A talk by Carl Savage at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine. All available content from SSAI2017: https://scanfoam.org/ssai2017/ Delivered in collaboration between scanFOAM, SSAI & SFAI.

1. Evidence-based leadership –
Teaming, what does that mean?
Swedish Society for OR management
Malmö, 2017 09 07
Carl Savage, PhD
Clinical Management research group
Medical Management Centre
Department of Learning, Informatics, Management & Ethics

2. carl.savage@ki.se
”The medical profession has to too large
an extent focused more on studying
complicated biological processes than on
patient flows on a surgical ward.”
”Health care’s dilemma is not a lack of
resources but rather bad management.”
2017 09 07

3. THERE’S GOT TO BE A BETTER WAY…
carl.savage@ki.se 2017 09 07

4. THERE’S GOT TO BE A BETTER WAY…

5. What makes a team better?
carl.savage@ki.se
 23 NBA teams 1980-1994
 Greater roster stability
i.e. fewer trades and low player turnover
(Berman et al., 2002)
2017 09 07

6. Four types of situations
carl.savage@ki.se
Experience
Rule-based
Training
Urgency
High
Low
HighLow Time
Defer
Train others
TEAMING
2017 09 07

7. carl.savage@ki.se
Content
Process
Context
• Change managers
• Models of change
• Formulation/implementation
• Pattern through time
• Assessment and choice of products
and markets
• Objectives and assumptions
• Targets and evaluation
Internal
• Resources
• Capabilities
• Culture
• Politics
External
• Economic/Business
• Political
• Social
Essential Ingredients of Change
(Pettigrew & Whipp, 1993)
”WHAT”
”HOW”
”WHERE”
2017 09 07

8. mairi.savage@ki.se
RESEARCH
Action research
Mixed methods
Case studies
EDUCATION
Undergraduate
Graduate
Executive
Clinical Management Research Group:
Developing Innovative Management Practices
Multidisciplinary group: 6 MD, 4 MPH, 1 Economist, 2 Assistant professors, 1 Professor
VBHC
Lean
TDABC
Reimbursement
Medical leadership
Triple Aim
Business Model
Innovation
2017 09 07

9. ”What the best may have, above all,
is a capacity to learn and change –
and to do so faster than everyone else.”
– Atul Gawande

10. HOW DO WE DEVELOP THE
CAPACITY TO LEARN AND
CHANGE QUICKLY?
The question we should ask ourselves:
carl.savage@ki.se 2017 09 07

11. WHAT IS LEARNING?
[Experience + Reflection = Learning]
carl.savage@ki.se
(Dewey)
2017 09 07

12. Patient flows:
Three performance patterns emerged over five years
Percentage of patients ready to leave the ED within 4 hours
Large,
sustained,
achieved
targets
(ENT & Gyn)
Moderate-
large,
sustained
(Medicine &
Peds)
Initial
improvement
Not sustained
(Surgery & Peds)
Mazzocato et al. (2014) Complexity complicates lean: lessons from seven emergency services. J Health Organ Manag

13. Teaming
“Teaming is teamwork on the fly – coordinating and
collaborating, across boundaries, without the luxury of
stable team structures. Teaming is especially needed when
work is complex and unpredictable.”
carl.savage@ki.se
(Edmondson, 2012)
2017 09 07

14. Contextual complexity complicates lean
Low Complexity High
Fewer admissions
Fewer examinations
Fewer patients
Open during business hours
Physician in the room
More admissions
More examinations
More patients
Open 24/7
Physicians and patients
move between rooms
Mazzocato et al. (2014) Complexity complicates lean: lessons from seven emergency services. J Health Organ Manag
pamela.mazzocato@ki.se & carl.savage@ki.se 2017 09 07

15. (Glouberman & Zimmerman, 2002)
2017 09 07carl.savage@ki.se

16. carl.savage@ki.se
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations:
systematic review and recommendations. [Research Support, Non-U.S. Gov't Review]. Milbank Q, 82(4), 581-629.
2017 09 07

17. Types of health care
pamela.mazzocato@ki.se & carl.savage@ki.se
(Christensen et al., 2009)
Learning-for-actionLearning-from-actionLearning-in-action
2017 09 07

