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Myron Rogers Master Class 17th September
1
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.
Myron Rogers Master Class 17th September
2
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
• Personalize Thy InstructionA History of Systems Theory.
in 15 minutes.
Myron Rogers Master Class 17th September
3
Cybernetics,Living Systems Theory
Socio technical systemsOpen systems
Group DynamicsAction Research
T‐groups
Macy Conferences
Lewin,Lippitt, et alNTL
Trist, Emery,Tavistock
Von Neumann, Wiener, Meade, Bateson, Shannon Forrester, et al
All of this and more in 1947?What was going on?
General Systems Dynamics:
Bertallanfy,
1920
The technology revolution
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…
Chaos and complexity
Emergence
Cognition
Networks
Self-organisation
Working with Social Systems as Living Systems:
The Big Five
Myron Rogers Master Class 17th September
4
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.
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.
From: The Innovators:How a Group of Hackers, Geniuses and Geeks Created the digital Revolution.
‐‐Walter Isaacson
How do systems work?
How doesthis systemwork?
Myron Rogers Master Class 17th September
5
How do we workthe system?
How do I workin and with this system?
How do we know?
Myron Rogers Master Class 17th September
6
Culture eats strategy
“And I really don’t thinkthere is much we can doso it’s not really a factorduring the flight because there is not muchwe can do about it.”
Linda Ham, MMT Leader
What goes on
below the surface
affects the surface
Andy Goldsworthy
Myron Rogers Master Class 17th September
7
Culture is VORACIOUSIt eats…
• Structure• Policy• Procedure• Process• Purpose• Intent
• Oh, and… INNOVATION.
Why do good intentionsgenerate unintended consequences ?
VUCAVolatile Uncertain Complex Ambiguous
Myron Rogers Master Class 17th September
8
If you can find a path with no obstacles it probably doesn't lead anywhere.
The essential need is to seewho we are now based on whatwe do, not what we say about what we do.
Myron Rogers Master Class 17th September
9
What was our intent?
What really happened?
Why did it happen that way?
What have we learned?
What do we keep, create or abandon?
U.S. Army, AFTER ACTION REVIEWS
What are we trying to do?
How do we need to do it? How do we know?
And Who Needs to Do It?
The following courtesy of
Professor Keith Grint, University of Warwick
Myron Rogers Master Class 17th September
10
The NHS: ¼ century of change (AKA Restructuring)1982: Abolition of Area Health Authorities1982‐85: Introduction of general management1985: Creation of NHS Board at the Dept of Health1989‐93: Establishment of NHS Trusts1989‐95: Creation of GP Fundholding & Commissioning1989‐95: Setting up NHS Management Executive (later NHS Executive)1990: Replacement of FPCs (Family Practitioner Clinic) by FHSAs 1991‐97: Reconfiguration of Health Authorities1991: Restructuring of NHS Organisation Boards1994: Reorganization of RHAs (Regional Health Authorities)1994: Abolition of FHSAs & incorporation into Health Authorities1995: Reconfiguration of Acute Services & Trusts1996: Abolition of RHAs, incorporation into NHS Executive1997: Abolition of GP fundholding, replacement with PCGs (Primary Care Group)2000: Abolition of NHS Executive, incorporation into the Dept. of Health2001: 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 Trusts2002: Creation of Health and Social Care Trusts2005: Merger of 300 PCTs into 100 larger PCTs2005: Merger of 28 SHAs into 10 larger SHAs2006: Reorganization of Dept of Health to split NHS and DH responsibilities
