Tag: process

Categories
- Empowerment - Prevailing Conceptions - Primary Care Discourse Health Care Power

Is Primary Care Actually Effective?

In the field of emergency medicine, there is an idea called “door-to-balloon” or “time-to-cath”, which is the amount of time that has elapsed from the moment a patient who is having a specific kind of heart attack walks into the emergency department to the time that a catheter enters the occluded vessel.  (There are two general types of “heart attacks”, or myocardial infarctions (meaning death of the heart muscle); one requires immediate surgical intervention with a catheter to open up the blocked blood vessel – the definitive treatment – while the other can be treated with medicines initially.  It is the first kind to which the “door-to-balloon” idea relates).

 

An enormous amount of energy and resources from a myriad organizations have gone into systematic efforts to reduce this “door-to-balloon” time, and subsequently reducing the number of deaths after the onset of a myocardial infarction.  The American College of Cardiology launched a large national “initiative” and the American Heart Association launched a complementary “mission” to standardize and reduce time-to-cath; emergency departments have received incentives over the years to make this an ordinary practice, it has become a core measure for healthcare accreditation, and it is now common vocabulary within the healthcare field and among the public.  Over the last decade, because of its success, it has become a common topic of medical research and direction for scientific inquiry.

 

And the results are impressive.  At the foundation of this idea is a set of hospital procedures and protocols, a collection of ready human and technological resources, an algorithmic approach to diagnosis and management for the ED team, and a mechanism for administrators to identify and eradicate delays in the process.  Whatever means are needed to bring door-to-balloon to under 90 minutes is supplied.

 

And none of that involves the patient.  In fact, the system probably runs smoothest when the patient is unconscious…one step from dead…as passive as possible while still able to be kept alive.

 

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Because of its tremendous success, and coupled with society’s event-oriented mindset and infatuation with instant results, the concept of attaining a goal within a certain time has become common in health care.  More and more, time parameters are set on objectives, which dictate reimbursement structure, staffing needs, research practices, and overall resource allocation.

 

What the health care system does well is simply a reflection of what society does well – eliminate the will of an individual and let the system’s will force short-term and end-oriented results.  We can miraculously prevent a patient from dying if their heart stops receiving blood, yet we can’t seem to do anything about the rising incidence of the need to do this.

 

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So it seems that primary care is the answer.  Manage disease before it becomes an “event”, before it requires “immediate results”, before it necessitates life-saving measures.

 

But it’s not that simple.  Let’s take an example with diabetes management in primary care.  Common in the discourse now is “time-to-goal-A1c”.  A1c is a great blood test that measures the average amount of blood glucose over 3 months, let’s say.  It has now become the standard for diagnosis and monitoring of diabetes.  Below 7.0 is good control; so ambitious primary care proponents are pushing the idea of lowering a patient’s A1c to 7.0 within 3 months of their first visit to a clinic.  Time-to-cath, 90 mins.  Time-to-goal-A1c, 90 days.  Makes sense.  It works in the emergency setting – the only difference between emergency and primary care is time, right?

 

Unfortunately, there has been little to no success.  Despite the enormous amount of energy and resources from a myriad organizations, despite the incentives offered to clinics, despite the core measures and accreditation criteria, despite the research, the prescriptions, the counseling, the protocols, the ready human and technological resources, the algorithms, the mechanisms, despite all efforts by the will of the medical system, there is no success.

 

Because, this time, the patient isn’t unconscious.

 

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The reason why our healthcare system – and, indeed, our society in general – is excellent at drastic end-of-life situations is because the variables are in the hands of the system itself; the patient doesn’t factor.  Emergency situations, albeit outwardly chaotic, are very controlled by those in charge.  Simply, the more the system is empowered to act, the better will be results.  And the same reason explains why primary care is unable to parallel such impressive results: because the power to act still is being locked within the clutches of the system, yet it is the patient who is the primary actor.  It mistakenly thinks that if it becomes more empowered, it will deliver health better.  However, while a patient may encounter the system’s will for 15 minutes every week, and be given prescriptions in the broadest sense of the word, this does not account for the other 6 days, 23 hours, and 45 minutes he is alive.  Delivering health is not the same as delivering a service or good that is needed in an immediate or life-threatening situation; in fact, health is not something delivered, it is something of which a patient is empowered to take charge.  Instead of focusing on the system as the deliverer of health, real healthcare means focusing on empowering patients to take charge of their own health care.

