What Can We Learn from Leading-Edge Business Research?

Health System Leadership:What Can We Learn from Leading-Edge Business Research?

KO Strategies Inc. – Kevin Osiowy, CA, CMAPresented at the 2011 National Healthcare Leadership Conference (June 6, 2011)

Co-hosted by Canadian College of Health Leaders / Canadian Healthcare Association - Whistler, British Columbia, Canada

Health System Leadership:Health System Leadership:

Kevin Osiowy, CA, CMAKevin Osiowy, CA, CMA

What Can We Learn fromWhat Can We Learn fromLeadingLeading--Edge Business Research?Edge Business Research?

y, ,y, ,KO Strategies Inc.KO Strategies Inc.

Presentation to the 2011 National Healthcare Leadership ConferencePresentation to the 2011 National Healthcare Leadership ConferenceCanadian College of Health Leaders / Canadian Healthcare AssociationCanadian College of Health Leaders / Canadian Healthcare Association

Whistler, British ColumbiaWhistler, British ColumbiaMonday, June 6, 2011Monday, June 6, 2011

Health System LeadershipHealth System LeadershipPressure to PerformPressure to Perform

More than ever before,More than ever before,today’s healthcare leaderstoday’s healthcare leaderstoday s healthcare leaders today s healthcare leaders

and decisionand decision--makersmakersface face intense pressureintense pressure

from the publicfrom the publicto improveto improve

h l hh l hhealth systemhealth systemperformance results. performance results.

KO Strategies Inc.© 2011

Ensure that the healthcare system provides:More Services

More Safely

In More Locations

At aLower Cost!

In More Locations

At aLower Cost!



More Safely

Governments

HealthcareLeaders &

Services…

CareProviders

Safely… Locations… Lower Cost!Locations… Lower Cost!Services… Safely…

350Leaders &Decision-Makers


HealthcareBoards

Patients &Families


As leaders, how can we respond

to this pressure?





Health System LeadershipHealth System LeadershipWe Can Learn From…We Can Learn From…


“ Accelerating improvement“ Accelerating improvement[in healthcare] will[in healthcare] will

Health System LeadershipHealth System LeadershipThe Need for Innovative Management PracticesThe Need for Innovative Management Practices

[in healthcare] will[in healthcare] willrequire large shiftsrequire large shiftsin attitudes towardin attitudes towardand strategies for and strategies for developing thedeveloping thedeveloping thedeveloping thehealthcare workforce.”healthcare workforce.”

D.M. Berwick. Improvement, trust, and the healthcare workforce.Quality and Safety in Health Care, 2003; 12;448-452

Source:http://www.hhs.gov/open/contacts/cms.html

Don BerwickDon Berwick



“ At present,“ At present,p ,p ,prevailing strategiesprevailing strategiesrely largely onrely largely onoutmoded theoriesoutmoded theoriesof control and of control and


Don BerwickDon Berwick standardization of work.”standardization of work.”




“ More modern, and much “ More modern, and much ff ti th iff ti th imore effective, theoriesmore effective, theories

of production seek to of production seek to harness the imagination harness the imagination and participation of the and participation of the workforce in reinventingworkforce in reinventing


Don BerwickDon Berwickworkforce in reinventing workforce in reinventing the system.”the system.”








Grey literatureGrey literatureFormal academic research articlesFormal academic research articles

Popular business booksPopular business books


This capabilities framework defines the knowledge, skills, and attitudesa leader needs to exhibit in order to successfully contribute to an

effective and efficient Canadian health system.

Source: http://www.cchl-ccls.ca/default_conferences.asp?active_page_id=6492KO Strategies Inc.

© 2011

Deming defined a system as:Deming defined a system as:a network ofa network of

interdependent componentsinterdependent components

KO Strategies Inc.© 2011http://en.wikipedia.org/wiki/W._Edwards_Deming

interdependent componentsinterdependent componentsthat work together to try tothat work together to try to

accomplish a particular aim.accomplish a particular aim.W. Edwards DemingW. Edwards Deming

(1900 (1900 –– 1993)1993)


More Safely

In More Locations

At aLower Cost!

