Jack

Warren, you talked about the FMA Health Collaborative that was a national collaborative. It was very successful, people liked it, people attended to it, and it was successful. Then you said it was too big, and you wanted to try it locally. I’m curious if you’ve been able to sort out how local you can do this versus what’s the right number. They have found that variations in language are more difficult in small regional variations than in larger. So, I’m curious about the right number. How many people do you need to bring innovation? Usually, if I’m just doing it in my practice, then I’m happy doing it the way I’m doing it. So, I’m just curious, where’s the sweet spot that brings in variation, innovation, shared culture, etc.

Warren

We were doing this at the same time that we were extending what we called the IPIP program, Improving Performance in Practice, that you had in Colorado as well. Ultimately, we got to 1,450 primary care practices. We used the UK experience, but their numbers were huge. They indicated that you need to have 100 in each collaborative, but that was beyond our capacity.

I can offer a more practical lesson, and I’m talking to many of you who live and work in California. The really valuable part of this was that people were able to meet face-to-face and travel together. What residencies would do is they would go and come together. So they’d have a team meeting, and on the way there and on the way back, you’d bring together residents and you’d bring together staff. It ended up being a bonding thing. We had brought in Virginia but I didn’t read a map very well. We decided we’d meet in Asheville, which is a perfectly pleasant place to go. Yet the way the roads worked, if you were coming from Fairfax, Virginia, it was a 10-hour drive, which was much too much. I’m joking. Our program survived the distance, but the webinar piece is, for me, really critical—but only when you establish relationships in person. So drivability is really important for team structure and team bonding as you go forward.

Jeremy

I don’t know if this relates directly, but there’s this thing called the Dunbar number. Each of us as an individual can maintain roughly semi-intimate relationships with 150 people. It makes sense to me that when it feels too big, there’s a sense if we got a little smaller, we get a little more intimacy, you get a little more trust, probably more free-flowing information. It makes me think there’s probably some magic.