Jack

But the balance of that, Jeremy, is that if you want to have variation and innovation, you have to have enough different people showing up that bring in that random chance of variation. From an evolutionary standpoint, you have to have a successful mutation in one number to be able to introduce some new idea.

Warren

We introduced geographic variation. It turns out that the healthcare culture and structures in the three states were quite different. Virginia was very commercialized. North Carolina was, because of the AIC system, the most likely to be not-for-profit. South Carolina was very traditional. And then you had a lot of variation within the residencies, university, a variety of kinds of affiliations, and very different community links. And they were pretty embracing of these variations. We managed to make sure that everybody was representative. It ended up being a pretty diverse group. To your point, I think diversity is really important. You need enough numbers.

The other thing that helped, at least with an academic collaborative, was that they had responsibility for developing projects. And that was part of why they ultimately wanted it. They wanted to go to STFM. That ended up being a very successful feature. It isn’t enough to attend every session, you have to present. There was a commitment that you had to present.

And I guess another feature is creating a culture of safety. I still remember during the second year we decided to have a session on failures. We had every residency in the session, present on failures. And by that time, they knew each other well enough that they felt safe. But you could hear a pin drop in the room, because people said, I know them. They’re good people. This was a really clever idea. How on earth and why did it fail? And it was incredible learning, but only if you knew people and were safe. And it was, and how do you get there?