantage Prescription Drug
MedPAC: Medicare Payment Advisory Commission
MERD: Medical Early Risk Detection
EALORS: Executive Auxiliary Linked Office Regional Systems
MEWA: Multiple Employer Welfare Arrangement
NAIC: National Association of Insurance Commissioners
NIH: National Institutes of Health
PCORI: Patient-Centered Outcomes Research Institute
PPS: Prospective Payment System
§§1402, 1 412; HCERA §1001
Patient Protection & Affordable Care Act, P.L. 111-148;
Health Care & Education Reconciliation Act, P.L. 111-152
Prepared by: Joint Economic Committee, Republican Staff
Congressman Kevin Brady, Senior House Republican
Senator Sam Brownback, Ranking Member
10
Myron Rogers Master Class 17th September 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 11
Myron Rogers Master Class 17th September Dupont, Belle, West Virginia a.k.a., CHEMICAL VALLEY
NIMBY
What is the source
of safety?
12
Myron Rogers Master Class 17th September A living system
preserves its identity.
It will change
in order to preserve it.
© Myron Rogers, Margaret Wheatley, 1998
A living system
preserves its
pattern of organization…
its network of relationships
The Phenomena of Organization:
Structure
Policy
Procedures
© Myron Rogers, Margaret Wheatley, 1997, 2002, 2010.
13
Myron Rogers Master Class 17th September Emerge from the Dynamics of Organizing:
Identity
Information
Relationships
© Myron Rogers, Margaret Wheatley, 1998
Which create the capacity for change
and organization
Meaning
Action
Trust
© Myron Rogers, Margaret Wheatley, 1998
Structure
Identity
Systems
Processes
Information
Relationships
Meaning
Action
Trust
14
Myron Rogers Master Class 17th September Identity
Actions 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
© Myron Rogers, Margaret Wheatley, 2005
15
Myron Rogers Master Class 17th September Creating the capacity for change
Myron’s Maxims
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
Thus the work is to enter
into a world of
shared significance.
Francisco Varela,
neurobiologist
© Myron Rogers, 2005
16
Myron Rogers Master Class 17th September © Myron Rogers, 2005
© Myron Rogers, 2005
© Myron Rogers 2005
17
Myron Rogers Master Class 17th September For inquiring minds:
What are the conditions we need to create?
How can we create them?
Who needs to create them?
…to create the capacity
for people to do for themselves
most of what has been
done to them.
© Myron Rogers
The Three Commandments
• Know Thy Students
• Know Thy Practices
• Personalize Thy Instruction
18
Myron Rogers Master Class 17th September Our action research project…
How do we create the capacity for collective change?
19
Myron Rogers Master Class 17th September 20