In More Locations

At aLower Cost!


More Safely


Governments

HealthcareLeaders &

Services…

CareProviders

Safely… Locations… Lower Cost!Locations… Lower Cost!Services… Safely…



HealthcareBoards

Patients &Families




Quality Safety Delivery CostDelivery CostQuality Safety

Health System LeadershipHealth System LeadershipThinking SystemicallyThinking Systemically

‘TRUE NORTH’‘TRUE NORTH’

Governments CareProviders

Healthcare

‘TRUE NORTH’‘TRUE NORTH’SYSTEM GOALSSYSTEM GOALS


HealthcareBoards

Patients &Families

Leaders &Decision-Makers ChChange

for the BetterKO Strategies Inc.

© 2011

Changefor the Better

• The Shingo Prize


• The Shingo Prize• Good-to-Great• Good-to-Great

The ShingoTransformational Process

The Shingo Principlesof Operational Effectiveness

http://www.shingoprize.org/files/uploads/education/ModelsGuidelines_v5.pdf http://www.shingoprize.org/files/uploads/education/ModelsGuidelines_v5.pdf

• The Shingo Prize• The Shingo Prize


Jon M. Huntsman School of BusinessJon M. Huntsman School of BusinessUtah State UniversityUtah State University

((http://www.shingoprize.orghttp://www.shingoprize.org))




What factors distinguishthose companies that

made a successfult f titransformation

from thosethat did

not ?

• How the Mighty FallKO Strategies Inc.

© 2011

• Good-to-GreatJim Collins

• How the Mighty Fall• Good-to-Great

eads selfeads self

ngages othersngages others GROUPS OF INDIVIDUALS

INDIVIDUALS

g gg g

chieves resultschieves results

evelops coalitionsevelops coalitions

AIMS / GOALS

GROUPS OF GROUPS

IN ORDER TO ACHIEVE…


ystems transformationystems transformationKO Strategies Inc.

© 2011

GROUPS OF GROUPS

CHANGE FORTHE BETTER

Health System LeadershipHealth System LeadershipWhat Can We Learn From…What Can We Learn From…




eads selfeads self

ngages othersngages othersg gg g



IN ORDER TO ACHIEVE…


ystems transformationystems transformationKO Strategies Inc.

© 2011




eads selfeads self

11 S lfS lf AA1.1. SelfSelf--AwareAware2.2. Manages SelfManages Self3.3. Develops SelfDevelops Self4.4. Demonstrates CharacterDemonstrates Character


UnderstandingUnderstandingY lf

eads selfeads self1.1.SelfSelf--

AwareAware

(Inner Work Life)YourselfYourself

“Would hidden observerswatching you go through


g y g gthe day really understand

your inner work life?Of course not.”

Source: Inner Work Life: Understanding the Subtext of Business Performance,Teresa M. Amabile and Steven J. Kramer (Harvard Business Review; May 2007) (p. 72-83)

UnderstandingUnderstandingY lf

eads selfeads self1.1.SelfSelf--

AwareAware

(Inner Work Life)YourselfYourself

Perceptions(How we make sense of our work, ourselves, our team, our organization)

WorkPerformance

Motivation for Work(What to do, whether to do it, how to do it, when to do it)

Emotions(How we react to workday events)


Source: Inner Work Life: Understanding the Subtext of Business Performance,Teresa M. Amabile and Steven J. Kramer (Harvard Business Review; May 2007) (p. 72-83)

CreativityProductivityCommitmentCollegiality

eads selfeads self2.2.ManagesManages

SelfSelf

Overcoming AdversityOvercoming Adversity

Governments

HealthcareLeaders &

CareProviders

g y



HealthcareBoards

Patients &Families




eads selfeads self

Overcoming AdversityOvercoming Adversity

2.2.ManagesManagesSelfSelf

(Stockdale Paradox)

Retain faith that youwill prevail in the end,

dl f

AND,at the

Confront the mostbrutal facts of

t lit


Source: Good to Great (Why Some Companies Make the Leap and Others Don’t),Jim Collins (2001) (p. 86)

regardless ofthe difficulties

same time your current reality,whatever they might be

LearningLearningeads selfeads self

3.3.DevelopsDevelopsSelfSelf

gg

“The rhetoric of success(‘We’re successful because we do specific things.’)

