This document discusses complexity science and its implications for decision making in healthcare systems. It contrasts linear, Newtonian thinking with an appreciation of complexity, uncertainty, and positive deviance. Tools are needed to address non-linear situations, such as minimum specifications, wicked questions, and generative relationships. Positive deviance identifies uncommon but successful practices within a community. Variation is unpredictable, and black swan events represent surprises that linear thinking cannot anticipate. A variety of references are provided to further explore these complexity-related concepts.
La Unión Europea ha propuesto un nuevo etiquetado de alimentos para proporcionar información nutricional clara y comparable a los consumidores. El sistema de etiquetado frontal "ROTULO" clasificaría los alimentos en categorías de salud basadas en su contenido de grasa, azúcares y sal para ayudar a las personas a tomar decisiones saludables sobre sus compras de alimentos.
Geometría 1 unidad 2 tema 1 actividad de aprendizaje 2 ElíElí García Sánchez
El documento presenta un resumen de la Unidad 2 sobre geometría lineal del estudiante Elí García Sánchez para el semestre 1. Incluye soluciones a 6 ejercicios sobre ángulos, perpendiculares, proporcionalidad y empalme de líneas utilizando compás y escuadras.
- Lou Chen is a test engineer with over 8 years of experience designing, developing, and implementing cost-effective test solutions at Texas Instruments, including developing the first 16-site strip solution for an ARM MCU and generating a less than 10% COB test solution for an audio codec with stereo class-D speaker amplifier.
- Lou holds a Master's degree in Electric Engineering from National Cheng Kung University and a Bachelor's degree in Electronics Engineering from I-Shou University.
- Lou's achievements at Texas Instruments include developing the first jitter measurement solution for a phase-locked loop device and saving 60% in test costs by converting a tester platform.
This document summarizes the development of athletics programs at Scheck Hillel Community School in North Miami Beach. It describes how the school lacked athletic facilities for practices and games and had a vision to build an athletic complex. It then discusses lessons learned from creating the athletics program, including the importance of shared commitment from the whole school community, prioritizing safety, recognizing that winning is not the primary goal, and ensuring the program reflects the school's Jewish identity. The complex opened in 2014 and now hosts over 3,000 people for events and games.
Session 12 - Introduction to Information ToolsMedXellence
This document summarizes tools for gathering performance improvement evidence, including the Template Analysis Tool (TAT). TAT provides clinic and provider-specific templates to analyze appointment categories, statuses, and dates. It summarizes appointment data for specific clinics, providers, and time periods to evaluate access and utilization. The document discusses using TAT and other sources like the Tricare Operations Center to examine metrics like empaneled patients, visits per 1000 patients, and provider availability. The goal is to provide actionable data to support decision making and demonstrate improvement tools for staff.
This very short document does not contain enough content to generate a meaningful 3 sentence summary. It only includes two words: "Just name" and "Another", which provides no context or identifiable topic to summarize.
La Unión Europea ha propuesto un nuevo etiquetado de alimentos para proporcionar información nutricional clara y comparable a los consumidores. El sistema de etiquetado frontal "ROTULO" clasificaría los alimentos en categorías de salud basadas en su contenido de grasa, azúcares y sal para ayudar a las personas a tomar decisiones saludables sobre sus compras de alimentos.
Geometría 1 unidad 2 tema 1 actividad de aprendizaje 2 ElíElí García Sánchez
El documento presenta un resumen de la Unidad 2 sobre geometría lineal del estudiante Elí García Sánchez para el semestre 1. Incluye soluciones a 6 ejercicios sobre ángulos, perpendiculares, proporcionalidad y empalme de líneas utilizando compás y escuadras.
- Lou Chen is a test engineer with over 8 years of experience designing, developing, and implementing cost-effective test solutions at Texas Instruments, including developing the first 16-site strip solution for an ARM MCU and generating a less than 10% COB test solution for an audio codec with stereo class-D speaker amplifier.
- Lou holds a Master's degree in Electric Engineering from National Cheng Kung University and a Bachelor's degree in Electronics Engineering from I-Shou University.
- Lou's achievements at Texas Instruments include developing the first jitter measurement solution for a phase-locked loop device and saving 60% in test costs by converting a tester platform.
This document summarizes the development of athletics programs at Scheck Hillel Community School in North Miami Beach. It describes how the school lacked athletic facilities for practices and games and had a vision to build an athletic complex. It then discusses lessons learned from creating the athletics program, including the importance of shared commitment from the whole school community, prioritizing safety, recognizing that winning is not the primary goal, and ensuring the program reflects the school's Jewish identity. The complex opened in 2014 and now hosts over 3,000 people for events and games.
Session 12 - Introduction to Information ToolsMedXellence
This document summarizes tools for gathering performance improvement evidence, including the Template Analysis Tool (TAT). TAT provides clinic and provider-specific templates to analyze appointment categories, statuses, and dates. It summarizes appointment data for specific clinics, providers, and time periods to evaluate access and utilization. The document discusses using TAT and other sources like the Tricare Operations Center to examine metrics like empaneled patients, visits per 1000 patients, and provider availability. The goal is to provide actionable data to support decision making and demonstrate improvement tools for staff.
This very short document does not contain enough content to generate a meaningful 3 sentence summary. It only includes two words: "Just name" and "Another", which provides no context or identifiable topic to summarize.
This document discusses linking population health and medical management in the military health system. It covers utilizing population health data to identify populations, assess health status, forecast demand, and manage demand. It also discusses capacity management, evidence-based care and prevention, program evaluation, case management, utilization management, and disease management as parts of a medical management model. Key resources mentioned include the Department of Defense Instruction 6025.20, Population Health/Medical Management Guides, Medical Management Webinars, and the Milliman Inpatient & Outpatient Guidelines.
[BLT토크콘서트] US startup patents - 김재연 미국특허변호사JEONG HAN Eom
This document discusses US patent prosecution strategies for start-up companies. It outlines different entity status levels that provide fee deductions and examines strategies like expedited prosecution and continuation applications. Micro entity status provides the largest fee deduction for start-ups. The document emphasizes establishing patentability and claim scope early while showing dedication to funding to strengthen patent applications.
