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Health Care
Reform: Five Miles
Gone…A Long Way
Home
Edward O’Neil, PhD, MPA, FAAN
O’Neil & Associates
How we wish we could lead
change…
3
How it really is…
Change

5
L = Vision + Task + Relationship

6
Level Set: Three Drivers

Why can’t we change?

•US spends 1/ more
3
7
Big Challenge
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
US Health Care: Four Options
•Drive it less- ration
•Shift the costs
•Pay less for it- controls
• Expensive
• Overbuilt
• Underperforming

•Build a new chassis
Human Cussedness
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
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
Add These Numbers
Add These Numbers
1000
Add These Numbers
1000
40
Add These Numbers
1000
40
1000
Add These Numbers
1000
40
1000
30
Add These Numbers
1000
40
1000
30
1000
Add These Numbers
1000
40
1000
30
1000
20
Add These Numbers
1000
40
1000
30
1000
20
1000
Add These Numbers
1000
40
1000
30
1000
20
1000
10
Add These Numbers
1000
40
1000
30
1000
20
1000
10

=

4100
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
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)
Why Are We Blind?
• Systems
• Consumer
• Efficient
• Teams
• Collaboration
• Public Health
• Behavioral
Abraham’s World and Its Problems
To Improve …
• Modern science
• Practice and research
• Autonomy
• State regulation
• Control by the profession
• Standard regulation
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
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
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
Nursing leverages reform

• Quality Improved
• Costs lowered
• Consumers satisfied
To See the Glass Half Full, ALL Nurses
Must See Themselves as Leaders.

33
Six Ways to Build Leadership

34
Build from Core Competencies
– care management
– population - systems
context
– teams
– psycho-social-behavioral
– service orientation
– use of resources
– adaptive and innovative

35
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
Focus on the Future

Stop Eating the Young
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
Be Different
Follow These Leadership ABCs

• Bring coherence
• Lead up
• Assert your leadership through
change
• Build leadership skills everywhere
• Expect leadership from every nurse
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.
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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The Strategic Imperative for Innovation

  • 1. Health Care Reform: Five Miles Gone…A Long Way Home Edward O’Neil, PhD, MPA, FAAN O’Neil & Associates
  • 2. How we wish we could lead change…
  • 3. 3
  • 6. L = Vision + Task + Relationship 6
  • 7. Level Set: Three Drivers Why can’t we change? •US spends 1/ more 3 7
  • 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. US Health Care: Four Options •Drive it less- ration •Shift the costs •Pay less for it- controls • Expensive • Overbuilt • Underperforming •Build a new chassis
  • 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. 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
  • 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. 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. Why Are We Blind? • Systems • Consumer • Efficient • Teams • Collaboration • Public Health • Behavioral
  • 27. Abraham’s World and Its Problems
  • 28. To Improve … • Modern science • Practice and research • Autonomy • State regulation • Control by the profession • Standard regulation
  • 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. 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. 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. Nursing leverages reform • Quality Improved • Costs lowered • Consumers satisfied
  • 33. To See the Glass Half Full, ALL Nurses Must See Themselves as Leaders. 33
  • 34. Six Ways to Build Leadership 34
  • 35. Build from Core Competencies – care management – population - systems context – teams – psycho-social-behavioral – service orientation – use of resources – adaptive and innovative 35
  • 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. Focus on the Future Stop Eating the Young
  • 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
  • 40. Follow These Leadership ABCs • Bring coherence • Lead up • Assert your leadership through change • Build leadership skills everywhere • Expect leadership from every nurse
  • 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. 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

Editor's Notes

  1. 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.
  2. How we see determines what we see. Self fulfilling prophecy story. Discuss dominant paradigms
  3. What are your paradigms
  4. 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
  5. Life expectancy 46 male,48 female, 1919 mecurcorome discovered by Johns Hopkins, crowded, 140 die at shirt waste fire, environmental hazards, no immunizations,
  6. 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
  7. 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
  8. How we see determines what we see. Self fulfilling prophecy story. Discuss dominant paradigms