The failure of the Right Moves Project stimulated research into the widespread problem of a lack of engagement among the occupational communities of doctors, dentists, and other professionals. Listed here are some of the leading causes of widespread disengagement among healthcare professionals.

The Health Beliefs Model survey instrument provided the values of each key beliefs of a targeted patient population.  The EV construct measures the patients' evaluations of their care in the aggregate and individually. Each patient demonstrates a unique "profile" of salient beliefs that has diagnostic and communications significance

Developing the intangible "construct" of organizational climate turned out to be a powerful driving force of many different forms of organizational performance..

Engagement is one of the hottest topics in management today.  In this work: "On Decorum" Hippocrates identified the vital importance of empathic engagement. Unfortunately, his admonitions suffered "a little neglect that breeds great mischief."

These impressive results were demonstrated when the US Physician Services Industry suffered a massive implosion in the annual rate of growth.  The implosive decline in the rate of growth was about 70%, an amount which classifies historically as a collapse.Type your paragraph here.

Please note that the handwritten alphabets (e.g. EC, EV, PC, etc.) in the top right of the adjacent graphic are the same dimensions which constitute the nine dimensions that characterizes the phenomenon of patient satisfaction. These dimensions were gleaned from more than 600 published works on the subject of patient satisfaction that produced the survey instrument presented later. Hence, the same factors that drive doctor selection are the same beliefs that drive patient satisfaction. Not an unreasonable finding.

Mark Satterthwaite, PhD is a professor at the Kellog School of Management at Northwestern University.

From its inception, the National High Blood Pressure Program has been endorsed by a blue-ribbon coalition of prestigious organizations and agencies, such as the Center for Disease Control and CMS (Medicare).  The program has been endorsed by more than three dozen prominent healthcare organizations, such as the Academy of Family Physicians, The American College of Physicians, the American Medical, Dental, and the American Hospital Associations, plus the American Osteopathic, the American Orthopaedic, and the American Nurses Associations, just to name a few.

The main reason why the Right Moves Project failed to meet its promises is because there was a total absence of early adopters in the occupational communities of doctors in the San Diego county target area.

Coping styles are the keystone of prosocial, proactive, beneficent engagement. Managing coping styles at the requisite level of management sophistication is mandatory in a hostile business environment such as American healthcare..

In retrospect, this cartoon was an understatement. Mega-billion dollar losses, secret government bailouts, and illegal slush funds where only a few symptoms of this shocking fiasco.

The same results were obtained for dentists: the absence of the early adopters was widespread.

The Right Moves Project Also Focused On Private Practice Dentists. The Groundbreaking Surgeon General's Report (Published In 2000) Is Considered To Be The Blueprint For Dentistry In The 21st Century. One Of The Recommendations Is To Focus On Patient Outreach. The National Call To Action To Promote Oral Health Was Meant To Implement The Mandates Set Forth In The Oral Health Report.

Ronald Melzack, PhD, Professor Emeritus, McGill University in Canada demonstrated in the 1960s that how patients described their pain had both diagnostic and therapeutic significance.  His pioneering work was used to develop an exclusive patient communications model that would have important ramifications on the effectiveness and ethicality of targeted patient outreach and patient recruitment efforts.

Interviews among scores of dentists in San Diego County demonstrated that most dentists had not read the Surgeon General's Groundbreaking report, "Oral Health in America."  Plus, none had implemented or planned to implement any of the key recommendations put forth in the report.

The late doctor Cecil Helman was an pioneer and an inspirational leader in the field of medical anthropology and medical humanities. He was the author of the seminal work: Culture, Health, and Illness. He was vocally skeptical of the growing, pathogenic institutionalization of healthcare. He was an advocate of fully understanding a patient's unique explanatory model of how that person gets sick and how he or she gets well. He realized that a doctor's understanding of the patient's explanatory model not only drives the quality of the doctor-patient relationship, it also drives the quality and outcomes of care.

"It is better to know the patient who has taken on the disease rather than the disease that has taken on the patient." .

Everett M. Rogers, PhD (1931-2004) is considered to be the "father" of the innovation diffusion phenomenon. He identified the "early adopters" as the critical group of people who were pivotal in the communication and diffusion of an innovation.

