Creating Tomorrow Today: Unleashing Learning as a Power for Transformation
Download as PPTX, PDF0 likes108 views
The document discusses the IHI Forum 2022 presentation on leveraging learning as a transformative power in healthcare, emphasizing the need for a shift from traditional models of healthcare delivery to more collaborative and person-centered approaches. It highlights the importance of unlearning outdated practices and fostering an environment for continuous improvement and knowledge sharing across healthcare systems. The presentation outlines 'seven simple rules' for leaders to implement in order to create a more effective and proactive healthcare landscape.
Creating Tomorrow Today: Unleashing Learning as a Power for Transformation
- 1. IHI Forum 2022 14 December 2022 VA08: Creating Tomorrow Today: Unleashing Learning as a Power for Transformation Goran Henriks Zoe Lord Helen Bevan
- 2. VA08: Creating Tomorrow Today: Goran Henriks Zoe Lord Helen Bevan @GoranHenriks @zoelord1 @HelenBevan #IHIForum
- 3. Disclosure No relevant relationships: None of the planners, presenters, or staff for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
- 4. After this session attendees will be able to: 1. Develop a new perspective and appreciation of the role of learning in creating and sustaining change 2. Discover novel ways to help people grow, generate capacity for change and keep learning processes flourishing 3. Apply what you learned to support change and improvement in your own context @GoranHenriks @zoelord1 @HelenBevan #IHIForum
- 5. Helen Bevan & Goran Hendricks
- 6. 6 | 6 | Hardcastle, A.C. et al. The dynamics of quality: a national panel study of evidence-based standards 2015 Braithwaite and Glasziou May 2020 D’Avena A, Agrawal S, Kizer KW, et al.: Normalising High-Value Care: Findings of the National Quality Task Force. 2020 % of quality indicators for healthcare received by participants The challenge in numbers Cardiovascular disease Diabetes Depression Osteoarthritis 0 10 20 30 400 50 60 70 80 90 Healthcare represents a paradox. While change is everywhere, performance has flatlined: 60% of care on average is in line with evidence- or consensus-based guidelines, 30% is some form of waste or of low value, and 10% is harm. The 60-30-10 challenge has persisted for three decades. Despite impressive gains, notable shortcomings persist in normalising consistent, high-value, person-centered care. What is primarily missing is not progress in measurement, but progress in results. Changes in culture, investment, leadership, and even the distribution of power are even more important than measurement alone”
- 7. 7 | We cannot continue with the way we are doing things now All service...at some level...is produced by professionals in collaboration with those who receive the benefit John Maynard Keynes The biggest challenge is not to make people accept new ideas….it is to make them abandon the old ones Transformation is more often about unlearning than learning
- 8. Doing things differently means shifting from “expert” to “explorer”
- 9. 12 11 10 9 5 4 3 2 1 8 7 6 Via Sasha Karakusevic Source: adapted from What if we are in the wrong paradigm?
- 10. Paradigm: A set of assumptions, concepts, values, and practices that constitutes a way of viewing reality for the community that shares them @GoranHenriks @zoelord1 @HelenBevan #IHIForum #CreatingTomorrowToday
- 11. Investing in health through a life-course approach & empowering people Tackling the major health challenges of noncommunicable & communicable diseases Strengthening people- centred health systems, public-health capacity, emergency preparedness, surveillance & response Creating resilient communities & supportive environments for health & well-being New paradigms: Advocating intersectoral action for health equity and well-being www.euro.who.int/__data/assets/pdf_file/0017/330560/Advocating-intersectoral-action-ljubljana-report.pdf?ua=1
- 12. Moving to Quality 3.0 in health and care improvement A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals to coproduce health. Peter Lachman, Paul Batalden, Kris Vanhaecht 2022 f1000research.com/articles/9-1140 Quality 1.0 Quality 1.0 Quality 3.0 Quality 2.0 Thresholds “How might we establish thresholds for good healthcare service?” Illustrative themes: • Development of standards • Inspection to assess • Certification • Guidelines Organisation-wide systems “How might we use ‘enterprise-wide systems’ for best disease management?” Coproduction of health “How might we improve the value of the contribution that healthcare service makes to health?” Illustrative themes: • Systems, processes • Reliability • Customer-supplier • Performance measurement Illustrative themes: • Logic of making a “service” • Ownership of “health” Kinship of coproducing people • Integration of multiple knowledge systems • Value-creating system architecture
