Mobilizing For Health Reform

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Central East Local Health Integration Network

• Mobilizing For Health Reform

Designing a System that Works
Quantum Transformation Technologies
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A Threshold Moment!

• A key moment in the evolution of Ontarios
  healthcare system.
• Unleashing the power of self-organizing systems.
• Optimism (LHINs)
• Relief (QP not in control)
• Era of micro-management is over.

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Healthcare Reform in Ontario

• From Frank Miller to George Smitherman 25 years
  of healthcare reform initiatives/strategies.
• Financial imperatives sustainability
• Paradox Our society will get sicker if we
  invest any more in healthcare services.

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Healthcare Reform in Ontario

• Customer-driven vs. Provider-driven.
• Staff/Physician Satisfaction.
• Financial performance a leveraged use of
  resources.
• Accountability for results.

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Current Results

• Decline in patient satisfaction rates/public
  confidence.
• Deficits/waste/inefficiencies.
• Gaps in services.
• Quality of care/patient safety.

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Current Results

• 25,500 preventable deaths annually in Canadian
  hospitals.
• Equals () two jumbo jets crashing weekly for a
  year.
• Today, 1 in 13 patients will be harmed in
  Canadian hospitals (Community care research
  pending).

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Healthcare Politics

• The public demands that the system be fixed.
• Weve had 25 years of fixes from on high.
• Fixed for a generation.
• How well have the top-down fixes worked?

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Fixes-that-Fail

• Fixes-that-Fail the one-off solutions that
  dont work, but we keep doing them anyway.

Fixes-that-Fail
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What is Your Strategy?

• 25 years of failure to transform the system.
• What will you do differently?
• What will we do differently?

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Lessons Learned

• 70 30

Failure
Success
Failure Rate
TQM/CQI/Re-engineering/Process redesign,
organizational transformation.
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The Barriers to Implementing Strategy
The Barriers to Implementing Strategy
The Barriers to Implementing Strategy
Only 10 of organizations execute their
strategy
Barriers to Strategy Execution
Resource Barrier 60 of organizations dont
link budgets to their strategy.
Vision Barrier Only 5 of the workforce
understands the strategy.
People Barrier Only 25 of the managers have
incentives linked to strategy.
Management Barrier 86 of executive teams spend
less than one hour per month discussing strategy.
Balanced Scorecard Collaborative, Health Care
Summit 2003
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Demings Wisdom

• WISDOM KNOWLEDGE EXPERIENCE REFLECTION (-
  EGO)

Design Issues
People Issues

• 93 vs. 7

Half the time the problem is skills, therefore
people are the issue only 3.5 of the time
Design of Systems, Structures, Processes
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System Design

• System design at the macro, network and
  organizational level is the key.
• -- Macro redesign (Provincial).
• -- System redesign (LHIN).
• -- Organizational Redesign (BSC).

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Macro and Organizational DesignAnd The 93 vs.
7 Deming Rule
1 in 13 Patients Harmed
Ministry of Health
Service Delivery Organizations
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93
Organizational Designs/ Structures/ Processes/ C
ulture and Strategic Management Systems
Governance Boards
Macro Design of Health System (incentives,
LHINs, etc.)
Care Service Providers
Patient Experience
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CEOs Management Teams
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Demings 93 vs. 7 Rule suggests that most
performance problems are design issues, and only
7 are people-related issues.
Quantum Transformation Technologies
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Dialogue Exercise 1

• Generate examples _at_ tables of how the partners in
  the Central East LHIN are like the blindmen and
  the elephant.
• (20 mins.)

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Central East Local Health Integration Network

• Managing Change

Quantum Transformation Technologies
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Bifurcation
Product Life-Cycle S Curve
Maturity
Decline

Growth
Death!
Beginning
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Bifurcation
Another S Curve in the Life-Cycle
Evolve or Die

New System
Death!
Old System
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Bifurcation
Between the old system new system one.
New System

We operate the old system while building the new
one.
Old System
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Bifurcation
Where in the DREC are we?
Commitment
Exploration
Resistance
New System
Denial

DREC
Old System
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Reality Lens M Scott Pecks Community
Development Model
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Dialogue Exercise 2
NOTES?

