 It is time for the next leap in vision, that the hospital as a medical provider is just an example of the larger medical industry as a whole. The U.S. medical industry is a medical provider to the citizens of the nation. We can address the entire industry as a black box. We have the tools to arrange for the management of the industry as a whole, so that this industry most effectively provides us, as we the people, with the services that we value. The first step is getting rid of that us and them attitude that will arrange division and waste. It starts with recognition that we, as people, own this industry and everything that is in it. It is part of our economy. We are also its customers. It only exists to serve the people. We are also the authority behind government management of this industry and can direct leadership to see to our benefit. This is a whole new application of intelligence and vision. We can have significant influence on what an entire industry will do, seeing to our own best interests. We can, by establishing a vision that supports our coming together, accomplish beneficial changes. My part in this is as an engineer. The product of my effort is technical support for those who are empowered. It is supporting what you will do to come together with others and to make such alterations as will better assure that all of us receive what we value at a good price. That technical support will include the black box as a visual tool to see opportunities for improvement. It helps us see value relations and it is a communication tool for presenting vision to others. That technical support will also include change processes that support both personal and public investments in changes. The word investment is intentional as technical support is not just based on pursuing value but also on minimizing costs. Our subject here is personal empowerment, the purpose for the larger study of human performance. We are empowered by people as we have choices that have consequences. We are empowered when we choose to expend our time and effort and other resources to gain what we value. Our working tool is a black box. It will keep focus on the essentials. And the first lesson is that the value cycle has us as customers and medical providers. There are no services to insurers, medical industry, manufacturers or by pharmaceutical businesses or the like. When we look at the whole industry, their ancillary effects are all inside the box. Perhaps the most important observation for this new level of application is that the only true income for the industry is from us as patients. If there is waste, we will have to pay for it. There is no other income to cover it. Even the dollar that is taxed out of the medical industry is going to come out of our pockets. Whole industry operation has to be covered by the prices asked of us for medical services. Every regulatory cost required of those in the industry will bump up the cost of services to us. And in the opposite, if we eliminate a tax or a regulatory cost, it will no longer have to be covered and the price for services can drop. And so we open the black box, another technique that we have come to know. It now shows the medical industry gaining income from us, converting it into medical services and delivering those to us. This diagram also shows management raising the question of who is in charge and that is where we have a new understanding. For us, it opens a new opportunity. There is nobody actually in charge of the larger industry. There is nobody who has authority to run things. Nobody to take responsibility for the larger industry's performance cycle. We do have the authority and it is our authority being exercised through government. It is just not now in charge of seeing to our purpose. Most applications of performance engineering was intentionally addressed to just this situation. Frederick Taylor was active in an environment where the boss assigned and received work, but did not otherwise manage what workers did. He started the effort of putting responsibility for management on the foreman and soon it was clear to everyone in the group that they became more effective when there was someone who was actively managing their efforts, coordinating what the workers were doing and serving their efforts by defining what each had to accomplish, giving a process designed to achieve a group result. Using the black box approach, we have just designed the valued group result for the medical industry. It is the delivery of valued medical services to patients. Our general technique will include having government provide foreman-like performance support to those in the medical industry so that they can operate in trust of each other, concentrating on their pieces of the larger purpose of serving us as customers. That's right, we already have a model that works. The direction of improvement is already known. Not only is it known, but we have the tools to communicate our vision to others. But there is even more on the cost side of changes that we might initiate through government. It is that there are no administrative managers taken trying to run this industry. We're addressing the whole industry. It is largely unmanaged and operates as a collection of independent businesses with each acting pretty much alone and to its own purpose. There is little expected resistance from establishing authorities. There are no privileged leaders running things to their personal understanding of how to do the right things properly. Our most difficult challenge will be influencing privileged leaders in government. We have already addressed some of the waste associated with medical insurance. To go further, we need to apply the black box to the concept of medical insurance. Our first realization is that we have two concepts of insurance, regular and malpractice. We have already addressed the existing business model as