There is an old joke in the innovation business: "you can always spot the pioneers because they are the ones with the arrows sticking out of their asses."

David Satcher Surgeon General- 1998-2002.

The painstaking work done in the 30+ year R&D Program and demonstrated in the seven innovation development projects produced extraordinary results during the worst period in the history of the industry. Most private practice doctors say: "It's simply too good, to be true!"

After decades of research, accurately understanding the concept  of patient satisfaction turned out to be an extremely challenging endeavor. Early on, 660 published studies addressing the topic of patient satisfaction were located. This effort produced the nine dimensions of patient satisfaction presented here. The published survey instruments were tested on patients in doctors' offices selected at random. Ultimately for several reasons, the conclusion was reached that patient satisfaction could not be accurately and legitimately measured on patients themselves. The increasing use of measuring satisfaction among "standardized" patients confirmed the conclusions. This problem was eventually resolved by measuring the organizational climate of the private practice organization.

​​​Started in 1982, the Right Moves Project is one of seven innovation development projects in a private 30+ year R&D program that is today the undisputed, definitive authority on the rise and fall of the provider sector of the American healthcare establishment.

The mission of the Right Moves Project was to create, to develop, and to implement an exclusive, evidence-based, innovative, patient health communication, patient outreach, patient health education intervention, and patient recruitment management knowledge-base that would successfully implement and meet the goals of the national program launched by one of the institutes at the National Institutes of Health in 1972. The national program was called the National High Blood Pressure Education Program.

One of the notorious drawbacks of commercial advertising is called "wear out." Over time regular advertising looses it drawing power. Consumer response slows down and evaporates. Repeating the same message may even backfire. The finding that the exclusive patient outreach, motivation, and recruitment model actually demonstrated a "wear up" was exceptional performance.

This Is A Work In Progress. This website was updated on April 4, 2019. The content is copyrighted; reproduction of the content  is prohibited without written permission. Registration Certificate: Number TXu 1-705-384, effective July 15, 2010. For more information contact Francis A. Toto in San Diego, CA at 858-278-5050. Email: or visit these websites: and Search Google for: bimodal annihilation catastrophe for the scientific explanation of how the healthcare industry will suddenly and violently collapse.

One of the five universal principles of survival in the increasingly hostile business environment of American healthcare is gaining in-depth and comprehensive understanding of the consumer--the patient as consumer. Understanding how a patient perceives his or her risk is vital in fostering the right kind of motivation, in overcoming delay, and in driving proactive engagement and compliance (adherence).

As demonstrated here, there are numerous factors which influence how patients interpret their symptoms; this model provides caregivers with in-depth knowledge of the patients and meets Hippocrates' dictum: "It is better to know the patient that has taken on the disease, rather than the disease that has taken on the patient."

Professor Howard Leventhal, PhD Is a highly distinguished scholar in the field of psychology. During his fruitful career, he has received more than a dozen honors and awards. Among the honors are the APA Gold Medical for Lifetime Achievement in Psychological Sciences. While at Rutgers University he received the Board of Trustees Award for Excellence In Research. His groundbreaking work on the development of the construct of illness cognitions provides a deep understanding of how people think about illness--a disvalued state of being.

Richard Carmona Surgeon General- 2002-2006

What makes the results presented here even more impressive is the fact that patients can demonstrate high levels of delay.

"The positive antithesis of burnout is engagement."

Mark Pauly, PhD is a professor and vice dean and chair of the Health Care Systems Department in the Wharton School at the University of Pennslyvannia.

One of the objectives of the Right Moves Project was to develop an evidence-based, exclusive knowledge-base covering the subjects that would reveal the best way to conduct patient outreach, patient communications, and patient recruitment activities. Here is one of the first knowledge-bases that was developed: it was based on thousands of published works. This material was integrated to produce numerous scientific models, some of which are show below. Health threat communication and health education intervention studies and models were included as one of the main subject areas. Plus, this work produced the most sophisticated, most extensive management knowledge-base on the subject of patient satisfaction. A survey instrument was created from some 600 studies; this instrument was tested on numerous patient samples from medical and dental practices (see below). Finally, the 30+ year R&D program produced a sophisticated, evidence-based management knowledge-base and demonstrated how to build a successful, population-based private practice.