This document does not contain any text to summarize. It only states "new file", which provides no information about the content or purpose of the file.
The document provides contact location information for ITT connector products worldwide. It lists specific location details including addresses and phone/fax numbers for offices in Germany, Hong Kong, Italy, and the UK, as well as the USA. It also includes a table of contents for specifications and product information on Cannon CA-Bayonet connectors.
Mônica Barbosa Yoshida is seeking a position as an Information Security System Engineer or Project Manager with over 20 years of experience in information security, networking, databases, ERP and supply chain. She has extensive experience in pre-sales, commercial activities, project management, and training. Her background includes roles managing security projects and solutions, business development, and sales at companies such as Pirelli, Otis Elevators, Techne, Baan, ISS, VisaNet, Disec, NEC, iBLISS, NET, and Cipher S.A. She has a degree in Electric Engineering and post-graduate degrees in Industrial Administration and Business Management.
Session 03. [alots business group] 박한진 대표 startup entry silicon valley (1)JEONG HAN Eom
This document provides an overview of Silicon Valley for companies considering entering the US market. It describes Silicon Valley's size, demographics, and high concentration of technology companies and jobs. The ecosystem includes access to human capital, R&D, ideas, capital, and supporting professional services. Culture emphasizes failure as a learning experience and entrepreneurship. Startups are primarily funded through angel investors and venture capital. While Silicon Valley offers opportunities, companies must prepare for challenges such as high costs, lack of existing networks, and pressure to show results.
Graffiti refers to writings or drawings created illicitly on walls or other surfaces in public places. Graffiti has existed since ancient times but modern graffiti most commonly uses spray paint and markers. While graffiti was common in ancient cultures, today most countries consider unauthorized graffiti on private property to be defacement and vandalism, which is punishable by law.
The document discusses a report on cost savings from using electronic data interchange (EDI) instead of manual processes in the UK grocery supply chain. It finds that the UK grocery sector saves £650 million per year from using EDI for orders, invoices, and dispatch notices. While EDI adoption is high for orders (87%) and invoices (84%), only 38% of dispatch notices are electronic, indicating potential savings of an additional £200 million if fully implemented. The grocery sector was an early adopter of EDI and has benefited from faster transactions, deliveries, payments, and improved supply chain visibility. However, 81% of all companies still rely on manual processes, showing opportunities for wider EDI adoption across sectors.
[BLT] 스타트업을 위한 인증제도 안내 2016.08.03 엄정한_ver3.1 - 복사본JEONG HAN Eom
기업을 하면서 필요한 기본적인 인증제도에 대한 안내자료입니다. 인증에 관련된 컨설팅이 필요하시면 언제든지 연락주세요. ^^
- 엄정한 변리사 드림 (shawn@BLT.kr / 010-2393-5709)
- BLT특허법률사무소 (info@BLT.kr / 070-4100-0102)
1) The document discusses the limitations of rationalist, linear models for understanding complex systems like infrastructure, ecosystems, health care and economics that have adaptive, evolving components.
2) It argues that these systems cannot be fully understood or predicted using reductionist, "exact science" approaches and notes problems that have arisen from assuming universality and transportability of models.
3) The author calls for new approaches that acknowledge complexity, uncertainty, context and local interactions, including new epistemologies, agent-based models, and engagement with moral philosophy and political economy.
The document discusses dealing with uncertainty when making decisions about complex systems. It argues that traditional scientific approaches based on rational calculation and predictive modeling are inadequate for addressing real-world problems involving living systems, people, and interconnected risks. True uncertainty arises from complex, adaptive phenomena that cannot be reduced to simple cause-and-effect relationships or predicted with statistical models. Decision-making must account for the observer's role, embodiment, distributed robustness of living systems, and ethics. Flexible, participatory approaches are needed instead of top-down scientific management.
This document discusses managing complexity using the Cynefin framework. It begins with the author's background and reflections on past project performance. It then discusses that complexity is the norm for many projects and initiatives due to interconnected systems and emergent behaviors. Traditional reductionist approaches are insufficient for complex problems. The Cynefin framework categorizes problems into obvious, complicated, complex, and chaotic domains and suggests sensemaking and appropriate strategies for each. The document advocates understanding complexity, influencing rather than controlling systems, and learning over rigid planning when managing complex initiatives and environments.
These are the slides which I used is a 3 day workshop which I gave to university students in Brazil. Any feedback, and additional material that I could use (text, pictures, cartoons or videos), very gratefully received.
The document discusses concepts from complexity science and how it relates to shapes and forms in nature. It focuses on self-similar and fractal patterns found throughout nature that often follow simple mathematical rules like the golden ratio. The document also contrasts natural shapes with man-made artifacts, noting that natural shapes tend to be rough and adaptable to their environment while artifacts aim for smooth identical replication. It proposes complexity science and fractal geometry as useful frameworks for developing more natural and sustainable technologies.
This document discusses linking population health and medical management in the military health system. It covers utilizing population health data to identify populations, assess health status, forecast demand, and manage demand. It also discusses capacity management, evidence-based care and prevention, program evaluation, case management, utilization management, and disease management as parts of a medical management model. Key resources mentioned include the Department of Defense Instruction 6025.20, Population Health/Medical Management Guides, Medical Management Webinars, and the Milliman Inpatient & Outpatient Guidelines.
[BLT토크콘서트] US startup patents - 김재연 미국특허변호사JEONG HAN Eom
This document discusses US patent prosecution strategies for start-up companies. It outlines different entity status levels that provide fee deductions and examines strategies like expedited prosecution and continuation applications. Micro entity status provides the largest fee deduction for start-ups. The document emphasizes establishing patentability and claim scope early while showing dedication to funding to strengthen patent applications.
This document does not contain any text to summarize. It only states "new file", which provides no information about the content or purpose of the file.
