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1145 leo kearns healthcare conference may 2015 final.v1
1. Leo Kearns
National Lead Transformation and Change
Clinical Leadership in the Context of
System Reform
2. โUnlike even the very best management process,
leadership has as its primary function the production of
change.
Without leadership, purposeful change of any magnitude
is almost impossibleโ
John Kotter, 1992
3. Fundamental reform
of the model of health
care
Societal
Changes
Ireland
People &
Culture
Economics
A complex
System
Quality &
Patient
Safety
4. Health System Reforms
Empower those closest to patient
Clear responsibility, authority and accountability at all levels
Design and implement integrated models of care
Prevention a strategic priority
Quality designed in
All financial levers used to incentivise models of care
Necessary knowledge and information available at all levels
Motivated staff working in a positive and accountable culture
Rebuild trust
System-level, strategic understanding and control
5. 7
Hospital
Groups
90
Primary Care
Networks
50,000 avg.
population
REFORM of
social care,
mental health
and health and
wellbeing
services
9
Community
Healthcare
Organisations
Saolta
Hospital
Group
UL
Hospital
Group
South/
South
West HG
RCSI
Hospital
Group
Ireland
East
Dublin
Midlands
Children's
Hospital
Group
Community Healthcare Organisations & Hospital Groups
6. AcutePrimary Mental
Health
Social Health &
Wellbeing
Older Person โฆ. Clinically led, multi-disciplinary, design authority
Children โฆ
Chronic Disease Prevention & Management โฆ
Maternity โฆ
Patient Flow โฆ
Finance
Human Resources
ICT/eHealth
Service
Improvement
change
management
performance
improvement
geographic,
cross
boundary,
transition to
BAU
Integrated Care Programmes
Performance Indicators/Assurance
DesignAuthorityEnablers
7. Reform of Human Resources
A vision & strategy for people in the health service
Engagement
Knowledge
Data
Accessibility
Work
Optimization
Leadership,
Managements
and Talent
Management
Learning and
Development
8. Reform of Human Resources
A vision & strategy for people in the health service
Engagement
Knowledge
Data
Accessibility
Work
Optimization
Leadership,
Managements
and Talent
Management
Learning and
Development
11. Call for Nominations
Council of Clinical Information Officers - Office of the Chief Information Officer
A Council of Clinical Information Officers has been established to provide clinical governance to the delivery of eHealth solutions and in particular the
Electronic Health Record (EHR) Programme. Its role is primarily as an advisory group, supporting the primary governance and oversight provided by the
Office of the CIO and the eHealth Ireland committee.
It is composed of a wide clinical leadership, and those with hands-on successful programme delivery experience in the Irish healthcare system. There are
deep and diverse experiences and perspectives represented on the Council which will support the development of national level programmes such as
Electronic Health Record (EHR) Programme and the eReferral programme.
Current Membership is as follows:
Member Title
Grainne Wyer ICT Clinical Analyst, Sligo
Joyce Healy Senior Physiotherapist.
Mary Fitzsimons Principal Physicist, Beaumont
Prof. Richard Greene Professor Clinical Obstetrics, UCC; Director of the National Perinatal Epidemiology Centre, Newborn & Maternal
Dr. Linda Nugent Research fellow, RCSI Faculty of Nursing and Midwifery/NMPD.
Michelle Kearns Director of IT
Dr. Brian O'Mahony National ICT Project Manager, GPIT Group.
Dr. Conor O'Shea Practising GP; National Co-ordinator, GPIT group, ICGP.
Dr. Rob Landers Clinical Director
Dr. Brian Marsh Clinical Director
Emma Benton Therapy Professions Advisor
Broadcast
12. Population
and patient
National Centre
Population Needs Assessment
Integrated Strategy & Planning
Accountability Frameworks &
Performance
System-level Metrics
Service Delivery
Organisations
Community Healthcare
Organisations โ
Hospital Groups โ
Ambulance โ National
Screening โ PCRS
The Centre
13. Population
and patient
National Centre
Population Needs Assessment
Integrated Strategy & Planning
Accountability Frameworks &
Performance
System-level Metrics
Service Delivery
Organisations
Community Healthcare
Organisations โ
Hospital Groups โ
Ambulance โ National
Screening โ PCRS
The Centre
16. It is a cart if it travels well,
else it is but timber
Hindu Proverb
17. โYouโve got to think about big things while youโre doing
small things, so that all the small things go in the right
directionโ
Alvin Toffler
Editor's Notes
Good morning, everyone.