Major inquiries and the main legislation affecting policing 1960‐20081960 Establishment of the Royal Commission on the Police1964 Police Act – establishment of the Tri‐Partite Structure for policing1967 Home Office circular encouraging unit beat Policing1968 Lord Denning ruling1976 Police Act1977 Fisher Report1980 Home Affairs Select Committee Report on Sus Laws1981 Royal Commission on Criminal Procedure, Byford Inquiry – The Yorkshire Ripper1983 Home Office circular 114/83 (Financial Management Initiative)1984 Police and Criminal Evidence Act1988 Home Office Circular 106/88 (new management strategies for Police)1989 Publication of the Operational Policing Review1989 Taylor Report on the Hillsborough Stadium Disaster1991 Royal Commission on Criminal Justice1993 Audit Commission publishes Helping with Enquiries1993 White Paper on Police Reform1993 Publication of the Sheehy Inquiry report1994 Police and Magistrates Court Act1994 Audit Commission publishes Cheques and Balances1995 Core and Ancillary Tasks Review – Final Report1996 Final Report on the Cassels Inquiry, Audit Commission publishes Streetwise, Police Act1997 Police Act – Creates PITO and NCIS1998 Crime and Disorder Act1999 Stephen Lawrence Inquiry report1999 Patten Report – future of Policing in Northern Ireland2000 Regulation of Investigatory Powers Act2001 Criminal Justice and Police Act, Cantle Report, Clarke Report, 2001 Home Office White Paper – Policing a New Century, Private Security Industry Act2002 Police Reform Act‐National Policing Plan, PCSO’s introduced IPCC established2003 Bichard Inquiry, HO Green Paper‐ Policing: Building Safer Communities together, Anti‐Social Behaviour Act2004 National Policing Plan 2005‐20082005 HMIC report on workplace modernization, HO report – Neighbourhood Policing2005 Prevention of Terrorism Act, Serious and Organized Crime and Police Act2006 Terrorism Act, Police and Justice Act (Establishes the NPIA)2008 Flanagan Report2008 Policing Green Paper
Other New Bureaucracies
22 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
Other New Demonstration
& Pilot Programs
26 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
Other NewGrant Programs
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 ,
4 2 02 , 4 30 4 , 5 1 02 , 5 20 6 , 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
10 32 3 , 10 3 33 ,
10 40 8 -1 0 , 10 41 3 , 10 50 1 , 10 5 03
Loan Repayment
& Forgiveness Programs
4 5 2 0 3 , 52 0 4 , 5 20 5 ,
5 31 1
Other New Regulatory Programs
4 1104, 6102, 610 3
Special Interest
Provisions
19 110 2, 1201, 200 6, 3 137, 3201 , 330 1,
6 001, 900 1, 90 10, 90 14, 9 023 , 1020 1, 1 0317 , 10 323, 1 0324, 105 02, 10601 ,
1 0901 , 10905; H CERA 1 101, 1103 ,1 106, 120 3, 14 06
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
New Government
AGI: Adjusted Gross IncomeAHRQ: Agency for Healthcare Research and QualityCDC: Centers for Disease Control & PreventionCHIP: Children’s Health Insurance ProgramCLASS: Community Living Assistance Services & SupportsCMS: Centers for Medicare & Medicaid ServicesCO-OP: Consumer Operated & Oriented ProgramFFS: Fee-for-ServiceFSA: Flexible Spending ArrangementGAO: Government Accountability OfficeHCERA: Health Care & Education Reconciliation ActHHS: Health & Human Services Department
