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Roles for Health-System Governors:
Leading Innovation
National Health Leadership Conference 2012
Matthew Lister
With Thanks…
• John King, SVP, St Michael’s Hospital, Toronto
• Cathy Szabo, CEO, Central CCAC, Toronto
• Cathy Ulrich, CEO, Northern Health BC
• Mary Ackenhusen, COO, Vancouver Coastal Health
• Robert Hamilton, McGill University Health Centre, PQ
• John Bullivant, Director, Institute for Good Governance (UK)
• Mark van Clieaf (MVC Associates)
• Nizar Ladak, COO, Health Quality Ontario
• Alberta Health Quality Council
• Mike O’Keefe, Chair, Eastern Health Newfoundland
• Joanne Dykeman, VP Quality, Revera
• Spencer Gear, CIO, MOSAIC (US)
• Professor Tony Davies, University of the Witwatersrand, South Africa
• Captain Catherine Bonhoff, Executive Officer, US Air Force (US)
• Professor Derrick Crooke, Nuffield Department of Clinical Medicine, Oxford University (UK)
• Professor Claus Rerup, Richard Ivey School of Business
• Dr. Les Levin, Medical Advisory Secretariat, Ontario
• Jerry Koh, Ontario Ministry of Health & Long Term Care
• Joan Lister, CEO, HealthComm
• Wayne Marsh, Independent Facilitation Services
• Gail Garland, CEO, Ontario Bioscience Industry Organization (OBIO)
• Prof. Dr. Yusuf Çelik, Hacettepe University, Turkey
• Peter Tanaka (deceased), CEO, Comcare Health Services
Governance & Innovation Questionnaire
Clinical
Infrastructure
Administrative
Please Identify: 1. Your region
2. Your organization type
3. Drivers (requirement, discovery, policy, etc.)
4. People involved
5. Who initiated it/them
6. Current status
7. Obstacles faced
Workshop Map: Governance & Innovation
A
WHY?
B C
D
WHO? WHERE?
WHAT?
E
WHICH?
F
HOW?
G
NEXT
According to system experts (governors, professors, economists, think-tanks, industry, etc.), if we change ‘the’ system, quantitative evidence shows:
System Integrity S
yste
m V
alu
e
+ ve, +ve
+ ve, -ve -ve, -ve
-ve, +ve
Linguistics Perspective: System Change
Quadrant One: Positive System Integrity & Positive System Value
Ha
rmo
ny
Divine
Gratitude Eternal Episodic
Civilizational Disruption:
Great Leap Forward
Global Exemplar
Appropriate
Democratic & Prosperous
Moral
Linguistics Perspective: System Change
Economic 6th Gear
Quadrant Three: Negative System Integrity & Negative System Value
Pan
ic
Apocalyptic
Tolerable Shame Eternal
Civil War
Economic
Collapse
Inaccessibility
Rising Cost
Staff Can’t Work =
Service Suffers
Favouritism
Linguistics Perspective: System Change
Linguistics Perspective: System Change
Linguistics Perspective
According to system experts (governors, professors, economists, think-tanks, industry, etc.):
1. Canadian Health System: “Crisis mode” for 50 + years
2. Sustainable and unsustainable: Proposed Remedies Lead to Paradise (Scandinavia) or Hell (United States)
3. We need “an adult conversation”
D
FOREIGN EXCHANGE
C
GLOBAL HEALTH SYSTEMS
E A
MILITARY SPENDING
B
ALL GOLD MINED TO DATE
OIL & ENERGY
Health Systems: An Industry Comparison (2010)
D: $6.1 T C: $7.2 T E: $2.1 T A: $2.7 T B: $9.1 T
FOREIGN EXCHANGE
GLOBAL HEALTH SYSTEMS
MILITARY SPENDING
ALL GOLD MINED TO 2010
OIL & ENERGY
Health Systems: An Industry Comparison (2010)
Governance
Health System Governance: • Misaligned functions • Differentiated provincially (BC vs. ON) • Disproportionately massive civil service
Health Organization Governance:
• Skilled in governance or management • Unskilled in industry operations • Short term can hinder effectiveness
Management
≈ Organization
Accountability
Governance
≈ System
Accountability
Stewardship
≈ Public
Accountability
Governance: System Hinge b/w Operators and Regulators
Governance in Context
1 Fiduciary Mode
Strategic Mode
Generative Mode
P People
2
3
Governance in Context
P
1 Fiduciary Mode
Strategic Mode
Generative Mode
P People
2