Iโm speaking this morning about clinical leadership in the context of system reform, each of which is deserving of many hours discussion, so in 15 minutes, I will have to be brief
Leadership is such an overused term, that I think at the outset it is useful to remind ourselves of a fundamental truth about leadership. As this quote from John Kotter neatly puts it โ Frankly, I think every single person working in the health service has this leadership responsibility โ in small ways or big. And I think there are countless examples of wonderful leadership for change all over the system.
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But leadership and change in the context of a healthcare system is somewhat different.
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Healthcare 50 years ago was a relatively simple matter. People died much earlier than today. Because we didnโt live as long, we died before there was an opportunity for complex multi-morbidities. If you were diagnosed with cancer, it was the equivalent of a death sentence. Therapies and diagnostics were very limited and basic. GPs delivered babies. Families took care of older people in their own home.
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Managing the health system in this context was a relatively straightforward task. In a much simpler system, the local GP, the Matron and the Consultant Physician or Surgeon were responsible for and managed the delivery of care to their communities. These were the clinical leaders of 50 years ago.
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However, since then, and largely driven by quite astonishing medical advances, health systems have become infinitely more complex than existed 50 years ago and as a result more difficult to lead and manage.
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The public, political, regulatory and societal environments within which health systems operate have changed hugely and have greatly added to the challenge of managing healthcare systems.
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But still, despite this increased complexity, we instinctively understand that those responsible for care delivery must also be responsible for leading and managing the system that supports that care delivery.
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And they absolutely must be centrally involved in changing that system.
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And what of that system? Does it need to change? Health systems across the world are facing extraordinary challenges:
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Society is changing as we speak. People are educated and informed. They demand a level of responsiveness and service. They expect good outcomes, and are intolerant of poor standards and especially poor communication. Social media is changing the way society itself thinks and behaves. This is the society we operate in, and whether we like it or not it exerts an unstoppable force on what it is we do.
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Many incidents of harm to patients has led to loss of trust; and often increased regulation (Staffordshire, Morecambe Bay, Savita, Portlaoise etc). Loss of trust is corrosive. What should be possible becomes impossible; little problems become major obstacles; communication breaks down. Trust is essential part of any human construct, and none more so that in the health service. Its loss is extraordinarily debilitating and damaging. And of course can only be recovered with inspiring leadership.
Ironically, as our ability to understand, treat and cure disease has grown exponentially over the last 100 years, our ability to manage the resulting complexities has relatively stagnated.
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The desire to apply relatively unsophisticated bureaucratic and regulatory controls, which is the instinct of a political system when things appear out of control, jars with the complex adaptive system that is healthcare.
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The increased complexity of the system has not been matched by an increased understanding in how to manage that complexity;
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Bob Kaplan, Professor Emeritus in Harvard, speaking at a HSE Leadership Masterclass last year, in the context of the need to move to โvalue-based healthcareโ said that in terms of management systems, processes and capabilities, healthcare systems were where other industries were in the 1920s.
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Health systems are finding that there is never going to be sufficient resource to meet demand and increasing capability. So the very economic basis for healthcare is in a state of flux.
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Don Berwick, the founder of the Institute of Healthcare Improvement in the US, speaking at a conference in RCPI here in Dublin three years ago, spoke about health systems reaching the point where they will bankrupt nations. Put crudely, we need to keep people healthy in mind and body, prevent illness from progressing, and use our most expensive resource only when necessary.
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In this context, the best use of available resource, becomes not just an issue for managers and finance directors, but is, he said โan ethical issue for cliniciansโ.
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All healthcare is delivered by people, yet within healthcare we allow a culture where people who work in the service routinely feel devalued and disrespected. Many people feel that they are being placed in an impossible situation; being asked to achieve contradictory objectives simultaneously; managers working 20-hour days routinely; and far from being held to account, being blamed? Through our own misguided actions or indeed lack of actions, we have persuaded a generation of doctors and nurses that the Irish health system is not a good place to work.
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In Ireland, we have had our own peculiarities. The HSE has developed as a centralised, command & control, siloed organisation. This has disempowered those closest to the patient; and prevented the national centre from dealing with critical system-level issues. Governance and Accountability has been confused and inappropriately applied.
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So I donโt think we are talking just about change here. What is required is fundamental reform of how we structure, govern, manage and deliver the health service; and a parallel cultural transformation in how we behave within it. So that the Irish health system becomes a great place to work. And a system that delivers the right care in the right place to those who need it.
