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The future of palliative care - Issue #8

"You never change things by fighting the existing reality. To change something, build a new model tha

The future of palliative care

April 15 · Issue #8 · View online
In many respects, we've arrived. Yet what we know now won't get us to the next level. So I'm looking for signals from the future, & I'm curating them here.

“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” Buckminster Fuller

1. The economic impact of early conversations.
Many palliative care clinicians need trigger warning for the persistent C-suite request for the ROI [return on investment] on early conversations. Yes it is the kind of discussion that makes me feel like I need to take a shower afterwards. But now, we have a citation: thank you Bond et al: the ROI for the education costs in their advance care planning program, in an ACO, was 104%. Impressive.
Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs | Journal of Palliative Medicine
2. A new model for a post-capitalist economy.
I’ve following the work of Otto Scharmer’s Presencing Institute; they’ve just launched a “Transforming Capitalism” Lab online, and the first speaker was Kate Raworth, an Oxford economist who talks about designing economies that are about more than growth–her new book, Doughnut Economics, introduces a model for economies that is multidimensional. The parallel for us is this: how could we design healthcare that is about more than prolonging survival? We need to think bigger.
Her big thinking about the new economy, at TED Vancouver earlier this week.
Her big thinking about the new economy, at TED Vancouver earlier this week.
Kate Raworth on why growth isn't enough (3 min)
3. A way to find leverage points: visualize the network.
A nice review in the Stanford Social Innovation Review lays out a roadmap for effective collaboration–and the last step, Collaborating for System Impact, is something we could learn from. One of their example is 100Kin 10, a collaboration of more than 200 partners working to support STEM (Science, Technology, Engineering, and Math) educators, and train 100,000 excellent new STEM teachers by 2021. The 100Kin10 website is worth a look–they’ve put their achievement timeline right on the front page. We could have something like this for primary PC education, yes?
Cutting Through the Complexity: A Roadmap for Effective Collaboration
4. Social determinants, meet big data.
Three sweeping empirical reports use big data science of social determinants to show why we need to pay more attention to the parts of the serious illness ecosystem that lie outside health systems. First: being admitted to the hospital, just once, is bad for your personal finances. Second: eviction is another sentinel event (check out this Eviction Lab data visualization). Third: being black and male stacks the economic odds against you, because of racism. Made me wonder: we talk about African-American patient distrust–but is the problem actually institutional structures that reduce access or turn away these patients?
Extensive Data Shows Punishing Reach of Racism for Black Boys - The New York Times
5. Living in the fragility of life.
Kate Bowler had just joined the faculty of Duke Divinity School when, at the age of 35, she was diagnosed with metastatic colon cancer. Her new book, and interview by Terry Gross on Fresh Air, are worth a look: “I remember in those few moments when I would wake up–I would remember [my cancer] like it was the first time.…all of a sudden I would think ‘oh no, I might die this year’, and I kept having to rediscover that every day.” Reminds me of this under-cited philosophical exploration by Todd May
A Stage-4 Cancer Patient Shares The Pain And Clarity Of Living 'Scan-To-Scan' : NPR
Death - Todd May - Google Books
6. Brooks Headley is trying to master foccacia.
Wow, this newsletter has been pretty serious. So let’s finish with a sideways look at the fragility of creative work. “We are trying to master an extremely inefficient and time-consuming thing that may or may not become a thing we can sell for money.“ Sound familiar? This noted chef, whose last project was a now-legendary hole-in-the-wall veggie burger place in NYC’s East Village, is working on foccacia. Made me smile.
Brooks Headley Is Moving On to Focaccia | TASTE
This newsletter is made possible by the John A. Hartford Foundation. But the views, opinions, and recommendations are mine only. 
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