A Key Marker for Declining Organizations

(Over-confidence)


replaces

understanding and insight”(‘We’re successful because we understandwhy we do these specific things an under

what conditions they would no longer work.’)

Source: How the Mighty Fall (and Why Some Companies Never Give In),Jim Collins (2009) (p. 43)



g

“The Odds of SuccessA P

(Over-confidence)


Are Poor…

But Not for Me”

Source: Think Twice: Harnessing the Power of Counterintuition,Michael J. Mauboussin (Harvard Business Press) (2009) (p.7)

‘Inside View’

Learningeads selfeads self


Learningg

“A system can not understand itself.

(Outside View)


W. Edwards DemingW. Edwards Deming(1900 (1900 –– 1993)1993)

The transformation requiresa view from outside.”

Source: http://deming.org/index.cfm?content=66Excerpted from W. Edwards Deming, The New Economics for Industry, Government, (1993), Chapter 4






Learningg

“The outside view asks ifthere are similar situations that

(Outside View)


can provide a statistical basisfor making a decision.”




Learningg

“Rather than seeing a problem as unique,the outside view wants to know if

(Outside View)(Inquisitiveness)


others have faced comparable problems,and, if so, what happened.”




g

“Leaders lose the inquisitivenessand learning orientation

that mark those truly great individuals who

A Key Marker for Declining Organizations

(Inquisitiveness)


that mark those truly great individuals who,no matter how successful they become,

maintain a learning curve as steepas when they first began their careers.”




g(Gemba)

“Where ish l h d ?”


health records?”Anonymous healthcare leader




eads selfeads self4.4.DemonstratesDemonstrates

CharacterCharacter

OurIntelligence Our Character

OurEmotions

OurWillpower

OurValues

OurKnowledge

OurMorals

OurConscience

OurAttention

OurWisdom

OurSense ofHumor

Our MentalAttitudes

OurImagination


eads selfeads self

ImaginationImagination

4.4.DemonstratesDemonstratesCharacterCharacter

g(Impact on

Compliance Behavior &Probability Estimates)


OurImagination

Steven J. Sherman, Robert B. Cialdini et al, Imagining Can Heighten or Lowerthe Perceived Likelihood of Contracting a Disease: The Mediating Effect of Ease of Imagery,

Personality and Social Psychology Bulletin, Vol. 11 No. 1, March 1985 118-127

eads selfeads self

ImaginationImagination


ggEasy-to-imagine

(Low energy, muscleaches, headaches)

Difficult-to-imagine(Disorientation, malfunctioning

nervous system, and inflamed liver)

1 = Very likelyto contract

10 = Very unlikely

to contract

5.25 7.70


OurImagination

Steven J. Sherman, Robert B. Cialdini et al, Imagining Can Heighten or Lowerthe Perceived Likelihood of Contracting a Disease: The Mediating Effect of Ease of Imagery,

Personality and Social Psychology Bulletin, Vol. 11 No. 1, March 1985 118-127

to contract

Attentioneads selfeads self


Attention

Psychology Professor - Daniel Simons(Visual Cognition Laboratory, University of Illinois)

(The Illusion of Attention)

OurAttention


For more information, please see:http://www.simonslab.com/index.html

The Invisible Gorilla,And Other Ways Our Intuitions Deceive Us

Spoiler Alert!