The document provides contact location information for ITT connector products worldwide. It lists specific location details including addresses and phone/fax numbers for offices in Germany, Hong Kong, Italy, and the UK, as well as the USA. It also includes a table of contents for specifications and product information on Cannon CA-Bayonet connectors.
Mônica Barbosa Yoshida is seeking a position as an Information Security System Engineer or Project Manager with over 20 years of experience in information security, networking, databases, ERP and supply chain. She has extensive experience in pre-sales, commercial activities, project management, and training. Her background includes roles managing security projects and solutions, business development, and sales at companies such as Pirelli, Otis Elevators, Techne, Baan, ISS, VisaNet, Disec, NEC, iBLISS, NET, and Cipher S.A. She has a degree in Electric Engineering and post-graduate degrees in Industrial Administration and Business Management.
Session 03. [alots business group] 박한진 대표 startup entry silicon valley (1)JEONG HAN Eom
This document provides an overview of Silicon Valley for companies considering entering the US market. It describes Silicon Valley's size, demographics, and high concentration of technology companies and jobs. The ecosystem includes access to human capital, R&D, ideas, capital, and supporting professional services. Culture emphasizes failure as a learning experience and entrepreneurship. Startups are primarily funded through angel investors and venture capital. While Silicon Valley offers opportunities, companies must prepare for challenges such as high costs, lack of existing networks, and pressure to show results.
Graffiti refers to writings or drawings created illicitly on walls or other surfaces in public places. Graffiti has existed since ancient times but modern graffiti most commonly uses spray paint and markers. While graffiti was common in ancient cultures, today most countries consider unauthorized graffiti on private property to be defacement and vandalism, which is punishable by law.
The document discusses a report on cost savings from using electronic data interchange (EDI) instead of manual processes in the UK grocery supply chain. It finds that the UK grocery sector saves £650 million per year from using EDI for orders, invoices, and dispatch notices. While EDI adoption is high for orders (87%) and invoices (84%), only 38% of dispatch notices are electronic, indicating potential savings of an additional £200 million if fully implemented. The grocery sector was an early adopter of EDI and has benefited from faster transactions, deliveries, payments, and improved supply chain visibility. However, 81% of all companies still rely on manual processes, showing opportunities for wider EDI adoption across sectors.
[BLT] 스타트업을 위한 인증제도 안내 2016.08.03 엄정한_ver3.1 - 복사본JEONG HAN Eom
기업을 하면서 필요한 기본적인 인증제도에 대한 안내자료입니다. 인증에 관련된 컨설팅이 필요하시면 언제든지 연락주세요. ^^
- 엄정한 변리사 드림 (shawn@BLT.kr / 010-2393-5709)
- BLT특허법률사무소 (info@BLT.kr / 070-4100-0102)
1) The document discusses the limitations of rationalist, linear models for understanding complex systems like infrastructure, ecosystems, health care and economics that have adaptive, evolving components.
2) It argues that these systems cannot be fully understood or predicted using reductionist, "exact science" approaches and notes problems that have arisen from assuming universality and transportability of models.
3) The author calls for new approaches that acknowledge complexity, uncertainty, context and local interactions, including new epistemologies, agent-based models, and engagement with moral philosophy and political economy.
The document discusses dealing with uncertainty when making decisions about complex systems. It argues that traditional scientific approaches based on rational calculation and predictive modeling are inadequate for addressing real-world problems involving living systems, people, and interconnected risks. True uncertainty arises from complex, adaptive phenomena that cannot be reduced to simple cause-and-effect relationships or predicted with statistical models. Decision-making must account for the observer's role, embodiment, distributed robustness of living systems, and ethics. Flexible, participatory approaches are needed instead of top-down scientific management.
This document discusses managing complexity using the Cynefin framework. It begins with the author's background and reflections on past project performance. It then discusses that complexity is the norm for many projects and initiatives due to interconnected systems and emergent behaviors. Traditional reductionist approaches are insufficient for complex problems. The Cynefin framework categorizes problems into obvious, complicated, complex, and chaotic domains and suggests sensemaking and appropriate strategies for each. The document advocates understanding complexity, influencing rather than controlling systems, and learning over rigid planning when managing complex initiatives and environments.
These are the slides which I used is a 3 day workshop which I gave to university students in Brazil. Any feedback, and additional material that I could use (text, pictures, cartoons or videos), very gratefully received.
The document discusses concepts from complexity science and how it relates to shapes and forms in nature. It focuses on self-similar and fractal patterns found throughout nature that often follow simple mathematical rules like the golden ratio. The document also contrasts natural shapes with man-made artifacts, noting that natural shapes tend to be rough and adaptable to their environment while artifacts aim for smooth identical replication. It proposes complexity science and fractal geometry as useful frameworks for developing more natural and sustainable technologies.
Seminarie Computernetwerken 2012-2013: Lecture I, 26-02-2013Vincenzo De Florio
Seminarie Computernetwerken is a course given at Universiteit Antwerpen, Belgium
A series of seminars focusing on various themes changing from year to year.
This year's themes are: resilience, behaviour, evolvability; in systems, networks, and organizations
In what follows we describe:
themes of the course
view to the seminars
rules of the game
The document provides an overview of a presentation on evolving cyber risk from a multidisciplinary perspective. It discusses emerging cyber risks like hacking of industrial control systems, medical devices, and driverless cars. It acknowledges that emerging risks are difficult to anticipate because they involve things we are unaware of or combinations of known risks in new ways. Emerging risks often have complex and opaque relationships that challenge traditional risk modeling approaches. The presentation emphasizes some cognitive and group biases that can cause emerging risks to be overlooked or underestimated. It concludes by noting the importance of considering alternative perspectives to account for the context-dependence of risk.
Macro Trends, Architecture, and the Hidden Nature of Complexity (and what doe...David Meyer
Layered architectures provide robustness through abstraction layers that standardize interfaces between layers. This allows flexibility in adjacent layers through loose coupling and horizontal transfer of new protocols and technologies between layers. However, layering also introduces new fragilities through standardized interfaces that can be attacked or hijacked. SDN aims to provide evolvability through flexible programming of the network, but must balance this with robustness through proper abstraction layers and avoidance of new fragility-inducing interfaces. Understanding universal principles of complex systems like layered architectures, bowties, and robust-yet-fragile tradeoffs is important for engineering networks and protocols like SDN that can adapt to changing technologies and environments over long timescales.
