Core Values and Agency
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Focus on individual health and local systems
Bottom up improvement with local and central accountability
Key agents: individual patients and clinicians, self-organizing
healthcare networks and partnerships
Core value is individualized patient care and community health
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Focus on “control” of individual disease
Top down improvement with protocols and incentives
Key agents: policy makers, data analyzers, funders, administrators,
providers
Core value is evidence-based disease management
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Structure and Processes
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Complex dynamic multi-layered systems
Bottom up: self-organization of interacting agents forming evolving
structures shaped by internal levers or constraints, or local
contextual interactions
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Discreet intervention protocols, best practices, static notions of
quality
Top down: policy leverage and financial incentives used to manage
system performance around external system levers and constraints.
Linear structures and processes may or may not adjust for local
context and systems
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Outcomes
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Empowerment emerges from complex environments
Adaptability, self-organization, and empowerment enable the emergence
of improved health outcomes
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Success comes from clarity of accountability, “obsessive” tracking
and action on key performance indicators, and process-based teamwork
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