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NATIONAL HEALTH

"It's better for everybody when it gets better for everybody." Eleanor Roosevelt

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* ORGANIZE SYSTEMS

c o m m u n i t y     b y     c o m m u n i t y

 

  

  

   

  

 

 

O  R  G  A  N  I  Z  E      S  Y  S  T  E  M  S

  

    

    

  

                  

 

 

INTRODUCTION

   

   

” Communityship  needs  to  be  strengthened  in  many  organizations  today.

This  does  not  mean  that  we  have  to  put  it  on  a  pedestal,

in  place  of  leadership.  It,  too,  can  be  overdone.

After  all,  witch  hunts  had  their  roots  in  community.

What  we  need  is  balance.  We  would  do  well,  therefore,  

to  see  both  forces  as  working  together  in  a  socially  responsible  way  

to  get  past  the  insularity  that  exists  in  many  organizations.

A  healthy  society  balances  leadership,  communityship,  and  citizenship. ” (19)

Henry  Mintzberg      (  1939  –        )

   

                                      

Henry Mintzberg is a professor of Management Studies at McGill University in Montreal.  His  “The Last Word” Commentary appeared in the July-August 2009 edition of the Harvard Business Review.  The citation above is the last paragraph of the Commentary.  Can there be any doubt?  In one paragraph, he summarizes the essential challenge for the reform of our nation’s healthcare industry.

In 1968, Senator Robert Kennedy spoke about a wide-spread social disturbance, now worsening more rapidly for 20 years, that could destabilize any strategy for healthcare reform that was based on the community.  The opening quotation, on the “MINDLESS MENACE …”  Sub-Page of the  APPENDIX  Page,  described Senator Kennedy’s view of the pervasive violence occurring throughout our land.  Although healthcare reform is the primary focus for  NATIONAL HEALTH,  the indirect motives for healthcare reform could also be its support for “A healthy society” and a related reduction in the “mindless menace of violence” with its adverse effects on the  Family  of each citizen throughout our nation’s, community neighborhoods. 

This Global Task,  ORGANIZE SYSTEMS,  defines the leadership structure for the governance that would direct the affairs of  NATIONAL HEALTH  as it promotes  “communityship and citizenship”  for the reform of our nation’s healthcare.  The cornerstone of our nation’s  Survival Commons,  its healthcare for each citizen, requires a paradigm shift.  This level of renewal must withstand many sources of turmoil, not just the pervasive violence in our neighborhoods.  The degree of human goodness and strength to promote change already exists in every community.  We must seek it out and remind our neighbors and  Extended Families  about the fundamental strength that exists in every community to achieve  Stable HEALTH  For All Citizens.  The current state of our nation’s healthcare is in a high degree of disrepair.  The renewal of healthcare must be considered systematically, beginning with Primary Healthcare that is  equitably available to and ecologically accessible by every citizen. 

  

LEADERSHIP

  

If this  Initiative  has an attribute open to honest differences of opinion, it is its process for selecting the initial and permanent leadership to represent the spectrum of appropriate vested interests required for its governance.  Also, choosing the optimum size for a group of individuals to successfully govern an institution is not clearly understood.  I have chosen nine. Given these uncertainties, the nine Members for the Board of Trustees of  NATIONAL HEALTH  would each represent, respectively, one of nine groupings of states. Each group of States would encompass a roughly equal population of approximately  34,000,000  citizens.  The resulting nine groupings of one or more states would coincide with regionally shared, social and geographic characteristics.  Each regional group would have its own Regional Council to assist the Board of Trustees in an advice and consent relationship.

 

Eventually, the nine Regional Councils would each establish nine District Coalitions, formed to promote the existence of enhanced Primary Healthcare for approximately  4  million citizens.  The  81  District Coalitions would each promote a locally driven formation of nine or more  Community HEALTH Forums  for the citizens within their District.  The functions of each  Forum  would be supported through technical assistance by the Associates, i.e. staff employees, of their respective District Coalition.  Each  Forum  would serve a community of between  100,000  and  700,000  citizens, depending on the geographic size and its population density.  All together the nearly  800  Forums would each promote  social capital  as a basis to define a Community HEALTH Plan,  annually updated, for assuring that equitably available Primary Healthcare existed for each citizen.  Eventually, the nearly  800  Community HEALTH Plans would specify the development of  HEALTH SECURITY  certified Primary Healthcare throughout their community.  

