My thinking about ACEs is informed by a systems approach I learned while adopting and implementing a management concept called “Lean Thinking.” There are two essential elements to Lean Thinking: respect for people and continuous improvement.
As I analyze how knowledge about ACE’s moves into the public consciousness, it is gratifying to see the discussion of potential solutions. However, one lesson I learned many years ago was not to jump to solutions before you understand the facts. I am not saying study everything to death. We assess the current level of factual knowledge available to us, and we act on that knowledge with appropriate experimental solutions. We discuss how to improve a system in an event called Kaizen.
In business settings, Kaizen is a one-week improvement event where many participants in the process being analyzed identify relevant facts, map out the current state, propose countermeasures to the problems/defects they identify, put together a project plan to test the countermeasures, review the progress regularly, and if the countermeasures are successful, add them to the most effective way you have identified to do the work. It uses the PDCA Cycle (plan-do-check-act/adjust) as a scientific method for problem identification, research, systems analysis, solution proposal and testing. It truly works for improving already existing systems.
Kaikaku is a different process. Years ago, I studied the concept of Blue Ocean Strategy. The concept discusses how you identify a place in the market that is not occupied. When you find Blue Ocean, you generally have the market to yourself. Kaikaku is the Lean process of finding Blue Ocean. It introduces radical change, and that can be difficult. However, when you compete in the Red Ocean, you face constant pressure from competitors. When you find Blue Ocean, you have great freedom to access the market and great benefit.
I worked in health care delivery in rural Alaska for 10 years. Kaizen is not applied in Alaska Tribal health care. We spend about a billion dollars annually for health care for Alaska Natives. I estimate that we could recapture about $300 million in value from our current systems with an effective Lean transformation. Imagine what that could do for Alaska Native health care. I am not sure how much additional revenue could be captured, but I suspect it’s considerable. Many Alaska Natives do not use their Tribal Health care systems because they do not address their needs—either because of lack of capacity or long wait times.
Recognition of ACEs and development of a new response system for health care is Blue Ocean. Kaikaku is the process I used to envision a different system of care that promotes healing instead of profit. The Red Ocean that we are engaged in is interesting. Consultants, researchers and funding agencies are all focused on problem identification and are seeking new and innovative approaches. But they do not have the foundational, systemic facts that are required for new solutions. Nor are there many minds open to new solutions and new ideas. It is basic human nature to resist change and innovation. We have to change that, and Acesconnection is a wonderful tool for sharing ideas and thoughts on how to change.
I wanted to share my thought process because what I see on AcesConnection are many wonderful people going through the fact-collection stage. Solutions are being proposed, but they are based on Red Ocean. That space is already occupied, and we need to find the Blue Ocean. Funding agencies need to think about Blue Ocean. I had a chance to think about this when the National Institute of Mental Health put out a Request for Information on how to address the issue of suicide prevention in Indian Country. NIMH is mining the Red Ocean and seeking Blue Ocean. I fear they don’t have a mindset that allows them to see it. You can respond to the RFI until February 12th if you want.
I responded to the RFI. My basic approach states that the facts implicate developmental trauma (ACEs) in the development of suicidal thoughts and actions. If we approach identification of developmental trauma causation and its effect on all behaviors and health issue, we have a factual basis on identification of an at risk population. The countermeasures will have to be individually developed, but the earlier we can identify someone who has risk markers for development of suicide, the earlier we can intervene. And our intervention will not only help to reduce suicide, it will help to reduce many other risks that we currently address through what I refer to as “silos.” Addressing developmental trauma should help address many issues.
I know this might sound like a strange post. But we have been addressing many developmental trauma-based issues for decades and developed a deep Red Ocean. I hope there are enough people who understand this concept and can start the movement to identify new practices. If you have made it this far, thank you for reading.