By Susan Carr

The simple trick of using colored paper — even mediocre blue reminiscent of faded school hand-outs — worked to get my attention. The invitation to "Continue Creating System Transformation" was one blue flyer among many sheets of white in the registration materials I picked up at the Institute for Healthcare Improvement's (IHI) National Forum in December. With the flyer, the co-chairs of the Forum invited all attendees to consider overarching questions as they attended regularly scheduled sessions and then come to an extra 45-minute workshop at the end of each day to share ideas and "contribute to the creation of pertinent documents," which might become a "design model and toolbox for transformation."

That seemed optimistic given days that were long to begin with and the full schedule to which I was already committed. Not to mention the Yankee skepticism and reticence to which I am prone. But this was IHI, after all — where people are dedicated, sincere, and creative, and the environment promotes thinking new thoughts. I thought there might not be a better group of individuals with whom to transform, and I was not disappointed.

Each day, I attended various sessions in which we were encouraged to consider "system transformations," taken loosely to include all healthcare enterprises and locales, as well as the United States and international healthcare delivery systems. Discussion parameters seemed purposefully vague, and many of us had to work hard to shed our assumptions and think new thoughts. The joy of that work often came from active support and discussion among the random collection of people in the room — truly remarkable.

Doug Eby from Alaska, Chuck Kilo from Oregon, Göran Henriks from Jönköping, Sweden, and others urged us to consider what an ideal delivery system would look like. When one group I was in bogged down debating reimbursement details, we were encouraged instead to first work toward agreement about what kind of care we wanted to fund.

Even the late afternoon sessions were lively and well attended. The one on the last day was a delight. After small-group discussions, much writing on flip charts, presentation of ideas back to the larger group, the lid — our lids — finally came off a bit. A group of perhaps 30 transformers talked and laughed, sharing dreams and fears, in one of the most moving group discussions I can recall. We became more frank about our frustrations with a system (in the U.S.) that is broken and more creative and playful with ideas for the future. The ideas were more like the early stirrings of ideas, but in them and especially in my TransForum colleagues, I find much hope.