   

The  initial Members  of the Board of Trustees and Regional Councils would be selected by a temporary, expedient process.  This would involve a Governor from the state or group of states associated with each Regional Council.  When all of the District Coalitions within a Region have been operational for two full years, the permanent process for selecting each of the Members for that Regional Council would begin.  Once the affairs of  NATIONAL HEALTH  had stabilized, the Chairman of the Board of Trustees would recommend an applicant to become its President and Chief Executive Officer.  The President/CEO would function as an ex officio Member of the Board of Trustees as defined by an Operational Statement approved by the Board of Trustees.  Most importantly, the combined Membership of the District Coalitions, Regional Councils and Board of Trustees would achieve the requisite experience for the continuous acquisition of leadership skills throughout NATIONAL HEALTH. 

The  Initiative  requires  NATIONAL HEALTH  to prepare an annual report for the President and Congress.  The annual report would be the basis for proposing any new Congressional action that may be necessary to resolve any barriers to reform encountered by  NATIONAL HEALTH.   Optimally, these  requests would not be controversial and would represent widely supported improvements in the reform process for our nation’s healthcare industry.

Locally connected leadership will be a special requirement for each  Forum  as they formulate a  Community HEALTH Plan  to sponsor equitably available Primary Healthcare for each citizen.  This Plan would  1) eventually specify Primary Healthcare that has achieved  HEALTH SECURITY  certification and  2) avoid unintended, but potentially divisive, problems associated with provider panels, community anti-trust, intellectual property, neighborhood service areas, physician career commitments or population shifts.

       

The basis for the  Community HEALTH Plans  may eventually require Congressional clarification given the risk of either inaction or anti-competitive activities.  As the benefits of enhanced Primary Healthcare begin to mature, the nearly  800 Forums would focus the their  Community HEALTH Plans  on other community  HEALTH  problems. These would include a consideration of the current community-wide participation in the local, regional and national pre- and post-disaster preparedness. The vast majority of disasters are knowable, except for their exact location, strength and timing.  In one sense, the process of preparedness for the knowable disasters is the most important means to promote the  resilience  for responding appropriately to the disasters that are not substantially for-see-able, such as an Influenza pandemic.  

   

Eventually, each of the annually revised  @800  Community HEALTH Plans would comprise three sections.  The fist Section would detail the character of its Primary Healthcare: its level of availability as assured cooperatively by its local institutions, its prevalence of  HEALTH SECURITY Certification, and its anticipated future augmentation needs.  The second Section would describe the community’s most prominent adversities that are amenable to the use of collective action for their reduction or stabilization, such as:  1) early childhood education,  2) adolescent health (suicide, addiction, STD ),  3) pain control or  4) homelessness.  Finally, the third Section would describe the readiness of the community’s ability to mitigate before, during or after a disaster event including the steps in place to maintain this readiness.  A nationally sanctioned effort, community by community, to maintain these Community HEALTH Plans  might be the most important benefit of healthcare reform as it helps each community revitalize the importance of each citizen’s  Extended Family  and their  Family Traditions  for a citizen’s  Stable HEALTH.   The national benefit occurring from having all communities using the same strategy may be it most important attribute for focusing more clearly the community’s continued support of its  social capital  for each community’s  Survival Commons.

     

GOVERNANCE 

 

The top two levels of governance would be established based on a plan described within the Congressional Charter and initiated by the President.  A  Sub-Page  of the  GOALS  Page  describes one model for selecting the  initial MEMBERS  the  Board of Trustees.  The President, or a designee, would preside over the  initial Meeting  of the Board of Trustees at a location defined by the Congressional Charter.  Presumably, the  initial MEETING  would  1) select its Officers and  2) establish the structure and content of the initial  OPERATIONAL STATEMENTS  including  General Operating Principles  and an  initial Strategic Projects Plan.  A possible model for these two  OPERATIONAL STATEMENTS  can be found as  Sub-Pages  of the  GOALS  Page.  

