The Strategic Imperative for Innovation

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  • Schultz, Starbucks chair wants to retain health benefits but is increasingly unable to. Starbucks employees 80K workers and provides benefits to those working over 20 hours a week.
  • How we see determines what we see.
    Self fulfilling prophecy story.
    Discuss dominant paradigms
  • What are your paradigms
  • Tell Rose story and then dissect the elements of change: IT to move knowledge, new professional roles, new location of service, new role for patient, new role for family/community, “a” change not “the” change, leadership. Barriers to the change: finance, lack of seeing the whole
  • Life expectancy 46 male,48 female, 1919 mecurcorome discovered by Johns Hopkins, crowded, 140 die at shirt waste fire, environmental hazards, no immunizations,
  • Embrace the change do not defend the paradigm
    Keep the values; give up the structures
    Develop a long-term perspective and vision
    Develop new partners and alliances
    Use every tool- IT, Practice Models, Consumer demand to make the change
    Develop your skills
    Lead
    Embrace the change do not defend the paradigm - Keep the values; give up the structures
    Pursue a long-term perspective and vision
    Develop new partners and alliances – professional, insitutonsal customers, states, business
    Use every tool- IT, Practice Models, Consumer demand to make the change
    Develop your skills
    Lead
  • Embrace the change do not defend the paradigm
    Keep the values; give up the structures
    Develop a long-term perspective and vision
    Develop new partners and alliances
    Use every tool- IT, Practice Models, Consumer demand to make the change
    Develop your skills
    Lead
    Embrace the change do not defend the paradigm - Keep the values; give up the structures
    Pursue a long-term perspective and vision
    Develop new partners and alliances – professional, insitutonsal customers, states, business
    Use every tool- IT, Practice Models, Consumer demand to make the change
    Develop your skills
    Lead
  • How we see determines what we see.
    Self fulfilling prophecy story.
    Discuss dominant paradigms
  • The Strategic Imperative for Innovation

    1. 1. Health Care Reform: Five Miles Gone…A Long Way Home Edward O’Neil, PhD, MPA, FAAN O’Neil & Associates
    2. 2. How we wish we could lead change…
    3. 3. 3
    4. 4. How it really is…
    5. 5. Change 5
    6. 6. L = Vision + Task + Relationship 6
    7. 7. Level Set: Three Drivers Why can’t we change? •US spends 1/ more 3 7
    8. 8. Big Challenge
    9. 9. Transition Tomorrow • Chronic prevention and management • Pay for value • Pay for transactions • Price competitive • Cost unaware • Consumer responsive • Professional prerogative • Ambulatory – Home and Community Today PPACA HCERA • Acute treatment • In-patient Strategic Success • Team • Individual profession • • • Traditional practice • Information as record • Patient passivity Market Evidence based practice Information as tool • Consumer engagement and accountability
    10. 10. US Health Care: Four Options •Drive it less- ration •Shift the costs •Pay less for it- controls • Expensive • Overbuilt • Underperforming •Build a new chassis
    11. 11. Human Cussedness
    12. 12. Paradigms 80 70 60 Productivity • Effective tools • Make things work • Provide coherence • Eventually, limit what we think we can do • Eventually stops working 50 40 30 20 10 0 Inputs
    13. 13. The Paradigm and Benefits of the SQ Health Professional work has provided: •Worthy, fulfilling work •Social meaning •High social status •Prestige •Independence •Good Incomes And, at its very heart, Meaning, Self-definition and Identity
    14. 14. Add These Numbers
    15. 15. Add These Numbers 1000
    16. 16. Add These Numbers 1000 40
    17. 17. Add These Numbers 1000 40 1000
    18. 18. Add These Numbers 1000 40 1000 30
    19. 19. Add These Numbers 1000 40 1000 30 1000
    20. 20. Add These Numbers 1000 40 1000 30 1000 20
    21. 21. Add These Numbers 1000 40 1000 30 1000 20 1000
    22. 22. Add These Numbers 1000 40 1000 30 1000 20 1000 10
    23. 23. Add These Numbers 1000 40 1000 30 1000 20 1000 10 = 4100
    24. 24. What is a New Practice Model? What Changed? •Professional role •Management of information •Sequencing of care •Engagement of consumer •Engagement of community •Practice model •Business model New Value Proposition Created
    25. 25. New Practice Models Need Seven Things • Systems Integration (> 7) • Focus on patient/consumer (>6) • Radical efficiencies in resource use (>4) • Team based care (>6) • Collaborative practice (>3) • Community- Public engagement (>4) • Integration of behavioral and physical (>5)
    26. 26. Why Are We Blind? • Systems • Consumer • Efficient • Teams • Collaboration • Public Health • Behavioral
    27. 27. Abraham’s World and Its Problems
    28. 28. To Improve … • Modern science • Practice and research • Autonomy • State regulation • Control by the profession • Standard regulation
    29. 29. A Century Passes… • Knowledge becomes siloed • Consumer are isolated, ignored and powerless • Professions become wholly autonomous • System and incumbents become disengaged from general health and well being • General wisdom gives way to specialized information
    30. 30. What would Abe see today? • Shocking cost of care • Knowledge that moves • Consumer unrest • Babel of our enterprise • Unskilled professionals • Fatal disconnect professionals and the public
    31. 31. Nursing and the Transition Problem • Expensive Solution • Unionized •Right skills • Passive mentality •Future oriented • Lack critical thinking • Looming shortage or •Patient focused •Problem solver •Institution based
    32. 32. Nursing leverages reform • Quality Improved • Costs lowered • Consumers satisfied
    33. 33. To See the Glass Half Full, ALL Nurses Must See Themselves as Leaders. 33
    34. 34. Six Ways to Build Leadership 34
    35. 35. Build from Core Competencies – care management – population - systems context – teams – psycho-social-behavioral – service orientation – use of resources – adaptive and innovative 35
    36. 36. Work Across the Continuum of Care and Lead Where You Stand Community Transitional Healthy Aging Care Wellness Clinics School Clinics Beginning of Life Community Chronic Care Palliative Care
    37. 37. Focus on the Future Stop Eating the Young
    38. 38. Perform In the hospital: • every nurse an agent of quality • incentivize innovation, creativity and change • make them smile, when they make them smile • share the gains
    39. 39. Be Different
    40. 40. Follow These Leadership ABCs • Bring coherence • Lead up • Assert your leadership through change • Build leadership skills everywhere • Expect leadership from every nurse
    41. 41. The Myth of Sisyphus We tend to think of Sisyphus as a tragic hero, condemned by the gods to shoulder his rock sweatily up the mountain, and again up the mountain. The truth is that Sisyphus is in love with the rock. He cherishes every roughness and every ounce of it. He talks to it, sings to it. It has become the mysterious Other. He even dreams of it as he sleepwalks upward. Life is unimaginable without it, looming always above him like a huge gray moon.
    42. 42. The Myth of Sisyphus He doesn’t realize that at any moment is permitted to step aside, let the rock hurtle to the bottom, and go home. Tragedy is the inertial force of the mind. Stephen Mitchell, Parables and Portraits

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