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Copy of a facilitated workshop at the 2009 Annual Conference for the European Health Management Association in Innsbruck, Austria
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Innovation for Healthcare:
Creating Opportunities to Explore, Expand & Excel!
Kenneth A. Rethmeier, DrPH
European Health Management AssociationAnnual Conference
June 25, 2009
Goals for the Day
• Excellence in uncertain environments… the mandate for critical thinking, creativity & innovation…for performance!
• On-going healthcare reform efforts lead to exploring market choices…exploring organizational performance, competitive advantage…creative & critical thinking… introducing tools to “rethink our thinking!!”
• Implications for leading others to take risks & manage innovations…”success is a journey”…!
• Excellence in uncertain environments begins with the journey…
Context
E3 used by permission from The Rethmeier Group, LLC
Ideas Relationships Processes Systems
explore™
expand
excel
Shaping minds to build business.™
Payoff of innovation…performance!
Top performers generate 75% revenue fromproducts &/or services…did not exist 5 years ago…
poorest performers…10%….if you’re into mediocrity, then try 41%...PriceWaterhouseCoopers
Innovation Survey, undated
Payoff of innovation…results!
performance! = f(trust…idea management…+)idea management is about…
•seek & gather ideas/knowledge
•ideas/knowledge…freely accessible
•encourage diversity of thought
• delayed premature judgment
A brief exercise
“Best in Class”…who?…why?…. Who’s 2 or 3…difference?
How did they survive? Competitive advantage?
What do these results mean for health care reform?
Assumptions for our time…• Healthcare….cuts to core & manifests a country’s social values• Demographics….work against future funding of healthcare systems…
ratio >65/labor force • Healthcare costs….rise exponentially w/out constraints…never
enough funds regardless• Policy makers….set the tone & parameters of the environment for
opportunities of change• > Paternalism in systems constrains creativity & ideation….ergo, less
optimism for reform • Healthcare consumers …smarter & more demanding of their role in
managing their health• Innovation….critical leadership competency… sustained superior
performance• Time is now to explore options & focus on innovative solutions to
create your future & NOT take one from strangers!!
Operating definitions….
• “In-no-va-tion”…15th century– Introduction of something new…idea, method or
device…”novelty”– For our context, as long as it is new to you or your
system…it is an innovation
• Healthcare “re-form”…14th century– To put or change into an improved form or
condition…removal of faults or abuses…changed for the better
– For our context, any change designed to improve the current state is “reform”…(Hint: there are “degrees”)
• “Cre-a-tiv-i-ty” …14th century– To produce through imaginative skill
Areas for exploration…be willing to go where no one has gone before!
• Coverage…• Services in the program…• Cost sharing…• Management of the benefit package…• Processes of care & outcomes…• Structure of the “plan”…• Expenditure control…• Payment structure & guidelines…• Primary care physicians…• Degrees of system integration…• Spectrum of providers…
A Model of reference… Innovation!
….it’s all about creating value!
IDEATIONIMPLEMENTATION
DEVELOPMENT
Creative
Thinking
Testing Evaluation
Convergent Thinking
Tool #1… “Vision vs. Current Reality”
Tool #1…
Tool #1…
THE
V IS ION
Forces Forces supporting against
Tool #1… Practice Fields:
Identify & define the “vision” for healthcare reform
Productive dialogue to promote understanding & aligned thinking
Recognize & discuss/uncover what is the “today”…do we really know?
Brainstorm potential strategies & focal points for innovations…to close the “gap”! Promotes awareness, reflection, understanding attitudes & beliefs
Visions…Organizing, Learning & Environments for Changing
VISION
ORGANIZATION DESIGNTO DELIVER THE VISION
THINKING INTERACTING
Visions Develop... Capacity for Learning
• Perceive reality through open-mindedness, observation & feedback
• Make meaning & create knowledge• Take effective action toward the vision
LEARNING includes the ABILITY to:
Bottom Line? …avoid the trap of “mental models”…not transparent!