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Here in Ireland we are embarked on reform of the health servce. We know there are no easy or quick answers. To claim that we can โfixโ the system is naรฏve. Akin to saying we can โfixโ the human species.
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But, over time, we can make it better. Much better. Our greatest asset is that there are thousands of incredibly dedicated people right across the health service who are fundamentally committed to the care of the patient. And thatโs a great place to start!
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And, although in early stages, we do have clinical leadership emerging in very powerful and effective ways at all levels of the health system.
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The most critical parts of our reform programme are:
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SEE SLIDE
Speaking Notes
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1 Community Health Care Organisations and Hospital Groups These are in very early stages of development and a detailed implementation planning exercise is currently underway. Clinical Directors.
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2 It seems like quite a basic requirement, but we have also got to be able to define the service we want to provide. So if you are an elderly person with a range of health needs, what model of care should you expect from the health service? We donโt expect to call Ryanair to book a flight and then have to figure out who is going to fly the plane, who is going to load the baggage, will our bags be on the same flight and to the same destination as we are going to. No, we expect all that to be worked out by Ryanair. So, too patients expect that basic requirement from us.
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So, building on the clinical programmes, we are looking to develop models of care that are patient-centred, clinically-led, multi-disciplinary, and are integrated across the system from a patient perspective. You heard from Aine Carroll earlier on this development.
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3 We are also embarked on reform in all key enabling services โ critically in Human resources, Finance and ICT. These three, in particular, have an enormous enabling influence on the delivery system, and the reforms they are embarking on are fundamentally grounded in helping and enabling service delivery.
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And so, for example, with the appointment of the first CIO for the health service, Richard Corbridge, we now have an opportunity to take a planned and strategic approach to technology. One of the first priorities being pursued by Richard is the establishment of the Individual Heath Identifier - decades in the making, the first register will be available this Summer. For the first time we will be able to begin implementing systems that can track and support patients across care settings. Richard is establishing a Council of Clinical Information Officers to support his work.
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Similarly, work underway by Maureen Cronin on Activity Based Funding, although early days, offers the chance to begin matching what is funded to what we want to happen. As you can imagine, this will be challenging.
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HR is leading the development of a new vision and strategy for the people who work in the health service โ our most precious resource.
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4 Finally we know that for these reforms to take root, the centre of the health service must delegate authority and responsibility for operational matters, and instead begin to more effectively plan the health service on the basis of the needs of the population, and hold service delivery organisaitons to account for their outcomes.
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The challenges we face, the reforms we need in order to face those challenges โ none can be achieved without clinical leadership. Clinicans stepping up to take responsibility at service level, within their practice, ward or department; within the hospital, and also at national in strategy and policy.
Clinicians are now leading the way at all these levels. Clinicians like Donal OโShea and Frank Murray who are influencing public debate on issues of obesity and alcohol; Frank Keane and Garry Courtney, Peter Kelly and Joe Harbison who have led real change in clinical services; Eilis Croke who has been instrumental in the early warning score; Richard Green, Michael Keane, Rhona OโMahony, Pat Nash, Colm Henry who have shown the way for clinicians in management; Barry White and Aine Carroll in national strategy. The list goes on. We need more and we need to support them as they literally break new ground for clinicians.
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The easier pathway is to leave this to someone else. But in my view, this is a challenge for each of us on an individual basis. Clinician or manager โ can we listen to each other, reflect on our own positions, challenge our own beliefs and thinking; have the courage to ask our colleagues to move in a different way. Leaving it for someone else is not an option.
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Yes, this is an infinitely more complex environment than faced by clinical leaders 50 years ago. That shouldnโt dissuade us.
I like this. A Hindu proverb.
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It is a cart if it travels well. Else it is but timber.
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It reminds us that no matter how good each individual part is, itโs pretty much useless if it doesnโt do what it is intended to do as a whole. Even if every single part is as good as it can be, itโs useless if they donโt collectively do what they are intended to do.
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And itโs a reminder that as we all focus on our little piece of the whole, our effort is wasted, if we lose sight of why we are there in the first place. Whether that is to make a cart that travels well โ or a health system that cares well and safely for its patients.
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Finally. I do have confidence that we can make a real and lasting positive difference to the health service in Ireland. Clinical Leaders are emerging as never before. We must not be discouraged by the scale of what lies before us, but be energised by the wonderful opportunity that presents itself to us.
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As long as we keep an eye to the big picture โ why we are here, and where are we going, then every step we take will be in that direction.
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In the words of Alvin Toffler, youโve got to think about big things while youre doing small things, so that all the small things go in the right direction.
