equitably available
B U I L D C O M M U N I T Y
INTRODUCTION
“Experience gleaned from primary care practice-based research networks
confirms that the adoption of innovations often depends
on individualized support provided within the context
of trusting relationships.” (Grumbach & Mold 2009)
This opening quotation cited above appeared in a COMMENTARY published in the June 24, 2009 Edition, Journal of the American Medical Association. Submitted by Doctors Grumbach and Mold, it alludes to the precedent established by the Cooperative Extension Service for our nation’s agriculture industry. Congress authorized the Smith-Lever Act for the Cooperative Extension Service “…in 1914 as a collaboration among federal, state, and county governments; agricultural experts at land grant universities; and farmers.” (17) In the COMMENTARY, the authors propose a similar effort for Primary Healthcare. Promoted by NATIONAL HEALTH, each Community HEALTH Forum would include an obligation to support the community’s connection with the PRIMARY PHYSICIAN EDUCATION PLAN of NATIONAL HEALTH. To emphasize the importance of the Cooperative Extension Service as a model, it is important to recognize that our nation’s agriculture industry is the most efficient among the 51 advanced/developed nations of the world. In contrast, our nation’s healthcare industry is the least efficient. Importantly, our nation’s agriculture and healthcare industries are, respectively, the most and the least effective also by substantial margins.
As proposed, each Community HEALTH Forum would be nationally “franchised” by NATIONAL HEALTH and locally maintained by each community of between 100,000 and 700,000 citizens. The Community HEALTH Plan formulated by each Forum would promote local efforts to assure that Primary Healthcare is equitably available to each citizen. The Plan would evolve over time with the collaborative involvement of each community’s prominently responsible stakeholders. Eventually, each Community HEALTH Plan would promote Primary Healthcare that is also HEALTH SECURITY certified. The annual revision of its Plan would include the community Forum’s commitment to mitigate the ecologic and cultural adversities that substantially affect the HEALTH of its own citizens. Along with the equitable availability of enhanced Primary Healthcare, each Community HEALTH Plan would include 1) collective action projects, known also as collective impact projects, for certain improvements of its local Survival Commons, aka augmented safety net, and 2) the annual assessment and revision of the community’s Master Disaster Mitigation Plan. Each community’s Plan would conjointly evolve in association with its adjacent communities’ Forum.
To promote our nation’s social cohesion, the options open to the Board of Trustees for the new strategy will initiate a level of collective thrust projects with nationally unprecedented dimensions for improving our nation’s social cohesion. The challenges represented by this level of collective action by nearly 800 communities would initiate a level of focus and accountability never before contemplated for any healthcare industry among the world’s 51 advanced developed nations.
In effect, this Global Institutional Task represents the new strategy of NATIONAL HEALTH. It is proposed as the best means to redirect our nation’s healthcare reform to a community-centric, nationally promoted commitment. It is required for potentiating the benefits of enhanced Primary Healthcare from the support of the Three National Projects. They are sanctioned by the provisions of the PURSUE ‘VISION’ Sub-Page. These Projects then are focused locally by nearly 800 communities, each representing, on average, 400,000 citizens. Some of the communities will be formed along with 1 or more additional Forums to represent a large metropolitan area. Many others will be isolated within a large rural area. For the first time in our nation’s history, this change will represent a nationally equitable and locally-sustained cooperative effort on behalf of each citizen’s HEALTH. Remember again the quotation cited above, “It’s better for everybody when it gets better for everybody.”
CONGRESSIONAL CHARTER PROVISIONS FOR THIS GLOBAL TASK
I. EXPRESSION OF PRINCIPLES
A. Each Member of the Board of Trustees, Regional Councils, and District Coalitions, Associates of NATIONAL HEALTH, and Advocates of each Forum shall initiate and annually revise thereafter a Career Achievement Plan based on the V I S I O N, MISSION, and PRINCIPLES as defined by the current Strategic Projects Plan of NATIONAL HEALTH.