      

  

  

          

CONGRESSIONAL  CHARTER  PROVISIONS  FOR  THIS  GLOBAL  TASK 

                           

                         

A.  The Congressional Charter shall define the initial   V I S I O N   for the affairs of  NATIONAL HEALTH  beginning with the  initial Meeting  of the Board of Trustees. 

   

[ COMMENT:   For the first ten years,  “Stable HEALTH  For Each Citizen”  could represent its  V I S I O N.  And,  its   VALUES  could be:  ALTRUISM,   TRUST,   COOPERATION,   RECIPROCITY   and   EXCELLENCE. ] 

  

 

B.  The Congressional Charter shall require  NATIONAL HEALTH  to establish and maintain three national projects to support healthcare reform  AND  to implement a  new strategy  for achieving community based collective action for promoting its own needs, especially for Primary Healthcare.  The three national projects, the  new strategy  and three  GOALs  shall be achieved within 10 years after the  initial Meeting  of the Board of Trustees. 

    

          1. The three national projects shall be: 

                    a.  a  PRIMARY HEALTHCARE  BENEFITS  PLAN  that defines

                              the minimum benefits to be covered by all financial sources

                              for the reimbursement of health care provided to any citizen

                              for their Basic Healthcare Needs including the options applicable

                              for the augmented support of  HEALTH SECURITY  certified  

                              Primary Healthcare.

   

[ COMMENT: This will likely take several years to finish.  The use of multiple layers as a basis for recognizing regional and community institutional needs may be an important attribute of this  PLAN  to assure its local and regional acceptance as an important contribution to the overall reform of our nation’s healthcare industry.  A broad base of public support will be necessary for the successful completion of the  PLAN.   Furthermore, the legitimate concerns about change must be engaged responsively given the complex, institutional and economic traditions involved. ]

    

                     b.  a  PRIMARY PHYSICIAN  EDUCATION  PLAN  that

                              describes the career-long training systems necessary to assure the availability

                              of  Primary Physicians as required by the  PRIMARY

                              HEALTHCARE  BENEFITS  PLAN,   and

     

[ COMMENT: As in “a.” above, an initially slow then rapidly evolving means to support and focus the efforts of our nation’s medical schools will be most important.  The initial drafts of the  PLAN  should focus especially on defining a physician’s basic skill-set required for Primary Healthcare.  This preparedness should include, especially, the technical and emotional adaptability for managing the breadth and depth of daily uncertainty associated with a person’s Basic Healthcare Needs.  This uncertainty is driven by the high level of genetic and sociodemographic diversity underlying each person’s  HEALTH  that is largely unknowable at the time of any healthcare encounter.

   

In addition, this  PLAN  would specify and implement a coordinated Post-graduate medical education process for all Primary Physician’s of all  HEALTH SECURITY  certified, Primary Healthcare clinics.  Its coordination with the appropriate specialty certification Boards would be most important.  A continuing process of accommodating the combined changes regarding  HEALTH  within the world-wide realms of its   Resources,   Knowledge  and   Human Dignity   will be necessary for the Primary Healthcare offered within each community. ]  

                                

                    c.  a set of criteria necessary for any Primary Healthcare clinic to qualify for the  

                             HEALTH SECURITY  CERTIFICATION  PLAN   as the basis for its augmented

                             financial support;

  

[ COMMENT: The criteria should create a process that recognizes a clinic’s initial commitment for change as a basis for immediately improved reimbursement. Subsequently, the annual level of increasing achievement for continued Certification would be defined for a span of 3-5 years.  As  NATIONAL HEALTH  matures, the initial “professional, non-economic buy-in”  phase could be shortened to 1-2 years.  The District Coalitions would monitor the Certification process.   NATIONAL HEALTH  would use its own resources as may be required for this monitoring. ]

  