HSA: Health Savings AccountIPAB: Independent Payment Advisory BoardIRS: Internal Revenue ServiceMA-PD: Medicare Advantage Prescription DrugMedPAC: Medicare Payment Advisory CommissionMERD: Medical Early Risk DetectionEALORS: Executive Auxiliary Linked Office Regional Systems MEWA: Multiple Employer Welfare ArrangementNAIC: National Association of Insurance CommissionersNIH: National Institutes of HealthPCORI: Patient-Centered Outcomes Research InstitutePPS: Prospective Payment System
§§3001, 10335
§3011
§2602
§5605
§4302
§2602
§2602
§3013
§1411
§§1333, 10104
§§1341, 10104
§1311
§1411
§3006
§2602
§§3403, 10320
§3011
§5605
§6301
§6301
§6703
§6703
§4004
§3403, 10320
§3011
§3311
§8002
§8002
§3001
§1001
§1001
§3403
§3012
§1302
§§9004, 9005; HC
ERA
§1402
§§1401, 1412, 10105; HCERA §§1001, 1004
§§1513, 10106; HC
ERA: §1003
§1421, 10105
§§9001, 10901; HC
ERA §1401
§§9010, 10905; HC
ERA §1406
§4002
§6703
§6301 §6301
§4002
§1341, 10104
§1331, 10104
§§1001, 10101
§3004
§4004
§6301
§6301
§1323; HCERA: §1204
§3026
§3026
§§1311, 10104
§8002
§8002
§§9001, 10901; HCERA §1401
§§9009, 10904; HC
ERA §1405
§9008; HCER
A §1404
§3005
§§9015, 10906; HC
ERA
§1402
§1311
§1322
§3403
§1323; HCERA: §1204
§§1311, 10104
§1313, 10104
§§1331, 10104
§§1401, 10105
§1322
§6703
§§3403, 10320
§10407
§3001
§1331, 10104
§1313, 10104
§3011
§3013
§8002
§§3006, 10301
§§1501, 10106; HC
ERA
§§1002, 1004
§§1402, 1412; HC
ERA §1001
§§1402, 1 412; HCERA §1001
Prepared by: Joint Economic Committee, Republican StaffCongressman Kevin Brady, Senior House RepublicanSenator Sam Brownback, Ranking Member
Patient Protection & Affordable Care Act, P.L. 111-148;Health Care & Education Reconciliation Act, P.L. 111-152
§3004
§1421, 10105
Rationing Potential
Taxes & Monetary Fees/Penalties/Cuts
Other Expansions
Involvement in Health Insurance Market
Represents Bundles of Additional Entities
Mandates
Trust Fund(Rationing Potential)
Other New Trust Funds/Monetary Benefits
Expanded GovernmentGovernment with Expanded Authority/ Responsibility
Government Financial Entity with New Inflows/Outflows
State/Territory with Expanded Authority/Responsibility
New RelationshipsRegulations/Requirements/MandatesReporting Requirements
Oversight
Money FlowsConsultation/Advisory/Info Sharing
Structural Connections (Includes Existing)
Private
Unchanged Private Entity
Private Entity with New Mandates/Regulations/Responsibilities
Special Interest Provisions
§3301; HCERA §1101
§3013§6301
§§1401, 1412, 10105; HC
ERA
§§1001, 1004
§§1331, 10104
Small Business Health Options
Program§1311
NAIC§§1333, 1341,
10104
§3007
HC
ERA
§1402
§1001, 10101
§3311
§2701
§2703
§5605
§2701
§2602
§2703
§3012
§§1513, 10106; H CERA §1003
§1334, 10104
§8002
§6301
§§3004, 3005
§1513, 10106
§6703
§4102
§§1341, 10104
§10407
§10407
§2701
§1334, 10104
§§3022, 10307
§3004§3004
§8002
§§1301, 10104
§1333, 10104
§§1341, 10104
§§1201, 1301, 1304
§§12 01, 1301, 1304
§1342
§1301
§1001
§§1201, 1301, 1302
§1331, 10104
§1302
§§1311, 10104
§1342
§1511
§3004
§1561
§1411
§1342
§3012
§4004
§4004
§4004
§4002
§10409
§1311
§6703
§6703
§3012
§4001
§1512
§1511
§3403, 10320
§4003
§8002
§8002
§8002
§8002
§§9001, 10901; HCERA §1401 §§9001, 10901; HCERA §1401
§§1001, 10101
§9004
§9003
§§9009, 10904
§9008; HCERA §1404
§§9010, 10905; HCERA §1406
§9002
§§9005, 10902; HCERA §1403
§1501
§§1311, 10 104
§§3103, 10320
§1334, 10104
§§1322, 10104
§1333, 10104
§1312
§6301
§3005
§3011
§§3021, 10305, 10306
§3026
§4001
§§3006, 10301
§1411
§4305
§1001
§§1201, 1301, 1302
§1331, 10104
§1341, 10104
§8002
§1513, 10106
§6605
§§2001-2004
§§9017, 10907
§§1501, 10106; HCERA §§1002, 1004
§§9015, 10906; HCERA §1402 §9013
§1511
§1511
§§1201, 1301
§1312
Tit le I II
§§3201, 10318; HCERA §1102
§8002
§§3001, 10335
§6301
§§1311
§§1514, 10106
§1321
