The Challenge of Changing Behaviors

[We revised this posting on Wednesday 26 March.]

This posting is inspired by the questions Joe Alberti asked here. Joe teaches theatre and acting, and is working on a PhD. Some time ago he began studying wierd stuff – the writings of Fernando Flores and Humberto Maturana in particular. I like the heart of Joe’s question: the central challenge he faces is changing the orientations, ways of thinking and acting – the behaviors – of the people with whom he works. That is the central challenge that a lot of us face.

Frequently people speak of “those not under our control” as emblematic of this challenge. The way we talk about work in modern organizations produces the illusion that we have some people under our control, and others not. This is an illusion. We don’t control cats, we don’t control goats, we don’t control dogs, we don’t control horses, and we don’t control human beings. We dance with them in consensual spaces. (Yes, I agree that there are places and situations in the world where, effectively, people move with guns held at their heads. That is not the common situation in the developed world today.)

The overall challenge is to design reliable structures in which the right kinds of actions can happen when people are working together.

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An Impressive Start on a New Service Delivery Model

Today I began the process of signing up for a new kind of primary healthcare services. What I am signing up for has not been available in most of the US since I was a child. I will have a primary care doctor who will be available for appointments on the day I call, or the next day, 7 days a week, and available by phone when I need help. The doctor will meet me in their office, and not in a hospital. The doctor will track my health with me, and advise me on how to design my life so that I can remain healthy to do the things I want to do in my life. Of course, the doctor takes time off, and if I get sick when he or she does, I will be served by one of their colleagues. For this service I will pay $55/month.

I will maintain my health insurance, because this is primary care we are talking about, and not care for what we pray we will not encounter – the terrible illnesses in which we might need the dangerous and formidably expensive services of a big hospital. But I will increase my deductible massively so that the cost of that insurance will come down from its current level of $1,000+/month for Shirah and me. After we finish balancing the various services I will pay a lot less for healthcare than I do today, and I will get far, far better service.

You can see what I am signing up for here, and you can see the inventor of the service talking about his invention here. I recommend you think about this as an important start on a new future for healthcare in the US. It looks simple, and on the surface very similar to what is already done. It is not the same; this is a radical departure from the approach found throughout the country today. One place where you can grasp the difference is that my new doctor will have under 1,000 patients, and a “normal” primary care physician will have 3-4,000 patients. The service I am signing up for is currently available only in Seattle, but it will expand rapidly to other parts of the country.

For some time now I have been preparing a new company, CareCyte. My colleagues and I at CareCyte have been speculating about and beginning the design of a new kind of primary care that is desperately needed here in the US and in many other parts of the world. The group that I am signing up with is working on the third generation of a design to address the same challenge we have been working on. They have arrived at the point where they are preparing to scale an effective new approach to primary care services that fits beautifully with what we have been preparing ourselves to do. And, better yet, they are our neighbors here in Seattle. We hope to help them spread this across the country by providing a new standard of high-quality facilities for healthcare service delivery at lower costs, and much faster than has been possible in the past.