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Creating tomorrow today: a radical manifesto for leaders of health and care

Slides from the talk "Creating tomorrow today" that Goran Henriks and Helen Bevan gave at #Quality2020 today. The slides set out the principles of "simple rules" for transformation & explains our 7 simple rules for leaders that we've developed over the past 9 years. #Quality2020

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Creating tomorrow today: a radical manifesto for leaders of health and care

  1. 1. Creating tomorrow today: a for leaders of health and care with Helen Bevan Chief Transformation Officer, Horizons Team, England Goran Henriks Chief Executive of Learning, Jonkoping Region, Sweden @HelenBevan @GoranHenriks #Quality2020
  2. 2. Michael Hammer 1993 Creating tomorrow today: the Covid-19 pandemic Methods for delivering health and care that we took for granted as the norm have been swept away in the Covid-19 response as people have responded in extraordinary ways. Yet looking back over the last 30 years, the speed and complexity of change has been increasing all that time. Covid-19 has amplified what was happening already. This is not about a pre or post-covid world; it’s about a world that was already moving fast, got faster as a result of Covid-19 and will continue at speed, The more we mobilise people around the potential for a radically different future, the better we prepare for the future. @HelenBevan @GoranHenriks #Quality2020
  3. 3. The person (patient) in focus The person as a member of the team Speeding up a change in perspective….. Partnership This graphic was used to describe the perspective of care for the very first person diagnosed with Covid-19 in Jönköping on 31st January 2020 @HelenBevan @GoranHenriks #Quality2020
  4. 4. Our manifesto: some simple rules “Simple rules” is a core principle for transforming mindsets that drive behaviours and actions in large complex systems. If we want to get a very large group of people, across an organisation or system, to behave differently, with everyone moving in a coherent direction we can do this in one of two ways: Principles: adapted from General Stanley McChrystal Team of Teams 1. Policies, approvals and top-down cascade Create clear polices and operating systems & hold formal leaders to account 2. Alignment through simple rules Identify a few simple rules that everyone is accountable for, operating in conditions of greater individual freedom @HelenBevan @GoranHenriks #Quality2020
  5. 5. Background: why simple rules? • Rather than compliance to sets of standards and policies, we seek to identify a few simple rules so that everyone understands why and what we are doing • We want a situation where everyone understands the simple rules and delivers them in their own way Our goal with the simple rules is not to exercise control but to establish the high level principles within which we all operate What we are NOT saying: • This is how you should do it or • Do whatever you like What we ARE saying: • these are the ways we want to work– express yourself using those elements
  6. 6. 8 simple rules for designing the future of health care 1. Name the problem 2. Build on successes 3. Take leaps of faith 4. Look outside medicine 5. Set aims and show constancy of purpose 6. Understand systems 7. Make action lists Source: Frank Davidoff : summarising the underlying in principles in the book Escape Fire by Don Berwick, 1992-2002 8. Never, ever, lose sight of the patient as the central figure
  7. 7. Oldham: simple rules for Covid-19 response *Note: the NCA is the Northern Care Alliance, the local NHS system of which Oldham is part *
  8. 8. The simple rules of Timpsons Ltd. Source: Tweet from John Timpson, the CEO of Timpsons Ltd: https://twitter.com/J amesTCobbler/status /1315580698447745 025 • We prefer initiatives to processes and shop visits to meetings • We like working hard and having fun • We don’t have secrets and we don’t do politics • We like lots of ideas and very low overheads • We keep it simple and do it straight away
  9. 9. The people Everyone in the system who has a right to health, healthcare and wellbeing and seeks to be healthy and well (on the terms by which they define “healthy” and “well”) Everyone who has a role, individually and collectively, in the service of supporting people to be healthy and well Leaders of the system The simple rules are for leaders, in the context of partnership People who contribute to the leadership task of providing service and keep people healthy and well, within the formal and informal system Givers of service Our shared purpose @HelenBevan @GoranHenriks #Quality2020
  10. 10. Givers of service Learning from soccer: the “triangle” to minimise risk @HelenBevan @GoranHenriks #Quality2020
  11. 11. Through co-production @HelenBevan @GoranHenriks #Quality2020
  12. 12. @HelenBevan @GoranHenriks #Quality2020
  13. 13. Creating tomorrow today: Seven simple rules for leaders @HelenBevan @GoranHenriks #Quality2020
  14. 14. Jönköping: Our shared purpose 1. Define our shared purpose @HelenBevan @GoranHenriks #Quality2020
  15. 15. Creating tomorrow today: Seven simple rules for leaders 2. Root our transformation efforts in a sense of belonging @HelenBevan @GoranHenriks #Quality2020
