Welcome to the Blackboard Collaborate Classroom
Space Webinar Tutorial 1-1:30pm EST
Oct 12, 2012
Agenda:
• Testing Sound
• Testing Video
• Raising your hand
• Posting a message in the chat box
• Troubleshooting in a breakout room with our
“experts”
• You must have headphones or mute your mic
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RETHINK HEALTH:
TRANSFORMING QUALITY IMPROVEMENT
WEBINAR SERIES
Introduction, Course Overview, Building for
Collaboration and Leadership in Organizing
Ruth Wageman, PhD
Ella Auchincloss, MTS
Oct. 12, 2012
Session Goals
• Conduct a before-action review
– Identify and anticipate key leadership challenges based on your experience
– Harvest lessons from your experience about how to address key challenges,
especially about how to get off to a good start
• Review the coverage of the course
• Connect the modules, syllabus, and overall aims of the course to key
leadership challenges in your work
• Introduce Organizing as a unique and distinct theory of how leaders
can make change happen
• Discuss the work processes and support aspects of this course
• Surface key strategic questions
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Ground Rules for Our On-line Classroom Environment
•
•
•
•
•
Stay focused on the classroom
Be on time
Raise your hand before you speak
Step up to be on deck
Use the chat board for
questions/comments but stay on
topic
• Use headphones to prevent
feedback
• Mute if there is background noise
• Others?
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Introduction to the Key Players and
Teams:
ARK
QIO
HOU,
QIO
Albany
QIO
Coach:
Pedja
Stojicic
RTH Faculty:
Ruth
Wageman
CFMC Team:
Lindsay Kirsch, Kim Irby,
Jane Brock
Baton
Rouge
QIO
BALT
QIO
Coach:
Chris
LawrencePietroni
RTH Project Mgmt:
Ella Auchincloss
Liza Holtzman
Santa
Cruz,
QIO
WVA
QIO
Coach:
Risa Hayes
RTH Faculty:
Kate Hilton
Other ReThink Health
Faculty:
S. Immediato,
M. McGinnis,
B. Milstein
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Leadership is…
• …Accepting responsibility to create the
conditions that enable others to achieve
purpose in the face of uncertainty
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Introductions and Before Action Review
• Who are you? Tell us a story from your own history
that will teach us something about you:
– Why you aspire to lead this change
– What leadership challenges you have faced in your work
that this course and this community of practice can enable
you to face more effectively
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Before Action Review: Your Story
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Before Action Review
Reflecting on the challenge before you and the
obstacles your colleagues have identified…
What one or two key lessons of experience would you
be sure to capture? What works/does not work in
leading this kind of change effort?
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Key Lessons from your experience
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Seeing Ourselves in the System
First image of the
entire Earth - 1968
Each of us is a system citizen
in that we are (potential) change agents
in the systems of which we are a part.
The Volume of Evidence and Recommendations
for Action is Expanding…Very Quickly
…Raising Many
Practical, Strategic, Ethical Questions
“WHAT IF…” Questions
•
•
•
•
•
•
•
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Which policies to prioritize?
Likely consequences?
Synergies or Tradeoffs?
Sequences?
Costs?
Time-frame?
How to catalyze action?
How to chart progress?
ReThink Health’s Beginnings
Don Berwick, CMS, IHI
Elliott Fisher, The Dartmouth Institute
Amory Lovins, Rocky Mountain Institute
Jay Ogilvy, Global Business Network
Celinda Lake, Lake Research
John Sterman, MIT System Dynamics
Group
Marshall Ganz, Leading Change, Harvard
Peter Senge, MIT and the Society for
Organizational Learning
Elinor Ostrom, Nobel Laureate in
Economics, Indiana University
Laura Landy, Rippel Foundation
About ReThink Health
Problem
Identification
Evidence,
Examples,
Ideas
How to spark
and sustain
system-wide
change?
Measures
Stewardship
Organizing
Dynamics
Organizing-Stewardship-Dynamics
Organizing
Stewardship
Dynamics
What does it take to
build the leadership
for widespread
engagement and
shared
commitment to
focused
campaigns?
•
•How is the health
system structured?
What conditions enable local
leadership teams to develop
the will and ability to act on
behalf of the whole, and
sustain their stewardship over
time?
•
Right people, governance
structures?
•
Strong starts or renewed
beginnings?
•
Shared values, intrinsic
motivations?
•
Collaborative muscle?
•How and when does it
change (or resist
change)?
•Where is the greatest
leverage?
•What trade-offs are
involved?
•What if non-experts
could test possible
interventions for
themselves?