Gigamap example by Manuela Aguirre: https://www.slideshare.net/ManuelaAguirre/policy-support-full-presentation
In this presentation you will learn about design tools and techniques to solve wicked problems, using Systems Thinking.
Systems Thinking looks at the whole of a system rather than focusing on its individual parts, to better understand complex phenomena. Systems Thinking contrasts with analytic thinking: you solve problems by going deeper, by looking at the greater whole of a system and the relations between its elements, rather than solving individual problems in a linear way via simple cause and effect explanations.
You can apply Systems Thinking principles in different situations: to understand how large organisations function and design for the enterprise (e.g. when you are trying to revamp a large intranet), but also to solve social problems and issues (e.g. unemployment with disadvantaged youth or mobility in larger cities). So basically whenever there is complexity and conflict (of interest) in your project, Systems Thinking will be helpful.
After an introduction to Systems Thinking and its core concepts, we will first explain and practice a few techniques that you as a designer can apply to better understand complex systems, for example creating a System Map and drawing Connection Circles. In the second part of the workshop, we will introduce techniques that help you shape solutions, for example using Paradoxical Thinking for ideation and writing ‘What-if’ Scenarios.
Presented at EuroIA 2015 with Koen Peters.
Complexity arises from interactions within systems and an attempt to solve problems. As societies try to address more issues, complexity tends to increase over time. However, periods of increased complexity are often followed by renewed simplicity through major innovations that replace old complex systems with new simpler paradigms. Managing and understanding complexity can provide competitive advantages for companies, but unlimited growth is unsustainable as resources are limited.
An overview of "resilience thinking" for participants at a meeting on resilience in the electricity space organized by the Electric Power Research Institute (EPRI).
Playing at the speed of thought-A Decision-Action model for soccer-pt.3Larry Paul
System 1 and System 2 are the two modes of thinking that underlie decision making in soccer. System 1 allows for fast, intuitive reactions while System 2 enables slower, more analytical thinking. Both systems interact across a soft boundary, with System 1 guiding most in-game actions while System 2 learns from experiences to update heuristics. Effective training balances both systems by combining tactical instruction with behavioral practice and feedback.
A comprehensive exploration of an operating next-generation organization.
Core founding assumptions
Vision & Values
Culture is key .. wirearchy as opposed to hierarchy
Practical operational aspects
Slides with notes for my workshop at Lean UX 2014. This is an iterated version of my 2013 workshop - different exercise, slightly different content, but much is similar. Includes link to handout!
Berwick the triple aim - care, health, and costMedXellence
The document discusses the "Triple Aim" of improving the U.S. healthcare system by simultaneously pursuing three goals: improving individual care experiences, improving population health outcomes, and reducing per capita healthcare costs. It argues that achieving the Triple Aim requires identifying a specific population, establishing constraints like universal coverage, and designating an "integrator" organization responsible for coordinating care across settings to achieve all three goals. The integrator's key functions include engaging patients, redesigning primary care, managing population health, and integrating different parts of the healthcare system.
CDR James Ellzy discusses increasing the effectiveness and efficiency of military treatment facilities (MTFs) through population health and medical management approaches. He emphasizes that the primary function of medical officers is disease prevention, not just treatment of the sick. Ellzy then outlines key concepts like the levels of prevention/intervention, the disease continuum, the epidemiologic triad, and the importance of population health surveillance systems. The presentation provides tools and data sources that MHS leaders can use to understand their patient populations' health status and service needs.
Session 8 - Introduction to Lean Six SigmaMedXellence
This document outlines an agenda for a presentation on continuous performance improvement through Lean Six Sigma in the Military Health System. The agenda includes discussing the MHS decision to adopt Lean Six Sigma, basics of Lean Six Sigma, how it fits into strategic performance execution, linking strategy to performance improvement, leveraging learning across the organization, and early lessons learned. The document provides background on the MHS decision-making process, including a QDR mandate to select a common performance improvement method and accelerate the MHS journey with consistent implementation across all components. It introduces Lean Six Sigma concepts and what makes its approach different from prior performance improvement frameworks.
This document discusses the patient-centered medical home model of care. It provides data on outcomes from two implementations of the medical home model, showing reductions in utilization and cost for patients enrolled in a medical home. It discusses lessons learned from implementing the medical home model, including the importance of culture change, defining new metrics for productivity, optimizing staffing models, and maintaining a focus on population health and wellness. The timeline of one medical center's rollout of the medical home model over two years is also summarized.
This document discusses population health and delivering the quadruple aim. It outlines three sub-aims of population health: health determinants, individual health risk, and illness/disease burden. Success is defined as emptying hospitals. Delivering the quadruple aim involves addressing where and to whom it can be delivered, as well as supporting initiatives like reducing tobacco/alcohol use and improving infant health outcomes. The challenge is to build measures, change mindsets, incentives, and behaviors to achieve these aims.
The document describes the experiences of an 18-year-old college student diagnosed with possible Crohn's disease or ulcerative colitis. Their care was fragmented across multiple providers and hospitals, resulting in a lack of education, unnecessary tests and hospitalizations, missed school, and feelings of helplessness. Communication improved after the patient obtained direct contact information for their provider, reducing subsequent hospitalizations. The case demonstrates how poorly coordinated care can negatively impact the patient experience.
The document discusses managing total healthcare costs for a defined population on a per capita basis. It outlines shifting from a fee-for-service mindset that rewards volume to a value-based mindset that rewards outcomes over total cost of care. Key points of focus include enhancing primary care, reducing unnecessary procedures and referrals, and focusing on prevention and management of high-risk patients to reduce waste and per capita medical costs. Metrics such as inpatient discharges and RVUs per beneficiary are discussed to monitor the drivers of per capita medical costs.
