In September 2013, the Robert Wood Johnson Foundation (RWJF) launched its Flip the Clinic initiative with a conversation. We gathered at the RWJF headquarters in Princeton, New Jersey, with a dozen smart folks from various corners of the health and health-care world – including patients – and asked them how we could do things differently. How could we rethink the routine doctor’s visit to be a more fruitful, more fulfilling part of health care?
To be honest, that conversation was all we had in mind at the time. But the ideas that Flip the Clinic sparked proved bigger than we had expected, and we realized that there might be more to this process. We spent the next year compiling many powerful ideas at FliptheClinic.org, and now we’re settling into our second year of exploration. We’re shifting Flip the Clinic from a conversation to an open experiment, where we aim to enlist hundreds of people across the US in trying to see how we can improve the clinical encounter.
What’s an open experiment? It’s a way for us to admit upfront that we don’t have the answers. We know there’s a need out there; we know that lots of practitioners want to change their practices; and we know that legions of patients are eager to change the role they play in their own care. But we can’t say we have a validated, airtight model for how that happens. Rather, Flip the Clinic is a community that agrees there’s a need for change, has the capacity to do it, and seeks an opportunity to figure it out in the real world in real time. In Flip the Clinic, we have permission to try, to experiment with different strategies, and to enlist various stakeholders to build on the library of tools at FliptheClinic.org with new ideas and strategies.
This year, we’re hosting a series of workshops around the country – in San Francisco, Phoenix, Minneapolis, Philadelphia, Durham, and Austin – with local leaders and stakeholders from across the health-care world, including providers, hospitals, local companies, and individuals who bring a patient’s perspective. Our aim is to share our ideas, but also to leverage theirs – to enlist them in the project and see what works. Each workshop will build on the next, so that with the sixth one, we should be sharing what we’ve learned along the way.
We started the process in San Francisco in January. Working with the University of California San Francisco Center for Excellence in Primary Care, we gathered about 40 people from all aspects of the health-care system: digital health entrepreneurs, academics, experts in insurance, pharmacists, nurses, administrators, city health officials, physicians (both primary and specialists), policy wonks, and – most important of all – several honest-to-goodness patients. We asked them to spend a day working through the potential of Flip the Clinic, but also to see where they could test our ideas in their own environment. We didn’t want to talk about change – we wanted to make it happen.
In a busy day, we came away with some definite insights worthy of sharing. We immediately saw that physical connections matter. There’s nothing like a face-to-face talk to make your ideas and concerns clearer. And when you’re working through a problem in person, you have the chance to touch back with people later. Webinars and Hangouts are great, but there’s nothing like proximity to make things happen.
Proximity to people of different stripes is especially important. It would have been easy to fill the room with well-meaning doctors and academics, and hash over some common problems and opportunities. But we wanted to make sure that we were building a coalition, not consensus. Having patients there gave us a chance to gut-check every great idea with authentic experience. And including entrepreneurs allowed us to test if the conventional approach was the best one. This range of voices and perspectives yielded great dividends.
Bringing these groups together enabled people to find common ground. Many of the most promising connections at the San Francisco lab happened when participants realized that they were facing the same problem – and some were further along in solving it than others. These were essential connections, and they set off sparks; they got people thinking that they could tackle a new approach, especially if someone else had already laid down some of the paving stones.
In fact, these connections worked so well that we had to keep our enthusiasm in check, being careful to balance pragmatism with possibility. When the goal is “flipping the clinic”, it’s tempting to start reinventing it from the ground up and hope somebody will come along to foot the bill. That’s an unlikely scenario, though, so we asked our workshop participants to consider the problem this way: Given our collective resources and influence, what’s the most we could get done? This approach creates necessary constraints of reality: We want to make things happen now, not just cook up ideas that might happen later.
As much as we demanded of everyone in San Francisco, it was a great day, filled with laughter and wit and even joy. Health and medicine can be wonderful things to participate in, and helping people find that joy can make for a more fruitful lab.
We carried these insights to our Flip the Clinic lab in Phoenix, which took place on March 5. The group was quite different from the one in San Francisco, with markedly different ideas and needs. For that reason, it was fascinating to see where the ideas generated in Phoenix paralleled others (waiting room design, fractured decision making, clinician-patient communication) and where new ideas arose (mind/body/spirit care and finding clinician efficiencies).
Our local events will culminate next fall in a national summit where we’ll gather around 250 leaders to share what we’ve discovered and see if we can scale Flip the Clinic even more. We’re eager to share our insights – but also to learn a lot more.