Partnershipapproachestosolvingbigproblems:StewardshipteamsandhealthtransformationRuthWagemanMay,2016

Leadership teams �  Leadership teams:

�  Composed of leaders each of whom hold individual leadership responsibilities

�  Collectively accountable to lead some larger enterprise

�  Three criteria of effectiveness �  Team meets the leadership needs of all

main constituencies �  Team grows in capability over time �  On balance team experience contributes

to learning and development of members

2 Studies of Leadership Teams

�  Senior leadership teams �  Expert panel assessed effectiveness on criterion 1

�  Team Diagnostic Survey to assess team design, second and third criteria of effectiveness

�  Competency, motives, other individual assessments

�  Health system change leadership teams �  Evaluated on criterion 1-3 using expert nominations �  Team Checklist to assess team design, second and

third criteria of effectiveness

Wageman, R., & Hackman, J. R. (2010). What makes teams of leaders leadable? In N. Nohria & R. Knurana (Eds.), Handbook of leadership theory and practice (pp. 475–506). Boston, MA: Harvard Business School Press. Wageman, R. (2014). Building great leadership teams for complex problems.  Chapter 4 in Eduardo Salas (Ed.), Developing and enhancing high-performance teams in Organizations.  Malden, MA: Wiley.

The necessary transformation in health

�  The current reality: Rising costs of care, declining population health, quality and access unreliable…

4

Moremoneyforshorterlives

5

U.S.projected

U.S.actual

HealthSpendingperCapita

LifeExp

ectanc

yatBirth

Thenecessarytransformationinhealth

•  Fragmentation:Decisionauthority,resources,controlovereachofthesevaluesoutcomesisheldbydifferentindividuals,groups,andinstitutions

•  Stuckness:Makingprogressrequiresinterdependentactionamongdisconnected…andsometimescompetitiveorhostileactors

6

Elinor Ostrom as inspiration

�  Some communities fall prey to the “Tragedy of the Commons” – as families, companies, or groups each harvest as much as they can for their own gain.

�  Some communities do not. Instead, they form local groups of leaders who are users of the resources

7

Ostrom, E. (1990). Governing the commons: The evolution of institutions for collective action. Cambridge, UK: Cambridge University Press.

Ostrom’s findings over 40 years….

�  “Communities of individuals have formed human institutions, resembling neither the state (government) nor the market to govern some resource systems with high degrees of sustainability over long periods of time.”

�  Ostrom identified nearly 5,000 case studies from disciplines including:

�  Human ecology, rural sociology, economics, anthropology, history, political science, forestry, irrigation sociology, and specific geographic studies from Western Europe to Africa

8

�  Stewardship: Well-positioned leaders who take responsibility for the effectiveness of the health system for the long term, and who lead together on behalf of that system, not just their own organizations

9

Stewardship teams

Less than a quarter of senior leadership teams are outstanding teams

Increase in capability over time

24%

43%

33%

Performance

21%

42%

37%

Outstanding

Poor Mediocre

Wageman, R., Nunes, D., Burruss, J., & Hackman, J. (2008). Senior leadership teams: What it takes to make them great. Boston, MA: Harvard Business School Press.

Isstewardshipofthehealthsystemevenpossible?

11

Isstewardshipofthehealthsystemevenpossible?

12

Examplesofstewardshipteams

13

Concernsaboutthe“thousandflowers”

•  Narrowscopeofwork•  Fragmentedefforts•  Smallaspirations

14

TeamDiagnos6cSurvey

15

Suppor6veContext

SolidStructure

TeamCoaching

CompellingDirec6on

RealTeam

RightPeople

TEAMLEADERSHIP

The

ESSENTIALS

TheENABLERS

Wellvalidatedinstrument,assesses:•  Sixcondi6onsfor

teameffec6veness•  Qualityofkeytask

processes•  Outcomes

Wageman,R.,Hackman,J.R.&Lehman,E.V.(2005).TheTeamDiagnos6cSurvey:Developmentofaninstrument.JournalofAppliedBehaviorScience,41,373-398.

StewardshipTeamDiagnos6cChecklist•  “Considerateaminyourcommunityorregionthat

convenesforthepurposeoftransforminghealth”•  Cross-organiza6onal,mul6-sector•  TeammemberusetheChecklistandassesstheirstrengths

andchallenges

16

The purpose of the stewardship team is unclear, unshared, too narrow in scope because

o  They do not feel “authorized” to lead

o  The vision for the system, and the path forward are unclear

o  Teams struggle to define purposes together

RESULTS Wheel-spinning, lost momentum, players walk away

17

Common design flaws of Stewardship Teams 1. Lack of Purpose

The “wrong” leaders are convening

o  Not stewarding the whole

o  Little attention to ability to work collaboratively

o  No legitimacy to make decisions or broaden purposes

o  Little ability to see the whole system

RESULTS:

Discussion without action, mired in conflict, or narrow task focus

18

Common design flaws of Stewardship Teams 2. The Wrong People

The meetings are a waste of time

o  Discussion, not decisions

o  The real issues are un-discussable

o  Competition among key stakeholders

RESULTS

Fractured relationships, disbanded team

19

Common design flaws of Stewardship Teams 3. Missing Structure

Design condition 1: Craft a compelling purpose

20

Acting stewards Get the process started

Collaborative approach to the

whole health system

Create the conditions for others to join

Aspiration to build a model for the

country

o  Share stories o  Build values-based relationships and shared purposes that are - Clear,

Challenging and Consequential

Design Condition 2: Compose stewardship teams intentionally and well

Recruit the “right people” �  Seek stewards

�  Expand cross-sector leadership for legitimacy

�  Look for systems-thinking

�  Recruit those with collaborative skills

21

Design Condition 3 : Create structure

Make sure the leadership team is engaged in real leadership tasks:

o  How can we create opportunities for others to become part of the vision and the work?

o  What real experiments can we lead together?

o  What can we invest in making that possible?

Norms of conduct are explicit…and enforced

o  Candor and transparency with confidentiality

o  Leading for the whole

22

Leadership teams evolve over time

�  Pay attention to beginnings of teams

�  Consider a team “re-launch”

ü  Identify natural breakpoints in the life of the effort

ü  Call a “pause” for reflection

ü  Use as opportunity to recruit new leadership

ü  Use as opportunity to sharpen purposes, raise the game

ü  Conduct a well-designed team launch

ü  Purposes

ü  People

ü  Tasks, norms

23

Developing Leadership Capacities for Collaborative System Change

�  Stewardship teams need to know some things… �  Systems thinking �  Collective strategizing and decision making

�  …and need to know how to do some things �  Convening, launching, leading leadership teams

effectively

�  Building widespread vision collaboratively

�  Promoting innovation and redesign

�  …and need to be some things �  Committed to collective aspirations

�  Empathic to others’ challenges and concerns 24

rethinkhealth.org/stewardship

Copyright©FannieE.RippelFounda6on.Allrightsreserved.

PRODUCED WITH SUPPORT FROM

More at rethinkhealth.org