http://www.marketplace.org/topics/life/health-care/rethinking-hospital-readmissions

This is a wonderful story about a community health worker and how she did in two weeks what six years of therapy and hospital treatment did not do.

All those hospital visits, oxygen tanks, the X-rays, the MRIs, the CAT scans — the Veterans Administration picked up the tab for all of it….Within two weeks [of meeting Mary, community health worker], Joe started going to a community senior center that Mary introduced him to. A month later he was teaching classes there — one in drums, the other in computers. Those two weeks did what six years of therapy and no-smoking programs and nicotine patches couldn’t do.

 

The average cost of a hospital admission in around $10,000. Joe was going monthly.  For six years.  This cost the Veteran’s Administration, and the federal government/taxpayers, nearly 3/4 of a million dollars.  IF the community health worker is paid a generous $50,000 a year, her two weeks with Joe would have only cost around $2,000.

If Joe had been introduced to the community health worker after the first year, the savings would have been  $600,000, or a return on investment of 300:1 !!!

Medicare spends $17 BILLION a year on hospital “cycling” – chronic readmissons.  Yet we know that all healing has a social component and the need for hospital readmission can be significantly reduced by connecting people to a community – not to receive cheaper services, but to make friends, contribute skills and talents, and become full members of a community.

Until now there has been no incentive for hospitals to do this.  They are paid to keep beds full and procedures abundant.  The new health care law will start to fine hospitals for excessive readmits.  But why wait until hospitals have to pay fines to start saving money and increasing health with the use of social capital in the form of community health workers?

This may sound like a “soft solution” or “kumbayah” talk, but a 300:1 financial savings is very, very real.

Recently, I was in a meeting.  A painful meeting.  It took nearly three hours to accomplish what could have been done in 15-20 minutes.  You have been there too, remember?  The meeting that generates 3 pages of doodles and a grocery list in addition to whatever the actual meeting content was.

In my meeting I tired of doodling. I’m not artistic and only have about four shapes I can draw..  So, bored and with no end in sight, I decided to start a list of things that were making the meeting last so much longer than necessary.  I published the first four last November – http://www.pacificcommunitysolutions.com/blog/.

You should go back and read my amazing insights into these four techniques for making meetings last longer, but to summarize, they are:

1. Make sure no money or resources are at risk.
2. Eliminate accountability.
3. Make sure everyone has access to their email and mobile devices.
4. DO NOT define the meeting’s desired outcomes at the beginning of the meeting.

For those who mastered these techniques yet, like Dilbert, have returned to your desk and had to do actual work, here is the long awaited second installment:

5. Squash creativity.  This is advanced stuff.  Obviously focused creativity is efficient and productive.  Steve Jobs and Google proved it.  So to make a meeting stretch out beyond its usefulness, make sure there is no place on the agenda for the group to brainstorm, offer new ideas or create solutions.  When there is no obvious place for participants to contribute their ideas, they will find a way to get them into the discussion.  This will take the meeting off agenda multiple times and extend its length.

6. Use the phrase “this is something we should discuss at some point.”  This works to create more meeting time in several ways.  Right away it splits the group into three parts: those who want to discuss this now, those who are relieved this was postponed, and those who don’t care.  Mathematically, the utterance of this phrase creates six (6) different directions the meeting can go!  AND, as a bonus, it gives every participant a topic for which to call a future meeting!  Extend the length of the current meeting and create the need for another meeting all with one phrase!  Brilliant!

7. Finally, add a meeting outcome or goal at the end of the meeting, and call a follow up meeting to accomplish that goal.  This works a bit like #6…it creates a time warp in the meeting by simultaneously creating space for people to talk about the subject now, but not have to move toward resolution or decision-making until later.  Since everyone knows that the decisions will be made another day, they don’t have to limit their expressed thoughts to those that are constructive or move the group towards a decision.  By adding this outcome at the end of the meeting and indicating that the decisions will be made at a follow up meeting, you ensure that the discussion will not focused, but rather include every thought participants have on the matter.  This will certainly extend the time you have with your colleagues.

That’s all for now, I have a meeting to get to.

This summer I a spent a week observing life in and around The Falling Rock
Cafe in Munising, Michigan.  No, I did not receive a MacArthur Grant or other
fellowship for observing coffee shops, although if you know of any I would love
to apply.  I was there visiting family.  But I was struck by the communities
that have formed in and out of this little establishment.

The Falling Rock Cafe and Bookstore is a sandwich/coffee shop/ice cream place
with a bookstore and community space attached.  The owners have put in tables
where groups as large as 15 can gather and meet.  They also have several picnic
tables and other places where smaller impromptu groups can strike up
conversations.  The Falling Rock serves up coffee and treats and sells books,
but they also create space for and welcome community.  The results are amazing.
By simply creating space and providing basic hospitality, the Cafe has created
a spot for many groups and asset based networks to meet and plan activities and
projects.  This has created connections across groups that otherwise would never
have discovered their mutual interests.

How did a coffee shop become a hub of community connections?  It seems to be
the little things that matter.  Furniture placements and a welcoming environment
certainly provide a great start!  I don’t think a saw a “NO” sign anywhere.  Of
course the proprieters would prefer if people who use the space buy some
goodies, but it is not a requirement.  They probably are required by health code
to insist that each of us wear a shirt and shoes when we come in, but that is
not the first thing they tell you when you approach the door. In fact, the Cafe
staff are more part of the background music to the main stage of neighbors and
tourists interacting and sharing observations about the news, weather or
coffee.

