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Page 1: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

1

Page 2: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Big Hairy Audacious Goals (BHAGs)

• Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of

certain forms of cancer, such as breast, prostate, and colorectal, were 75%, 69%, and 51%, respectively. In 2007, survival rates increased to 90%, 100%, and 67%, respectively.

• And the incidence of polio has gone down dramatically since 1988, when over 350,000 cases were reported. In 2014, that number plummeted to only 359 reported cases, a 99% decrease.

2

Page 3: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

“Over the decades, individual [mental

health] clinicians have made heroic efforts to

save lives… but systems of care have

done very little.”

Page 4: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

MYTH: HEALTHCARE CANNOT MAKE A DENT

Page 5: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

MYTH: HEALTHCARE CANNOT MAKE A DENT

REALITY: 80% OF INDIVIDUALS WHO DIE OF SUICIDE WERE SEEN IN THE HEALTHCARE SYSTEM IN THE PRIOR 12 MONTHS

Page 6: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 7: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

MYTH: WE DON’T SEE THOSE AT GREATEST RISK

Page 8: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 9: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

MYTH: THERE’S JUST NOT MUCH WE CAN DO TO STOP SOMEONE “TRULY INTENT”

Page 10: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 11: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

11

Prominent suicidologists, argued successfully, albeit erroneously, that this is not a healthcare issue. They kept suicide out of the mental health Bible, the DSM, stating, “suicide is, by definition, not a disease, but a death that is caused by a self-inflicted intentional action or behavior.”

Not a Healthcare Issue?

Page 12: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Many/Most Suicides Tragically Inevitable5

1

34

2

Some Suicides Tragically Inevitable

Some Suicides Preventable, But Only in Advance of Acute Risk

Every Suicide Preventable, But Only in Advance of Acute Risk

Suicide is preventable… but… Likert

Every Suicide Preventable, Even Up Until the Last Moment

Page 13: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

BIG IDEA #1REJECT THE MYTHS AND ASPIRE FOR ZERO

Page 14: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 15: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 16: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Suicide is a CHOICE

Page 17: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 18: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

No light; but rather darkness visibleWhere peace and rest can never dwell, hope never comes

That comes to all, but torture without end

Page 19: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 20: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

The Physical Pain Physiological Response

Page 21: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 22: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

People have succumbed when all their strength was fully,

completely gone.

Not a Choice

Page 23: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Someone who died by hanging with their hands bound behind their back and feet tied together was probably a murder, not a suicide.

A.TrueB.False

Page 24: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

BIG IDEA #2START YOUR GOAL FROM THE OTHER END

Page 25: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 26: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 27: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

BIG IDEA #3INCLUDE LIVEDEXP IN YOUR DESIGN PROCESS, LEADERSHIP AND DELIVERY

Page 28: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 29: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

1987

Page 30: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

1990

Page 31: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

1997

Page 32: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2005

Page 33: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2011

Page 34: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2014

Page 35: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2016

Page 36: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2017

Page 37: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2017

Page 38: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

BIG IDEA #4TAKE THE LEAD & JOIN A GLOBAL LEARNING COMMUNITY

Page 39: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

We are Sparta!

Page 40: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

WE CANNOT DO THIS ALONE

Page 41: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

EDUCATIONBuilding the capacity for change through

knowledge exchange and training

EDUCATION

Page 42: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Errors Are Costly

1986

CROSSING THE QUALITY CHASM

Better Care = Patient ExperienceSafe EffectivePatient-Centered TimelyEfficient Equitable

Triple Aim of Healthcare ImprovementBetter Health Better Care Better Value

1986

Don Berwick (USA)

Page 43: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Errors Are Costly

19861986

Don Berwick (USA)

Page 44: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

1996

Going to War with Suicide

David Litts

(USA)“[At the start] there was a lot of debate about whether or not it was even possible to reduce suicide through this type of an effort,” according to David Litts. “A lot of people, including mental health practitioners, were skeptical. But over a six-year period, the suicide rate dropped by one-third.”

US Air Force Initiative

Page 45: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2001

What if care were perfect?

20012001

Ed Coffey (USA)

100

80

60

40

20

02000 2010

Page 46: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2004

What was actually

different?

Henry Ford Clinical ProtocolPackage of Discrete Research-based Interventions Known to Be EffectiveRoutine Screening & Assessment

PsychosocialTreatment

Collaborative Safety Planning

Follow-Up

2004

Justin Coffey (USA)

Page 47: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Zero Suicide Healthcare that believes no one should die alone and in despair. Healthcare that’s safer.

