discovery - rjl.se · new roles and multigenerational workforces rapid expansion of technology...
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Discovery
September 8, 2016 Jonkoping, Sweden
Maureen Bisognano President Emerita and Senior Fellow
Utvetlingskraft
December 4, 1914
January 19, 1915
October 27, 1915
August 30, 1916 634 days
New Leadership Challenges Aging, and the increasing burden of chronic disease New roles and multigenerational workforces Rapid expansion of technology Research output at unprecedented levels and speed Increasing patient expectations for engagement Challenges to dramatically improve safety and flow Designing a learning system to decrease variation
Shackleton’s Lessons for Us All
New ways to think about people New phases and places for health and care; optimizing innovation Joy and resilience
It’s not about you; it’s about us.
Leading Teams Multigenerational teams Multiprofessional teams Diverse and inclusive teams Include patients and families
Multigenerational Teams
Five distinct generations on our teams Each brings different knowledge, skills, and views
Multigenerational Teams
Traditionalists (71 to 88 years old): loyal
Baby Boomers (56 to 70 years old): optimists
Generation X (36 to 55 years old): questioning
Gen Y, Millennials (21 to 35 years old): realistic
Gen Z, iGen (20 years old and younger): balanced
Changes the Next Generation Expects from Health Care
“Live for the moment” – Don’t see regular check-ups and testing as part of their health and
wellness
“Dr. Who?” – Seek advice and care from many sources; we’ll need new ways to
connect
Holistic health – Use meditation, massage, nutrition, exercise, and medicines
Track me, treat me – Less concerned about privacy and expect us to track and connect to care
Kaiser Permanente
Multiprofessional Teams
Learning together from the start Building skills in teams New ways to teach Using the IHI Open School as a platform for sharing
Diversity and Inclusion for Improved Teamness
Cultural “lunch and learns” Ethnography and curiosity Reflection sessions, and “what matters to you?”
Shackleton’s Lessons for Us All
New ways to think about people New phases and places for health and care; optimizing innovation Joy and resilience
Leading Teams
Hiring for culture, values, and teamwork Building skills for now and the future Mentoring IQ: intelligence quotient
EQ: emotional quotient
CQ: curiosity quotient
Hire for Values
IHI VALUES People Matter Boundarilessness Innovation and Systems Thinking Equity, Diversity, and Inclusion Generosity Transparency Speed and Agility Celebration and Thankfulness
Use Data to Predict and Plan
Pre-hiring
Boomerangs
Alumni recruitment
“Returnships”
Leading Teams
Multigenerational teams Multiprofessional teams Diverse and inclusive teams Including patients and families
What Matters to Your Team Members?
You can’t have joy without teamwork
Mayo’s COMPASS
Reach out
My First Challenges to You
Reach out to learn about the people on your team Ask “what matters to you?” tomorrow to a patient and to a team member
Shackleton’s Lessons for Us All
New ways to think about people New phases and places for health and care; optimizing innovation Joy and resilience
Innovating in Health Care
Dudley, Amos. "Orthoprint, or How I Open-Sourced My Face." Web log post.Squintin', Lookin', and Doin' 10 Mar. 2016.
Amos Dudley “How I Open-Sourced my Face”
Co-designing Care
Learn how to see, listen with your eyes Learn from extremes Video ethnography Immersive empathy, “walk in the shoes” Sharing insights
Gloria Steinem If you want people to listen to you, you have to listen to them If you hope people will change the way they live, you have to know how they live If you want people to see you, you have to sit down with them eye to eye
“It's not what you look at that matters, it's what you see.”
- Henry David Thoreau
#qmicro @Goran Henriks
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
Co-creation and co-production Swedish National Board of Health, 2012,
To give the word and open the space for individuals
• ….meet the real needs
• Personalising the service to improve safety
• Increasing personal responsibility
• Distributing competence so works increases
• Reducing waste and costs
#qmicro @Goran Henriks
2009 2010 2012
Patrik
From patient to employed From patient to patient support
The Microsystem Festival March 1–4 2016 plus.rjl.se/microsystemfestival
Jarle from Norway
Thomas Lystad
History: – 70 year old man with COPD, type 2 diabetes,
and two previous heart attacks – Suffered a major stroke, and spent a month in
the hospital – Left side paralysis, poor cognitive and
physical function Began prescribed reablement program, which was continuously reassessed; made good progress and entered health rehab Came back to reablement after challenges; they helped him find a new, more accessible apartment Now largely independent, and needs a wheelchair only for long distances
Reablement- Oslo Kommune Interprofessional team who are the first to meet with new patients in need of home-based care – occupational therapists – physiotherapists – nurses – social workers
Work towards independence and mastery of everyday life, transitioning patients to either: – discharge without need of further health care, or – home-based care with the best possible function
Thomas Lystad
Khoo Teck Puat Hospital, Singapore
Khoo Teck Puat Hospital, Singapore
Diverse Teams
The rate of innovation increases by three-fold when teams are diverse in age, profession, background, and style
Radical Redesign Principles Change the Balance of Power
– Co-produce health and wellbeing in partnership with patients, families, and communities.
Standardize What Makes Sense – Standardize what is possible to reduce unnecessary variation and
increase the time available for individualized care. Customize to the Individual
– Contextualize care to an individual’s needs, values, and preferences, guided by an understanding of “what matters” to the person in addition to “what’s the matter.”
Radical Redesign Principles Promote Wellbeing
– Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require health care.
Create Joy in Work – Cultivate and mobilize the pride and joy of the health care workforce.
Make it Easy – Continually reduce waste and all non-value-added requirements and
activities for patients, families, and clinicians.
Radical Redesign Principles Move Knowledge, Not People
– Exploit all helpful capacities of modern digital care and continually substitute better alternatives for visits and institutional stays. Meet people where they are, literally.
Collaborate/Cooperate – Recognize that the health care system is embedded in a network that extends
beyond traditional walls. Eliminate siloes and tear down self-protective institutional or professional boundaries that impede flow and responsiveness.
Assume Abundance – Use all the assets that can help to optimize the social, economic, and physical
environment, especially those brought by patients, families, and communities. Return the Money
– Return the money from health care savings to other public and private purposes.
CareMore Health System Focus on both medical and social determinants of health – Dental care integrated within
medical care – Transportation and air conditioners,
“whatever it takes” – Coordinated outreach and
continuous support team – Digital tools for connecting – Caregiver support – Power of asking, “what matters to
you?”
Social Isolation
The health impact of loneliness is the same as smoking 15 cigarettes a day Loneliness is the strongest predictor of increased ED visits, early mortality, depression, and higher health care costs
“There is an ethical dimension to innovation. Failing to integrate innovation that improves health is akin to withholding lifesaving medication.”
- Sachin Jain, MD
Lessons for Innovating Build the best, and most diverse, innovation teams – Build a system for harvesting
Teach innovation and exnovation, spread and undiffusion – Build the right “dosing formula” of improvement skills
Break down the walls – Think upstream, outside, and across
Shackleton’s Lessons for Us All
New ways to think about people New phases and places for health and care; optimizing innovation Joy and resilience
Joy and Resilience
Take care of yourself Teach empathy and caring by your actions Take care of each other
You can’t give what you don’t have.
Joy
Mastery: develop new skills Membership: build a great team, and hone individual assets Meaning: talk often about what we give to our patients and families
She who laughs, lasts
Tack!
Maureen Bisognano President Emerita and Senior Fellow Institute for Healthcare Improvement 20 University Road, 7th Floor Cambridge, MA [email protected]