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

Welcome to the Blackboard Collaborate Classroom Space Webinar Tutorial 1-1:30pm EST

Oct 12, 2012

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RETHINK HEALTH: TRANSFORMING QUALITY IMPROVEMENT

WEBINAR SERIES

Introduction, Course Overview, Building for Collaboration and Leadership in Organizing

Ruth Wageman, PhDElla Auchincloss, MTS

Oct. 12, 2012

• 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

Session Goals

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• 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?

Ground Rules for Our On-line Classroom Environment

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Introduction to the Key Players and Teams:Baton Rouge

QIO

ARK QIO

WVA QIO

RTH Faculty: Ruth

Wageman

RTH Project Mgmt: Ella Auchincloss

Liza Holtzman

RTH Faculty: Kate Hilton

AlbanyQIO

HOU, QIO

Santa Cruz, QIO

BALT QIO

Coach:Risa Hayes

Coach: Chris

Lawrence-Pietroni

Coach: Pedja

Stojicic

Other ReThink Health Faculty:

S. Immediato, M. McGinnis,

B. Milstein

CFMC Team: Lindsay Kirsch, Kim Irby,

Jane Brock

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• …Accepting responsibility to create the conditions that enable others to achieve purpose in the face of uncertainty

Leadership is…

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• 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

Introductions and Before Action Review

Before Action Review: Your Story

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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?

Before Action Review

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.

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• Which policies to prioritize?• Likely consequences?• Synergies or Tradeoffs?• Sequences?• Costs?• Time-frame?• How to catalyze action?• How to chart progress?

Don Berwick, CMS, IHIElliott Fisher, The Dartmouth InstituteAmory Lovins, Rocky Mountain InstituteJay Ogilvy, Global Business NetworkCelinda Lake, Lake ResearchJohn Sterman, MIT System Dynamics

GroupMarshall Ganz, Leading Change, HarvardPeter Senge, MIT and the Society for

Organizational LearningElinor Ostrom, Nobel Laureate in

Economics, Indiana UniversityLaura Landy, Rippel Foundation

ReThink Health’s Beginnings

About ReThink Health

Organizing

What does it take to build the leadership for widespread engagement and shared commitment to focused campaigns?

Stewardship

• 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?

Organizing-Stewardship-Dynamics

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Dynamics

•How is the health system structured?•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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• …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)

Leadership is…

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• 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

Course Coverage

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• 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?

Course Coverage

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• 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

Course coverage (continued)

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• 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?

Course Coverage (continued)

‘Leadership is taking responsibility for enabling others to achieve shared

purpose in the face of uncertainty.’

What is leadership?

Decision not a position Authority is claimed,

not bestowed Focus is on developing

others, not just yourself

Organizing: People, Power and Change

…people acting together to change the status quo

What is Power? The ability to achieve purposeThe ability to grow in capacity

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

Organizing is not to be confused with…

Awareness Raising: if people were informed, they would change their behavior

People don’t burnout or flake-out Everyone has a clear

role and sense of purpose

Leaders don’t have to “hold” everything

The team performs better over time

Our Goal: Interdependent Leadership

The Five Key Leadership Practices

Resources

GOALLEADERSHIP

CONSTITUENCY

How do we build interdependent leadership?

Operation Safe Surgery: South Carolina

The Challenge: Adoption of the Safe Surgery ChecklistMike 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

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

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• 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

Webinars and Coaching: Expectations

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• 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?

For next time

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• 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

Debrief and reflections