selling protection, a practice that ends up costing the public to pay for minimizing the threat that is largely generated by having that insurance interfering with patient provider relations. In this business model, it produces damages rather than value. Criminalizing the selling of protection works to good effect. Application to the selling of malpractice insurance to doctors is very likely to give us a good solution. Of course, doctors and hospitals can buy insurance spreading their risk among providers. That is a choice, but it is covering costs incurred by doctors, not by patients. There is a challenge in management as well, and that is in the courts who have come to allow actions seeking restitution instead of justice. The doctors and the hospitals who have done nothing wrong should never be called to pay damages. That is injustice that has been institutionalized through our courts. Regular insurance is fairly simple to address in terms of the industry black box. The obvious start is that there is no medical insurance in the diagram. Insurance does not produce or deliver medical services, nor does it have any effect on the cost of services. It plays no part in the value cycle. It does, however, have effect on customers, supporting the purchase of more expensive services at the expense of costs being added to more common services. It can have significant value to individual patients. It just does not involve delivery of medical value, nor a customer payment for services rendered. It is a resource for patients in their decision making capacity. Our challenge is in the interference in the provider-patient relationship, a business relationship between the provider and the patient. Nowhere is this more obvious than when a would-be patient is refused because they do not have an insurance relation with a private insurance business approved by the provider. Then again, there is a challenge of the insurance coverage influencing the services that are provided. What we have in the current system is the insurance carriers performing management of the patient provider value cycle. Again, the cure is fairly obvious. It is to remove the insurance business from the exercise of privilege. Its decision making role is both provider and patient decisions. Once that vision is gained, that the insurance business has no part of the value cycle, we have the potential solution already noted. It is that the insurance carrier becomes liable as an agent of the insured patient for any damages incurred through its influence upon the medical providers. That same carrier would become liable to the medical provider under a separate contract for interference with patient decisions that might cause damages to the provider. In legal terms, there is liability for trying to act as an agent for both sides of any business agreement. We can, through our influence on legislators, change the focus of law to recognize the potential agency of those who sell insurance as a business. It would redefine medical insurance in better accord with our common law. It would eliminate industry-based privilege and its associated waste. As also previously noted, the cost basis of medical services would also be a government service, giving a better cost basis for patients to see the relation between price and service, supporting their intelligent decisions to purchase medical services. It would also have an indirect impact on the medical provider by promoting customer decisions. If customers buy an ability to pay for some less used but higher price service, this becomes a factor in the medical community providing that service. We also face the challenge of an insurance carrier directly paying a medical provider on behalf of a patient. This is clearly the act of the patient's agent for payment. It is well settled in law that the agent only acts for a client where the client approves the action. Where the agent acts as a decision maker on behalf of a client, the client can refuse that action. It will then be the agent's personal responsibility to follow through with duties and promises associated with that action. The common law relationships are really very good at arranging some business to represented citizens. We have this already in place. There is no need to invent some new relationship to protect the industry from the results of the decisions that it makes. One way to see what has value is to get medical insurance out of the unauthorized practice of medicine. One incredibly valuable service is currently not provided by insurance carriers. It would be publication of the carrier's knowledge of and experience with individual medical providers. It could help insurance customers find the most trusted medical providers. Now with just one purpose of ensuring patients, this service would discourage provider participation. In another direction, the government can switch from regulation to support, from privilege direction for medical group action to supporting providers on behalf of the public. There are many things that a centralized management can do to support the value cycle connecting citizens with medical providers. It is the same value found in having a material handler serve a production line, a support for what the providers have to do so that they have what they need to complete the cycle with patients most effectively. For the application by government, we are addressing management support for the teaming of medical businesses with that teaming focused on delivery of medical services to patients. Where those in the medical industry are independent businesses, it parallels the promotion of teaming by support groups in an organization. It is assuring that each part of the effort is supportive of those who take direct part in completing the value cycle with patients. It is a management support service for those who provide support to medical providers. One obvious service