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For the things we have to learn before we can do them, we learn by doing them.

– Aristotle

From childhood, one of my bucket list goals was to attain a black belt.  The fact that my kids needed exercise, to learn about the link between practice and success and to experience the pain and reward of discipline presented the perfect opportunity.  Two to three times a week, we headed to Master Shin’s Martial Arts.  Master Shin is a genial Korean born man; a practicing engineer who converted to teaching Tae Kwon Do with credentials as a former national champion.  Our family was once featured on the website, in essence, “the family that fights together, stays together.”  We have at home a video of our four-year-old daughter repeatedly throwing functionally correct punches at a target I am holding in our living room.  Yet, the core activities of learning and practice happened in Master Shin’s Dojang.  Beginners watched higher level belts learn 360-degree spin hook kicks and everyone practiced at their level: every single class yielded improvements through this rigorous and discipline practice guided by those who have attained a certain level of expertise.  The typical scenario would be four or five clusters of students repeating different skills, supervised by students of progressively higher belts, interspersed with moments when all the students came together for the specific exercises.

All of us also did drills at home, and we sometimes went to competitions, but the real work happened in the dojang.  The Japanese (reminder: lean was truly brought to industrial prominence by Toyota, hence the use of Japanese words and concepts in the lean movement) martial arts equivalent of this immersive learning and practice environment called the Dojo.  The rationale for creating a clinical Dojo in the context of aiming for the ideal care model is quite similar: to provide a place for quick but ultimately transformative learning, of experimentation, of repeated safe failures that inform important learning on the way to success.  As we well know in medicine, there is no substitute for hands-on training and practice.

At LCHC, we will be launching our Dojo this summer.  The transformation from fee-for-service to value-based payment, from a system treating illness to one that focuses on wellness is similar to learning a martial art: we truly don’t have the skills to provide the care needed in this new model.  We need a space to serve as our training center, in which we introduce new clinical and support roles and the associated processes, transform old ones, and new ways of engaging patients in transforming their lives. Like Master Shin’s, there will be concurrent clusters of learning, for rapid improvement.  The foundation of this aspect of the Dojo is relentless experimentation, to find out what works in our context, with our patients.  Essentially, every step of the patient journey is up for redesign.  In time, the Dojo will serve as a space where visiting team members learn new skills, to find out what moves need to be practiced so that they are able to consistently perform them “at home”, in their workplace.

Just as in learning a martial art, we have an idea of what excellence looks like.  We also know that one cannot simply wish oneself to be “there”: experimentation, repetition, comparison to an ideal, and coaching are all necessary components.  The clinical Dojo will allow for learning, to identify the areas of most profound change and how to implement the transformational steps.

I am excited that we are finally at this juncture.  As the corny saying goes, the future is now.


What new skills and new concepts are you most looking forward to practice?

Tae Kwon Do Instructor and Student
Dr Kiame Mahaniah
Kiame Mahaniah


About Kiame

Inspired by a childhood divided between a war-affected third world country – the Congo – and a high performing first world one (Switzerland), as well as parents intimately involved in rural development NGOs, Dr. Kiame Mahaniah brings a deep passion for social justice and the fight against inequities to his work as CEO at the Lynn Community Health Center in Lynn, Massachusetts.

More About Kiame

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