- 13. A different way of thinking about learning and capability
- 14. Our success is measured in lives and health @GoranHenriks @zoelord1 @HelenBevan #IHIForum #CreatingTomorrowToday
- 15. 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? @GoranHenriks @zoelord1 @HelenBevan #IHIForum
- 16. 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 @GoranHenriks @zoelord1 @HelenBevan #IHIForum
- 17. 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 @GoranHenriks @zoelord1 @HelenBevan #IHIForum
- 20. Creating tomorrow today: seven simple rules for leaders We have created a set of “seven simple rules” for leaders who want to create tomorrow today, based on our collective learning over seven decades as leaders and internal change agents in the health and care systems in England and Sweden and the work we have done with leaders in health and care in many other countries. • Read blog one: our approach to creating the simple rules. • Read blog two: Define our shared purpose here • Read blog three: Root our transformation efforts in a sense of belonging • Read blog four: Predict and prevent: start at an earlier stage (“upstream”) in the intervention or care process • Read blog five: Support people to build their agency at every level of the system
- 21. @GoranHenriks @zoelord1 @HelenBevan #IHIForum
- 22. “Is it possible to move from an approach of just stability to an approach where we become successful in change?“ Albinsson 1998
- 23. Are you ready – to “take” a new perspective? If we think differently today, can design a new tomorrow?
- 24. Reference: @katebhilton at #IHIForum The know-do gap
- 25. Production Industries Quality Improvement Learning health systems: “An “engineering” paradigm • Linear / highly specified • Variation unwarranted • Objective / quantifiable • Technical skills paramount • Low context-specificity • Low complexity organisation Reference : Al Mulley MD MPP Professor of Medicine and of Health Policy and clinical practice The Dartmouth Institute, Visiting professor, UCL
- 26. Thinking to learn and change Test on the smallest scale possible to learn.
- 27. Foundations of the science of improvement Source: Associates in Process Improvement
- 28. What methods* do we use? Lens of Improvement Science Tools & Methods Understanding Variation Run Charts Shewhart Charts Frequency Plots Pareto Charts Appreciation of a System System Maps (Linkage of Processes) Flow Diagrams SIPOC Theory of Knowledge PDSA cycles Planned Experiments Psychology Observation/Shadowing Interviews Focus Groups *Sample of common tools and methods from improvement
- 29. Person-centred thinking • Iterative / experimental • Variation warranted • Subjective / qualitative • Relational skills paramount • High context-specificity • High complexity organisation Learning health systems: the “service giver” paradigm Service industries Reference : Al Mulley MD MPP Professor of Medicine and of Health Policy and clinical practice The Dartmouth Institute, Visiting professor, UCL
- 30. Respecting complexity at the level of the organisation/system Uncertainty about Outcomes Disagreement about Value of Outcomes High High Low Low Control Chaos Complexity Adapted from R. Stacey, P Plesk Reference : Al Mulley MD MPP Professor of Medicine and of Health Policy and clinical practice The Dartmouth Institute, Visiting professor, UCL Implications for leaders • In ‘control’ you can manage like an architect or engineer • In ‘complexity’ you manage with awareness of human dynamics and emergence • The ‘complexity/chaos’ border is where creativity happens
- 31. Respecting complexity at the level of the person Uncertainty about outcomes Disagreement about preferences High High Low Low Control Chaos Complexity Evidence-based Adapted from R. Stacey, P Plesk Reference : Al Mulley MD MPP Professor of medicine and of health policy and clinical practice The Dartmouth Institute, Visiting professor, UCL The need for simple rules • The care needed and wanted – no less but no more • Informed by what is possible and valued • Manifest respect for what matters to the person
- 32. What is best for Esther? • Be responsible for your work, give feedback to the step before you and make it easier for the next step! • We do it together
- 33. Acute setting: Learning from indications, interventions and outcomes of care in ITUs Community setting: Learning from shared decisions about elective and complex care Learning health systems– at the frontlines across settings Reference : Al Mulley MD MPP Professor of Medicine and of Health Policy and clinical practice The Dartmouth Institute, Visiting professor, UCL
- 34. Shifting our paradigm: Single-loop and double-loop learning Single-loop - results of our practice don’t fit theory and we interpret the need to change or fine-tune our practice. Double-loop - do we need to change our underlying theory and practice. Source: Argyris, C. (1977, Sep/Oct). double-loop learning in organizations. Harvard Business Review, p115-125 Theory Practice Results single- loop double- loop