ZeroSuicide.org for global learning community. ZeroSuicide.com for fidelity toolkit/resources.

Page 48: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

A Simple Emergency Room Intervention Can Help Cut Suicide Risk

Page 49: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Standard Crisis Care

2005

John Draper(USA)

Page 50: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

The Clinician

Viewpoint

20092009

David Covington

(USA)Magellan Health Surveys 30,000 in Workforce

Page 51: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Lived Expertise

Voice

2010

Eduardo Vega(USA)

Page 52: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

REDESIGNMoving beyond best practice to innovative

designs based on novel concepts

EDUCATION REDESIGN

Page 53: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2010“Over the decades, individual [mental health] clinicians

have made heroic efforts to save

lives… but systems of care have done

very little.”

Forgotten Patients

Richard McKeon (USA)

Page 54: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Gotta Have a Model

2011

Suicide Care in Systems Framework

Michael Hogan (USA)

2011

Page 55: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2012

Systems Models

2012

Nav Kapur (UK)

Page 56: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2013

Website & Seven

Elements

2013

Julie Goldstein

(USA)

Page 57: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

Implementation Academies

2013

Julie Goldstein

(USA)

Page 58: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

MOVEMENTUnifying the industry around the common

cause of improving health care for all

EDUCATION REDESIGN MOVEMENT

Page 59: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2014

1st

Int’l ZS Summit

Jerry Reed (USA)

Oxford

Page 60: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2015

A Whole Nation

Discussion

2015

Norman Lamb, MP

(UK)Suicide Prevention in Ontario Hospitals

Page 61: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2015

2nd

Int’l ZS Summit

Jo Smith (UK)

Page 62: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

SEA #56

Michael Hogan (USA)

2016

Page 63: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2017

ZERO APPLIED

Sydney

From International Declaration to Local Action

3rd

Int’l ZS Summit

2017

Sue Murray

(Australia)

Page 64: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2018

London

1st

Int’l Crisis Summit

2018

Caroline Dollery

(UK)

Page 65: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2018Rotterdam

4th

Int’l ZS Summit

2018

Jan Mokkenstorm (Netherlands)

Page 66: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

FULL SCALEChanging mainstream practice standards

by ensuring widespread deployment

EDUCATION REDESIGN MOVEMENT FULL SCALE

Page 67: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2013

US News & World Report

2013

Becky Stoll

(USA)

Page 68: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2014

SUPRA-NET Care &

Community

2014

Jan Mokkenstorm (Netherlands)

Page 69: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

4th

Int’l ZS Summit

2017

Jan Mokkenstorm (Netherlands)

October 2017

Page 70: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2015

Social Movement

2015

Joe Rafferty

(UK)

Page 71: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2017

Joe Rafferty

(UK)

Page 72: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2016

Speed to Market

Gold Coast Health

2016

Kathryn Turner

(Australia)

Page 73: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2017

Gaining Momentum

2017

Ian Dawe (Canada) Suicide Prevention in

Ontario Hospitals

Page 74: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2018

MD & MBA

2018

Steve Duffy

(N. Zealand)

Page 75: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

2018

NIMH 5-Year Grant

Brian Ahmedani

(USA)

Page 76: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,
Page 77: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

JENNA HEISETexas, USA

JAN ULRICHKentucky, USA

VIRNA LITTLENew York, USA

FRED MESERVEY New York, USA

PAUL SCHYVEJoint Commission,

USA

DAVID JOBESCatholic University,

USA

KATE COMTOISSeattle, USA

THOMAS JOINERFlorida State

University, USA

CHRIS DAMLEPhoenix, Arizona

GREGOR HENDERSONLondon, UK

HELEN GARNHAMLondon, UK

PAUL YIPHong Kong, China

ADRIAN JAMESExeter, UK

SALLY SPENCER-THOMAS

Denver, USA

KEVIN HINESAtlanta, USA

URSULA WHITESIDESeattle, USA

Page 78: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

CrisisNow.com

Page 79: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

washdc201802

Page 80: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

england202005

Page 81: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

ZeroSuicide.org

zerosuicideinternational

For quality,

NASABerwick went to

Page 82: Big Hairy Audacious Goals · 10/29/2018  · (BHAGs) • Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of certain forms of cancer, such as breast, prostate,

davidwcovington.com


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