This is probably the last post I will do on the Wellthcare site. It’s been four months since the last one. This is not because our work faded; quite the opposite. Things really took off and that’s partly why I have decided to change how I work and write.
There have been three major achievements in the last four months.
Firstly, the nine organisations that I announced in my last post all met in New York on July 22nd. We spent the day discussing how we’re struggling to think of health beyond the bio-medical model, while at the same time sharing some of our attempts to create health. It was clear that we’re only at the beginning of an entire new discipline of ‘health creation’, and that we have more questions than answers – but we all saw that as a good thing.
Secondly, on August 27th I hosted a meeting with the Institute of Medicine (IOM) on designing evaluations for what communities really value. The underlying premise of the meeting was that while we clinicians may want people to think of their health in specific ways, communities have their own priorities, many of which are non bio-medical. Given that it’s always best to start from where people are, the idea was to devise an intervention to meet their needs and then devise an approach to evaluation. We used one of the communities from the Way to Wellville challenge, Spartanburg, South Carolina, as an example. What struck me most was when asked what they wanted for their health, they often said ‘security’; when was the last time you saw a clinical intervention to increase security? It was invigorating, real-world stuff; challenging and important. On the right is my keynote from the event.
Thirdly, there is clearly a strong desire to continue all this work, especially in the US where the population health provisions of the Affordable Care Act are forcing people to think about communities as well as individuals. While this may not feel like a ‘major achievement’, consider how the above two meetings came about: one bloke from his kitchen table in Clerkenwell, London, sought out the right people from four nations, got them to meet, catalysed a meeting at the IOM (at the IOM, no less), and then got unanimous support to carry on. I don’t often give myself credit but I did well, that I know.
But carrying on is going to take money and that’s where we’ve hit the buffers. All of the organisations at the table want to help fund the work but their institutional money is locked in spreadsheets designed around the bio-medical model. The irony of this is best conveyed by an excerpt from the best 1200 words I have read on the tension between health and health care:
Though clinical medicine and public health have some of the same interests at heart, the economics of the healthcare sector ironically puts them in competition with one another for a limited supply of power and influence—often to the detriment of health outcomes.
That pretty much sums it up: the economics of the health care sector is limiting our progress.
The core of the money needed is to pay for my time. I find that an uncomfortable reality but the simple truth is that it takes a lot of work to bring disparate organisations, each with different parts of the puzzle, together, and then help them find common themes between their efforts. Establishing the July 22nd meeting in New York, for instance, was almost a full time activity for five months. The problem was that I had funding to work on it part time for three months. You don’t have to be a mathematics genius to see the numbers didn’t add up.
The good news, however, is that some people and organisations understand the need for new forms of collaboration to address wicked problems. As part of my follow up to the above two meetings I have written a funding request for what we might do next and four funders have asked to see it. We’ll see what happens next but one thing I have learnt is that these things take time and in the interim you need to be making money elsewhere.
In parallel to all this, I have found that the term ‘wellthcare’ does not serve me – or anyone else – well. It did at first. When people read it they thought it cute and immediately ‘got it’. However, the more I talked about it the more I realised it didn’t work; when it’s said in speech you have to clarify the spelling and then you can see people thinking about it before the penny drops – all of which gets in the way of the discussion. On balance, it didn’t work. Indeed, I’ve come to believe that the use of a neologism creates a barrier between you and your audience, effectively inhibiting further dialogue.
All in all, I have decided to bring my work together under a single name – my own. On the new website, I am going to bring together my multiple activities into a lucid whole.
I’ll share what I am working on as well as what I am exploring, part of which is what was previously called ‘Wellthcare’ and is now being called the ‘Creating Health Collaborative’.
As if all of the above reasons for the change were not enough, my favourite came from one of the potential funders of the Collaborative. He told me that his organisation was really interested in supporting the work but they didn’t know who I was; they were worried, to use his words, that I am “the Bernie Madoff of health care”. When people compare you to an America stockbroker convicted of massive fraud you soon realise it’s time to change!
It’s important to emphasise that the work started under the name ‘Wellthcare’ is continuing. It does, however, need funding and I remain positive that the four organisations looking at the proposal will come through. I’ll keep you posted on all of this via the new website (and I have taken the liberty of transferring the list of subscribers to this site onto the new one). The key thing I have learnt is that being “one bloke from his kitchen table in Clerkenwell, London” only takes you so far; sooner or later you need some sense of formality to go to the next level.
I’ll end with a personal reflection. In April 2012 I was convinced that the future of health lay outside of the current system; that was why I quit my well-paid job and started rummaging around to work out what I wanted to do. Back then I couldn’t have imagined that I would co-host TEDMED, give strategy advice to the NEJM Group, corral numerous organisations to come to a meeting in New York under the auspices of a made-up name, and do a key note at the IOM. There’s clearly an appetite for change out there but most people are locked in the current system. If we’re going to create the kind of change I think many people want to see – including working out what it means to create health through community – we need to see beyond the current system, and support those willing to seed a new one.
See you all on the next part of this journey.