§2703
§5605
§§1311, 10104
§6301
§4001
§9002
§8002
§1414
§1411
§2701
§3403, 10320
§6703
§1331, 10104
§2602
§3403, 10320
§1512
§§1514, 10106
§1411
§1411
§§3001, 10335
§3004§3004
§3011
§3021
§3022, 10307
§3026
§2701
§2701
§2701
§2703
§4001
§4302
§3013
§1411
§4004
§6301
§6301
§6703
§3011
§4305
§10409
§3311
§3311
§3021
§3011
§3012
§8002
§3311
§§1311, 1413
§3005
§3004
§1411
§1313, 10104
§§1001, 10101
§5605
§1512
§5605
Qualified HealthPlans
§§1301, 1302,1311, 10104
HealthCare Choice
Compacts§§1333, 10104
Reinsurance Program§§1341, 10104
Value-Based Insurance Design
& Coverage of Preventive Health
Services§1001
Optional Basic Health
Program§§1331, 10104
GAO§§1401, 3001, 3403, 6301,
10105, 10320
Comptroller General§§1313, 1322MedPAC
§2602
States§§1311,1331,
1333,1341, 10104, 10407
State Surveyors
§6703
Vital Statistics Agencies
§10407
US Territories§1323; HCERA §1204
KeyNational
Indicator System Implementation
Institute§5605
Commission on Key
Indicators§5605
National Academy of Sciences
§5605
CongressMembers
& Personal Staff Mandate:
Only Exchange Coverage
§1312
NationalTraining Institute for Federal and State Surveyors
§6703
AHRQ§3012, 3013, 6031
EssentialHealth Benefits
Package§§1001,1201, 1301,
1302 PlatinumBronze
Silver Gold
Government Health Benefit
Exchanges§§1201, 1301,1302, 1311, 1312, 1313, 1321, 1323, 1334, 1411, 1413, 10104;
HCERA §1204
Internet Portal§1311
Data Collection
§1311
HHS Inspector General
§1313, 8002,10104
Eligibility Determinations
§1411
Privacy Study
§1411SecretaryHealth & Human
Services
HealthInsurance
CO-OP§§1322, 10104
CO-OP Advisory
Board§1322, 10104
Private Purchasing
Council§1322
USPreventive
Services Task Force
§1001
Health Savings Accounts§§9003, 9004
Medicare Beneficiaries
§3311
Health Insurance Policy Holder
§§1001, 10101
Small Employers§§1304, 1311, 1421, 1512,
10105
Large Employers§§1304, 1511, 1512, 1513,
1514, 10106
MedicarePart C & Part D
Insurers§3311
Large Group Market
§§1201, 1301, 1511
PremiumTax Credit Subsidies
§§1401, 1412, 10105; HCERA §§1001,
1004
Annual Fee§§9010, 10905; HCERA §1406
3.8% Investment Income Tax
HCERA §1402
HSAUse Restriction
§9003
Misuse ofHSA Funds
§9004
“CadillacPlans” Tax§§9001, 10901; HCERA §1401
Subsidies:Out-of-Pocket
Expenses§§1402, 1412;
HCERA§1001
Individuals
Mandates, Regulations,& Taxes
§§1311, 1411, 1501, 9003-9005, 9013, 9015, 9017, 10106, 10902, 10906, 10907;
HCERA §§1002, 1004, 1402, 1403
“Excessive Profits”
§§1001, 10101
Patients
MedicarePayroll Tax
Increase: 0.9%§§9015, 10906; HCERA §1402
Flexible Spending Arrangement
§9005, 10902; HCERA §1403
Only Medical Expenses
Above 10% of Income (AGI) are Tax
Deductible§9013
FSA ContributionLimit: $2,500
§§9005, 10902; HCERA§1403
RiskCorridors
§1342
Large Business Employees
§1511, 1512
Small Business Employees
§1512
MEWAHealth Plans
§§1301, 6605
Self-Insured Health Plans
§1301
Small Group Market
§1301, 1304, 1342Individual Market§1201, 1301, 1304, 1342
10% Tax On
Indoor Tanning Services:
§§9017, 10907
W2 Health
InsuranceDisclosure
§9002
Individual Mandate: Buy Health Insurance
§§1501, 10106;HCERA §§1002, 1004
Employer Mandate:
Provide Health Insurance
§§1513, 10106; HCERA §1003
Mandatory Worker Auto-
Enrollment§1511
Small Business
Health Insurance Tax Credit
§§1421, 10105
Insurance Mandates
§§1001, 1101, 1201, 1251, 10101, 10103; HCERA §2301
17
Health Insurance Companies
Mandates, Regulations, Required Benefits, &
Taxes§§1001, 1201, 1252, 1301, 1334, 1341,
3311, 9001, 9010, 10101, 10104, 10901, 10905; HCERA §§1401, 1406
Employers
Mandates, Regulations, & Taxes