This document discusses strategies for achieving the Quadruple Aim in the military health system. It outlines challenges like increasing health care demand and costs. It introduces the Quadruple Aim of readiness, population health, experience of care, and per capita cost. The document proposes reviewing each aim by discussing what it is, what can be done about it, and why it is important, then having participants discuss one aim and report back. The overall goal is to develop and manage initiatives to improve performance.
The document discusses resource management processes within the Department of Defense (DoD). It provides an overview of the planning, programming, budgeting process used by DoD, including the Planning, Programming, Budgeting and Execution System (PPBES). It describes how the PPBES is used to allocate resources among competing programs based on perceived threats. The document also summarizes the TRICARE contracts and financing model, including incentives like the performance guarantee, award fee, and risk-sharing of healthcare costs between the government and contractors. It discusses the Prospective Payment System used to value and redistribute funds for military medical treatment facility workload.
The document discusses the evolution of healthcare quality and the marketplace. It notes that trends in civilian healthcare will increasingly impact the military health system, and that federal health programs are seen as test beds for innovations. Payment reforms like value-based purchasing, pay for performance, and accountable care organizations aim to link payments to quality outcomes and reduce costs. Quality measurement and public reporting are important tools but must be done carefully. Overall the healthcare system is gradually shifting to pay providers based on the value of care delivered rather than volume of services.
Session 14 - Incorporating Improvement into Performance PlanMedXellence
The document discusses performance planning in the Military Health System (MHS). It provides an overview of the performance planning process, which translates MHS strategy into action through business planning. Performance plans support budget submissions and identify enrollment projections, workload projections, and performance objectives. The goals of performance planning are to improve outcomes, experiences of care, population health, and control per capita costs. Financial incentives are being developed to reward quadruple aim performance.
Online Session - Medical Executive DataMedXellence
This document introduces common measures of workload used in the Military Healthcare System and identifies where medical executive data is available. It discusses raw and weighted workload measures such as admissions, encounters, relative weighted products, and relative value units. The document describes where raw data can be accessed from the MDR and processed data can be found in the M2 and other tools to enable data-driven decisions.
The document outlines an agenda for a healthcare leadership course that focuses on applying data and continuous improvement processes to better serve patients in a complex healthcare system. The course covers topics like health policy, resource management, patient-centered care, and Lean Six Sigma and includes presentations, case studies, exercises in process mapping and solution development. Participants are asked to consider a healthcare delivery issue from their facility and how their facility could help address it.
The document provides an agenda for a medical executive skills course taking place from April 22-27, 2012 in Orlando, FL. The course focuses on critical decision making for medical executives and keys to improving healthcare delivery. Various sessions will cover topics like complexity in healthcare, the Military Health System vision, health policy, American healthcare, resource management, patient-centered care, decision making ethics and effectiveness, increasing facility effectiveness and efficiency, lean six sigma, and information management. Presentations, case studies, exercises and team times are included each day.
The document discusses the evolution of healthcare quality and the marketplace. It notes that the federal healthcare systems do not operate independently and are increasingly interconnected with civilian healthcare. Trends in civilian healthcare will impact the military health system, and the MHS will be viewed through the lens of civilian oversight. Payment reforms like value-based purchasing and payment for performance are pushing providers to improve quality and efficiency. Various models for alternative payment like bundled payments, global budgets, and accountable care organizations are discussed. Quality measurement and transparency are evolving and being used for different purposes like improvement, selection, and accountability.
This document provides an overview of health policy concepts for junior staff members. It defines health policy as patterns of government decisions and actions to address health problems. Health policy involves balancing competing values like liberty, equity, and efficiency. The US spends more than any other country on healthcare as a percentage of GDP, around 20% projected by 2016. However, higher spending does not always mean better quality or outcomes. Rising healthcare costs are driven more by higher prices and administrative overhead than an aging population. Understanding these issues is important for policymaking and military health system management.
Session 1 - Case Study Content - CrawfordMedXellence
The Commander's Executive Board will discuss several issues impacting the local military treatment facilities, including: long wait times at Valhalla Medical Center's emergency department, deployment of staff from Olympus Ambulatory Clinic, a recent sentinel event and lawsuit involving Valhalla, and water damage at Olympus Clinic. The Board will charge an Integrated Product Team to analyze the causes of long wait times at Valhalla ED and recommend solutions within 5 days.
Kevin A. Dorrance is a Commander in the U.S. Navy Medical Corps and serves as the Department Head for Internal Medicine at the National Naval Medical Center in Bethesda, Maryland. He has over 15 years of experience as a physician in the Navy. Commander Dorrance received his medical degree from Georgetown University and is board certified in internal medicine.
The MedXellence program is a week-long executive education course run by the Uniformed Services University for tri-service military healthcare leaders. It aims to educate leaders on concepts like strategic planning, decision making, and quality improvement to help them effectively lead organizational change. The interactive course covers topics like healthcare delivery systems, ethics, and data analysis. Its customized curriculum and expert faculty are designed to develop leadership strategies and maximize students' educational experience.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
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Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
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How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
1. Session 2: CompleXity, Surprise,
Innovation & Deviance in
Decision-making for Health Care
Systems
Galen Barbour, MD FACP, FACHE
Director, Health Services Administration
Uniformed Services University
2. Questions
Why doesn’t strategic planning work?
Why do decisions work sometimes
and sometimes not?
Why aren’t ‘best practices’ importable?
2-2
3. Objectives
1. Appreciate Newtonian thinking and the elements
of the ‘linear world’.
• Contrast Linearity with:
- the implications of Complexity Science
- the concept of Positive Deviance (and why ‘best practices’
are so hard to import)
- the framework of Disruptive Innovation (and application to
the national health care debate)
- the ubiquity of randomness and the reality of the
Black Swan phenomenon
- the relationship to Uncertainty and Surprise
• Develop problem solving approaches for non-
linear situations.
2-3
4. A Short History of Physics
300 BC: Aristotle: Observation & Deduction;
1700 AD: Newton, Galileo, et al: Exp & Induction:
A body persists its state of rest or of uniform motion unless
acted upon by an external unbalanced force.
