As you can see, I am standing under a live oak tree and the reason for choosing this tree will become clear shortly. Today I will be discussing the lessons of Samuel Adams can teach us about transforming healthcare. But before I begin this discussion, let me return to Mary. After Mary was discharged from the hospital, I discussed Mary's case with my fellow faculty members. They shook their heads and frowned, typical glances were These things happen. That's the way it is, Mary was unlucky. I never received an apology or an acknowledgment that errors had been made. I later learned that a confidential inquiry concluded that I was overly emotional and too involved in Mary's case. I was the problem. It was very clear to me that my medical center had a physician-centered culture that focused on research and families over patient care. As my conversations had revealed, these healthcare professionals accepted the way it was as inevitable. But I feel strongly that we all need to take responsibility whenever we discover a problem that requires change. When we do nothing, our inaction suggests we are powerless to make change. By permitting such attitudes and ways of working, we are promoting them to permit is to promote. Now let's talk about one of the great adaptive leaders and founding fathers of the United States, Samuel Adams. You don't hear much about him, because the British mischaracterized his leadership. Climb the great incendiary because some of his followers burned down a British tax office. And when he organized a gathering of colonists, the British called it a mob. I am standing under this large tree because Samuel Adams met fellow Sons of Liberty On an similar tree in the center of Boston called the Liberty Tree. It was under this tree that he convinced many of his fellow countrymen to move from apathy to action. And the consequence of his relentless campaign, was the American Revolution. I am standing under these tree because I am trying to recruit you to follow the example of Samuel Adams. Together we can make a difference and your reaction to the conditions I have outlined during the first six weeks should not be these things happen. Using the organizing techniques of Samuel Adams and subsequently used by Gandhi, Cesar Chavez, Martin Luther King, Nelson Mandela. And many others, each of us can profoundly change the attitudes of everyone who provides and receives healthcare. Just like this founding father, we all have the power to make a difference and you can help to organize a revolution in healthcare. This image shows the timeline of Samuel Adams campaign. The horizontal axis is time and the vertical axis the level of campaign activity. Classically, campaign timelines remain relatively flat at the beginning, have progressive peaks to a final pinnacle, shown on the far right. As you can see, this campaign began in 1748 and peaked in 1773. What motivated Samuel Adams to oppose the British rule? In 1748, while young Samuel was a student at Harvard, his father joined other local businessmen to organize the land bank. At that time, Boston merchants we're having difficulty obtaining loans to expand their businesses. British loyals controlled all credit, providing loans at excessively high interest rates. His father, a local beer brewer, another offered their land deeds as collateral to create a bank that offered loans to fellow colonists at fair interest rates. The loyalists complained to the British parliament. The parliament outlawed the Land Bank and declared his father liable for all the outstanding loans. His father went bankrupt. From that time on, Samuel understood the capricious power of the British. However, his fellow colonists were contend under British rule. The colony's where growing and prospering. A few recognized the potential impact of meaning of British taxation. In the 1760's the British began enforcing taxation on molasses and subsequently added Sugar Act and that taxed sugar. Followed by the Stamp Act that taxed all legal documents, and the Townsend Act that taxed paint, paper, glass, then tea. When Samuel Adams complained to Benjamin Franklin, he was told that fighting the British taxation would be the equivalent of hindering the Sun from setting. But Samuel Adams did not listen he set about converting colonists. First, his primary strategy the beginning of his campaign in the 1750's was to meet one on one with his fellow colonists and to form a leadership team. As an elected tax collector, he came in direct contact with men from all walks of life. During his meetings, he shared his high aspirations for the Massachusetts Bay colony. He met with his younger second cousin, John Adams, and urged him to become involved in civic affairs. Essentially John helped Samuel but after several years with a tooth in the campaign because he found it too stressful. He only returned to politics after the Boston Tea Party. Samuel also recruited young and influential physicians and lawyers and merchants including John Hancock And for the leadership team. Together they discuss the goals of the campaign and formulate the strategies for publicising the dangers of British rule. As his second strategy, he utilized the power of the pen and his oratory, to capture the emotions of the colonist and to create a sense of urgency. Joining with others, he purchased a newspaper, The Public Advertiser. And also became an active contributor to The Boston Gazette. Under various pseudonyms, he wrote essays espousing the natural rights of man and the concept of taxation without representation. In public meetings, he proved to be a passionate speaker. He used personal narrative to charge the hearts of his audience. His writings and speeches transformed the colonists from complacent British subjects to independent Americans who demanded the right to determine their own destiny. Third, he organized large public meetings, actively participated in many civic organizations. He brought together large crowds in Faneuil Hall at Old South Church and under the Liberty Tree and at Boston Harbor. His final approach was to craft strategy and encourage action. When the british levied the sugar act, it was Adam's who proposed that the merchants agree not to import british goods in order to create financial pressure to resend this tacks. He called this action non-importation. John Hancock and other merchants lost money as a consequence, and many including Hancock Withdrew from Adams' campaign. 100 years later, this strategy became known as the boycott and to this day, remains a common pressure tactic to bring about change. You may be thinking our course is electronically bringing together thousands of like-minded people. Furthermore Twitter, Facebook are online discussions creating many one on one opportunities using social network tools. I urge you to form your own leadership teams to create achievable goals and strategies for improving health care delivery. We no longer have to meet under the delivery tree we can create our own websites that describe our missions and goals to attract others to our campaigns. I hope you will share your websites and organizing experiences with me and with your fellow students. In our last session, I hope to highlight some of your experiences and to suggest potential campaigns for change in healthcare delivery. Let me return to Samuel Adams. The peak of his carefully orchestrated campaign cane in 1773, during the standoff over three ships docked in Boston Harbor, waiting to unload British tea. He organized the North End Caucus, where representatives from Boston and the outlying towns unanimously agreed, British Tea could not be unloaded on the docks at Boston Harbor. When the ships arrived, the captain honored the colonists' wishes. Our British law declared that all goods had to be unloaded within 20 days of the initial docking. On the 20th day, Adams recruited a huge crowd of 7,000 people, nearly half the population of Boston, to gather at the Boston Harbor. That day the captain of the ship requested that the governor allow him to sail back to Great Britain without loading his tea. The governor refused. Nervously, the captain returned to the angry crowd. He asked for permission to unload his tea, should Adams publicly agree to a violent riot? Adams knew that inciting the crowd to violence would brand him a traitor and a criminal. As a huge crowd waited impatiently called out, this meeting can do nothing more to save our country and he disbanded the crowd. As if on signal, a group of 40 men, some in Indian disguises admitted the yell out, Boston Harbor Teapot tonight. As the delighted crowd watched, these men rushed to the ships, and with their hatchets broke apart all 342 tea chests, and dumped them into the harbor. The Boston Tea Party galvanized nearly all colonists in support of independence. This event precipitated a British blockade of Boston Harbor, the landing of four British troop regiments, the Battle of Lexington and Concord. The convening of the Continental Congress, the Declaration of Independence, and the Revolutionary War soon followed. Samuel Adams's campaign led to the eventual creation of the United States of America. In our next two sessions, I will discuss in more detail the campaign tactics that allowed one person, Samuel Adams, with the help of many others. To achieve what many people, including Benjamin Franklin, John Adams, and John Hancock, felt was impossible. Independence from Great Britain. And using these same approaches, we can achieve another seemingly impossible goal, transforming healthcare delivery. Thank you.