is support through continuing education at public expense when provided to licensed providers. It would be services like industry-wide surveys of practitioner experiences with treatments. It could even have some voluntary surveys that address customer evaluation of the services they receive relative to the cost. This would not only have incredible value to practitioners in their decisions and guidance to patients, but would even be more valuable to researchers and industrial developers. It would provide knowledge for where new medicines, treatments of the like, will most likely find public value. In short, it would provide industry-level management information services to those who are actively taking part in the industry. Another service would be general delivery of industry notifications, medical samples, or general advertising of information for medical providers, where the industry now pays workers to make that delivery, often causing pauses in provider activities. The delivery cost would be largely covered to appropriate licensed practitioners. This is industry-level simplification of process. The cost of medical support people working with individual doctors, hospitals, and pharmacies would likely be reduced to a small percentage of what is now commonly expended. Industry would likely be a good public investment for political leadership. Another information service would be the publication of ongoing medical trials that have been approved. This would likely be a database application where providers could access any specific trial where the subject and summary indicate potential application. Maintaining this data could serve providers with ready access to information that would be valuable to their patients. Doctors and hospitals could access the most appropriate trials for their areas, even having a survey of active trials that might support some patient's specific need. It would increase the value patients receive at very little cost as a central support service. As another information source, we could have laws and regulations appropriate to the practice of medicine. It would again be an updated database of appropriate information for no-cost publication to changes to licensed providers helping them serve their patients. I also see this as a great benefit to the patients. As available information, it would support the legal activities of providers. A patient could see why medical activities proceed in a certain way. Having a common understanding of medical practice limits, purposes, and procedures could go a long way toward provider patient agreements and promote effective teaming. Consider a public database of approved medications with generics with linkage to information on each as provided by the manufacturer. It would of course include the manufacturer's published wholesale pricing and could also include any suggested retail price for the product. That would be the short-term end to questions of middleman pricing gouges. Having a common basis for costing to go along with the information on use and purpose would have a great increase in the trust between providers and patients. They would have a reasonable costing of services. For the most part, such services, as are described above, could be provided very economically in place of what is now being done in the industry. It could promote trust relations between the various elements of the larger medical industry and keep focus on the central purpose of delivering medical services to we the people of the United States. This is a potential for government saying to the welfare of the people by promoting efficient performance of the larger medical industry. These are also services that can increase the trust between medical providers and patients. It gives them an increased base of common value in the services rendered and costs of providing it. It promotes increased teaming of patients with medical providers. Our government is not licensed to practice medicine. The idea that our legislators can decide what is and is not good medicine practice or good and effective medicine does not make an effective basis for saying to the welfare of we the people. Neither legislation nor regulation should be allowed to replace the industry's responsibility to patients. We go a long way toward a more effective management of the industry when we get the courts out of the business of restitution and back to focus on delivering justice. The government supports the welfare of we the people when it gets out of the business of specifying good medical practice and starts doing what it can to support what the industry is providing to patients to earn its operating income. The question is not one of what constitutes due diligence in a human trial for a medical process or a medicine. The question is what support the government can provide to those who seem to have a reasonable basis for advancement in medicine? Can it run common testing at lower costs from making it a service instead of a regulation? Can our leaders determine medical need by survey of the population and wider practice of medicine and fund research based on the needs and wants of citizens? There are services that government can provide to the benefit of that all important value cycle between the industry and patients. As noted, major improvements can be accomplished by simply publishing information to both providers and patients so that they can more easily find agreement. A simple listing of the current wholesale prices of medications can be marvelously effective. Where the trust relationship is supported, the doctor who describes the pharmacist who fills and the patient who uses a medication are more able to operate as a team with a common purpose. For our performance orientation, such things eliminate competitions and distractions. It helps people stay focused on the value cycle, on what the patient receives and values, and