• Where in the DREC are we?
• Denial/Resistance/Exploration/Commitment
• At what stage in Pecks model? Whats next? How
  are we going to get there? Are we ready?
• How could we get ready?
• (15 min)

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1st Curve 2nd Curve Healthcare Systems

• 1st CURVE SYSTEM industrial model.
• 2nd CURVE SYSTEM emerging system.

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Dialogue Exercise 3

• Take 15 min to review all the shifts outlined.
• Take another 20 minutes to pick two shifts
  determine Leveraged Actions that would propel
  us forward.
• (35min)

Take Notes!
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Martin D. Merry, M.D. Quantum Learning Systems
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Martin D. Merry, M.D. Quantum Learning Systems
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Leveraged Actions
What action(s) could we take to propel us towards
the emerging vision of your health system?
Leverage
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Leveraged Actions

• Maximum impact for least effort.
• Highest return on investment (ROI).
• Biggest bang for the buck.
• with the least number of unintended consequences

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McGuinty Governments Health System Vision

• Our vision is of a system where all providers
  speak to one another in the same language, where
  there are no longer impenetrable and artificial
  walls between stakeholders and services a system
  driven by the needs of patients, not providers.

- George Smitherman Economics Club February 24,
2004
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Where are the Patients/Customers/Clients?
Organizational Scorecard (Strategy)
Service Accountability Agreements
Integrated Health Service Plan
Provincial Health Strategy
PHS
BSC
IHSP
SAA
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What are You Waiting For?

• The emerging system is being designed so that it
  can self-organize to fix itself.
• The Made-in-Ontario model unleashes the
  self-organizing capacity of the system.
• The MOHLTC and LHIN are not designed to
  micro-manage or control service delivery
  organizations.

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Community-Based, Not Ministry-Driven

• Trying to run Ontarios health care system from
  a suite of offices at Queens Park is like trying
  to shave while blind-folded.
• --
  George Smitherman
• Economic
  Club
• 
  February 24, 2005

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Liberate System Know-How

• The answers to our most complex challenges are
  within the system.
• People/systems are brilliant.
• LHINs can support the system to learn from one
  another.

Collaboratives
Priority Networks
Task Groups
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Connecting the System Together

• When a system is failing, or performing poorly,
  the
• solution will be discovered within the system --
  if
• more and better connections are created. The
• solution is always to bring the system together
• so that it can learn more about itself, from
• itself. A troubled system needs to start talking
  to
• itself especially to those it didnt know were
• part of itself.
• --
  Margaret J. Wheatley
• Finding Our Way
• Leadership for an
  Uncertain Time

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Leadership

• Who leads this?
• Ambiguity.
• We all need to become leaders.
• Peter Koestenbaum, Philosopher

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Where Should We Focus?
Koestenbaums Leadership
Diamond
ETHICS
REALITY
VISION
Polarity
COURAGE
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Your Scores

• ETHICS
• VISION
• COURAGE
• REALITY

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4
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Dialogue Exercise 4

• At your table, share your scores.
• Which point on the diamond had the lowest score?
• THIS IS OUR GREATEST POINT OF LEVERAGE!
• (15 min)

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Community-Based,Not a Regionalization Model

• What is needed is better integration and
  planning at the local level so that we can
  deliver better results in each part of the
  province. Not a regionalization model. A
  made-in-Ontario solution that builds on the
  strength of our community-based organizations
  large and small.
• - George Smitherman
• Economic Club
• February 24, 2004

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Can We Change the System?

• FEW, IF ANY, FORCES IN HUMAN
• AFFAIRS ARE AS POWERFUL
• AS A SHARED VISION.
• - Peter Senge
• The Fifth Discipline