Force equals mass times acceleration (F = ma).
To every action there is an equal and opposite reaction.
Aristotelian and Newtonian thought generated a very
linear way of seeing the world:
“this (always) follows that”
2-4
5. A Short History of Physics
300 BC: Aristotle: Observation & Deduction;
1700 AD: Newton, Galileo, et al: Exp & Induction:
A body persists its state of rest or of uniform motion unless acted upon
by an external unbalanced force.
Force equals mass times acceleration (F = ma).
To every action there is an equal and opposite reaction.
1950 AD: Planck, Rutherford, Bohr, Einstein: Observation,
Experimentation and Analytic Theory
Quantum theory
2-5
6. The Quantum World
• Is non-linear
• Is unpredictable (but leaves tracks)
• Encompasses innumerable possibilities
(not ‘mutations’)
• Studies of the quantum world led to
appreciation of complexity
2-6
7. The Conundrum
Newton’s Laws ‘explain’ the macro world and make sense for
most issues.
When we apply Newtonian thinking, we are seeing the world in a
mechanical and quite linear way. (and that works for the most
part)
When something unexpected intrudes, we are unprepared. We
tend to think there is a ‘mechanical’ or ‘linear’ aspect that we didn’t
measure or consider. We must be ignorant or negligent.
Truth is, “Variation Happens” and we would be better if we knew
how to deal with it.
Variation = complexity.
2-7
9. Understanding of Complexity
Initially, a theoretical construct explaining time
and space
Later identified at micro-levels in biology
Now recognized at every level of existence as ‘the’
(or a partial) explanation for heretofore
puzzling phenomena.
Derivative studies on SWARM INTELLIGENCE and
NETWORKS and STRING THEORY have added
additional insight.
2-9
10. Examples of CASs
• DC/NOVA slug lines
• Stock market
• NYC food distribution
• Forest
• Hospital
Each system “succeeds” by adapting to its
changing environment.
2-10
11. Characteristics of CASs
• diversity • novelty; prog. adaptations
• adaptability • capacity to change
• interdependency • linkages
• • scalar
embedded nature
• “butterfly” effect
• nonlinear
• past context
• history-dependent
• not machinery
• ‘biologic’ • many “both-and” rather
• paradoxical than “either-or”
2-11
12. Implications of Complexity
1. Inter-related processes form systems – with
Order, Chaos and Complexity within the
system.
2. Systems that are complex show signs of self-
organization – they adapt to external forces
and other causes for change.
3. We are surrounded by complexity – but we still
approach each situation as if it is Simple and
Linear.
2-12
13. C
o
Leve l of Syste m
h
Turb ulen ce
s
a
High
Low
Low
High
Level of Immediate Necessity
2-13
14. simple
Zone 1
Routine, expected issues
– Staffing
– Budgeting
– Information Management
– Marketing
2-14
15. Zone 1 simple
Tools
Rational decision-making
– Use components and boundaries
– Prioritize using critical issues
– Plan, measure, adjust, reward
– Linear approaches work well here
2-15
16. complicated
Zone 2
• Events not as predictable; more uncertainty
exists about the future
• Labor negotiations
• Opening new services
• Developing an incentive system
2-16
18. complex
Zone 3
Complexity increased by an order of magnitude
Different tools needed
• Dramatic legislative changes
• Re-design of health care delivery systems
• Mergers (systems, departments, etc.)
2-18
19. complex
Zone 3
Tools
We need to recognize the situation as
‘non-linear’ (e.g., a ‘mystery’ not a
‘puzzle’) before we can begin to think of
using ‘non-linear’ tools.
Applying linear thought and problem-
solving to complex situations is highly
unlikely to work.
2-19
20. Zone 3 complex
Tools
• Reflection
• Minimum specifications
• ‘Wicked’ questions
• Metaphor
• Generative relationships
• Lifecycle to ecocycle
• etc. (See: Edgeware: insights from complexity science for
health care leaders. B Zimmerman, P Plsek, C Lindberg
Critical Decision Making for Medical
2-20
21. Comparison of Approaches
Simple Complicated Complex
• Planning is quite • Multiple plans with • ‘Plan’ is very general
detailed (e.g., a interaction (more questions than
recipe, blueprint) answers)
• Outcomes are big and
• Clear, measurable complicated • Uncertainty is king
outcome
• Reliance is on the • Use Minimum
• Measurement, goals experts specifications
and targets
• Heroes win, villains • Embrace the
• Accountability at a cause trouble or prohibit paradoxes with
personal level. success. optimism.
2-21
22. Complicated
Modern medicine has created knowledge and
practice patterns that are very complicated:
• Emergency response to chest pain
• Sudden onset stroke (“brain attack”)
• Cardiac bypass surgery
• Organ transplantation
How can we reduce ‘errors’ and ‘ineptitude’?
2-22
23. Linear
Linear thinking can (at times) mislead people into thinking
they are in one business when they are really in another.
1920s-1950s: Railroad Executives pushed for more track and
more powerful engines for the “Railroad Business”
1940s-1970s: Trucking companies moved in to the small
markets not served by railroads and began to expand in the
“Transportation Business”
1960s – 1980s American railroads nearly went bankrupt (and
some actually did).
2-23
24. mer
g ing custo
in n
n o demand
ai ati Most
st v
S u no
In
Performance
n
io
v at
no
In
e
tiv
up
D isr
er
gc ustom
demandin
Least
Time
2-24
25. Integrated Steelmakers
Sheet steel
Structural steel
Performance
Mini-mills
Other bars
and rods
Rebar
Time
2-25
26. “Disruptions”
Characteristics of these successful “disruptions”:
2. Breaks with ‘linear’ thinking
3. Starts with simple technology and functionality
4. Operates ‘under the system’ by starting in ‘rebar’ markets
with minimal regulatory barriers
5. Is cheaper; allows less costly people to meet the needs of
an emerging market.
6. Initially competes against non-consumption; later meets
more demanding needs without customers having to
change their ways.
