The tumult and the shouting dies;
The Captains and the Kings depart:
Still stands Thine ancient sacrifice,
An humble and a contrite heart.
(Rudyard Kipling, Recessional, 1897)
It’s been almost two weeks since the attendees and speakers of Mayo Clinic’s Transform Symposium wound up conversations and dispersed to their day jobs as physicians, internet researcher, writers, caregivers, engineers and business people. The Captains, Kings and Queens have all departed and still the humble and contrite heart on which all health(care) is based, remains. Waiting, still waiting, for something to change.
A fine colleague of mine, Dr Gwyn Barley, asked me the other day what I had seen or heard in terms of what symposium participants the future of health(care) would/should/could be. I had been turning this over in my mind for the last ten days or so, after I asked Transform’s lead facilitator and chair, Dr David Rosenman (@davidrosenman) of Mayo Clinic, how he would know the impact of the conference. You know the feeling after you’ve attended an inspiring and inspired meeting of people with extraordinary minds and energy? You’re all charged up, want to go out there and JUST DO SOMETHING TO CHANGE THE WORLD. But the world makes itself present almost immediately before you can marshall and direct all that energy to start something new. So I wondered what we would all achieve, all 500 of us at that conference, in the next 12 months that would flow directly from that conference and into health in everyday life.
Two words came to mind – BEHAVIOR MODIFICATION. Now, I am not just talking about us changing all those things that eat away at our health – the non-exercising, the non-sleeping, the non-eating right….. the list is endless. I mean behavior modification at a systemic level (which of course requires us relinquishing all those non-activities I just mentioned). Behavior modification like that desired by…
The Critical Thinkers, such as…
Esther Dyson (@edyson), who just wants us to check our facts and ask critical questions, of everyone and everything, especially ourselves when it comes to health.
Alice Tolbert Coombs, who wants us to consider ourselves resourceful, empowered and literate so we can ask serious questions about procedures, qualifications, experience, and the impacts of all of these for our health.
Tahir Amin and Priti Radhakrishnan, who drive I-MAK and want us all to participate in the patent system, encourage real innovation and support lawful and legitimate trade in generic medicines.
Jamie Heywood (@jamie_heywood), better known as the cofounder of PatientsLikeMe, who wants us to ask this inspiring question, “Given my status, what is the best outcome I can hope to achieve and how do I get there?” And to keep asking it, of everyone, in our quest for care and health.
Macharia Waruingi, a global health revolutionary, who demands we check our facts, our research methods, and our researchers and to critically examine all outcomes, knowledge and practices flowing therefrom because as he argues, people know more than they can tell and we have a responsibility to support their voices so we may have health on all our terms.
The Care Collectivists, like…
Sanne Magnan, who wants us to connect health systems to environmental and community systems and to think collectively and holistically about all the forces that produce good health.
Patch Adams, who urges us to embed compassion into caregiving practice and to consider health as a collective commodity and of collective origins so the source of our health as those being cared for is directly related to and impacted by the health of those providing that care.
Rebecca Onie, Sonia Sarkar and the crew at Project Health, to whom I am going to send as many college students as possible, dedicated to providing assistance and advocates for those in need of basic resources, also known as the social determinants of health in communities.
Sona Mehring of CaringBridge which I believe should just be as ubiquitous as Facebook for all the unending care it provides for those in need, and which urges us once more to consider the care giver and their overall health as they attempt to support others.
Mrs Q (@fedupwithlunch), blogger heroine of the school lunch movement and avatar after my own heart, who believes we should ask more questions about where the food going into our kids comes from, not to mention the generational impact of same on population health.
Thomas Goetz (@tgoetz), who believes in the power of positive data to change our decisions and courses of action; to make our health, our own story.
Sidna Tulledge-Scheitel, dedicated to figuring out how to support people for all the minutes of their life not spent in their primary care practitioner’s office through the use of community based technologies.
Sharon Gibson of Cisco who co-led and re-directed a lifeconnections center in San Jose based on employee desires for innovation, health and sustainability and who believes that we need to be discussing health and people and not healthcare and patients. RIGHT ON.
The Transformative Technologists of…
Catherine deVries, who advocates for community appropriate technology (a la Atul Gawande); technology which is disruptive because it is energy efficient and flexible, not to mention extremely affordable. After all, developing communities should not be the technology landfill for more advanced industrial nations and healthcare systems.
Susannah Fox (@susannahfox), Internet Geologist Extraordinaire, who wants information to come to where we are and be portable, personalized and most importantly, and participatory. NOW.
John Wilbanks (@wilbanks), Game Changer, who makes us think about fundamental choices around our use of the Inter-net (check out Wired’s article on the Web is Dead) and the radical divides that we still struggle and need to work on as we try to harness our technological gifts for health. The answer is not anonymity by the way (c.f. PatientsLikeMe). I’m a HUGE supporter of Creative Commons, so of course, John is one of my new heros.
Ian Eslick (@ieslick), patient narrative advocate (hooray!), who wants us to expand our understandings of science, like Macharia, to include all voices and to take diverse forms of knowledge seriously in order to support health in specific populations.
Sandhya Pruthi, who in 15 minutes taught me a lot about breast cancer via a computer based education tool and to David Rosenman’s point, in that moment, transformed a future health story.
Dean Ornish, who I really need to email or google to find his awesome work on the power of sustainable changes in diet and lifestyle as treatment for some of our more troubling chronic conditions like heart disease. I need to distribute that information through my family, stat.
The Daring and Disruptive Designers such as…
Patricia Moore, design heroine, who wants to shatter the myths we have about the elderly and like many designers, wants us to reconsider how design excludes and fails many demographic groups. I bow to her as an ethnographer for her awesome work traveling the country as an elderly woman for 3 years to ground her practice.