- 36. Unleash learning as a power for transformation
- 37. Unleash learning as a power for transformation
- 38. A system in transformation: requires and creates a lot of learning Single Double Triple
- 39. Single-loop and double-loop learning Presentationsrubrik 39 • Single-loop learning is like a thermostat that learns when it is too hot or too cold and then turns the heat on or off. The thermostat is able to perform this task because it can receive information (the temperature of the room) and therefore take corrective action. • Double-loop learning involves changing the setting on the thermostat (i.e., changing the objective of the system). Double- loop learning calls for changing the objective itself. Indeed, double- loop learning is not only about changing the objective, but involves questioning the assumptions about that objective, the ways of discovering and inventing new alternatives, objectives, and perceptions, as well as ways of approaching problems. • Double-loop learning is an educational concept that involves teaching people to think more deeply about their own assumptions and beliefs. It was created by Chris Argyris in the mid-1980's
- 40. Triple-loop learning: Moving beyond institutional limits 40 • Our strategic thinking in health & care is mostly single-loop (what/how are we doing?) or double- loop (why/how do we do what?) We have to make time & space for triple-loop learning (rethinking our thinking) • A diversity of models, methods and theories are used that disrupt established institutional frames (which maintain single and double-loop thinking). • Single and double-loop learning is appealing to organizations that want to be in control, whereas triple-loop learning acknowledges that in complex systems, control is usually an illusion. Source: Ben Zweibelson Triple loop learning: moving beyond the pale of the institutional limits
- 43. Unleash learning as a power for transformation The habit of collaborative learning The only way we may ever get at the knowledge we need for large scale change is through collaborative learning with others. Improvement oriented individuals, organisations and systems start from the premise that it is better to be open and curious than defensive. The habit of change No matter how much we know, improvement only comes about when we do something differently. People, givers of care and leaders who are successful at improvement know that improvement requires change. EVIDENCE-BASED QUALITY IMPROVEMENT, PRINCIPLES, AND PERSPECTIVES, Paul Plsek, https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.203.3566&rep=rep1&type=pdf
- 44. Using methods to learn and change behavior, attitudes, and culture Source: Developed by the Associates in Process Improvement based on work on ABC – (Antecedent Event, Behavior and Consequences) used by safety engineers (see Thomas R. Krause, John H. Hidley, and Stanley J. Hobson, The Behavior-Based Safety Process (New York: Von Nostrand Reinhold, 1990).
- 45. Improve work processes Level 3: Triple-loop Enable a healthier life Level 2: Double-loop Develop primary care Level 1: single-loop Develop clinical processes Organising for learning - value network actions Join us! Join in! Join up! Transfer power to service users, families and community rather than keeping it in the system Transformation by examples Person centered redesign
- 46. Triple-loop leadership to deliver a different tomorrow Accelerated learning of new skills and development of systems at all levels; i.e. "self-care", new design of clinical meetings, new regional structures . A leadership that focuses on service at home through and with families and communities and primary/open care A leadership that works in partnership with stakeholders beyond classic care limits A leadership that is increasingly working with health and social systems to improve health A leadership that enables everyone to do their best work and respond to ever-changing demands and expectations Building a learning system for today and tomorrow: so that the system is continually expanding its capacity to create its future. It's about valuing the time and creating the conditions & connections so people in the system can test, fail early, share, learn & grow together
Editor's Notes
- #7: Braithwaite . Glasziou https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01563-4 Hardcastle, A.C. et al. The dynamics of quality: a national panel study of evidence-based standards. Health Services and Delivery Research. 3(11) April 2015
- #16: Välkommen till en presentation av Region Jönköpings län. Regionens vision ”För ett bra liv i en attraktiv region” sammanfattar vår verksamhet och våra ambitioner.
- #17: 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