Creating tomorrow today; tackling the dilemmas at the heart of transformational change
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The document discusses the challenges and contradictions in transformational change within healthcare, emphasizing the need to embrace tensions such as patient-centered versus clinically-led care. It encourages leaders to reframe these dilemmas, adopt a 'both/and' mindset, and innovate collectively for better outcomes. Key strategies include recognizing and reframing contradictions, fostering interdependence, and shifting focus from individual to collective goals in healthcare systems.
Creating tomorrow today; tackling the dilemmas at the heart of transformational change
- 1. A1: Creating tomorrow today; tackling the dilemmas at the heart of transformational change Helen Bevan Goran Henriks Facilitator: Hugh Mccaughey Learning system leads: Annika O’Connor and Zoe Lord @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 2. Objectives of this session • Identify some of the big dilemmas in creating tomorrow today, positioning them as inevitable contradictions and tensions • Reframe the questions we are asking about making change happen • See the big picture and search for new possibilities @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 3. Slido Do you know: 1) just know the person to the left of you 2) just know the person to the right of you 3) know the people at both sides 4) know neither of the people @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 4. Slido Do you know: 1) just know the person to the left of you 2) just know the person to the right of you 3) know the people at both sides 4) know neither of the people Say hello to the people you don’t know and explain why you chose this session @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 5. Our success is measured in lives and health @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 6. Every system is perfectly designed for the results it gets Version 2017-02-16 ”For a good life in an attractive region” What kind of system do we want for the future? @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 7. Source: Improvement Directorate, NHS England and NHS Improvement, from a model created by the Institute for Healthcare Improvement The quadruple aim
- 8. Microsystem Patients and professionals Meso Primary care Medicine Surgical Psychiatric Makro Governance Before Today Redesigning our welfare system From reactive to proactive management Beyond today’s patient records @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 9. Support and rehab Primary care Specialised care Continuosly improve daily work and invest in innovations; Innovate and learn everywhere at the same time – we need simple rules to unite people in system thinking Health in daily life @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 10. https://blogs.bmj.com/bmjleader/2021/02/01/creating-tomorrow-today-seven-simple-rules-for-leaders-by-helen-bevan-and-goran-henriks/ @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 12. @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 13. Thinking about contradictions and tensions • Leading, holding and working with contradictions and tensions is a key role for improvement leaders • “Creating tomorrow today” is a contradiction and tension • The act of creating tomorrow today is full of contractions and tensions: • Patient/citizen/community led versus clinically led • Personalised care versus standardised care • Preventive versus curative • etc • Most of them cannot be “solved” as there is no one right answer • We need to name, reframe and hold the contradictions and tensions • Contradictions and tensions drive the movement towards creating a different tomorrow @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 14. Contradictions and tensions drive the movement towards creating a different tomorrow ABBA Pop music Avici Electronic dance music ABBA-tars Sound designers Artists DJs Music tables Servers
- 15. Healthy food A life in motion - exercise Sustainable and healthy choices Create safe places and stimulate exercise Self-care Recipe Support in the use of medicines Primary care through online clinics A healthy personal economy can counteract stress Insurance for a safer everyday life Contradictions and tensions drive the movement towards creating a different tomorrow
- 16. 17 | Contradictions and tensions in quality improvement Clinical expertise AND patients manage their own health Care close to home AND expert, specialist care Reduce cost AND Improve quality Value clinician’s time AND value patient’s time Deliver operationally AND transform care Work through the formal system AND Build a social movement Tried/tested approaches AND Innovate and experiment Transformation AND continuity Storytelling AND Data Personalised care AND standardised care Me AND We It’s not “either/or”: we have to work with both There is rarely a “right”, “wrong” or “best” for all contexts. We have to work comfortably with the contradictions of “both/and”