        2. The  new strategy  shall be to:

                    a.  sponsor locally driven, community solutions for the equitable availability of enhanced

                              Primary Healthcare that is also ecologically accessible,

                              justly efficient and reliably effective for each citizen,

                    b.  promote the use of collective action as a community by community tradition

                              to augment its locally resilient  Survival Commons,   and

                    b. promote  the  NATIONAL HEALTH   VALUES  as a general standard  

                              for all levels of the healthcare industry.   AND

   

          3. Three  GOALs  shall be achieved within ten years or by its substantially steady progress to:

                    a. reduce our nation’s annualized health spending to  13.0%  or less      

                              of our nation’s gross domestic product,

                    b. reduce the annualized national maternal mortality ratio by  70%,   and

                    c. achieve ratification of the Congressional Charter by all States.

    

[ COMMENT: This would be more likely if at least 30 of the States ratified the Congressional Charter for  NATIONAL HEALTH  within its first 4 years.  The  GOALs  outcome year shall be the calendar year following ten full years of operational status following the  initial Meeting  of the Board of Trustees. ]

   

    

C.  The Board of Trustees shall have the sole authority and responsibility to carry out the affairs of  NATIONAL HEALTH  as defined by the Congressional Charter.  The Board of Trustees shall:

    

            1. establish its affairs according to the Congressional Charter; 

                  

[ COMMENT: A  Sub-Page  of the  GOALS  Page  describes one alternative for inclusion within the  Congressional Charter  as a basis to appoint the Membership for the  initial MEETING  of the  Board of Trustees. ]  

   

            2. have a non-voting Member selected within three years by the Chairman and approved by the Board

                        of Trustees for a term of  5  years as the President and Chief Executive Officer  

                        of  NATIONAL HEALTH  with eligibility for an additional  5  years;

   

[ COMMENT:  The initial Chairman may be a logical choice for this responsibility during the first  3  years.  The oversight role of the President and Congress should be defined within the Congressional Charter.  ]                    

 

            3. have  9  Members appointed temporarily that are replaced according to

                        a permanent selection process;

  

            4. have 9 Members appointed permanently beginning  3  years after the  initial MEETING 

                        to include at least  5  overlapping Members:

                        a.  one Member selected by the Members of each Regional Council and approved

                                    by the Board of Trustees for equally overlapping terms

                                    of  9  years from their respective Regions,

                        b.  select a Chairman from the current Members, having at least four years remaining

                                    as a Member   and  

                        c.  select a Vice-Chairman, having at least two more years remaining as a Member,

                                    by a vote of the Members every two years beginning the third year

                                    after the  initial MEETING;

   

          5. establish the Regional Councils according to the following nine groupings of States:

   

[  COMMENT: For this set of State  clusters  for  NATIONAL HEALTH,  I have taken the actual year of Statehood among the States of each respective Regional grouping to determine an average.  A rank ordering of these Regions recognizes the earliest versus the later, year of Statehood groupings of States.  The protectorates are not included in the average.  The State groupings represent citizen populations that average very close to 34 million citizens.   See  initial GOVERNANCE  Sub-Page  for the actual data.  ]  

   

                    a.  Region 1  East  –  1787:   Pennsylvania (1787),  New Jersey (1787),

                              Maryland (1787),  Delaware (1788),  District of Columbia, 

                              Puerto Rico,  U.S. Virgin Islands;

                    b.  Region 2  North East  –  1794:   Massachusetts (1787),  New York (1788),

                              Connecticut (1788),  New Hampshire (1788),  Rhode Island (1790),

                              Vermont (1791),  Maine (1820);

                    c.  Region 3  South East  –  1804:   Georgia (1788),  Virginia  (1788),

                              South Carolina (1788),  North Carolina (1789),  West Virginia (1863);

                    d.  Region 4  Central  –  1806:   Kentucky (1792),  Tennessee (1796),

                              Ohio (1803),  Indiana (1816),  Missouri (1821);

                    e.  Region 5  South Central  –  1826:   Louisiana (1812),  Mississippi (1817),  Alabama (1819),