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Leadership is…
• …Accepting responsibility to create the conditions
that enable others to achieve purpose in the face
of uncertainty
• Accepting responsibility: stewardship of the
whole
• Create the conditions: understand and act on the
system in ways that enable sustainable change
• Achieve purpose: shared purposes cannot be
assumed, they must be built
• Uncertainty: recognize that success is about
building others’ adaptive capacity (not solutions)
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Course Coverage
• Beginnings
– Harvesting lessons of experience
– Getting ourselves oriented and on a positive trajectory
• Leadership teams
– Convening the right people, working toward a shared
purpose, and getting them started on a healthy trajectory
– We are front-loaded on organizing skills needed to launch
action
• Narrative: Story of self
– Personal leadership practice
– Enabling the identification of truly shared purpose, rooted
in values
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Course Coverage
• Relationships, recruitment, and power
– Understanding others’ interests and resources
– Identifying and building key leadership capacity
• Learning from experience
– Lessons in practice: narrative, relationships, and
teams
• Story, strategy, structure: Story of now
– Building shared aspirations for positive possible
futures for the system
– What happens if we don’t act?
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Course coverage (continued)
• Strategy
– Building and deploying power and capacity
– Timing and goals towards measurable outcomes
• Structuring in learning, coaching, and
measurement
– Approaches to assessing capacity
– Building sustainable support for leadership skills
• System dynamics and campaign structure (Face to
face convening in December)
– Systems thinking and sustainability
– Building organizing structures that expand capacity
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Course Coverage (continued)
• Leverage for sustainability
– Your approach to sustainable system transformation
– Aspirational model and leadership implications
• Power, alliances and incentives
– The enabling conditions for sustainable, collaborative
stewardship of a whole system
• Professionalizing stewardship
– What if every community took the catalyst role
seriously?
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What is leadership?
‘Leadership is taking responsibility for
enabling others to achieve shared
purpose in the face of uncertainty.’
 Decision not a position
 Authority is claimed, not
bestowed
 Focus is on developing
others, not just yourself
Organizing:
People, Power and Change
Change:
Using this power to
address the challenge
the constituency is
called to face
Power:
Building a community
around that
leadership to create
power
People:
Recruiting and
Developing
Leadership
…people acting together to
change the status quo
What is Power?
The ability to achieve purpose
The ability to grow in capacity
Organizing is not to be confused with…
Marketing:
selling a cause or
issue
Charity:
We aren’t
providing a
service to
needy
clients
Technical
Innovation:
We aren’t
inventing a
solution to a
technical
problem
Awareness
Raising:
if people were
informed, they
would change
their behavior
Our Goal: Interdependent Leadership
People don’t burnout or
flake-out
Leaders don’t have
to “hold” everything
Everyone has a clear
role and sense of
purpose
The team performs
better over time
How do we build interdependent leadership?
LEADERSHIP
GOAL
Action
Creating Strategy
C
O
N
S
T
I
T
U
E
N
C
YPublic
Narrative
Resources
Creating Strong
Team Structure
Building
Relationships
The Five Key Leadership Practices
Operation Safe Surgery: South Carolina
The Challenge:
Adoption of the Safe Surgery Checklist
Mike Rose, the QI Chief at McCleod Hospital needed a way to the surgeon
accountable for using the checklist, because the goal is overall patient outcome.
His challenge is distributing leadership and responsibility among the OR teams.
The Campaign Goal:
Organizing hospital teams to achieve zero harm in surgery through
100% use of surgical safety checklist (brief, time out, debrief)
in his hospital.
The Intervention:
Building teams around shared values for patient outcomes and giving the team
the tools to hold itself accountable for using the checklist.
How Dr. Rose Used the Tools of Organizing
Taking Action: training
surgical teams to use
checklist
Developing Shared
Strategy: McCleod
Hospital Pilot
Structuring Leadership
Teams among key
constituents
Building
Relationships
among nurses,
surgeons and
administrators
Surface Team’s
values through
Public Narrative
Outcomes
• 100% of SC Hospitals are using the checklist
• Higher job satisfaction reported by nurses and technicians who went
through training
• 80% of surgeons at McCleod Hospital are using the checklist
• Dr. Rose reports that no other intervention has been more effective
• SCHA featured McCleod’s work in recruiting Atul Gawande to establish the
Operation Safe Surgery campaign—Mike Rose is leading the way
“We've been able to touch the lives many, many patients (and
renewed our own spirit) as a result of learning the methods and
ideas of your team.”
-Dr. Mike Rose, VP Surgical Services, McLeod Regional Medical Center
Webinars and Coaching: Expectations
• Attendance, preparedness and participation in all webinars
and at the QualityNet training
• Meetings with your coaching team on a weekly basis
• Completion of all worksheets, readings and reflections
• Commitment to “trying this on” and practicing the skill
• Commitment to coaching others
• Commitment to having the right technology for your
meetings: headphones, webcam and strong internet access
• RTH-CFMC commits to keeping emails to two or more per
week—please read them
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For next time
• Read “Building Great Leadership Teams for
Complex Problems”
• Watch “Nobody on the Podium” video in
advance
– Prepare these two questions:
• Positive lessons: What do you see in this unusual team
that you’d want to see in any leadership team of which
you are a part?
• Negative lessons: What do you see that you would not
want in any leadership team of which you are a part?
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Debrief and reflections
• What worked and didn’t today?
• Reflection to share with the group about key
challenges, new thoughts
• One word about how you’re feeling now
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