Jesse Dylan, artist, open source warrior and defender of citizen rights who wants us to demand true innovation as do the folks at IMAK, and to reinstate collaboration as many others argue, as central to the discovery of transformative practices and products for health.
Sekou Andrews, Disruptive Designer of the Social, wielding the power of words and performance, reminding everyone of the importance of inter-action and small children in our continued and necessary re-education in the importance of paying attention to the world, free of our stupefying adult minds.
Robert Fabricant (@fabtweet) and all the crew at frog design, believers and curators of white elephants who continue to ask how we can encourage people to move towards sustainable behavior through design and what engagement looks like. After his presentation, I tweeted Carlos Rizo(@carlosrizo) and Mark Scrimshire (@ekivemark) who run healthcamps on how to embed a health-hack-a-thon into a healthcamp.
Jill Morin and James Rasche of Kahler Slater who advocate for Total Experience Design and ask us what experiences should define us and how design can make them manifest.
Michael Celender, Lew McCreary, Lorna Ross and Chris McCarthy, who collectively and individually believe in the power of finding others who think differently and encourage collaborative design between individuals, departments and organizations, so that we focus on a patient’s potential not need when designing something for them. All to ultimately design better organizations.
David Rose of Vitality (@davidrose), for whom I ate M&Ms for an experiment on glowcaps, one of his range of enchanted objects (love that term!). We all need enchanted objects to help take care of ourselves and as a not normally compliant person, the cap actually worked! David thinks about the user and then some. Just amazing.
Finally, the Place-based Progressive Practitioners (you know who you are)…
Lyle Berkowitz, who wants us to think differently about electronic medical records and puts in place actionable, context sensitive screens and widgets in his dedication to the user. Lyle also patiently kept me geographically oriented during our 2 hour tour of the Clinic, when all the buildings and statues began to merge into one and minus the mountains of the west, I wandered around in circles. ROCK STAR.
Tye Farrow of Farrow Partnership Associates, who architects some of the most jaw droppingly beautiful health facilities I have ever seen. His dedication to taking unnatural environments and transforming them into regenerative contexts will blow your mind. He builds hope, on a large scale, and through his medium, health.
Chaki Ng, who building on Susannah’s directive for information to go where you are, takes this and technology together to make health interactions go where people are, in our own ‘streams’, both individually and organizationally.
Sharon Schindler Rising, Centering Healthcare Institute, whose idea and stories of moving care into groups almost made me cry. Her dedication to activating self care, community building, and empowerment on an everyday level of health, I know, transforms lives. Her profound belief in collective wisdom, like many others above, and her individual commitment to honor it and put it into action, make a mother like me want to clone her and have one of her sites for CenteringPregnancy in every single town!
James Levine of Mayo Clinic and Muve was just awe-inspiring although I found the treadmill office desk a little unnerving. His work on making us move, all the time for health, deserves a medal as he addresses all those non-activities I mentioned earlier and really asks us to make some concrete changes. NOW. EVERYWHERE.
I know what you’re thinking. That’s a lot of smart, creative, dedicated people, right there. And that was only the speakers! We should be able to transform health, right? Maybe it won’t happen in 12 months. Or maybe, just maybe, if each one of us took the spirit and ideas of these people and just did one thing, before we had to front up next year in Rochester, something might shift. 500 people is a lot of people and as Margaret Mead would say, “never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”
But how will we know? Oz Huner of NexJ and I wondered about whether if we had an unconference for the first part of the conference, chose some projects and then aligned all this talent against them, we might have some kind of longer term working groups come up with things transformative. But maybe that is not disruptive enough. Maybe there is power in just sending these ideas into the either so that they find their way into other people’s hands, hearts and minds, like they did ours. Maybe that in and of itself, attracts the critical minds of caring collectivists and transformative technologists who as soon as they meet a disruptive designer might just come up with a place based progressive practice.
So what will I do over the next 12 months (beside working with clients) to play my part in transforming health(care)? Here’s a few thoughts, and feel free to hold me to them in 12 months…:)
1. Work with a very dear physician colleague-mentor of mine who is soon to retire to bring his dream of telehealth and clinical genetics practice to rural areas to fruition. If you know of anyone who can help, please have them email me!
2. Participate in innovating clinical skills education in a closed system/employee physician organization to begin to transform the ways in which care is communicatively performed in current and future practicing physicians. If you know of an organization up for the challenge, I’d love to hear from you 
.
3. Start a micro journal where those with new, innovative, and creative ideas for improving clinical practice and health via participatory technologies can share their ideas with a wider audience outside traditional, mainstream publication venues. Keep watching this space!
That should be enough for the year, don’t you think? So what are you going to do? What changes would you like to see coming into and out of the Transform Symposium?
Remember, your children are watching and as Sekou reminds us, coming….
When the captains and the kings/queens depart, remember the humble and contrite heart of health…
With special thanks to luc.viatour, Horia Varlan, Jeff Kubina, lrargerich, fdecomite and Mara~earthlight~ for their phenomenal images!
Kirsti
Ah, the spaces in between. In between visits, in between patient and provider, in between colleagues, in between families. In between forms of clinical care also = old and new schools of medicine, for example.
collaboration and contestation? If we were comfortable with that frame? Perhaps we could get a better understanding of the complex negotiation and understanding of health and the body.Perhaps we would build a new architecture for organizing health and care so all ‘stakeholders’ (read individuals, families, community members, colleagues etc) could connect, re-connect and exist in partnership with each other. 
relationship with their specific doctors that could be considered “connected.” But a sizable minority did not. Steven J. Atlas, MD, lead author and co-director of primary care quality improvement at 