                              Arkansas (1836),  Florida (1845);

                    f.  Region 6  North Central  –  1841:   Illinois (1818),  Michigan (1837),  Iowa (1846),

                              Wisconsin (1848),  Minnesota (1858);

                    g.  Region 7  West  –  1850:   California (1850);

                    h.  Region 8  South West  –  1898:   Texas (1845),  Oklahoma (1907),  Arizona (1912),

                              New Mexico (1912);   and    

                    i.  Region 9  North West  –  1908:   Oregon (1859),  Kansas (1861),  Nevada (1864),     

                              Nebraska (1867),  Colorado (1876),  Montana (1880),  North and South Dakota (1889),

                              Washington (1889),  Wyoming (1890),  Idaho (1890),  Utah (1896), 

                              Alaska (1959),  Hawaii (1959),  the residents of Samoa and Guam;

   

          6. having a requirement for each Member of the Board of Trustees

                    that reflects expertise of applicable experience for at least  25  years:

                    a. five Members as medical doctors with three Members as a Primary Physician, 

                    b. one Member as an independent mental health practitioner who is

                              not a medical doctor,

                    c. one Member as an epidemiologist,   and

                    d. two others Members as necessary for long-term leadership, especially with

                              professional skills associated with ethics and collective action;

 

          7. Establish an Operational Statement for the affairs of the Regional Councils

                    whose Members are selected from Nominees recommended

                    by a District Coalition to the Governor of the Region’s State

                    with the best level of healthcare accessibility;

  

[ COMMENT: The Membership requirements of each  Regional Council  would be similar to the  Board of Trustees. ]  

 

         8. Establish an Operational Statement for the affairs of the District Coalitions

                    limiting their responsibilities to a group, on average, of  3-5  million citizens

                    residing within the group of States served by their respective Regional Council:

                    a. A District Coalition may have a portion of their citizens living

                              in two States as long as the two States belong to the same

                              Regional Council,  

                    b. The Members shall be appointed for equally overlapping terms of nine years

                              by the applicable  Regional Council  with Members to include:

                              i. three Primary Physicians, 

                              ii. one Registered Nurse from a HHS sponsored Community

                                        Health Center

                              iii. one from a community public health department,

  

[ COMMENT: This candidate must have at least a Master of Science Degree, preferably in Public Health. ]  

  

                              iv. one from a medical school,

   

[ COMMENT: The candidate must have had leadership responsibility for curriculum development associated with medical student education. ]  

     

                              v. three from the community,   and

                        

[ COMMENT: These three might be selected from those counties of a State divided into three levels of  population density. ]  

                            

                              vi. one non-voting, full-time, administrative

                                        support person;   AND

   

[ COMMENT: This person might assume the role of the Vice-Chairman.  The person would be appointed by the Chairman of the Board of Trustees for a five-year term and be eligible for an additional 5-year reappointment. ]

                   

                    c. Each District Coalition will establish an Operational Statement

                              for the affairs of their  Community HEALTH Forums  as

                              approved by their respective  Regional Council.

   

[ COMMENT: Each Community HEALTH Forum would  1)  serve contiguous geographic areas within a District Coalition’s boundary,  2)  generally respect county borders and  3)  be responsible initially for promoting the equitably available Primary Healthcare needs of between 100,000 to 600,000 citizens. ]

   

            9.  Establish an Operational Statement for notifying the Board of Trustees

                        Chairman in case of a vacancy for any Member’s appointment. 

                        A vacancy shall be declared as a result of a majority decision 

                        by the Chairman, Vice-Chairman and the current Member

                        with the longest length of appointment to the related

                        Board of Trustees, Regional Council or District Coalition;    AND

  

            10. Locate the home office for the Board of Trustees, Regional Council,

                        District Coalition or  Community HEALTH Forum  based on the

                        same criteria and establish the initial home office for  NATIONAL

                        HEALTH  at St. Louis, Missouri:

                        a.  equitable travel distance among each division’s citizens,

                        b.  equitable travel distance to a medical school or

                                    school of public health,   and

                        c. equitable travel distance to a state’s legislature.