Perspectives on re-thinking healthcare reform….time, space, & clinical-policy…..!• Time…defined in terms of the focus of the
model of “clinical” intervention…primary, secondary or tertiary prevention…i.e. the earlier the “time” the greater the impact on “quality & cost”…
• Space…defined in terms of the depth of potential reform…i.e. the deeper the effort bores, the greater the impact on “transformation”…
• Clinical – Policy ….each one affects the other…
Time & Space…..! (Hint: this is all about “our” thinking)• Time…. Prevention Primary Secondary Tertiary
+ risk factors +early detection & + Tx pain & treatment discomfort
• Space…. Events………………………React
Patterns/Trends……….Anticipate
Systemic Structures…….Design
Mental Models………………Transform
Time & Space…..! (Hint: this is all about “our” thinking)
• Time…. Prevention Primary Secondary Tertiary
+ risk factors +early detection & + Tx pain &
treatment discomfort
Time & Space…..! (Hint: this is all about “our” thinking)
• Space…. Events………………………React
Patterns/Trends……….Anticipate
Systemic Structures…….Design
Mental Models………………Transform
The 3rd Dimension…policy vis-à-vis clinical continuum…..! (Hint: this
is all about “our” thinking)
Policy Clinical
Meaning…some “innovations in healthcare reform” are primarilydirected at clinical medicine…(e.g. advances in technology), whileothers are driven by changes in governmentalpolicy (e.g. DRG’s & prospective payments)
What gets in our way of thinking…?
The card exercise…
“Begin Here”!
The basic proposition…today’s thinking based on philosophers of 2,500 years ago... • “Gang of three”…Socrates…Plato…Aristotle…
– the brain is self-organizing– intellect is driven by “relationships” or “patterns” & connecting the dots– “ultimate truth” is somehow found by removing all that is wrong
• Consequently, most thinking is based on:– events & lessons of the past…quickly repeat– knowledge of standard situations & the ways of dealing with them is sufficient…oriented around stable systems– “argument & debate”...primary idioms for current thinking…– need to develop “design” or “constructive” thinking
Hx of Thinking…the origins...
Vertical & Lateral Thinking…key characteristics….
• Vertical…– selective– moves if direction to move– analytical– sequential & follows patterns– correct at each step– uses negative to block off
certain pathways– concentrates & excludes
irrelevant– categories, fixed labels– most likely paths– finite process
• Lateral…– generative…disruptive…– moves to generate
direction– provocative– makes jumps & cuts across – does not need to be correct– no negative– welcomes chance
intrusions– no fixed labels– explores least likely– probabilistic process
As William James, philosopher said once…
“A great many people think they are thinking
when they are merely rearranging their prejudices.”
American Philosopher
1842-1910
CANCONTROL
CANNOTCONTROL
PROACTIVE
INACTIVE
MOVEFORWARD
WASTEDTIME
GIVINGUP
LETGO
Tool #2… “Can –Cannot”
CANCONTROL
CANNOTCONTROL
PROACTIVE
INACTIVE
MOVEFORWARD
WASTEDTIME
GIVINGUP
LETGO
Tool #2… “Can –Cannot”
CANCONTROL
CANNOTCONTROL
PRO
IN
CANCONTROL
CANNOTCONTROL
PROACTIVE
INACTIVE
MOVEFORWARD
WASTEDTIME
GIVINGUP
LETGO
Tool #2… “Can –Cannot”
Practice Fields:
Clarify & confirm Help setting areas for potential “brainstorming”
Furthers your learning agenda
Exposes “blind spots” +/-
Promotes critical thinking
Let’s stop for a minute….!
Stand up…stretch…turn to someoneat different table…
Introduce yourself…
Ask them what their “most critical healthcare reform issue is”…tell them yours…
Tool #3… “Brainstorming”
Brainstorming For Innovations
Tool #3… “Brainstorming”
Brainstorming For Innovations 1.Select one of the “Move Forward”
critical issues you identified…
2.Timed idea generation…three sets… 1 ½ min…1 min…30 seconds
3.Write down as many ideas you can…
4.Collectively review all of the ideas separating out best to one side
5.Be prepared to report to the group what you identified as the top “3”…
6.Why those “3”? Now pick only “1”…
Steps to Follow:
Tool #3… “Brainstorming”
Brainstorming For Innovations
Practice Fields:
Anytime you need creative thinking
Approaches & techniques can vary…
Keys to successful efforts:• do not judge ideas in process• promote extreme thinking• all ideas are good ideas• takes 100 ideas for “1” good one• set clear expectations & goals• leaders…take off your “leader” hat!
Have some fun! (Hint…yes….!)
Tool #4… “Blue Slips”
For Capturing &Organizing Thinking…
Practice Fields:
Capture ideas, collective wisdom & knowledge
Stimulate balanced thinking…
Minimize narrow-mindedness
Debrief meetings
Keys for success…• facilitator provides “keyword”• key word in upper left corner• one idea per blue slip• as many ideas as possible• substitute “post-it” notes to stick on walls….
