Collaborative Learning Communities in Health Care

In Chapter Six of The Firm as a Collaborative Community, contributing author: Michael Maccoby, explores a key premise of the book applied to health care. The book polarizes several distinctions, which remain unresolved by conventional models of organization , but could become integrated by collaborative communities:
  • solidarity and conformity / individuality and autonomy
  • deep trust among common interests / thin trust amidst transacting selfish interests
  • bureaucratic governance / market incentives mechanisms
  • policy compliance / entrepreneurial deviance

Maccoby's findings match my own intervention in a troubled merger between two pediatric health care providers. Some doctors operated private practices through their hospital and found ways to increase their revenue and profitability while giving superior service to patients and their families. The other physicians were paid salaries by the  second institution which dictated practices, policies and procedures over them. These two cultures clashed and saw no way to compromise the values, ethics and success patterns. 

Maccoby suggests that neither camp is supported with the necessary information, feedback and shared data to learn together. Everyone is perpetuating what they already know and working closely only with those they trust intimately. He foresees the transformation of the culture by making learning the norm which could dramatically increase collaboration beyond the confines of medical specialties. Yet he admits, the physicians conflicting values, social identities and camaraderie will impede unified efforts. 

This chapter, Health Care Organizations as Collaborative Learning Communities,  imagines the collaboration only among the experts providing medical services. The patients are the mere recipients, beneficiaries and consumers of those services. There is no exploration of the patients learning, trusting and collaborating more  when also supported by additional information access. Likewise the patients are not envisioned as becoming more responsible for initial self diagnosis, periodic self medication and ongoing self management of chronic conditions. There's no exploration of community health programs, support groups and preventative efforts. 

I expect the viable solution to emerge from the decline of privileged professionals, due to crowdsourcing and other P2P dynamics. We only need experts in charge of our health when we are feeling personally helpless and very much dependent on them. As information, tools, working arrangements and community support all come into play, collaborative efforts to keep each of us healthy and to orchestrate quick recoveries --  will result from everyone around us, including experts, contributing to those outcomes.


  1. Are there examples or models of managed healthcare in which the principles and practices are pushed down to the level of individual patients with chronic diseases? For example, healthcare plans that create tangible incentives for individuals to manage aspects of their care and its cost. These plans would create "point systems" and reward compliance with treatment plans and extra points for compliance with optional wellness/prevention activities. Major points would be awarded to individuals who can follow medical advice AND keep the cost of their care below that which would be expected for each particular chronic disease. People who earn enough points would receive a rebate from their insurer that would be funded by the savings that the individual helped create. What'ya think?

  2. I think it's a great idea to incentives compliance with treatment plans and wellness/prevention. I'm wary of using extrinsic rewards because they have such a debilitating effect on self-motivation, creativity and problem solving. The PBS documentary U.S. Health Care:The Good News explored an excellent use of extrinsic incentives in Grand Junction Colorado to lower delivery costs. I suspect that worked so well because the rewarded outcomes were monetary. Support groups and buddy systems would probably be more effective than point systems when compliance involved lots of tradeoffs, initiatives and inventiveness.

    Thanks for your thoughts Michael!