- 17. 18 | 1. Production logic AND patient/person centred service logic 2. Compliance mindset AND commitment mindset 3. Integrated care: the single integrator model AND the co-integrator model Three key contradictions and tensions that we need to hold to create tomorrow today @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 18. 1. Production logic AND patient/person centred service logic • The predominant model in health and care has been a “product” model • The key is not only the product but the function for citizens, patients and families • The competence base is no longer just what I do… • ..so how can we best develop collaboration, both internally in the patient journey but also in every meeting? • This is something profoundly different to pure production logic Service logic @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 19. 2. Compliance mindset AND commitment mindset
- 20. Independent Single integrator dependent Inter - Source: Stephen Covey and Bill Tolbert, From an adaption by Dave Ford. Care Oregon Multiple co-integrators: Vertical integration Horizontal integration 3. Integrated care: the single integrator model AND the co-integrator model Network model O w n e r s h i p Dependent @HelenBevan @GoranHenriks #Quality2022 #CreatingTomorrowToday Co- dependent Shared purpose, simple rules, collaboration Ownership
- 21. Slido and neighbour conversation What contradictions and tensions are you addressing and embracing in your daily work? @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 22. 23 | Contradictions and tensions in quality improvement Clinical expertise AND patients manage their own health Care close to home AND expert, specialist care Reduce cost AND Improve quality Value clinician’s time AND value patient’s time Deliver operationally AND transform care Work through the formal system AND Build a social movement Tried/tested approaches AND Innovate and experiment Transformation AND continuity Storytelling AND Data Personalised care AND standardised care Me AND We It’s not “either/or”: we have to work with both There is rarely a “right”, “wrong” or “best” for all contexts. We have to work comfortably with the contradictions of “both/and”
- 23. Addressing and embracing contradictions and tensions: some ideas and practical approaches
- 24. What we need to invest in, personally and collectively • The language of ”both/and” rather than ”either/or” or ”from/to” • Inter-dependence • Thinking differently • Understanding when boundaries are needed and when to work beyond boundaries • Working beyond boundaries means embracing the dilemmas, tensions and contradictions @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 25. Thinking interdependently Inter-dependent: I have my own goals but I am dependent on others to achieve them Focussed vision Awareness of others @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 26. Acknowledgement: Otto Scharmer Interdependence Our care system has been very focussed on “me” - what is important to me Our future system needs a stronger focus on “we” Balancing the tensions: • Me and we • Preventative and curative • eCo and eGo Shift in care and health
- 27. "There is a need to replace the security of stability with a high level of competence for change" Albinsson 1998 Close care, proximity care, integrated care – the way from decision to workshop Avinci took his own life Goran’s mum: tried to live her own life – accepting the contractions kept her life going Thinking differently
- 28. Our methodology for working with contradictions and tensions • Identify moments or situations where we have identified tensions and learnt to live with them • Build appreciation of the need to minimise the burden of the tension and reduce the conflict zone • Reframe seemingly different views as contradictions and tensions to understand the interdependence between the views/values we hold: “We need BOTH personalised care AND standardised care: how can we design a solution that maximises both of these for better outcomes?” @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 29. 1. Name the tension/contradiction 2. Reframe the issue 3. Develop comfort with the discomfort 4. See the big picture, connect, and search for new possibilities Paradox mindset, from Ella Miron-Spektor of INSEAD and Wendy Smith of the University of Delaware An approach to try Perspective & way forward @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 30. The versatilist Someone who can be a specialist for a particular discipline, while at the same time able to change to another role with the same ease
- 31. The versatilist
- 32. Skills for leading tomorrow today
- 33. Slido and neighbour conversation What will you do differently as a result of this session? @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday
- 34. Concluding remarks @HelenBevan @GoranHenriks @HughMcCaughey @ZoeLord1 #Quality2022 #CreatingTomorrowToday A1: Creating tomorrow today: tackling the dilemmas at the heart of transformational change
Editor's Notes
- #8: Välkommen till en presentation av Region Jönköpings län. Regionens vision ”För ett bra liv i en attraktiv region” sammanfattar vår verksamhet och våra ambitioner.
- #10: Vårt angreppssätt är att utgå från mikro, meso och makro nivån och se på olika behov och samspel. Mikrosystemnivån: Hur behöver ett vårdprogram vara designat för att vara lätt att använda? Vilka data behövs för att prioritera? Hur behöver de vara förpackade? Vilket stöd behövs för att omsätta kunskap i praktiken? Hur kan vi sprida våra goda erfarenheter vidare? Vad händer när andra nivåer bestämmer ”huret”? (t ex. Specialister – allmänläk) Mesonivå Vad behövs för att stödja strukturer för kunskapsstyrning? Vilka data behövs för att prioritera? Hur behöver de vara förpackade? Hur behöver överenskommelser och samarbeten se ut? Makronivå