§§1511, 1512, 1513, 9001, 9002, 10106, 10901; HCERA §§1003, 1401
Demonstra-tion Program
§3001Public Data Disclosure
System§3006, 10301
FFS Accountable
Care Organizations
Program§§3022, 10307
Community-Based Care Transitions Program
§3026
Hospital Quality
Reporting Program§3004, 3005
Medicaid Health Home
Program§2703
Federal Coordinated Health Care
Office§2602
Medicaid Quality
Measurement Program
§2701
State-Specific Adult Health Quality
Measures§2701
Medicaid Expansion: +16 million
§§2001-2004CBO Cost Estimate,
3/20/10
State Medicaid Agencies§§2602, 2701, 2703,
3011
MedicareCuts: $528.9bn(includes MA cuts)
Title III; CBO Cost Estimate,
3/20/10
Medicare Advantage
Cuts: $205.9bn§§3201, 10318; HCERA
§1102; CBO Cost Estimate, 3/20/10
Subsidy: Medicare Part D Drug Program “Donut Hole”
§3301; HCERA §1101
Hospital Compare Website
§3001
HospitalValue-Based Purchasing
Program§§3001, 10335
Centerfor Medicare& Medicaid Innovation
§§3021, 10305, 10306
Physician Value-Based
Payment Modifier
§§3007
Annual Fee§9008; HCERA
§1404
Hospitals§§1311, 3001, 10335
Skilled Nursing Facilities§§3006, 10310
§§3006, 10301
Ambulatory Surgical Centers
§§3006, 10301
Home Health Agencies
§3006
Medical Device Manufacturers
§§9009, 10904; HCERA §1405
Pharmaceutical Companies
§9008; HCERA §1404
Inpatient Rehabilitation
Facilities§3004
Hospice Programs
§3004
PPS-Exempt Cancer Hospitals
§3005
Medicare Administrative
Contractors§3311
Health Industry
Mandates, Regulations, Taxes, & Payment Cuts
§§1311, 3001-3006, 3311, 9008, 9009, 10327, 10331, 10335, 10904; HCERA
§§1404, 1405
Long-TermCare Hospitals
§3004
Medical Device
Excise Tax§§9009, 10904;
HCERA §1405
IPAB§3403, 10320
IPAB Consumer Advisory Council§§3403, 10320
Medicare Part A Trust
Fund§3026, 3403, 6301,9015
Medicare Part B Trust
Fund§3026, 6301
PublicHealth Quality &
Efficiency Measures Development
Program§§3013, 10304
Hours of Service Determination for Calculating
Employer Mandate Penalty
§§1513, 10106
Rules for Insurance
Claims Appeals§1001, 10101
Health IT Policy
Committee§1561
Office of Personnel
Management§§1334, 10104
President§§ 3012, 3024, 3403, 4001,
8002, 10320
Cures Acceleration
Network Review Board
§10409
National Diabetes
Report Card Program§10407
CLASS Independence
Benefit Plan§8002
CDC§§1001, 4003, 4004,
4102, 10407
NIH§§4305, 6301,
10409
National Partnership on Prevention &
Health Promotion
§4004
National Public Education
Campaign on Prevention & Health
Promotion§4004
Community Preventive
Services Task Force§4003
National Oral Health Public
Education Campaign
§4102
Cures Acceleration
Network§10409
CLASS Independence Fund Board of
Trustees§8002
Life Independence
Accounts§8002
National Diabetes Mortality Statistics Education Training Program
§10407
Eligibility Assessment
System§8002
PersonalCare Attendants
Workforce Advisory Panel
§8002
CLASS Independence
Fund§8002
CLASS Independence
Advisory Council
§8002
Black Lung Benefits Act
§1556
Office of Multi-State Qualified
Health Plans§1334, 10104
PublicHealth
Service§§3011, 4002, 4302
Surgeon General
§4001
AdvisoryGroup on
Prevention, Health Promotion, and Integrative and Public Health
§4001
PCORI Expert
Advisory Panels
§6301
PCORI Methodology
Committee§6301
PCORI Board of Governors
§6301
PCORIWebsite
§6301
State Protection & Advocacy Systems
§8002
Justice Department
§6703
National Prevention,
Health Promotion, & Public Health
Council§4001
Prevention Website
§4004
Website“Transparency
in GovernmentӤ1552
Prevention& Public
Health Fund§4002
Interagency Working Group on Health Care
Quality§3012
PCORITrust Fund
§6301
PCORI§§6301, 10602