When you walk in the first thing you notice are the mugs.  Coffee mugs.  All
over the walls.  Anybody can pay $25 a year to be a member of the mug club – you
get your own Falling Rock logo mug, your own peg to hang it on, and coffee for
1/2 price all year.  A good deal?  Yes.  Is that why people buy it?  No way.
They buy it because it gives them something that is theirs each time they walk
in.  AND, that something hangs among their neighbors mugs as well as those
bought by regular visitors to the area.  There are 2,000 people in town and 300
mugs on the walls of The Falling Rock Cafe and Bookstore.  Each one with a
neatly printed name under it.  It is YOUR mug.

The mugs make a beautiful sight that says “there is a community here” as soon
as you walk in.  But if you stand there for 5 minutes you realize something else
is going on.  There are slips of paper in some of the mugs.  It turns out that
these slips of paper are articles from newspapers or magazines that one member
thought would be of interest to another.  Others are notes from one to another.
The owner tells me the customers invented this practice and call it “cup mail.”
My curiosity was too much, and I could not think of any federal penalties
associated with tampering with cup mail,….so I peeked.   “Jenny will be in
town this weekend.  Stop by!”, “Fred wants to go out on the lake when he gets
back, wanna fish?”,  “Are you helping at the Farmer’s market this week?  Call
me.”

The second thing I noticed was an abberation.  One cup had a newspaper
article taped to the outside instead of rolled up on the inside.  It was an
obituary.  I asked the owner about it.  Turns out that the obituary was for the
owner of the mug and her family asked to keep it there in her memory.

“What about the hat?”  There was a mug on the top row of one wall mostly
covered by a stocking cap with some momento pins in it.  “That was El’s hat.  He passed away last year and his wife  keeps the mug membership.  He wore
that hat everyday.”

People are so connected by their mugs and associations made in this cafe that
they stick around after they are gone!

From cup mail to book clubs to the local art’s association’s planning for the
summer art fair, the Falling Rock Cafe and Bookstore is cooking up community as
well as coffee and cupcakes.  And it is doing it by creating space and
hospitality, not through programming or pontification. In other words it is
facilitating the community’s efforts to create their own connections and
networks.

Posts: The Economics of Neighborliness (05-25-2011) – Abundant Community.

I am often asked to work with organizations that want their programs to be more effective.  Sometimes it is at the beginning and they are planning for effectiveness.  Always the best case scenario.  Sometimes it is in the middle after struggling, staff turnover or a funder “suggesting” changes.

Regardless of whether the program is an organizing project intended to empower people or a service program intended to provide a service, the key to improving effectiveness always starts with involving the effected people.  Organizations often rely too much on staff meetings, “stakeholder meetings” that  are meetings of staff from several organizations, or something they read in a “best practices” article.

These approaches often produce a program with less than satisfactory performance.  This is becasue they rely on program design and so-called “logic models” based on the best thinking of staff – which in most private non-profit organizations means a few people at most.  Staff members are usually dedicated and smart people, but they often are not the “target” of the program.

Without asking the potential customers what they want, what they will use, how they would access a program and what would motivate them to get involved, the program is a prototype.  Once a prototype is developed staff and volunteers are put in the position of having to “sell it.”  Nonprofit staff often wrap up the seemingly crass notion of selling their services with phrases like “get people involved,” “engagement” and “outreach.”  But what it means is “get people to use this program we came up with.”

This leads to frustration on the part of staff, who want to make a difference, and to minimal program effectiveness.  In the worst cases it leads to false hope, broken trust and/or disillusioned people amongst those the program was intended to help.  Yes, poor program design can not only do minimal good, it can do damage in a community.  So, if an organization doesn’t want frustrated staff and mediocre program performance, what SHOULD it do.

Here are a five basic principles for planning programs that will be effective.

1. People Power.  Program effectiveness has everything to do with how empowered the people are who participate in the program.  Programs are made of people, not logic models.  Logic models can be very helpful, but they do not make a program effective.  The people implementing the logic model make it effective.

2. “Not about me without me.”  This phrase has emerged out of the Inclusion Network .  The truth of the phrase in this context is that programs that organize people or provide services to people do much better when they do it WITH the people they intend to benefit.  If I am at the table planning and implementing something I WANT, then you don’t have to sell it to me.  I will be doing the “outreach” and “engagement” with more authenticity and effectiveness than any staff member could.

3.  There are no best practices.  There are promising practices. Every successful practice should be analyzed to uncover what will work in “our context.” Replicate what makes sense in a way that makes sense here, and dump the rest.

4.  Stop consumerism. As long as programs are designed so that the role of individuals is to consume services, they will have inherently finite effectiveness.  The consumer model of program delivery requires that the program can only be improved or expanded by adding staff and financial resources.  A participant driven model can go many directions and expand itself, sometimes exponentially, without adding additional staff.

5. Start by building on what you have. Many programs start by assessing needs and deficiencies.  Then people gather around to design a program with a logic model that will “meet” those needs.  The problem is that there has never been a need that solved a problem.  Programs that are built from existing strengths, resources and assets are more sustainable, reduce needs, and require fewer outside resources to be effective.

Some of this is fairly simplistic, but programs designed with these guiding principles in mind will be more effective and more sustainable than programs designed around the traditional consumer/recipient model.  Powering people creates effective programs.