3
Governance in Context
1
1 Fiduciary Mode
• Financial Oversight
• Asset Oversight
• Performance Oversight
Governance in Context
2
2 Strategic Mode
• Decision Support
• Strategic Diligence
Governance in Context
3
3 Generative Mode
• Ambiguity
• Interpret Operating Environment
• Making Sense of Complexity
Governance in Context
1 Fiduciary Mode
Strategic Mode
Generative Mode
P People
2
3
Innovation
“The future’s already here, it’s just not evenly distributed.” William Gibson
T i m e
Adopti
on &
Matu
rity
Innovation: Lifecycle View
Innovation
Innovation Value Improvement*
* Sustainable and greater than the system’s “natural state” of evolution
Governance & Innovation
Intersection of Governance & Innovation
© MVC and Associates, 2005
value
Level of Governance
5 Organization sustainability, service to humanity
4 Business stewardship, public good
3 Strategic duty & viability
2 Enhancing operations
1 Statutory compliance
Level of Innovation & Risk
E Global business / societal innovation
D Global or industry innovation
C New business model innovation
B New product, service, or market innovation
A Process or program innovation
A B C D E
5
4
3
2
1
Innovation: Health-System Examples
A B C D E
5
4
3
2
1
Level Examples
A Fraser Health Authority, Peer Review Process for DI
B Spartan Bioscience, Ottawa: Point of Care DNA Testing
C Wound Care in Home Care and LTC
D The Narayana Hrudayalaya, Bangalore: Production Line Heart Surgery
E Diagnostic Related Groups (DRGs), ICD Codes
Exercise One: Innovation & Extinction Map
Innovation
Extinction
Present Future 2013 2015 2017 2020 2025
Exercise One: Innovation & Extinction Map Warm Up
Innovation
Extinction
Present Future 2013 2015 2017 2020 2025
Smart Dust
Coins & Paper
Money CDs / DVDs
Smart
Cosmetics
VR Enhancing
Drugs
Exercise One: Innovation & Extinction Map
Innovation
Extinction
Present Future 2013 2015 2017 2020 2025
Exercise Two: Parsing Innovation & Extinction: Mission-Aligned Processes
2013 2015 2017 2020 2025
Inn
ova
tio
n /
Ext
inct
ion
Typ
e
Inn
ova
tio
n Infrastructural
Administrative
Clinical
Exti
nct
ion
Clinical
Administrative
Infrastructural
Governance Roles for Innovation
Internal Hybrid External
Governance Enabled (Mandatory?) • Supports executive in
“generative mode” • Defining project
dissolution metrics
Collaborative Governance
• Collaboration between private enterprise and government organizations
Government • Externally appointed and
driven • ‘Remedies’ mechanism
for non-conformance
Governance Enabled & Financed • Governance team funded
(X-Prize concept) • Prizes for priority
innovations
Accreditation Organization
• Typically for A and B levels of governance
Institutionalized Function • Office of Innovation or
Knowledge Management • Chief Patient Experience
Officer, or Chief Innovation Officer
Governance Roles for Innovation: Internal
Internal Findings & Observations
Governance Enabled (Mandatory?) • Supports executive in “generative
mode” • Foresight development through
scenario planning, trend forecasting,
Governance Enabled: The message of this presentation: this is an undeveloped and critical board function for health-system innovation; therefore, the bare minimum
• Innovation priorities must address the organization’s or the system’s greatest needs
• Innovation must be developed and
demonstrated
• There’s no such thing as failure—it becomes an organizational lesson
• Implementation plan and dedicated teams strongly advocated (see The Other Side of Innovation for team design)
Governance Enabled & Financed • Governance team funded (X-Prize
concept) • Prizes for priority innovations
Institutionalized Function • Innovation Centre, Chief Patient
Experience Officer, or Chief Innovation Officer
• Saint Elizabeth Health Care • Cleveland Clinic
Governance Roles for Innovation: Collaborative