SocialSecurity
Administration§1411
Homeland Security
Department§1411
Labor Department
§§1001, 1302, 1311, 1511, 1512, 1513, 6605, 10101, 10106
CLASS Program
§8002
Officeof Tax
Analysis§§1331, 10104
Elder Justice
Coordinating Council
§6703
AdvisoryBoard on Elder
Abuse, Neglect, & Exploitation
§6703
Multi-Disciplinary
Panels on Improving Long-
Term Care§6703
Elder Abuse, Neglect, &
Exploitation Forensic Centers
§6703
IRS§§1401, 1402, 1411, 1412 1414,
1421, 1501, 9004, 9005,10105, 10901; HCERA
§§1401, 1402
Treasury Department
§§1311, 1331, 4002, 8002, 10104
National Health Disparities Data Collection &
Reporting System
§4302
HealthCare Quality
Website§§3011, 3012
Interagency Pain Research Coordinating
Committee§4305
NationalHealth Strategy
& PrioritiesOffice
§3011
Medicaid/CHIP
Title II; §§1413, 3011
MedicareTitle III, §2602
CMS§§3013, 3021, 3026, 3403, 10305, 10306,
10320
Medicare Prescription Drug
and MA-PD Complaint System
§3311
CMS Actuary
§§1331, 3403, 10104
Your New Health Care System
Congress§§1312, 1411, 3311, 5605, 8002
Non-Hospital
Value-Based Purchasing
Program§§3006, 10301
§3004
§§3002, 10327, 10331
§§3002, 10327, 10331
§3007
§§3007
Physician Quality
Reporting System
§§3002, 10327, 10331
Physicians§§1311, 3002, 3003, 10327, 10331
Myron Rogers Master Class 17th September
11
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
Myron Rogers Master Class 17th September
12
Dupont, Belle, West Virginia a.k.a., CHEMICAL VALLEY
NIMBY
What is the
sourceof safety?
Myron Rogers Master Class 17th September
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A living systempreserves its identity.
It will change in order to preserve it.
© Myron Rogers, Margaret Wheatley, 1998
A living systempreserves its pattern of organization…its network of relationships
The Phenomena of Organization:
Structure
ProceduresPolicy
© Myron Rogers, Margaret Wheatley, 1997, 2002, 2010.
Myron Rogers Master Class 17th September
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Identity
RelationshipsInformation
Emerge from the Dynamics of Organizing:
© Myron Rogers, Margaret Wheatley, 1998
Which create the capacity for change and organization
Meaning
TrustAction
© Myron Rogers, Margaret Wheatley, 1998
Identity
RelationshipsInformation
Structure
ProcessesSystems
Meaning
TrustAction
Myron Rogers Master Class 17th September
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IdentityActions 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
Myron Rogers Master Class 17th September
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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
Creating the capacity for change
Myron’s Maxims
Thus the work is to enter into a world of shared significance.
Francisco Varela,neurobiologist
© Myron Rogers, 2005
Myron Rogers Master Class 17th September
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© Myron Rogers, 2005
© Myron Rogers, 2005
© Myron Rogers 2005
Myron Rogers Master Class 17th September
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For inquiring minds:
What are the conditions we need to create?
How can we create them?
Who needs to create them?
…to create the capacityfor people to do for themselvesmost of what has beendone to them.
© Myron Rogers
The Three Commandments
• Know Thy Students
• Know Thy Practices
• Personalize Thy Instruction
Myron Rogers Master Class 17th September
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Our action research project…
How do we create the capacity for
collective change?
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