Multi-taskingeads selfeads self

Multi-tasking


g(The Myth of Multi-Tasking)

OurAttention


Reference: The Myth of Multitasking,Christine Rosen, The New Atlantis

(pp. 105-110) (2008)


CharacterCharacter

OurEmotions

(Elephant & Rider)


http://www.wpclipart.com/animals/E/elephant/elephant_2/elephant_with_rider.png.html

eads selfeads self

EmotionsEmotions


EmotionsOur

Emotions

70%70%BaseBase--raterate



(Modeling PatientDecision-Making)


Positive anecdote 92% 93% 78%Ambiguous anecdoteAmbiguous anecdote 81% 69% 29%

Negative anecdote 43% 15% 7%

Source: Think Twice: Harnessing the Power of Counterintuition,Michael J. Mauboussin (Harvard Business Press) (2009) (p94)


CharacterCharacter

OurWillpower

OurMorals

Professional Will Personal Humility

“Demonstrates an “Demonstrates a


unwavering resolve to dowhatever must be done to

produce the best long-termresults, no matter how difficult”

compelling modesty,shunning

public adulation;never boastful.”





Responsibilityeads selfeads self


Responsibilityp y

Professional Will Personal Humility“Looks in the mirror,not out the window

“Looks out the window,not in the mirror to

(Accountability for Performance)


not out the window,to apportion responsibility for

poor results, never blamingother people, external factors,

or bad luck.”

not in the mirror, toapportion credit for…

success – to other people,external factors,and good luck.”




Responsibilityp y(Accountability for Performance)

“The b rden is o rs!”


“The burden is yours!”

Passing the buck“The data are wrong!”

“The dog ate my homework!

D.M. Berwick. Improvement, trust, and the healthcare workforce.Quality and Safety in Health Care, 2003; 12; p. 451




“The responsibilit is mine!”


“The responsibility is mine!”“I’ve got the ball”

“The buck stops here!”






“…requires trust in oneself, belief inone’s own worthiness, intention,

and capacity to improve.”









“…requires that failures beembraced because ofwhat they can teach.”






“Psychologically,taseki (i.e. blame)is much easier!”


ngages othersngages others

11 F t D l t f OthF t D l t f Oth1.1. Foster Development of OthersFoster Development of Others2.2. Contribute to the CreationContribute to the Creation

of Healthy Organizationsof Healthy Organizations3.3. Communicate EffectivelyCommunicate Effectively44 Build Effective TeamsBuild Effective Teams


4.4. Build Effective TeamsBuild Effective Teams

ngages othersngages others1.1.Foster Development Foster Development

of Othersof Others

UnderstandingUnderstandingO h

(Inner Work Life)OthersOthers

“Most managersare not in tune with


Source: Inner Work Life: Understanding the Subtext of Business Performance,Teresa M. Amabile and Steven J. Kramer (Harvard Business Review; May 2007)

are not in tune withthe inner work livesof their people…”





of Othersof Others



“…nor do they appreciatehow pervasive the effects of



how pervasive the effects ofinner work life can be on

performance”


of Othersof Others



“Please Understand Me!”(Keirsey & Bates; Myers-Briggs)



“My supervisor, or someone at workseems to care about me as a person.”

Source: 12: The Elements of Great Managing, Rodd Wagner & James K. Harter (2006). P. xi,


of Othersof Others

M iM t iMentoringMentoring(Develop & Grow)

“There is someone at work


There is someone at workwho encourages my development.”

Source: 12: The Elements of Great Managing, Rodd Wagner & James K. Harter (2006). P. xi,

Recognitionngages othersngages others

1.1.Foster Development Foster Development of Othersof Others

Recognitiond P id P iand Praiseand Praise

(Psychological Cost of Negative Results)(“Find the Bright Spots”)


Low-Performing Teams

2.8 negative comments toevery 1 positive comment

High-Performing Teams

5.6 positive comments toevery 1 negative comment

Source: 12: The Elements of Great Managing, Rodd Wagner & James K. Harter (2006). p. 55.




Recognitionngages othersngages others

1.1.Foster Development Foster Development of Othersof Others

Recognitiond P id P iand Praiseand Praise

(Reversion to the Mean)

Natural Tendencynot to Praise Must be

frequent


Natural Tendencyto Blame

frequent(weekly)


of Othersof Others

S hSt th(“Do what you do best”)

StrengthsStrengths


Source: Go Put Your Strengths to Work: 6 Powerful Steps to Achieve Outstanding Performance,Marcus Buckingham (2007) (p. 99)

“I hate it whenI have to do this”

“I can’t waitto start!”


of Othersof Others

S hSt thStrengthsStrengths(“Do what you do best”)



“Will thisever end?”