 
Empowerment, like health, is also not something delivered from the empowered to the unempowered; it is something fostered through the creation of environments and relationships.  It occurs through the generation of knowledge, through selfless service, and through humility.  It draws on the powers of the human spirit and the capacities of the soul.  It is a process that demands the active participation of the protagonists of social transformation – all of humanity.

 

 

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Categories
- Consultation - Empowerment - Governance - Religion - Three Protagonists Discourse

Summary of August 9th Message

Paragraph#:

1. 10 new Regional Councils (RC’s). 5-Year Plan messages foundation of action and study. Familiarity with dynamics of growth increases with core activities.

2. Dichotomy of neighborhood and centralized children’s classes (CC) transcended. 2 Junior Youth learning sites. Expansion/consolidation primary task of RC’s.

3. RC’s to ensure functioning of Regional Training Institute (RTI) and Area Teaching Committees (ATC). Two perspectives: cycles of activity and educational process.

4. RC to draw on world-wide system of generation and dissemination of knowledge. Relationship with Counsellors significant. Report successes and impediments.

5. Prospects for Junior Youth program especially bright. Transformation in junior youth and rapid development in those accompanied to serve as animators.

6.  Capacity for human resource development needed for sustainable progress in growth of Cause and transformation of society.

7. Intensity and patience are called for organically in accordance with the varying rates of growth in various populations.

8. Refrain from comparisons between differing circumstances. Validity of network teaching versus intense neighborhoods. Guard against inundating fledgling efforts.

9.  Attention to Latin, African, Asian children; now 1 in 4 children. Vibrant sense of community more pronounced. CC’s and JYSEP accelerate community building.

10. NSA to engage in regular consultation with Counsellors on form of scheme of cluster coordination being studied by International Teaching Center.

11. Ramifications for organization of National Center. Decentralization to respond to financial needs at grassroots. Funds for part- and full-time workers.

12. Growth not to revolve around expectations or presence of RC members. Requests for reports or gatherings deferred in response to needs of grassroots.

13. Appreciation of efforts. Ardent supplications on behalf of new RC’s. May Baha’u’llah bless American Baha’i community.

Department of the Secretariat

9 August 2012

Categories
- Governance Discourse

Surgical Politics

Our goal is to participate in discourses of importance to society at all levels of stratification, from informal discussions on internet forums and attendance at regional seminars, to the dissemination of insightful statements and relationships with government officials. It is necessary to forge a dialogue and maintain a presence in the many social spaces in which thought and policy-making take place. But, we ought to desist from participating in partisan political processes and discussions that are not constructive.  To do this we must develop first a perception that discriminates between forums for constructive, noble discourse, in which we seek to engage, as opposed to divisive, partisan discourse, which must be quarantined and allowed to fade.

The principles that help identify boundaries between processes and discussions that are unproductive for us to participate in are part of a surgical approach to political discourse which is invasive and substantial, in terms of achieving social change, but which intentionally and distinctly avoids elements that can act as a quagmire or self-corrupting influence within partisan systems. What principles can guide us in our efforts to determine what elements and when to participate in specific discursive processes? What initiatives can we take to participate in public discourses as individuals and when should we maintain silence or non-involvement on a forum or issue for the achievement of an higher common unity?

How can we cultivate a deeper understanding of the grand narrative of social transformation at work in global challenges, reading into it more than just superficial phenomena, and how can we align our political goals with this epochal process? Partisan viewpoints that drag unsuspecting activists into immovable ideological gridlock ought to be avoided, among other things. What spiritual insight will guide us to distinguish constructive processes that advance civilization from divisive partisan processes that ought to be avoided?

