Tuesday, August 24, 2010

Disruptive Innovation For Real Community Health: Using the Incarnational Missional Model of Church For Other Community Organizing

A radical good idea has legs, has wings, will organically adapt and be transforming in other systems. "Disruptive Innovation" "Turning Your Organization/Institution Inside Out" "Creating Discontinuity With The Past" "Moving From Attractional To Incarnational" is something where the lessons of the church can help effect great change in society, not so much by what the church does sometimes, but by others adopting this emerging/ancient model of the church.

The project we are working on with OU and others in the Tulsa area around the concept of "lay health advocates or advisors" does to "the clinic" what we have shown here we can do for the church; turn it inside out, make it missional and not institutional, in order to do a better, more sustainable, job of creating healthy communities and lives.

The money that is spent on creating clinics with professional trained staff, and with a single building and equipment all in one place, where people have to come to, at a particular time, to be seen in a one on one basis (in fact where several staff dedicate themselves to a single individual, and then another single individual, etc.) based on fees for service that are based on a taxonomy of individual diagnoses, is all way past being sustainable, or especially for poor and broken communities the system does not work and way too often by its inherent nature makes health worse. For one thing, it takes the individual out of their home and neighborhood and treats them all alike based on an arbitrary standard; by doing so it not only forgets that the community is vital to the health of the person, but can undercut what the community might be providing. It is hierarchical, based too often on a knowledge-based instead of ignorance-based system (see Wes Jackson, see Wendell Berry, see the BP gulf oil spill).

The current health care delivery system, even in poor communities where health clinics are set up, perpetuate all this. In our area, it is good that we have a clinic; we hate that funds have been cut here where it is needed the most and so we have fewer staff and barely holding on to a clinic whereas the same community based clinics are thriving in other parts of the city where there are more insured to help feed into the system. But, even putting clinics in places where there havent been before and where they are sorely and surely needed, doesn't alter the situation above; the clinics themselves are still not as community and other-geared as they need to be to be radically disruptively innovative for our times.

All that I have written about health clinics has been written about systems of churches. The clinic is modernity incarnate at a time when culture has become postmodern; the values of the modern era work against completing mission in the postmodern era, an era that values all the opposites of what I described above, that values relationship, organic, sustainable, tribal, group over individual, the local, the unique, the egalitarian, experience over knowledge for its own sake, participation vs patients as spectators passive and silent, visual and story based and imagistic over print, and communal over individual; in other words the EPIC approach written about particularly by Leonard Sweet, and fleshed out by many other church analysts.

The health clinic today is too often at heart still like that telephone of the 1950s: one size, one shape, one color, attached to one place on the wall and to use it you had to go to it, and tethered by one wire, and with one function, and slow to use, and requiring a bigger and bigger phone directory in order to use it well. But today's "phone" is of course not like any of that at all; they are also by being connected online and with their own storage capabilities their own directories so you don't need the printed ones anymore.

There are multiple ways to turn the clinic incarnational and more like the "phone" of tomorrow than the phone of yesterday, same with the church; one of the ways we are moving toward is to create a system of paid community health advocates; they would be connected to the "clinicians" at the campus, for example, who would help them with the health care info and delivery, but they themselves would be teachers of the clinicians, and carriers to them about the community part of community health. They would be paid to be kind of like "Master Gardeners" in an area, but would be more like "Master Patients" as they would be able to help teach people how to interact better with their care providers, and teach the care providers how to do the same; they could adopt much of the "see one, do one, teach one" concept to become forms of health care providers themselves, learning in some cases how to do the basic kinds of things that family members are taught to do to help others in their families. They would become kind of like extended family for the community.

They would be community gatherers to help bring health care information and care to whole communities; perhaps each month working to focus on different health care topics in their neighborhoods through many different places where people naturally gather: stores, churches, parks, schools, etc. Go to them rather than trying to spend money to get them to come to the clinic. They would be paid, part time at first, and drawing from people with strong ties in the communities; they would live in the communities, unlike most professionals who might even serve in a poor community but live elsewhere.

And they would be witnesses for their neighbors; they would be paid in part to see what is happening in their communities that affects the health of those around them, including the environmental problems of houses and the areas, noticing where environmental injustice is linked with economic injustice, with issues of classism and racism and ageism and other ways that people have their health affected and their abilities discouraged to grow healthier. And they would pay attention to the other vital people in the communities who are resources for health, who even though they aren't paid, still have information and skills and experiences that can be tapped; they would be able to connect people in need up with others who can help them right near them, and notice that even those in need of health care can be givers of it too, and help in community to make that more visible.

Imagine every neighborhood designated area in north and west Tulsa and the adjacent underserved areas with three paid part time lay health advocates working together in their own neighborhoods organizing for health. I would take that over the re-establishment of the traditional clinic model, though I would prefer to have them working in conjunction with one another; wouldn't that be a novel approach, to actually favor an abandoned place as the place where this great experiment is conducted, and where resources for both traditional clinics and the incarnational health networks are put into practice. Imagine even the economic resources that would come in dollars going into these neighborhoods simply through the investment of dollars in several very local people instead of going into the pockets of a few who live elsewhere.

This is the vision that came out of a brainstorming session a couple of years ago at A Third Place Center, and it went underground as we moved onto other projects, but it was germinating, and now that the health delivery is at an even more crisis point with the closing of clinics in the areas that need them the most, when folks are looking for a truly different approach, our good idea rises again.

New meetings are underway; grants are being explored; concepts are taking shape and skeletons are beginning to get fleshed out. Whatever happens, there is no turning back; that's the way of taking "the red pill" of incarnational, missional thought; it takes hold and is not limited to one sphere or the other, to something called church but not to other organization and endeavors. To think it can be is to think in a modern way. And that's not a good way.

True, I am married to a doctor; we have been journeying in these joint waters for some time comparing worlds; she is also an organic native garden planter and artist and builder; being, as MLK said, "creatively maladjusted" to the way things are has been our way of life in many walks of life. This comes naturally to me. We also know by experience that transformations of this major kind do not come easy, but truly it is going to become harder and harder to live and work according to the rules of the world gone by; the more sustainable, local decentralized way is going with the grain of the emerging cultures; the problem is that we are still operating and functionally in more than one worldview, modern and postmodern/organic/quantum/ancientfuture whichever word you want to use.

Just as all things that change the world start with a small group of people working together, some of the biggest changes come from the most unlikeliest of places. Nazareth meet TulsaNorth/Turley.

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