“This isfun”


of Othersof Others

S hSt thStrengthsStrengths(“Do what you do best”)



“This is goingto take forever”

“I could dothis forever”





of Othersof Others

S hSt thOpportunities

StrengthsStrengths

Frustrated, Fragmented,

(“Do what you do best”)

Powerful, Passionate,

ppmust be daily



, g ,Disjointed, Awkward,Drained, Despondent,

Bored, Distracted

, ,Euphoric, Enthusiastic,

Natural, Authentic,Smooth, Confident

Trustngages othersngages others

Trust

2.2.Contribute to theContribute to theCreation of Healthy Creation of Healthy OrganizationsOrganizations

“Team membersseek as much credit

as possible for

“Each teammember credits

other people

Teams on the way down Teams on the way up

(Credit)


as possible forthemselves yet do notenjoy the confidenceand admiration of

their peers.”

other peoplefor success, yet

enjoys the confidenceand admiration ofhis or her peers.”


Resourcesngages othersngages others

Resources

2.2.Contribute to theContribute to theCreation of Healthy Creation of Healthy OrganizationsOrganizations

(Availability)

“I have the materials and equipment


I have the materials and equipmentI need to do my work right.”Source: 12: The Elements of Great Managing, Rodd Wagner & James K. Harter (2006). P. xi,

Dialoguengages othersngages others

3.3.Communicate Communicate EffectivelyEffectively

Dialogueg

“Team membersargue

“Team membersargue and debate


(Argument & Debate)


argueto look smart

or to improve theirown interests”

argue and debate…to find the best answers

to support theoverall cause”







Dialoguegg

“The team leaderhas a

The team leaderuses “a high


(Use of Questions)


very lowquestions-to-statements

ratio, avoidingcritical input…”

questions-to-statementsratio, challenging

people, and pushing forpenetrating insight.”




Dialogueg(Opinions)

“At work, my opinions seems to count.”


At work, my opinions seems to count.Source: 12: The Elements of Great Managing, Rodd Wagner & James K. Harter (2006). P. xi,



Dialogueg

People assertstrong opinions People bring data,


(Opinions)


without providingdata, evidence,

or a solidargument

evidence, logic andsolid arguments to

the discussion


Building Teamsngages othersngages others

4.4.BuildBuildEffective TeamsEffective Teams

Building Teamsg(Get the Right People on the Bus)Traditional Approach Great Organizations

First What(i.e. Set a vision for where to drive the bus.

First Who(i.e. Get the right people on the bus;


(Develop a road map for driving the bus)

( g p pBuild a superior team)

Then Who(i.e. Enlist a crew of highly capable ‘helpers’

to make the vision happen)

Then What(i.e. With the right people in place,

figure out the best path to greatness)





Building Teamsngages othersngages others

4.4.BuildBuildEffective TeamsEffective Teams

Building Teamsgg(Focus on the Goal)

Example:

(Measure What Matters)


For more information on the Oakland A’s remarkable transformation, please referto Michael Lewis’ book, Moneyball: The Art of Winning an Unfair Game (2003)

p

Oakland A’sunder GM Billy Beane


11 S t Di tiS t Di ti1.1. Set DirectionSet Direction2.2. Strategically Align DecisionsStrategically Align Decisions

with Vision, Values, and Evidencewith Vision, Values, and Evidence3.3. Take Action to Implement DecisionsTake Action to Implement Decisions44 Assess and EvaluateAssess and Evaluate


4.4. Assess and EvaluateAssess and Evaluate

Goalschieves resultschieves results 1.1.Set DirectionSet Direction

Goals

“A system must have an aim.Without an aim, there is no system.The aim of the system must be clear

(Deming)


The aim of the system must be clearto everyone in the system.The aim must include plans for the future.The aim is a value judgment.”

http://en.wikipedia.org/wiki/W._Edwards_DemingDeming, W. Edwards. 1993. The New Economics for Industry,Government, Education, second edition.



Goals(“Point to the Destination”)


DestinationPostcards

(Heath Bros.)

