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Chair: Paul Barach, MD, MPH Facilitators: Billie Atanasova & Vanessa Vanderhoek DEFINING MOMENTS: 20 YEAR VISION FOR HEALTH

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Burning platform Australias healthcare system is facing unprecedented challenges as many other Asia-Pacific healthcare systems Entire state budgets in Australia will be consumed by 2035 due to a rapidly ageing population and the rising cost of providing modern health services Scale and gravity of these challenges can be solved by transformational thinking and leadership to design a healthcare and social system that meets the needs of tomorrow We need to create new linkages, new structures, and new ways to work together

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Healthcare 2013 We are an overloaded system We cannot keep up with complex diagnostic and therapeutic technologies We have not changed workflows and roles in the past couple of centuries We have placed most emphasis on sickness control, not on wellness We face the same challenges everywhere, but are tackling them independently We are an overloaded system We cannot keep up with complex diagnostic and therapeutic technologies We have not changed workflows and roles in the past couple of centuries We have placed most emphasis on sickness control, not on wellness We face the same challenges everywhere, but are tackling them independently

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Health Care is Broken-view of patients It isnt safe! People not getting the care they need Secrecy and cover up of bad performers Costs too much and riddled with waste Systems are complex, bureaucratic We are not seen as partners in OUR care Patients and their families are not told the truth

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Health Reform Value As the Australian health care system continues to transform, it is only by listening to those we aim to serve that we can ensure that changes will produce the desired outcomes.

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The ACHSMs strategic goal of thought leadership for transformational change and a vision to create Brilliant Leadership for Healthy Communities ACHSM framework paves a path for how each of the domains and elements influence one another in large- scale transformational change The framework sets out how alignment, collaboration and co- operation between all of the domains are essential to achieve large- scale transformational change of the whole healthcare system

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Reason Complex Systems

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Normalized Deviance By a deviant organizational behavior, we refer to an event, activity or circumstance, occurring in and/or produced by a formal organization, that deviates from both formal design goals and normative standards or expectations, either in the fact of its occurrence or in its consequences. Once a community normalizes a deviant organizational practice, it is no longer viewed as an aberrant act that elicits an exceptional response; instead, it becomes a routine activity that is commonly anticipated and frequently used. Diane Vaughan, 1999: 273.

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The Normalization of Deviance: Do We (Un)Knowingly Accept Doing the Wrong Thing? Failure to wash the hands before and after patient contact No consultant or supervision overnight or on weekends Lack of/standardised Handovers of care at vital times (emergence, induction, separation from cardiopulmonary bypass, etc.) Ignoring key outcome metrics such as HSMR, patient complaints Productivity above all

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How does it start? A permissive ethical climate, an emphasis on financial goals at all costs, and an opportunity to act amorally or immorally, all contribute to managerial decisions to initiate deviance.

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The Role of Managers Normative standards of behavior are not simply imposed on managers by more powerful organizations such as the state or professional organizations. Managers themselves are participants in the construction of the commonly accepted standards of behavior under which they operate.

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Value Compass Thinking What are the outcomes in care that are important for us to measure?FunctionalStatus Satisfaction Against Need Costs

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Stages in the development of a safety culture CALCULATIVE We have systems in place to manage all hazards PROACTIVE Safety leadership and values drive continuous improvement REACTIVE Safety is important, we do a lot every time we have an accident PATHOLOGICAL Who cares as long as we're not caught Increasingly Informed Increasing Trust and Accountability GENERATIVE (High Reliability Orgs) HSE is how we do business round here

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Questions for reflection What does the system really need for large-scale transformational change of the whole healthcare system? What are the key issues for health leadership for health and what should be the focus when transforming the healthcare system? What kind of innovative initiatives should be implemented for large-scale transformational change? What are the elements for creating a culture of change that will lead to continuous improvement in the healthcare system? What is the role of consumers/patients and communities in driving healthcare reform?

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Let the discussions begin... What policies and practices are needed for large-scale transformational change? What is the role of transforming health services culture and behaviours in large scale transformational change? What is the role of prevention of disease and improving health-related quality of life in large scale transformational change? Who must be empowered and engaged to change the health care system?