Categories
- Language Discourse

Rise of a New Dawn

Red was painted the sky of man’s grey history, blood rained from clouds heavy, pregnant with the neglected structures and individualistic anachronisms that is our society.  Individualistic rhetoric carried over from biological sciences went unquestioned as it is introduced into social conceptions of human nature and figured in shaping institutional structure and political policy.  Neglect for spiritual insight and enlightened conceptions of human collective nature, social structure persisted under outdated and animalistic thought processes until disaster and ruin forced a questioning of the thought process. Pain heightens spiritual perception. Spiritual perception invites conceptual reform. Re-conceptualizing human nature allows structural reform at all levels. New versions of unity follow, Justice, Knowledge as the central process of human society. Finally power is reformed. Within this gamut specific discourses arise for conceptual, structural and practical reform. Discourses of politics, development, the harmony of science and religion, and discourse emerge first. Discourse on economics follows…

Crimson complete, red supervenes over the grey of humankind’s neglect of outdated policies and self-conceptions. The mediocre and lazy stance towards conceptions of human nature and society’s neglect of all-important spiritual discourse allowed neanderthal slogans and fragmentary conceptions to occupy the sacrosanct seat of mankind’s ideology and self-conception. Ancient and simplistic conceptions were derelictly accepted as doctrine. The grey of this neglect formed the backdrop of storm clouds that gathered over mankind’s destiny which as it poured its pregnant product mankind realized rained not rain but crimson blood. Blood of our kind, blood of our brothers, blood of our species, blood of our nieces and babies. Blood rained from the clouds of our neglect, from the clouds of our neglect of ideologies, from our neglectful ideologies. Red blood rained from our structural primitiveness. Spirituality is now forced. Pain breeds spiritual enlightenment. Blood has served it purpose. Grey neglect has bled its purpose. Crimson complete.

 

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Categories
- Consultation - Empowerment - Religion - Science Development Justice Knowledge Oneness Power

Beyond Modernism and Post-Modernism

Historically and currently, the relationship between power and knowledge has been strained and complex, to say the least.  Recently, “modernism” – which has constructed systems of knowledge around truth-claims about social reality – has come into critique by “post-modernism” – that these systems have been created through the operation of privilege and power, resulting in an unjust and inequitable social reality that brings modernism’s remarkable advances to only an elite minority.  Post-modernism, however, has reacted to an extreme position, asserting that all knowledge is grounded in power dynamics, that knowledge is oppression, that no truth-claims are more valid than others.  Instead of a solution, post-modernism has replaced all thought with endless critique.

Perhaps the following premises can help:
1)  Human comprehension is limited, human perspective is diverse, and social reality is complex and multifaceted.
2)  Science and religion, two systems of knowledge and practice, yield partial and tentative, though valid, insights into this reality.
3)  Over time, through a reflective learning process, humanity can judge the relative validity these insights (or truth-claims) against the goal of advancing civilization.

This is a consultative, evolving, and adaptive approach to knowledge.  It can be protected from oppressive uses of power by a) drawing in any and all diverse insights and perspectives, experiences and reflections, and constructive criticism from all people, and b) being guided by spiritual principles such as oneness, justice, interdependence, compassion, honesty, cooperation, etc.

This approach resolves the tension of knowledge and power, currently taking form as the crisis of modernism and post-modernism.  More importantly, it empowers humanity to take charge of its own destiny and the advance of civilization through the generation and application of knowledge.

Categories
Discourse Knowledge

Habits of Thought

Certain habits of thought also need to be fostered in connection with a culture of learning, often at odds with current society’s tendencies – three will be mentioned.  It is clear that society increasingly speaks with slogans.  To be able to analyze yet not reduce, to ponder and not dwell, to categorize but not compartmentalize are essential to form full and complex thoughts required of a learning mode.  To take science and religion as an example, there seems to be an endless quest to describe each of these vast systems using fewer and fewer words accompanied by clichéd pictures.  “Science flies you to the moon while religion flies you into a building” is one rather amusing one.  What is actually learned from this statement?