Big HairyAudacious

Goals (BHAG)(Jim Collins)





Goals(Clarity)

“I know what is expected of me at work”Source: 12: The Elements of Great Managing, Rodd Wagner & James K. Harter (2006). P. xi,


“What looks like resistanceis often a lack of clarity.”

Source: Switch: How to Change When Change is Hard, Chip and Dan Heath (2010). P..17,


Goals(Theory of Constraints)Every system has a bottleneck

or constraint that preventsthe system from achieving its goal



Goals(Measurement)

(Return on Investment)

ReturnReturn


Return onReturn onInvestmentInvestment

(ROI)(ROI)==

ReturnReturn

InvestmentInvestment


Goals(Prediction/Confidence Ranges)

Upper Limit

Point Estimate

Lower LimitKO Strategies Inc.

© 2011




ChoicesChoiceschieves resultschieves results

2.2.Align DecisionsAlign Decisionswith Vision, Values & with Vision, Values & EvidenceEvidence

(Paradox of Choice)


Example 1

ChocolateSampling

Example 2

HipSurgery

Evidence-Based DecisionsEvidence-Based Decisionschieves resultschieves results


“People assertstrong opinions without

“People bringdata


(Analytics)


strong opinions withoutproviding data,

evidence, ora solid argument.”

data,evidence, logic, and

solid argumentsto the discussion.”



Evidence-Based DecisionsEvidence-Based Decisions


“Pin hopes on unprovenstrategies – often with

“Formulate strategicchanges based on


(Analytics)


much hype and fanfare.”

“…make bold,untested leaps.”

empirical evidence,and

extensive strategic andquantitative analysis”


Evidence-Based DecisionsEvidence-Based Decisionschieves resultschieves results


(Analytics)

Data mining Decision support models Queuing models


Q g Optimization models Statistical process control (SPC) techniques




Executionchieves resultschieves results

Execution

3.3.Take Action toTake Action toImplement DecisionsImplement Decisions

(“Script the Critical Moves”)

Setting a goal or providing

(“Nudge”)


(Chip & Dan Heath)

Setting a goal or providinghigh-level direction is critical.

But, it is not enough.



Execution(“Script the Critical Moves”)

(“Nudge”)


Example 1

West VirginiaHealthy Eating

Example 2

TetanusShots



Execution

A t i F P l d

(Inertia; the powerof the Status Quo)

Rates of Organ DonationDefaultDefault

Denmark (4%)Netherlands (28%)

UK (17%)Germany (12%)

Austria, France, Poland,Hungary, Portugal (100%)

Belgium (98%)France (100%)Sweden (86%)

KO Strategies Inc.© 2011Source: http://www.ted.com/talks/lang/eng/dan_ariely_asks_are_we_in_control_of_our_own_decisions.html

DefaultDefaultOptionsOptions

&&ChoiceChoice



Execution

12090X

(Critical Chain)

8 14 4 9 10 66.5

Project Buffer16 28 8 18 20 90X

X60






Execution(“Just Do It”)

Implement improvement ideas that are:

Fast

Source: Breakthrough Business Results with MVT: A Fast, Cost-Free “Secret Weapon” for Boosting Sales, Cutting Expenses, and Improving any Business Process, by Charles Holland with David Cochran (p. 104)

Practical

Cost-Free

Measuring Resultschieves resultschieves results

4.4.Assess andAssess andEvaluateEvaluate

Measuring Resultsg(Prediction/Confidence Ranges)

Upper Limit

Point Estimate

Lower Limit

Measuring Resultschieves resultschieves results


Measuring Resultsg

> 3 standard deviations above prediction

2-3 standard deviations above prediction

1-2 standard deviations above prediction

(Prediction/Confidence Ranges)

StatisticalP< 1 standard deviation above prediction

< 1 standard deviation below prediction

1-2 standard deviations below prediction

2-3 standard deviations below prediction

> 3 standard deviations below prediction

ProcessControl


Measuring ResultsMeasuring Results


g(Good News vs. Bad News)

“Fear invites wrong figures.Bearers of bad news fare badly.”