Hybrid Findings & Observations
Collaborative Governance • Collaboration between private
enterprise and government organizations
McGill University Health Centre Glen Campus, $1.3 Bn budget Fraser Health Authority, Surrey Critical Care Tower, $512 M budget Comcare Health Services (now Revera), DuET Program: Wound Care, $1.2 M investment
• Knowledge, resources, and skills arbitrage among private and public partners
• Needn’t involve major capital projects
• With IT: often a drastically more affordable alternative – Excel instead of ORACLE
• Requires high degree of project management or portfolio management expertise
• BAIL BUTTON: Preventing escalating commitment
• Suitable when the innovation’s implementation will create:
1. Better public outcomes 2. Creation of additional resources
Governance Roles for Innovation: External
External Findings & Observations
Government • Externally appointed and driven • ‘Remedies’ mechanism for non-
conformance (for HealthQualityOntario)
Diverse Opinions • Relevant for Level A and B governance:
statutory compliance and organizational improvement
• A redundant bottleneck
• A great addition to the system—system support for standardizing practices
• Where enforcement or ‘remedies’ capacity exists, general compliance, but also process gaming
Accreditation Organization • Organizational accreditation (Accreditation
Canada) • Clinical accreditation (Regulatory college)
Exercise Three: Which Role Suits the Innovation?
2013 2015 2017 2020 2025
Inn
ova
tio
n /
Ext
inct
ion
Typ
e
Inn
ova
tio
n Infrastructural
Administrative
Clinical
Exti
nct
ion
Clinical
Administrative
Infrastructural
Summary
A
WHY?
APPROPRIATE UNTAPPED RESOURCE
B C
D
WHO?
BOARD
WHERE?
GENERATIVE MODE
WHAT?
INNOVATION & EXTINCTION
MAP
E
F
HOW?
INTERNAL HYBRID
EXTERNAL
G
NEXT
EVALUATION CONSOLIDATION
FOLLOW UP
WHICH?
CLINICAL ADMINISTRATIVE INFRASTRUCTURE
Parting Thought – The ‘When’ of Innovation
“The key to long-term success is to make innovation happen continuously.”
Arkadi Kuhlman, CEO, ING Direct, “Reinventing Innovation,” Ivey Business Journal, April – May 2010
NHLC: Up Next
15:15 - 15:45
NETWORKING BREAK - EXHIBITS AND POSTER VIEWING - Room 100
15:45 - 16:45
PLENARY - Critical success factors - Unlocking the power of the Blue Ocean Strategy: Room 200
16:45 - 17:00
PLENARY - Closing remarks: Room 200
Consultations
Publications
• The Wide Lens, Ron Adner
• The Innovator’s Prescription, Clayton Christensen
• The Innovator’s DNA, Clayton Christenson
• Collaborative Governance, John Donahue & Richard Zeckhauser
• Wrong, David Freedman
• The Other Side of Innovation, Vijay Govindarajan and Chris Tremble
• Willful Blindness, Margaret Heffernan
• Complexity: A Guided Tour, Melanie Mitchell
• The High Performance Board, Dennis Pointer & James Orlikoff
• The Innovator’s Manifesto, Michael Raynor
• Start Up Nation, Dan Senor and Saul Singer
Consultations (Continued)
Publications and Organizational References
• George Cooper, “Good governance first step toward curing system ills,” The Halifax
Chronicle Herald, January 13, 2012 http://bit.ly/xaFjGC
• Chris Morris, “Production Line Heart Surgery,’ BBC, August 2, 2010: http://bbc.in/a4uC8a
• The World Bank, Public-Private Partnerships and Collaboration in the Health Sector: An Overview with Case Studies from Recent European Experience, Irina A. Nikolic and Harald Maikisch, October 2006
• Spartan Bioscience, referred to as new product innovation in appended presentation
One Rationale for Collaboration: Lifecycle View
T i m e
A d
o p
t i
o n
T i m e
A d
o p
t i
o n
Supplier Clinician Organization Regulator
One Rationale for Collaboration: Lifecycle View
T i m e
A d
o p
t i
o n
Supplier Clinician Organization Regulator
One Rationale for Collaboration: Lifecycle View
Better Public Outcomes?
+ Creation of
Additional Resources?
Proceed