Leadership Capacity
Building
SCPHCA Annual Meeting
Myrtle Beach
October 2012
Peter Drucker
“Every few hundred years in the history of
Western society a transformation takes place. The
transformation transcends all aspects of society;
the government, the schools, the values, religion,
culture, etc. The transformation is not sudden, but
takes place over a 50 year or more period. The
transformation is so profound that the children
born in that era can not comprehend the time in
which their parents were born and in which their
grandparents lived.”
Key Points
If you are going to lead people, know
where you are taking them
 Understand you are part of the problem;
become part of the solution
 Direct the Rider; Motivate the Elephant
and
 Build leadership capacity throughout your
organization

Let’s Talk about the Issues
Environment Forces
Consumer Directed Healthcare
Malpractice/Risk Management
State Medicaid Crises
Medicare Modernization
40+ Million Underserved
Patient Safety
Changing Patient
Demographics
Pay for Performance
Work Force Dynamics
Competition for Patients
Public Accountability
& Transparency
Vendor Driven Healthcare(WalMart)
Employer Driven Healthcare
Medical Homes
Electronic Health
Information
In order to lead, you need to
know where you are going

What kind of future do you want to create?

Let’s dream together!
Remember When?
Marcus Welby, M.D.
Nana- 82 year old widow

Co-morbidities

12 Medications

5 providers

Lives alone
 PAD
 CHF
 COPD
 Diabetes
 Cancer
 Amputee
Nana
Jan
April
July
In/Out
Back
Dx
Procedure Pain
of
for
On-set Squamous
PAD
Cell Ca
ER
in Lung
Visit
Sept
Relocated
And moved
In with
Family
Chemo
ER visit
Clot
Rehab
ER
Prozac
Surgery Bed sores
Depressed
Gangrene
Fatalistic
Toes
Oct
New
Medical
Team
AUG
November
ER
CT scan
for
Fall
ICU
Family
Convened
Dec
Radiation
Begins
10
Toes
Fall off
Crashes
Christmas Day
WOODARD FAMILY
Recognize you are part of the
problem

Net Negative
-- - -+
- - - -- - +
-----+

Net Forward
++++
_+++
+ +++
Becoming the Solution

Recognize you are part of the problem

Be Positive- Create Net Forward Energy

Model the behaviors you are encouraging

Become a new employee and see through
the eye’s of your patients
PUBS; DOLPHINS AND
ELEPHANTS
Penwerris England Beacon
Project


Hazel Stuteley and Phil Trenoweth were case
workers in a housing project in Penwerris
England
Context:
 50+% unemployment
 Highest percentage of children on welfare
 Among the highest crime rate in England
 50% homes no heat
 Disenfranchised population
 Illness rate 18% > than the nation
Comments from Stakeholders

‘The whole estate was rapidly spiralling out of control and appeared to be
attaining ghetto status. A sea of grey, it was deeply depressing.’ Hazel
Stuteley.

‘When I came here, the community and the school were at a low ebb. There
were many despondent people.’ Richard Carter, Head teacher, Beacon Junior
School.

‘There was an attitude among the police and others that everybody living on
the estate was a criminal. There was no exchange of information. The
community didn’t trust us and we didn’t trust them.’ Bob Mears, Police
Community Liaison and Crime Reduction Officer.

‘Living in some of those houses, you might just as well have been in a tent on
Bodmin Moor.’ June Chappel, Vice Chairman, Beacon Regeneration
Partnership.
How did Hazel Transform a
Community?



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

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Started one on one listening
Created formal “Listening Forums”
Founded tenant associations for selfgovernance
Rational process for getting heating
Built a community center
Lit walking paths
Engaged school system
Public House held computer classes
Penwerris Continued

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



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Developed play areas safe for the children
Instilled neighborhood watch programs
Created a parent toddler group
Introduced traffic calming measures
Established a liaison with schools and police
Painted dreary buildings bright colors
Delivered services in accessible settingsLaunderettes
Housing representative as middle person for
dispute resolution
What did they achieve?
Heated all the homes
 Children on child protection down by 60%
 Child accident rate down by 50%
 Overall crime down by 50%
 Fuel bills cut by 180k pounds
 Boys’ SATS results improved 100%, girls
25%
 Improvements in key health indicators

Leading A Collaboration
•Phillip Scanlan , former VP for Quality for AT&T
led a profound collaboration to improve quality
•A family vacation was spoiled by pollution and
700 dolphins washed up on the shore
•Coordinated Federal Government; 2 State
Governments; 20+ municipalities; vendors and a
myriad of stakeholders
•Decided to use Quality Methods to drive the
collaboration
Dolphins and the Jersey Shore
Phil Scanlon established a core vision
 Enrolled others in the vision
 Developed an all volunteer infrastructure
to tackle the problem and execute the
vision
 Established Metrics to track progress
 Kept an eye on the business case
 Did a “Root Cause Analysis”

What did they find?