2-26
27. Disruptions and Health Care
We have the technology to disrupt
- the hospital business model
- the physician’s practice business model
- the reimbursement system
- the care of chronic illness
according to The Innovators Prescription: A
Disruptive Solution for Health Care
- Clay Christensen
2-27
29. Deviance
Positive Deviance = Best outcomes in the ‘community’.
Positive Deviants = Recognizable within the community
Use two key approaches
1. Acute situational awareness
Not decision tree or knowledge management
Modified Analytical Hierarchy
2. Patterned responses
Commitment, end-in-mind, action-oriented,
measure threats & progress, operate on evidence basis
2-29
30. Positive Deviance
Principles of disbursing Positive Deviance
2. Help ‘community’ identify the PDs
3. Obtain their involvement thru intrinsic motivation and
professionalism
4. Engage others thru Practice -> Attitude -> Knowledge (this is
‘backwards’ to the usual way of ‘teaching’)
The Power of Positive Deviance: How Unlikely Innovators Solve the World's
Toughest Problems Pascale, Sternin & Sternin
Vietnam diet
http://www.fastcompany.com/magazine/41/sternin.html
MRSA reduction
http://www.plexusinstitute.org/news-events/show_news.cfm?id=1
2-30
31. Puzzles versus Mysteries
Puzzle: problem or enigma; pieces must
be fit together in a logical (i.e., linear) way
to come to the right conclusion.
Mystery: occurrences or relationships that
are difficult to make clear; often have secret
or hidden qualities that need explanation
(i.e. red herring, misdirection, unexpected
events, etc.)
32. What About Uncertainty And Surprise
Variation is unpredictable & uncertain
(perhaps anticipated).
Black Swan theory:
The Black Swan: The Impact of the Highly Improbable. Nassim Nicholas Taleb
2-32
33. What About Uncertainty and Surprise
Variation is unpredictable & uncertain
(perhaps anticipated).
Black Swan theory:
The Black Swan: The Impact of the Highly Improbable. Nassim Nicholas Taleb
2-33
34. What About Uncertainty and Surprise
Variation is unpredictable & uncertain
Tools that deal with variation improve the ability to deal with
uncertainty.
Surprise is the culmination of uncertainty – the actual event as
opposed to the threat.
Answers (solutions) may come from CAS, or from PD or
maybe from DI . . .
-- but NOT likely from a linear approach or such an approach
should have predicted the event . . .
2-34
35. Tools
Some ‘tools’ to use in dealing with complex situations:
• Look thru the Complexity Lens
• Be sure you are asking the Right Question
• Set only Minimum requirements
• Use Metaphor (biologic not machine-like)
• Initiate Multiple actions (swarmware)
• Do some Chunking (bit development like UNIX)
• Allow Tension and Paradox (Generative relations)
• Ask Wicked Questions
• Tune to the edge
• Don’t shy away from being Wrong
• Reflect & Listen to the Shadow System
• Mix competition and cooperation
2-35
36. Leve l of Turb ulen ce
tion
nova
ti ve I n
D isrup
t i ve
dap are)
ex A ew
C ompl s (Edg
d
M etho
Co
mp
rom
Po
i se
s
it iv
eD
Ex Sw
ev
Str pe ar
r
i an
at egi tO m
cP pi Int
ce
High
l an ni el l
Low
nin o n ige
g, e nc
t al e
Low
High
Level of Necessity
2-36
37.
38. Reference List for Complexity et al:
• Edgeware: Zimmerman, Plsek, Lindberg
• The Innovators Prescription: Christensen
• The Power of Positive Deviance: Pascale, Sternin, Sternin
• The Black Swan: Taleb
• The Drunkard’s Walk: Mlodinow
• The Checklist Manifesto: Gawande
• The Perfect Swarm: Fisher
• Being Wrong: Schulz
2-38
Editor's Notes
June 2009 Slugging: grew out of nothing; created to address the long commutes which are bypassable only in the HOV lane. No supervisor, no schedule, no ticket and NO FEE. Rules: Agree on destination; no further interaction unless initiated by driver (no eating, talking, cell phones, etc.) Stock Market is classic example of ‘nesting CAS within other CAS NYC food distribution – no “CEO” to control the food that comes in, where it goes and how much is to be re-ordered. Forest – more nesting; somewhat blurry boundaries Hospital – Here we HAVE a CEO!! Does that make it better? Does that stop ‘self-organization’?
June 2009 Zone 1: Rational decision-making Use components and boundaries Prioritize using critical issues Plan, measure, adjust, reward Zone 2 Certainty > Agreement compromise, negotiation (political tools) Agreement > Certainty ideology, judgment (role for experts) Zone 3: Reflection Minimum specifications ‘ Wicked’ questions Metaphor and Language Generative relationships Lifecycle to ecocycle etc.
June 2009 In the life of steel making, the highest and most refined and sought after were those who made the finest rolled sheet steel for autos and the like. The making of rebars is coarse and rough and doesn’t require a lot of finesse – this type of manufacture is relegated to the bottom of the totem pole. The large integrated steel makers have not been sitting still; in recent years they have streamlined their processes (from 9 hours per ton to 3 hours per ton), pruned inefficient plants (reduced personnel from 93,000 to 23,000), and put in $15 Billion in R&D and improvements. They deliver high quality steel with a 30% margin and have realized real gain in their profits and stock price. Linear thinking would push for continued movement along the previous track: continued quality improvements and increased efficiency. And then, in the 1970s, along come the “mini-mills”. At small cost they set up trivial technology to begin producing the commodity products now shunned by the big companies – they began making rebar. Their technology was not so expensive and they represented a 20% cost advantage over the Major mills; they got the business and began to expand and make Other bars, then structural steel. They, however, remained small and responsive to the immediate commodity market where they could offer a price advantage. By the 1990s, the mini-mills had captured over 40% of the steel market and are continuing to grow while the major mills continue to make high quality sheet steel for their customers who are sticking with them – for now.