Source: http://deming.org/index.cfm?content=66Excerpted from W. Edwards Deming, The New Economics for Industry, Government, (1993), Chapter 4


“To keep his job, anyone may presentto his boss only good news.”




Measuring ResultsMeasuring Resultschieves resultschieves results


gg

“People shield those inpower from grim

“People bring forthunpleasant facts to be


(Confronting the Brutal Truth)


facts, fearful of penaltyand criticism for

shining light on theharsh realities.”

discussed;leaders never criticizethose who bring forth

harsh realities.”


Measuring ResultsMeasuring Resultschieves resultschieves results


gg

“The team conducts “The team conducts‘autopsies without


(Confronting the Brutal Truth)


‘autopsies with blame,’seeing culprits rather

than wisdom.”

‘autopsies withoutblame,’ miningwisdom from

painful experiences.”



11 P f ll B ild P t hiP f ll B ild P t hi1.1. Purposefully Build PartnershipsPurposefully Build Partnershipsand Networks to Create Resultsand Networks to Create Results

2.2. Demonstrate a CommitmentDemonstrate a Commitmentto Customers and Servicesto Customers and Services

3.3. Mobilize KnowledgeMobilize Knowledge


3.3. Mobilize KnowledgeMobilize Knowledge4.4. Navigate SocioNavigate Socio--Political EnvironmentsPolitical Environments

evelops coalitionsevelops coalitions1.1.Build PartnershipsBuild Partnerships

& Networks to & Networks to Achieve ResultsAchieve Results

NetworkDeming defined a system as:Deming defined a system as:

a network ofa network ofi d di d d

Network


interdependent componentsinterdependent componentsthat work together to try tothat work together to try to

accomplish a particular aim.accomplish a particular aim.W. Edwards DemingW. Edwards Deming

(1900 (1900 –– 1993)1993)




Social

evelops coalitionsevelops coalitions1.1.Build PartnershipsBuild Partnerships

& Networks to & Networks to Achieve ResultsAchieve Results

SocialSocialNetworkNetworkAnalysisAnalysis


Maryland Terrapins(“Terps”)

Source: Game Plan: First Find The Leaders, BusinessWeek (August 21, 2006)

Quality Safety Delivery CostDelivery CostQuality Safety‘TRUE NORTH’‘TRUE NORTH’

evelops coalitionsevelops coalitions2.2.Demonstrate a Demonstrate a

Commitment to Commitment to Customers & ServiceCustomers & Service

Governments CareProviders

Healthcare

‘TRUE NORTH’‘TRUE NORTH’SYSTEM GOALSSYSTEM GOALS


HealthcareBoards

Patients &Families

Leaders &Decision-Makers


Characteristics ofCharacteristics of

2.2.Demonstrate a Demonstrate a Commitment to Commitment to Customers & ServiceCustomers & Service

OrganizationsOrganizationsServiceService

Inseparability


Source: Cutting Corners and Working Overtime: Quality Erosion in the Service Industry,Rogelio Oliva and John D. Sterman; Management Science; Vol. 47, No. 7 (July, 2001)

LabourIntensive

IntangibleServices

Inseparabilityof the

Providerand

Customer


CustomerCustomer


(Satisfaction)(Engagement)

ServiceService

Loyalty•satisfied

• choose again• recommend


Source: The Constant Customer, Gallup Management Journal (GMJ) (2001)http://gmj.gallup.com/content/745/constant-customer.aspx

Confidence• trust

• deliver on promises

Integrity•fairness

•problem resolution

Pride• proud• respect

Passion• well-suited• lost without

Customer Engagement





Th i ll These highly


These partiallyoptimized

business units are1.7

times more effectivethan the baseline.

These highlyoptimized

business units are

3.4times more effective

than the baseline.

Baselinebusiness units

These partiallyoptimized

business units aree E

ngag

emen

t


Customer Engagement

business unitsare non-optimized.

[1.0]

business units are1.7

times more effectivethan the baseline.