what they must commit to receive it. There are like opportunities for government to promote teaming by various segments within the medical industry. Government can perform many of the duties of a foreman, supporting those who complete that value cycle with patients. It is assuring that supporting businesses do not isolate themselves, simply doing their function and reaping their rewards. Teaming is promoted where they share in responsibility for the operation of the industry, delivering value to patients to earn income. We have already developed the performance orientation. It is that the supporting business is a success when the medical provider has what he or she needs to deliver service to patients. The challenge of value is working to meet the provider's needs and wants so that service can be rendered. We must also be aware of the challenge that medical providers face in getting paid for the services they render, as they commonly provide the service on demand but receive payment after the fact. Getting paid can be a challenge. Can the government provide support for payment? Insurance is not really a government service. Appropriate support for collection actions could be. There could be a penalty for a patient intentionally stiffing a medical provider. There could be a fair broker advocate for challenges to medical charges. There are many opportunities to support the costing of medical operations and equipment to identify reasonable operating costs would support billing on that common base. It would strengthen demand for pay even as it assured patients of a level of reasonableness. I note that the fair broker only also is far less expensive than private attorney involvement or contested legal actions. Having the fair broker would also limit court actions and their costs in time and dollars. Again, the only source of income is the customer patient cycle. If resources are spent on legal actions, they must eventually be covered by what patients pay for services. Legal actions do not produce valued medical product. Their waste that have to be eliminated or minimized. We also have that harsh truth that government is not part of the provider patient value cycle. Any and all costs that it puts on either patients or the industry are by definition waste. They neither deliver medical services nor pay the providers for that delivery. All such costs must be covered by what the patients do pay. Government interference must either produce other values or be subject to elimination or to minimizing the necessary costs. One potential is the involvement of the law, legal services, as they are required for the proper and effective operation of our medical industry for the benefit of people. Going back to the Constitution, there are two required services stated as justice and welfare. These can be addressed as government services, not as items to be purchased from the economy. Justice can be addressed in a positive term of support for the industry patient medical performance cycle. Welfare is more a general term indicating interference with that same performance cycle for the general welfare of citizens employed in the industry or involved as patients. From its origin in the common law, justice addresses protection and maintenance of the peaceful interaction of people as they go about their business. It is support for people being able to rely upon each other in their interactions, where government supports teaming, having trust relations because of common purposes, justice is supported, where government acts to minimize any causes of disputes, it supports justice, where government provides for people peaceful and mutually agreed resolution of disputes, it provides justice. Our challenge is to provide for these at least expense upon those who receive justice. I see some potential for a judicial master and attorney acting for a court of jurisdiction who will, at public expense, hear medical disagreements between providers and patients and provide prospective rulings. The purpose would be to inform parties of the laws and rules that have influence on their disputes with suggested likely results of actions if the matter is pursued as a formal legal challenge. As above, it is government providing a fair broker who can either resolve the challenge or can further define it in support of negotiation, a far less expensive action than a trial before a judge and jury. The purpose of this effort is to find agreement where possible on the nature of the dispute and to encourage the peaceful settlement between the parties. If this is not realized, it is to help a court of jurisdiction if a formal legal action is entered. This is a public investment. The master's efforts are a public expense incurred with expectation of minimizing the cost of legal actions that it is able to defray or prevent by fair broker involvement. The settling of disputes by authority of the court does work, but it is costly in both time and other resources, as is usually the case, supporting the people as they go about their lives, finding agreement and teaming their efforts also works and is far less costly than application of authority. The courts would still be there to handle the exceptions where there would be no agreement to settle the matter. Its expense could then be assumed by those who use the system irresponsibly. Where court actions are still required, there could be a preliminary finding by the master and it would likely include what the parties to the dispute had already agreed upon. These could be presented with the permission of the parties as matters not in question. They would simply simplify the legal action, helping it come to sharp focus on where the disagreement was or the challenge. The first note is that I do not expect any of you to pick up the banner and call the rest of us to help you cut medical industry waste. It is important. It is an area of tremendous