[ COMMENT: The Career Achievement Plan is considered a self-evaluation that is initiated during the first month of each respective person’s official role for NATIONAL HEALTH. It would include provisions for a personally selected mentor and a mentor-reviewed plan for professional development during the next 12 months. Provisions for its individual involvement with Associate supervisory processes would also be initiated. ]
B. The Board of Trustees shall initiate a long-range planning process to assess the continuing evolution of NATIONAL HEALTH and its V I S I O N, MISSION, and PRINCIPLES starting five years after the initial MEETING of the Board of Trustees and every 10 years thereafter. Any changes for the Congressional Charter of NATIONAL HEALTH shall be forwarded to Congress and the President in a timely manner, and if approved, their implementation beginning on the day following the 10th annual MEETING of the Board of Trustees and every 10 years thereafter.
C. The Board of Trustees shall maintain an OPERATIONAL STATEMENT for a RISK MANAGEMENT PLAN as a means to prevent, mitigate, or ameliorate the occurrence of predictable disasters.
[ COMMENT: Preventive mitigation is known to have a return on investment (ROI) of 3-4 to 1 to improve the recovery from a knowable disaster. Furthermore, planning for knowable disasters then forms the template for responding to unpredictable disasters. This would include the existence of a Rainy-Day, financial reserve fund and an annual internal audit that is described in the MANAGE RESOURCES Sub-Page. Provisions for responding to disruptive public-relations events are described on the DEVELOP SKILLS Sub-Page. ]
II. NEW STRATEGY
A. The initial MEETING of Board of Directors shall consider an initial OPERATIONAL STATEMENT to promote a community-initiated commitment to establish a Community HEALTH Forum applicable to approximately nearly 800 contiguous geographic communities, each comprised on average, of 400,000 citizens *) to assure the equitable availability of enhanced Primary Healthcare is offered to each within each community to each of its citizens and *) to improve the level of social cohesion within their community. Within 6 months, an OPERATIONAL STATEMENT for its full implementation shall be considered for continuing approval.
[ COMMENT: See the COMMUNITY HEALTH FORUM Sub-Page for a representative OPERATIONAL STATEMENT format. Inherent for each Forum, the local stakeholders would maintain a Community HEALTH Plan for reducing the incidence of Unstable HEALTH within their community. This PLAN would include a MASTER DISASTER MITIGATION PLAN, an obligation to promote collective action projects to mitigate their locally prominent ecological and cultural adversities and the annual assessment of the community’s enhanced Primary Healthcare to assure that it is equitably available to each citizen within the community. ]
B. The initial MEETING of the Board of Directors shall consider an OPERATIONAL STATEMENT to authorize each Regional Council’s responsibility to structure its District Coalitions as a training and technical assistance center for their respective 8-10 Community HEALTH Forums.
[ COMMENT: The concepts of SOCIAL COHESION and collective action apply. The option of collaborative connections among several centers of expertise to structure these centers would offer a process to achieve precisely effective assistance. The appropriate OPERATIONAL STATEMENT could be initiated in combination with the associated OPERATIONAL STATEMENT for the Community HEALTH Forums.
A local and national connection with the Cooperative Extension Service for agriculture would be important to establish. By 2014, “Extension” had been assisting our nation’s agriculture industry with an agricultural variant of the new strategy for 100 years. By connecting the local rural and urban farmers with their State’s Land-Grant College of Agriculture, the Cooperative Extension Service represented a substantial contributor to its worldwide, high-level of efficiency and effectiveness.
The District Coalitions would be especially helpful for coordinating the connections between each Forum’s MASTER DISASTER MITIGATION PLAN and the mapping availability of its Primary Healthcare, neighborhood by neighborhood. The same capabilities would apply to the other community attributes of social adversity. ]
C. The Board of Directors shall establish an OPERATIONAL STATEMENT to annually assess the regional and national awareness of the GOALs and progress of NATIONAL HEALTH. This assessment will inform and occasionally, where appropriate, institute timely measures to mitigate the unfortunate occurrence of adversely informing, public events through a coordinated interpersonal strategy. A readiness capability will also be established by this OPERATIONAL STATEMENT.
[ COMMENT: A planned process should evaluate National and Regional public awareness, especially for the likely occurrence of unanticipated events. Eventually a Crisis Response Team for the Board of Trustees and each Regional Council may be appropriate for the NEW STRATEGY. This OPERATIONAL STATEMENT should include a role by each District Coalition to assess the various strategies occurring within the Primary and Secondary school systems, stand-alone Colleges, as well as undergraduate and postgraduate Universities to mold the level of Social Cohesion within their respective educational communities. ]