June 2009 Community = defined as the cohort with same or very similar resources and responsibilities. Getting beyond that ‘community’ makes comparisons invalid (this is why imported ‘best practices’ rarely work.) Situational awareness = “ecological survey” not using linear approaches like dec trees or systems like KM that identify and focus on the 5% outliers. PDs ask AH questions like ”are trucks clean or dirty?” “who says it is their job to prevent infection?” They also listen to the language (“WHO did this?” v. WHAT happened?”) Patterned Responses include acting on the most likely (the 70-80%) (Pareto Principle); keeping their vocabulary terse and their categories limited (Minimum Rules). They use a model that connects the high level measures to the worker level and they recognize threats and failures early and avoid continuing down wrong paths. They are action oriented (Ready-Fire-Aim) and they tend to hold people accountable (not blamable). Their resources include detailed references on how to do common and important tasks.
Four hundred years ago, Francis Bacon warned that our minds are wired to deceive us. "Beware the fallacies into which undisciplined thinkers most easily fall--they are the real distorting prisms of human nature." Chief among them: "Assuming more order than exists in chaotic nature." The problem, Nassim explains in The Black Swan , is that we place too much weight on the odds that past events will repeat (diligently trying to follow the path of the "millionaire next door," when unrepeatable chance is a better explanation). Instead, the really important events are rare and unpredictable. He calls them Black Swans, which is a reference to a 17th century philosophical thought experiment. In Europe all anyone had ever seen were white swans; indeed, "all swans are white" had long been used as the standard example of a scientific truth. So what was the chance of seeing a black one? Impossible to calculate, or at least they were until 1697, when explorers found Cygnus atratus in Australia. Taleb explains that conventional social scientists use induction to collect data, which is then plotted on the good old Gaussian bell curve. With characteristic silliness, Taleb dubs the land of the bell curve "Mediocristan" - and informs us that it is the natural habitat of the white swan. He contrasts Mediocristan with "Extremistan" - where chaos reigns, the wholly unexpected happens, power laws and fractal geometry apply and the bell curve does not. Taleb's fictional/metaphorical 'stans' share something with the 'stans' of the real world: very ill-defined borders. Indeed, one can never tell whether one is in the relatively safe territory of Mediocristan or if one has wandered into the lawless tribal regions of Extremistan. The bell curve can only help you in Mediocristan, but you have no way of knowing whether you have strayed into Extremistan - beyond the bell curve's jurisdiction. This means that bell curves are of no reliable use, anywhere. The Drunkard’s Walk explains the mathematics behind the Butterfly Effect through the understanding of the Law of Large Numbers and the corresponding law of small numbers. . . The randomness of unforeseeable events (?Black Swans) cannot be avoided and, in fact, account for much more of what constitutes an individuals path in life (as opposed to ‘career planning’ ) Nobel Laureate Max Born: “Chance is a more fundamental concept than causality.”
The Black Swan theory discloses a critical extension of the problem of induction logic. The theory operates on fact that most real-world distributions are not ‘normal’ they exhibit kurtosis and skew and carry an unknown (but very small) possibility of a major occurrence that is completely unpredictable. Concept of ‘orderly randomness’ underlies the concepts of Game Theory – but really only deal with ‘known unknowns’ – the Black Swan is a true ‘unknown unknown’ – and once the Black Swan intrudes, consequent events are linked and would have been unpredictable before the Black Swan (e.g., the impact on the railroad industry by the Interstate Highway system, prediction of the iPod when ARPANET was being developed, etc.) Publisher: Random House; 1 edition (April 17, 2007) Language: English ISBN-10: 1400063515 ISBN-13: 978-1400063512
Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery December 2009June 2009 June 2009 Another way to uncover paradox is to ask “wicked questions.” These are questions that have no obvious answers, but expose our assumptions. For example, in an organization that was trying to build a more-enabled environment, one leader asked, “Are we really ready to put responsibility for the work on the shoulders of the people who do the work?” Perhaps you can sense the discomfort in such a question. But challenging the sacred cows is an activity that can put you at the edge of chaos, and begin to reveal the hidden assumptions. "Clearly leadership has to do with the sustaining of creative tension in organizations. Creative tension is derived through strategic imbalance, which occurs when operating at the limits of organizational consensus or the boundaries of the organization. Innovation takes place on the edges of the organization where the potential for far-from-equilibrium conditions is optimal.“ –Zimmerman Leaders need to define success for the organization – only then can every person in the organization adapt that vision to themselves; further, when they ‘get there’ it will be evident to them and they will feel successful even if the leader is not right there to pat them on the back. You can most easily do these things if you view the organization thru a ‘complexity lens’ – that does not mean ‘seeing all the complexity’, rather it means to recognize the interactions and the working relationships for their biologic nature as opposed to a machine-like concept of the functioning of the organization. Minimum requirements are hard to determine and set (we all have a tendency to lengthen the list with a lot of ‘niceties’); sticking to the true basics will free the employees to develop many different ways to get the job done. Think of Battle Bots. When you do act, use multiple actions and vary between swarmware and clockware – give yourself and the organization the best possible chance to find a way that works. Often solutions come in ‘chinks’, small pieces that work in one area. Keep these and try to build on them. Creative tension often pushes us toward success; use the “either-and” rule Reflection is, therefore, a key skill for anyone in a CAS. Good leaders in a CAS lead not by telling people what to do, but by being open to experimentation, followed by thoughtful and honest reflection on what happens. Sometimes that input comes from the shadow system rather than thru face-to-face feedback. We are emphasizing teamwork – and the cooperation that underlies such effectiveness. But it is acceptable to recognize individual effort, too. That’s the idea of the MVP on the World Championship team, right?
June 2009 Zone 1: Rational decision-making Use components and boundaries Prioritize using critical issues Plan, measure, adjust, reward Zone 2 Certainty > Agreement compromise, negotiation (political tools) Agreement > Certainty ideology, judgment (role for experts) Zone 3: Reflection Minimum specifications ‘ Wicked’ questions Metaphor and Language Generative relationships Lifecycle to ecocycle etc.