High bacterial counts in the sand and
medical waste washing up on the shore

Piers rotting in New York Harbor were
floating down the Hudson and depositing
on the Jersey Shore

Dolphins died of bacterial infections and
metal poisoning
Drilled down further




Piers needed removal and planned replacement
Identified a toxin was related to tribunal tin in
recreational boat paint caused a cravotoxin
absorbed by food sources of Dolphins
Medical waste due to illegal dumping of hospital
waste off shore
Bacterial counts related to broken storm and
waste drains dating back to late 1800’s
What did they do?


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Launched a campaign based on vision
 Shore to Please
 Vanity license plates created by Bureau of Prisonsraised $1M
Infrastructure of Committees to work on each of the
issues
Tracked Metrics regularly Beach Closure Days
Corps of Engineers mapped the broken pipes needing
repair
Boating paint legislation drafted & passed
What happened?
Beach closure days went from 800+ to
less than 50
 Trash haulers prosecuted
 Storm drains repaired
 Boat paint legislation passed
 Economic impact and job impact
staggering
 Dolphins came back

Bright Spots- Vietnamese
Children and Jerry Sternin


Prior to 1990 Viet
Nam had one of the
worst levels of
malnutrition in the
world
How do you motivate
a nation to improve
outcomes?
Bright Spot
1990 Jerry Sternin was asked to open an
office for Save the Children in Viet Nam
 With a $50k budget told to fix malnutrition
for children across Viet Nam
 Started with 1 Village
 Recruited mothers who were “motivated’
 Identified Bright Spots among the
malnourished

Source: Dan Heath ; Switch 2010
The Bright Spots : What was
different?

Norms among
malnourished
 Fed

children twice a
day
 Let children feed
themselves
 Principal staple was
rice
 Sweet-potato greens
associated with a
stigma of being poor
Bright Spots
 Fed
children four times
a day
 Actively fed children
by spoon if needed
 Added shrimp, crabs
and sweet-potato
greens to the meal
Source: Dan Heath ; Switch 2010
Bright Spots- Vietnam

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The start- 4 mothers as Bright Spots
Spread to 50 malnourished families with
mother’s in groups of 10 getting together to cook
meals and feed kids
Six months later 65% of kids nourishment status
improved
Spread to 14 Villages
Reached 265 villages and 2.2 million
Vietnamese people
Source: Dan Heath ; Switch 2010
The Elephant and the Rider
Jonathan Haidt, UVA

The Happiness
Hypothesis
 Analogy
of an
elephant and a rider
 The elephant is the
emotional side
 The rider is our
rational side

Elephants have been
proven to be a
profound resource
over history

Change is like
keeping the elephant
on track- most often
fails
The Elephant

The elephant is lazy
and skittish, seeks
quick pay-offs; instant
gratification
The Rider
His strength is the ability to think long
term, to plan, to think beyond the
moment
The Elephant also has strengths

The elephant also has
profound strengths
 Love,
compassion,
loyalty
 When it comes to
change, the elephant
gets things done
 The elephant has the
energy to get things
done
The Rider also has weaknesses



Tendency to overanalyze and overthink
Paralysis from
analysis
Planning getting in
the way of execution
Getting a Rider and an Elephant
to Make Change
Rider and Elephant
In Balance Working
Together


The rider and the
elephant have to work
together
We have to appeal to
the rational and the
emotional side
Dan and Chip Heath- Switch

Direct the Rider




Motivate the Elephant




Follow Bright Spots
Script the Critical Moves
Point to the Destination
Find the feeling
Shrink the change
Grow your people
Shape the Path



Tweak the environment
Build the habits
Rally the herd
Dan and Chip Heath- Switch



Direct the Rider
 Follow Bright SpotsStarted with 4 Mothers
 Script the Critical move Codified the recipe and meals
 Point to the Destination Showed the healthy kids
Motivate the Elephant
 Find the feeling
Engaged the mother’s about their kids
 Shrink the change
10 women in peer pods cooking
 Grow your people
Empowered the women to spread
Shape the Path
 Tweak the environment Sweet potato greens
 Build the habits
Cooking as group
 Rally the herd
Emory studied the results and showed
the impact
Key Points
If you are going to lead people, know
where you are taking them
 Understand you are part of the problem;
become part of the solution
 Direct the Rider; Motivate the Elephant
and
 Build leadership capacity throughout your
organization