18. We need to organize for learning
to handle complicated and complex challenges
Execution as production
 Stable environment
 Lean health care –
standardize, lower
variation
 Focused factories
Gall bladders, ASA 1&2
Execution as learning
 Complex environments
 Variations create
opportunities for learning
 University hospitals (of
the future)
carl.savage@ki.se
(Edmondson, 2012)
2017 09 07

19. carl.savage@ki.se
Speaking up Experimentation Collaboration Reflection
Reaching Across Boundaries
Learning from Failure
Creating Psychological Safety
Framing for Learning
Diagnose
Design
Act
Reflect
Teaming
Organizing to Learn
Execution-
as-Learning
(Edmondson, 2012)
Teaming for learning
2017 09 07

20. Reality check
 How does the experience and reflection necessary
for learning match with the key goals of health care?
 Right now, we are organized and organizing for
production. This includes
Timeliness
Volume
carl.savage@ki.se 2017 09 07

21. A shift in focus from volume to outcomes
Jesper Olson, Jonas Lundberg, Johan Ejerhed, Carl Savage
Value =
Health outcomes
Costs
Value =
Volume x (Price − Cost)
2017 09 07

22. pamela.mazzocato@ki.se & carl.savage@ki.se
IMPROVED POPULATION HEALTH
The Triple Aim
(Berwick, 2008)
2017 09 07

23. pamela.mazzocato@ki.se & carl.savage@ki.se
IMPROVED POPULATION HEALTH
Patients
Politicians
Managers
Nurses &
midwives
The Triple Aim
Storkholm MH, Mazzocato P, Savage M, Savage C. Money’s (not) on my mind: a qualitative study of
how staff and managers understand health care’s triple Aim. BMC Health Serv Res. 2017;17(1):98.
Physicians
2017 09 07

24. (Dweck, 2007)
Qualities of effective physician leaders
enable a learning orientation
 Clarity of purpose
 Positive outlook
 Endurance
 Authenticity
mairi.savage@ki.se
(Savage, M. et al, 2017, manuscript)
2017 09 07

25. 1. Ground management in medicine
 Understand medical consequences of management decisions
through integrating knowledge in:
 Medicine
 Economics
 Quality improvement
 Organizational development
 Maintain integrity of purpose
 Identify and resonate with the mental models of different
professional groups through an engaging leadership practice
mairi.savage@ki.se
(Savage, M. et al., 2017, manuscript)
2017 09 07

26. 2. Work with others by teaming, not team work
 Ability to quickly build resonant
relationships with a wide range and mix
of colleagues
 Execution-as-learning:
 Reaching Across Boundaries
 Learning from Failure
 Creating Psychological Safety
 Framing for Learning
mairi.savage@ki.se 2017 09 07

27. 3. Catalyse systems by acting on
interdependencies
 Facilitate and act on contextual
understanding:
 interdependencies between actors
and interests (not simply present
”the health system”)
 Lead-by-example not as a
strategy to convince others but to
learn
mairi.savage@ki.se
(Savage, M. et al, 2017, manuscript)
2017 09 07

28. Learning loops
Input Process Output
OutcomeSingle-loop learning
(Argyris & Schön, 1978)
pamela.mazzocato@ki.se & carl.savage@ki.se 2017 09 07

29. Money’s (not) on my mind
Dominant among
What drives change
in health care?
Economics of
health care
pamela.mazzocato@ki.se & carl.savage@ki.se
Storkholm MH, Mazzocato P, Savage M, Savage C. Money’s (not) on my mind: a qualitative study of
how staff and managers understand health care’s triple Aim. BMC Health Serv Res. 2017;17(1):98.
2017 09 07

30. 4. Adopt a scientific approach to understand
problems and develop solutions
Evidence based
medicine
Evidence generating
medical practice
mairi.savage@ki.se
(Savage, M. et al, 2017, manuscript)
2017 09 07

31. ”Live life as a leadership laboratory”
carl.savage@ki.se
(Heifetz, Grashow & Linsky 2009)
2017 09 07