  16. 16. 2. Root our transformation efforts in a sense of belonging What is the essence (“the ….ness”) of your place or community that you want to bring out in your transformation approach? Fairness and justice How are you creating a sense of belonging so that everyone is seen and valued for our own unique and authentic selves? Belonging counts more than diversity (the facts) or inclusion (a choice) When we feel we belong, we thrive, and so do the people around us. https://t.co/ccUwUHRMjp?amp=1https://t.co/qIpGqZBL0p?amp=1
  17. 17. Creating tomorrow today: Seven simple rules for leaders 3. Go backwards in the care/health process as a core principle @HelenBevan @GoranHenriks #Quality2020
  18. 18. In Jönköping, the system for “health” starts a long way upstream of primary care 3. Go backwards in the care/health process as a core principle (go upstream) @HelenBevan @GoranHenriks #Quality2020
  19. 19. A mindset for connecting and improving complex care 2020-11-02 @HelenBevan @GoranHenriks #Quality2020
  20. 20. • 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 @HelenBevan @GoranHenriks #Quality2020
  21. 21. Digital coaches from the living library Digital ArthroS school The same digital platform for community care, primary care and specialty care New work processes and micro-team learning Patient compact As expressed in the Jönköping response to Covid-19 Supporting community health centres @HelenBevan @GoranHenriks #Quality2020
  22. 22. Creating tomorrow today: Seven simple rules for leaders
  23. 23. 4. Support people to build their agency (power) at every level of the system Source: Sir Harry Burns, Scotland
  24. 24. Power and flexibility to control their working lives, experience joy in their work, and to continuously learn and improve services Leaders of the system 4. Support people to build their agency (power) at every level of the system Leaders who coach others and humanise work, building collective agency, rather than coercing, dictating or treating people like “resources” or widgets Givers of service Different starting points in terms of power and privilege mean we have to address issues of inequality and injustice. A system that activates health rather than treat deficits or “fixes” people. People grow autonomy and the right to make their own choices about their own health, based on “what matters to me”, and shaped by access to expert and collective knowledge The people @HelenBevan @GoranHenriks #Quality2020
  25. 25. @HelenBevan @GoranHenriks #Quality2020
  26. 26. Creating tomorrow today: Seven simple rules for leaders 5. Embrace contradictions and tensions @HelenBevan @GoranHenriks #Quality2020
  27. 27. The covid-19 response is exposing many polarities (paradoxes/competing tensions) in the system • Commanding leadership vs relational approaches • Upstream care vs intensive care • Self screening vs diagnostic speed • Self-learning vs the development of competence • Population health vs specialist care • Specialist versus generalist • Formal power versus social influence There is rarely a “right”, “wrong” or “best” for all contexts. We have to work comfortably with the contradictions of “both/and” @HelenBevan @GoranHenriks #Quality2020
  28. 28. Creating tomorrow today: Seven simple rules for leaders 6. Unleash learning as a power for transformation @HelenBevan @GoranHenriks #Quality2020
  29. 29. Taking responsibility for our own learning so that personally and collectively, we can support people to achieve their health goals Leaders of the system 6. Unleash learning as a power for transformation Supporting people and givers of service to grow and develop in their own lives towards their potential Givers of service Gaining power by learning about our own health and wellbeing, in the context of our goals in life The people @HelenBevan @GoranHenriks #Quality2020
  30. 30. 6. 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 @HelenBevan @GoranHenriks #Quality2020
  31. 31. Unleashing learning: “Learning through the eyes of the user” the new era of process improvement “The secret to building great services is not creating awesome features but awesome users” Planning, organising people, communication and other components of a service to enhance the customer´s experience of the service @HelenBevan @GoranHenriks #Quality2020
  32. 32. 6. Unleash learning as a power for transformation
  33. 33. Creating tomorrow today: Seven simple rules for leaders 7. Action small-scale changes within a large-scale framework @HelenBevan @GoranHenriks #Quality2020
  34. 34. 7. Action small-scale changes within a large-scale framework
  35. 35. 7. Action small-scale changes within a large-scale framework @HelenBevan @GoranHenriks #Quality2020
  36. 36. Independent Co-dependent Single integrator: IndependentCo - Source: Stephen Covey and Bill Tolbert, From an adaption by Dave Ford. Care Oregon Multiple co-integrators: Vertical integration Horizontal integration Shared purpose, simple rules, collaboration A vertical or network model? Network model Ownership Dependent @HelenBevan @GoranHenriks #Quality2020
  37. 37. @HelenBevan @GoranHenriks #Quality2020
  38. 38. Friendship Love Collaboration ArtRelationship Partnership @HelenBevan @GoranHenriks #Quality2020

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