“Be impatient for action but patient for outcomes.” That’s a quote from Maureen Bisognano, the president emerita of the Institute for Healthcare Improvement, and it struck me as the perfect motto for upstream efforts. The world is full of groups who engage in lofty discussions—and feel virtuous doing so—but never create meaningful change. Change won’t come without action. At the same time, it can take a while for action to bear fruit. Downstream work is narrow and fast. Upstream is broad and slow(er). You can bring a homeless person a meal today, and you’ll feel good immediately. But to figure
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