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A Report from XanaduDonald M. Berwick, MD, MPP

26th Annual National Forum on Quality Improvement in Health Care

December 10, 2014

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Marco Polo

Don Polo

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Gorge Sanchez

Campaign Activities605 days of campaigning

208 fundraising events74 campaign strategy meetings

219 meetings with stakeholders and political figures

95 town caucuses

20-30 hours of fundraising phone calls every week

30,000 car miles visiting 185 towns and cities

5 parades

24 labor union breakfasts

52 radio and TV interviews

23 debates

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SSYI

SSYI Workshop

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Jackie and SSYI Get Results

39% reduction in

homicides attributed to youth violence in

Massachusetts.

No shooting deaths

among SSYI clients

since 2012.

SSYI Wall of Success

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SSYI Deaths

UTEC

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UTEC

Gregg Croteau

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UTEC Recidivism Results

Gary Slutkin

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HOW TOSTOP EPIDEMICS

1. Interrupt transmission1. Interrupt transmission1. Interrupt transmission1. Interrupt transmission

2. Change behavior2. Change behavior2. Change behavior2. Change behavior

3. Change norms3. Change norms3. Change norms3. Change norms

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Results – Logan Square Cure Violence

CURE VIOLENCE

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DOJ - INDEPENDENT EVALUATION

↓ 41 – 73% shootings and killings (overall effect seen)

↓ 16 – 34% shootings and killings (directly attributable)

↓ 100% retaliation murders in 5 of 8 communities

85 – 97% helped to jobs, school, out of gang

Demonstrated effective to reduce shootings and killings

Issues List: PartialJobs

Economic DevelopmentEducation

Poverty

EnvironmentEnergy

Health Care

LGBT RightsTransportation

Casinos

Affordable Housing

HomelessnessReproductive Rights

Gun Violence

Immigration

Criminal Justice

Veterans AffairsFisheries

Arts and Culture

Tax PolicyVoting Rights

Early Childhood Education

Infrastructure Gender Equity

Local Aid

Social Justice

Alternative EnergyCoastal Flooding

Standardized Testing

Smart Growth

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IHI Triple Aim

Triple Aim in a Community

and community health

and health for the individual and economic vitality

for the community

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Naromie

“Bring all the agencies together (both statutory and private sector), and bring a method.” – Derek Feeley

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Just Mercy and The New Jim Crow

Massachusetts Incarceration Rate

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LB

Massachusetts Budget FY 2001-15

Source: Massachusetts Budget and Policy Center

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$2,000,000,000

$4,000,000,000

$6,000,000,000

$8,000,000,000

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$12,000,000,000

$14,000,000,000

$16,000,000,000

$18,000,000,000

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15

Fiscal Year

Education

Environment & Recreation

Health Care

Human Services

Infrastructure, Housing &

Economic Development

Law & Public Safety

Local Aid

Other

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-60%-60%

Percent Change in Massachusetts Spending

FY 2001-15

Looking Back: What We Could Have Saved if We Had Matched the Next Highest Country (Switzerland)

Note: Per capita spending amounts adjusted for differences in cost of living, total U.S. savings adjusted for inflation. Source: D. Squires, The Road Not Taken: The Cost of 30 Years of Unsustainable Health Spending Growth in the United States, (New York: The Commonwealth Fund Blog, March 2013).

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Gorge and Jadiel

Baystate Medical Center

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Comparing Investments

“You’re either part of the solution or

you’re part of the problem.” – Eldridge

Cleaver

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Three Big Steps

1. Costs down. Really… I mean, REALLY!

15%

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66% started using substances

before age 20

29% experienced homelessness

60% struggle w/ mental health

50% have been in jail, prison

or arrested

50% are socially isolated

None have regular employment

Nearly all report difficulty

getting needed health care

Growing Up66% experienced ABUSE

(physical, emotional or sexual – often starting before age 6)

40% lived w/ adult substance users

23% were separated from their birth parents

50% struggled in school

Only 40% graduated

from high school

Adulthood

Who Are Medicaid “High Utilizers?”Replacing “What’s wrong with them” with “What happened to them…”

Lived-Experience interviews tell us that. . . .

Health Share / CareOregon

Health Resilience Program

How do we support building trust, safety, a sense of control, partnership?

What Is Possible?

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Three Big Steps

1. Costs down. Really… I mean, REALLY!

2. Broaden our engagement

Make the Problem Bigger

“Whenever I run into a problem I can’t solve, I always make it bigger. I can never solve it by trying to make it smaller, but if I make it big enough, I can begin to see the outlines of a solution.” – Dwight Eisenhower

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“The opposite of poverty is not wealth… the opposite of poverty is justice.” – Bryan Stevenson

To Do List

Join 100 Million Healthier Lives Initiative.Join IHI’s Leadership Alliance.

Students enroll in I-CAN. Join and be active in the Healthier Hospitals Initiative.Break through on energy and environmental responsibility. – Call Jeff Thompson, CEO of Gunderson Health System.

Personal cell: 608-397-5158. Say hi for me.

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Three Big Steps

1. Get costs under control

2. Broaden our engagement

3. Vote

No society can legitimately

call itself civilised if a sick person is denied medical aid

because of lack of means…

– Aneurin “Nye” Bevan, father of the UK National

Health Service

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Something is profoundly wrong with the way we live today.For thirty years we have made a virtue out of the pursuit of

material self-interest: indeed, this very pursuit now constituteswhatever remains of our sense of collective purpose. We know

what things cost but have no idea what they are worth. We no

longer ask of a judicial ruling or a legislative act: Is it good? Is itfair? Is it just? Is it right? Will it help bring about a better society

or a better world? Those used to be the political questions,even if they invited no easy answers. We must learn once

again to pose them.

--Tony Judt, Ill Fares the Land, 2010

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Minnesota Toward Zero Deaths

Gorge Sanchez

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Don’s Twitter Question of the Session

Tweet your answer

using the National Forum hashtag:

#IHI26Forum

How can

health care

help reduce

youth violence

in the

community?

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