waste. It is just not something that younger students have to deal with on a regular basis. And there are more immediate challenges that you will be facing. This is just opening the door into a new area where there are things to get done. It is the empowerment of people in owning and operating our economy. This is an example of how to see and address waste in an entire industry. It starts with the performance cycle and realization that the heart of all economic pursuit is the customer, the person who will assess the value that the industry would produce and the cost that is required to receive it. Only then will you be looking to decision on whether a medical service is something you would choose to buy. You as a person and as a citizen are the only party in interest. You are or will be the owner of the elements of industry. You are the active element through employment. You are the customer. It is all about you. There is no other public to be served. The technical support you are receiving here is a way to see the performance, to see how the industry now gets things done, and to see where it can be more effective in serving you. This lesson just yanks that door open. We are at this point just seeing what is in need of improvement, and some techniques that can lead most effectively to improvements. This is the first step in management. It is having something to accomplish through the efforts of others. Finding and communicating the change value to others is a huge step in empowerment. We have actually done more in the sense of our lessons in management. These allowed us to expand our vision to see the management role of government and the potential to arrange for beneficial changes in the industry through acts of industry governance. There is new potential for arranging a more effective management of the entire medical industry, and it is through impact you can have on government as citizen owners of this nation. The good news is that there is no other public to be served by government. You are also the owner, operator, and customer of government. The challenge we all have been taught to see is the huge cost of doing anything about the problems presented. The cost of doing anything about this is going to be staggering. And there are so many causes of significant waste that nobody can really have that much. Of course, that is the message of modern leadership, that you need to leave it in the hands of the special people who come to power. This course is focused on your empowerment. You are the only party in interest and the only source of power for leaders. Leadership has not been very good at addressing the many sources of waste we have examined in this lesson. Leader action may well have contributed to the challenges. Personal empowerment is in a new direction entirely. You are not alone. You do not have to do it alone. You are empowered by empowering each other, tapping into your ownership to gather the real power of the industry, putting such changes in place that most support our human needs and wants. And that is just the beginning. Not only will you be able to empower each other, you will have the potential for enlisting our leaders to carry out the changes that you initiate. We have a word for that. It is a word that has been brought to you over and over again. It is teeming with them. It is giving them the vision and purpose that you share with each other. It is enlisting them into the change efforts that you are able to initiate to manage or to support. Once again, you as a human being are the only party in interest. The power is already yours. It is not something that I am able to give you through instruction. It is not something that you earn through education. It is human. The power is what we learn from the human family. That people who have a common purpose come together and are empowered. It is that families that join in a tribe are empowered to do things that a family alone cannot expect to do. It is the power of human beings to come together to get things done. My purpose here is technical support. It is helping you see that power that is yours already. It is helping you see purposes that you can share and techniques to communicate your purpose to others so they are able to join with you in your efforts. Our currently common limit is a culture that disempowers people. Our great deal of this effort is this course is giving you an alternative, an empowerment that is a choice you will then have available to you. That choice will be yours. The medical industry has been allowed to drift into areas that cost us greatly without delivering appropriate value to people. It is currently unmanaged. The reins of this industry lie dusty from lack of use on the ground. Will you choose to pick them up? Empowerment is not just getting you to see new possibilities but guidance in support of your decision to do something about a need, a trust that the action of others will also join in. There is a cost in picking up the reins, a cost in time and effort to empower others to see and join the change effort. There is a cost in time and effort to enlist leadership to that very real potency that resides in people as citizens, owners and customers. Are you ready for a new challenge? It is also a cost in relation to the many opportunities you have to do other things. There is cost to make other changes, to pursue other purposes, to rest and relax from other efforts, to further your education and a myriad of other potentials. Your choice is to expand some of your limited life energy and there are so many things that empowerment will bring before you. Empowerment includes realizing that there is only one you and you have only one life to live. Empowerment is not teaching you to grab all you can. It is giving you the choice of accomplishing what you can value and doing it with that native intelligence that we share with one another.