   

[ COMMENT:  The Board of Trustees shall establish an Operational Statement for the home office locations and periodically revise the Operational Statement at least every ten years.  In 2010, a geographic location southwest of St. Louis about half-way between St. Louis and Springfield and close to the city of Plato, Missouri represented the population center for our nation. ]  

  

  

D.  While maintaining regular consultation with the Regional Councils, the Board of Trustees shall manage the affairs of  NATIONAL HEALTH  based on an annually revised  Strategic Projects Plan  approved by the Board of Trustees.  The regular consultation with the Regional Councils shall at least involve official review of any Policy or Procedure for the first time and subsequently, for any revision, if the Board of Governors retained final Approval Authority of a previously approved Operational Statement. 

   

[ COMMENT:   A preliminary draft for the  initial Strategic Projects Plan can be found as a  GOALS  Sub-Page. ]

  

   

E.  After consultation with each Regional Council, the Board of Trustees at any time may authorize its Chairman to submit a request to the President for a Congressional revision of existing Federal Regulations or laws for the purpose of improving the ability of  NATIONAL HEALTH  to implement its Congressional Charter.  This authority may include proposals for a change in the Congressional Charter for  NATIONAL HEALTH  excluding any authority to participate in the direct  financial reimbursement or any other form of direct economic support for the health services of a citizen.  

  

   

F.  All institutions interacting with  NATIONAL HEALTH  will recognize a single definition for Primary Healthcare as may be defined by  NATIONAL HEALTH.

   

[ COMMENT:   A preliminary definition of Primary Healthcare can be found on the  DEFINITIONS  Sub-Page of the  OVERVIEW  Page. ]  

   

   

G.  The Board of Trustees shall authorize the Chairman to propose an Operational Statement for the format to establish the Policies and Procedures of  NATIONAL HEALTH.  These Operational Statements shall use polycentric and derivative concepts as a basis for governance.  The Board of Trustees shall retain ultimate responsibility for the affairs of  NATIONAL HEALTH  as defined by the Congressional authorization.  The Board of Trustees may delegate certain of these responsibilities to its Chairman or to the Regional Councils. 

  

[ COMMENT:  A sample Operational Statement for the  GENERAL  OPERATING  PRINCIPLES  can be found on a  GOALS  Sub-Page. ]   

   

 

H.  Decisions of the Board of Trustees, Regional Councils and District Coalitions shall require a quorum of  5  Members. Any Meeting of a Community HEALTH Forum may not occur without 5 Advocates, or a designee, present.

   

   

I.  Three years prior to restarting the Nine Region sequence for appointing Members to the Board of Trustees, the Chairman shall initiate a reconsideration of criteria for assessing the level of healthcare accessibility for each State.  Initially, it shall be its maternal mortality ratio as measured over a  10  year interval. 

   

[ COMMENT: As of 2016, the data most recently available was for the years 2005 through 2014. ]  

  

  

J.  The deliberations of the Board of Trustees, Regional Councils and District Coalitions shall follow “Roberts’s Rules of Order,  Newly Revised” except when the Chairman declares a temporary Open Collaboration form of deliberation.  Each  Community HEALTH Forum  shall follow an Open Collaboration form of deliberation.

 

[ COMMENT:  No  Forum  would have the authority to directly implement any plan.  Their role will reflect only an effort to attain consensus and shared responsibility among the principle stakeholders within their community. ] 

   

     

K.  The Board of Trustees shall establish an Operational Statement for Special Meetings applicable to itself, the Regional Councils and District Councils.  This Operational Statement shall also provide for 

                    1.  the Notice and Limited Agenda Subjects of any closed Special Meeting  and  

                    2.  any requirements for independent observers.

  

  

L.  The Board of Trustees shall initiate a planning Task Force to assess the future evolution of  NATIONAL HEALTH  starting five years after the  initial Meeting  of the  Board of Trustees and every ten years thereafter.  Any possible changes proposed to Congress for the Congressional Charter of  NATIONAL HEALTH  shall be implemented within 5 years of its initial consideration. 

               

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