The Right Moves Project  successfully merged the consumer behavior knowledge-base with the clinical research on how patients, acting as consumers,  make decisions that lead to the highest level of engagement in order to maximize timely patient help-seeking, maximize patient compliance and to maximize clinical, social, and emotional outcomes.

One of the objectives of the local Right Moves Project was to implement the pioneering work of Professor George L. Engel, MD, creator of the Biopsychosocial Model Of Patient Care. His work is at the heart of the patient-centeredness movement, today.

Here is a sobering example of burnout. One of the characteristics of burnout is feeling of low professional self-worth; another is lack of proactive, prosocial engagement. Cynicism and callous treatment of other people are additional common symptoms of burnout.

This effort demonstrated that the patient outreach and recruitment model was also a good investment. The average return-on-investment was about 400%, simple payback.

After receiving the communications and reporting to the doctor, many patients would say: "Doc, this was talking right to me." Such responses would validate Mark Twain's old saying: "The difference between the right word, and the almost right word, is like the difference between lightening and the lightening bug."

One of the incentives for local people to join with private practitioners was that the leaders could use the prestige of the NIH sponsorship and the patient education materials created by the agency to establish credibility and purpose. There were more than 2,000 local projects conducted across the nation; each local project could develop innovative approaches to reaching the national goals. It was a brilliant strategy. The San Diego project adopted the logo presented on one of the publications (see above).

The year, 1990, was a milestone event. The front edge of the baby boomer population (estimated to be as many of 76 million people) was turning 45 years of age.  Generally, at this age, common diseases such as hypertension start to skyrocket. Payments to doctors crashed. This was an epic event which suffered from the "little neglect" syndrome.

One of the goals of the National High Blood Pressure Education Program was to augment the obsolete Flexner. or biomedical, model of knowledge-transfer (circa, 1910) by directly targeting professionals and the public on the importance of managing high blood pressure to prevent strokes and heart attacks. One reason for this approach, was the research demonstrating that journal readership among  physicians had been dropping dramatically.

The Right Moves Project demonstrated that the occupational communities of doctors and dentists in private practice demonstrated very high levels of burnout. A deeply embedded lack of  engagement among private practitioners was widespread. Published studied have also demonstrated high levels of burnout among practitioners--as much as 90%!

Obamacare was a complex innovation. This innovation was grossly mismanaged given the extant management knowledge-base on implementing successful innovations. None of the critical factors driving a successful innovation presented here were implemented by the leadership in the implementation of Obamacare. It was, as the old saying goes: "kicked out the door to see what happens."

Not duly recognized by the healthcare leadership and the practitioners was the deregulation of the provider sector of the healthcare industry (1972-1978). This milestone event produced, almost immediately, a consumer driven, classic neo-Keynesian marketplace where consumer demand was ultimately driving the evolution of the mainspring components of the industry--the US Physician Services Industry, the US Dental Services Industry, and the mammoth US Hospital Services Industry.

This paradigm shift was demonstrated by two prominent healthcare economists and was published in a prestigious journal during 1981. Here is a graphic representation of the factors and the relationships they demonstrated. This critical event was largely ignored by the leadership and by the government. It was a "little neglect that would breed great mischief." Such neglect contributed to the huge management gap that has handicapped private practitioners for decades, and will threaten all private practitioners with catastrophe, henceforth.

Based on the data from the gold-standard, federal study that has tracked the provider sector of the healthcare industry for some 60 years and presented here are the historical, annual rates of industry growth for the mainspring US Physician Services Industry.

When the industry rate of growth approaches the catastrophic threshold, the industry is reaching the "tipping point," becomes highly fragile, pathologically unstable, and vulnerable to dramatic implosion.

For more information on the computer model that demonstrates how and why the implosion happens, search the Internet with the Mozilla Firefox browser and the Google search engine with the term: "bimodal annihilation catastrophe."