“Balanced thinking in an unbalanced world”…
Tool #5… “the Ice Berg”
Concepts for Use:
Deeper means more effective outcomes…
Seek to uncover causes…
Ultimate exploration & discovery moves us toward exposing our mental models…in healthcare that will mean our “core social values” of our system…
Let’s see what we find!
Tool #5… “the Ice Berg”
An example:
England & Wales – “World Class Commissioning”… decentralized contracting for primary care services…what does this mean?
React………………Central to Local Contracts
Anticipate………Provider Certification
Design…………….Curative to Preventative
Transform………Performance Based on Health Status
- person-centered= patient - “consumer” driven - MD as facilitator/coordinator - improved health status
Tool #5… “the Ice Berg”
An example:
Germany… “free pricing” of pharmaceuticals to “best care” assessment…what does this mean?
React………………Cost-Benefit Analysis Determines Reimbursement
Anticipate………Rational Model for Management of Future Costs
Design…………….”Take More Self Responsibility”
Transform………”Times of Abundance Are Gone…Prioritization”
- significant implications - “unspeakable”…there’s an elephant in the room…! - how do you prepare & change for success?
Tool #5… “the Ice Berg”
Your turn:
1.Your best idea….
2.Walk through the “ice berg” & see where it takes you…
3.What level of “reform” could you achieve?
4.Take the next step…
Tool #5… “the Ice Berg”
Your turn:
Tool #5… “the Ice Berg”
Practice Fields:
Explore & expand a dialogue re current health care reform efforts to uncover the thinking behind the initiative
Examine & identify opportunities for innovations in response to OR proactively pursuing reform efforts
To test how far you can create systemic change
Challenge your mental models…in this case…the business model
Tool #6… “Space-Time –Policy”
Your ideas for “reform”:
1.Match your ideas by Stage of Prevention & Level of Reform.
2. Where do they “fit” in the table? What implications?
3.Select the one “you” feel has the best opportunity for successful imple- mentation.
4.Take the next step… testing, evaluation & implementation/ diffusion…measuring impact…!
Level of
ReformPrimary Secondary Tertiary
Event
Trends
Design
Transform
Stage of Prevention
Tool #6… “Space-Time –Policy”
Practice Fields:
Scenario planning to test moving down & left…
Uncover current thinking of stakeholders in the process
Illustrate for decision- makers value of a different “business” adding value
Foundation for strategy development…
Level of
ReformPrimary Secondary Tertiary
Event
Trends
Design
Transform
Stage of Prevention
Levels of Prevention
Primary Secondary TertiaryLevel
Of Reform
Events
Trends
Design
Transform
Time – Space Assessment Matrix
A Call for Leading Innovation…
McKinsey survey of 700+ executives…globally reveals their thinking & actions….
70% say innovation one of the top “3” drivers for growth in next 3-5 years
65% report gap between “aspiration for innovation” & “execution” …imitation of others not the answer
No “best practice” to seed/cultivate innovation… 94%
3 key fundamentals: strategy agenda, tap existing talent, & build trust within organization
Culture…ideas valued…safe/encouraged to express those ideas… oversee risk collectively!
So, then how do we embed creativity, critical thinking, & innovation…?
• Introduce & diffuse new knowledge, skills, & create practice fields…
• Explore our creative styles…to leverage new perspectives on “old” problems & new opportunities
• Maximize our capacity as leaders…to guide others toward new levels of performance…an exercise of quiet yet persistent will…!
• Senior management team development…
Creativity: Getting to the “Open” Mode
• Space…undisturbed & quiet area…make it special to encourage lateral thinking…!
• Time…specific period…start…stop• Time…play with the problem… defer the decision to later…• Confidence…avoid fear of making a mistake…morph “org” DNA to “this is how we do things!
• Play…humor…accelerates us to the “open” mode…leadership sets the tone!
“It is impossible to estimate how many good ideas are abandoned each and every day, the results of difficult to manage lateral relationships.”
--- John Kotter Power and Influence: Beyond Formal Authority
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A final question… an equation for success…but, what does it mean???
CQ + PQ > IQ
Hint: Tom Peterson…author of The World is Flat!
The power of one...
“Leadership is…having the courage to act. To do what is right, not to wait and see, not to wait and hope. But the courage to get involved, now.”
Author, unknown.
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