Society also breeds false dichotomies – many of which have already been mentioned: science vs religion, study vs action, individual vs collective, material vs spiritual, action vs reflection, mind vs heart, “us” vs “them”, etc.  They are all manifestations of fragmented thought, harmful to a culture of learning that seeks to understand the interconnectedness of all things.  Many stem from the general false dichotomy between being and doing.  These are two mutually informing aspects of one coherent human being;  an individual personally develops through service, and gains the impulse to serve through personal growth.

And thinking in terms of process, as oppose to society’s end-point oriented value system characterized by punctuated events, short-term vision, and instant gratification, is crucial in understanding that learning is a process that will proceed over time, will evolve in an organic fashion, will require sustained and long-term action and vision, and will never reach a definite conclusion.    Regardless of if current society has forgotten this fact, science and religion are both characterized  historical process, whether progressive unfoldment of revelation or progressive development of disease treatment.

Categories
- Religion - Science

Fruits of Assumptions

The last post mentioned some equivalent basic assumptions that underly science and religion as systems of knowledge.  All of these assumptions or articles of faith cannot be empirically proven, but rather, their validity is shown over time as they are operationalized – in other words, put into operation and practice.  The fruits of science, under these assumptions, have yielded their fruit – advances in communications, abilities in the health field, mass transit, to name a few – and we now have confidence in the premises of science.  Thousands of years ago, however, when the scientific enterprise began, these assumptions would have appeared radical and would not have been empirically verifiable.

The fruits of religion are less obvious, and the corruptions more apparent; leaving in many observers a skeptical stance.  However, religion’s positive contributions to humanity’s history cannot be overstated.  It is the leading force impelling civilizations, moral codes, unification, and many of the world’s moral, intellectual, artistic, and social advancements.  It has been the chief source of meaning, order, and guidance throughout human life.  Historically, religion’s generating influences have been geographically concentrated, progressively widening in scope in a punctuated manner with the advent of new religions, extending from the tribe to city-state to nation.  In time, through the continued operationalization of its underlying assumptions, the fruits of religion will be self-evident in the form and function of a world civilization.

Both science and religion are based on articles of faith, which can only be verified over time and through putting them into practice and application.  What fruits of assumptions do you see in daily life?

 

Categories
Development

Capacity Building

One fundamental feature of a development process that recognizes the material and spiritual requirements of social reality is capacity building.  In fact, development can almost be seen as synonymous with building capacity.  The people themselves are the protagonists of their own development, as all learn to generate and apply knowledge to manifest the latent capabilities inherent in each human being.  Development is not the provision of goods and services from a “developed” group to a “developing” or “underdeveloped” group.  Though this may happen at some points in the process, but it is not development; for it breaks down humanity into otherness, incompatible with the principle of oneness.  Every human being is inherently noble, endowed with talents and capacities that can be revealed to contribute to their community.  The people are the true treasures.

What does an economic system look like that is built on these convictions?

A conception of development that ignores spirituality marginalizes the populations that it aims to serve, as well as becomes deprived of humanity’s deepest roots of motivation.  Throughout human history, the achievements of religion have been moral in character; through religious teachings, people have developed the capacity to love, to unify, to seek truth, to sacrifice for the common weal.  Spiritual values in development not only engages the participation of the vast majority of humanity – which approaches universal participation demanded by justice – but also elicits powerful human capacities that can serve to benefit humankind.  True development necessitates spiritual principles as capacity is built.

What spiritual values are relevant to development?

Categories
Oneness

Social Organization Progressively Expands and Integrates

Social Organization initiated distinctly with the consolidation of the institution of family life, moved in stages successively through simple structures of clan-based and tribal existence to the eventual emergence of a diversity of forms of urban society, coming to rest only recently in the solidification of the nation-state schema of planetary division. Relative to the one before it, each stage opened up a wealth of new opportunities and realities for the exercise of human capacity in food, health, agriculture, technology, culture and prosperity. The advancement of our species in terms of the historical progression of social organization has not occurred at the expense of our individuality. Indeed all great vistas of what we consider human achievement have been made possible by the increasing integration and complexity of human social organization. Power for good and evil has increased both for it and because of it. As social organization has increased, the scope for the expression of the capacities latent in each human being has correspondingly expanded.