Richard DeLorenzo, a disabilities teacher who was the superintendent of the first school system to ever be awarded the Baldridge Award, transformed his school system from being time based and teacher focused to performance based and student focused.28 Delivering on the Promise: The Education Revolution tells this story, and if you read it, you may see it parallels with our healthcare system crisis. Student focused meant every student had their personalized learning plan that helped them attain the performance goals necessary to advance. Students with similar performance goals worked together, regardless of age, supported by a teacher who focused on where each student was, not where they had been in previous years’ lesson plans/book chapters. In other words, students would advance based on successful attainment, not grade by grade, which only averages success between good performance in one area with barely passing in another. As the student advances grade to grade, the deficiencies never get corrected. In Mr. DeLorenzo’s model, teachers become responsible to each student in helping them succeed in each part of their individualized plan.
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Explore This IssueNovember 2015
If we created a truly patient-centered, performance-based office, what would it look like? What would happen if you became really committed to change?
In the chapter, “Commitment and Moral Purpose,” Mr. DeLorenzo encourages the shift from taking small steps to engaging decisive action by quoting from a passage from The Scottish Himalayan Expedition by William H. Murray:
Until one is committed there is hesitancy, the chance to draw back, always ineffectiveness. Concerning all acts of initiative (and creation), there is one elementary truth, the ignorance of which kills countless ideas and splendid plans: that the moment one definitely commits oneself, then Providence moves too. All sorts of things occur to help one that would never otherwise have occurred. A whole stream of events issues from the decision, raising in one’s favour all manner of unforeseen incidents and meetings and material assistance, which no man could have dreamt would have come his way.
Through consulting and helping many systems change, Mr. DeLorenzo has concluded and states that transformation can’t occur unless the students/families, teachers and administrators are all committed from the beginning. This may be an important lesson for us—only when patients, providers and payers come together at the population level will we be able to change.
Now, back to my hammock!
Steven S. Overman, MD, MPH, FACR, is associate medical director of QualisHealth, founding member (retired) of The Seattle Arthritis Clinic and professor of clinical medicine at the University of Washington.
Possible Future Rheumatology Care Model
- Care contacts that move away from physician office schedules to on-demand care at their place of work or via the Internet;
- Care management that tracks patient performance and facilitates movement along a comprehensive, personalized care plan;
- Individualized programs that support your patients’ emotional, physical, social and spiritual concerns and conditions;
- Care extenders that reach out to individuals at risk of musculoskeletal morbidity; and
- New care strategies that reduce costs.
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- From Baldrige Performance Excellence Program. 2015. 2015–2016 Baldrige Excellence Framework: A Systems Approach to Improving Your Organization’s Performance. Gaithersburg, MD: U.S. Department of Commerce, National Institute of Standards and Technology.