Em

ploy

ee

Source: Manage Your Human Sigma, by John H. Fleming, Curt Coffman,James K. Harter, Harvard Business Review, July-August, 2005 (p. 112)

ServiceServiceevelops coalitionsevelops coalitions


Arrival rate = 0.1 call per minute (i.e. 144 per day)Arrival rate = 0.1 call per minute (i.e. 144 per day) Average timeAverage time--onon--task = 40.0 minutestask = 40.0 minutes GoalGoal: Respond within 08:59 ninety: Respond within 08:59 ninety--five percent of the time.five percent of the time.

Service Ambulance Avg. Daily

(Queuing Models)

Service Standard

AmbulanceUtilization

g yTime withno spares

6 ambulances 81.8% 66.7% 6 h: 50 m7 ambulances 93.1% 57.1% 3 h: 14 m8 ambulances 97.6% 50.0% 1 hr: 25 m



ServiceService


(Psychology ofWaiting Lines)

Occupied vs.Unoccupied Getting

St t dAssurance

A i t

Certain vs.Uncertain

Equitable vs. UnfairWaits


pTime

Group Waitsvs. SoloWaits

Started

Explained vs.Unexplained

Waits

vs. Anxiety

PerceivedValue

Waits

Source: The Psychology of Waiting Lines, by David Maister (http://davidmaister.com/pdf/PsycholgyofWaitingLines751.pdf)


Mining

3.3.MobilizeMobilizeKnowledgeKnowledge

MiningK l dKnowledge

(Wisdom of Crowds)Knowledge


Source: Surowiecki, James. The Wisdom of Crowds: Why the Many Are Smarter Than the Fewand How Collective Wisdom Shapes Business, Economies, Societies and Nations. Doubleday, 2004.





Mining

3.3.MobilizeMobilizeKnowledgeKnowledge

MiningK l dKnowledge

(Wisdom of Crowds)Knowledge

Four conditions for success:


Diversity

Source: Surowiecki, James. The Wisdom of Crowds: Why the Many Are Smarter Than the Fewand How Collective Wisdom Shapes Business, Economies, Societies and Nations. Doubleday, 2004.

Decentralization Independence Aggregation


GovernanceGovernance

4.4.NavigateNavigateSocioSocio--Political Political EnvironmentsEnvironments

What services should we provide?

A good governing body asks:

to whom?


at what cost?

evelops coalitionsevelops coalitions4.4.NavigateNavigate

SocioSocio--Political Political EnvironmentsEnvironments

GovernanceGovernanceOptimum System Cost

Costh ?

Who bearsh ?

Customer

CustomerOptimum System Cost

at what cost?KO Strategies Inc.

© 2011

to whom?the cost?

Organization

ystems transformationystems transformation

11 D t t S t Thi kiD t t S t Thi ki1.1. Demonstrate Systems ThinkingDemonstrate Systems Thinking& Critical Thinking& Critical Thinking

2.2. Encourage and Support InnovationEncourage and Support Innovation3.3. Orient ThemselvesOrient Themselves

Strategically to the FutureStrategically to the Future


Strategically to the FutureStrategically to the Future4.4. Champion and Orchestrate ChangeChampion and Orchestrate Change





Thinking

1.1.Systems/Systems/Critical Critical ThinkingThinking

Thinkingg(Disciplined Thought)


g

“Make panicky,desperate

“Get the facts,think


desperatemoves in reaction to

threats that can imperilthe company”

think,and then act (or not)

with calmdetermination”


Thinkingystems transformationystems transformation

1.1.Systems/Systems/Critical Critical ThinkingThinking

Thinkingg

EmotionalThinking

Gloomy &NegativeThinking

Inter-Connecting

Ideas &DisciplinedThinking

(Six Thinking Hats)


Facts &Logic,

ObjectiveThinking

Positive &OptimisticThinking

CreativeThinking

For more information on the Six Thinking Hat, please refer to Edward DeBono’sclassic book, Six Thinking Hats (Penguin Books) (1985)


CreativityCreativity

2.2.EncourageEncourage& Support& SupportInnovationInnovation

y“the ability to transcend

traditional ideas, rules, patterns, relationships, or the like, and

to create meaningful new ideas


to create meaningful new ideas,forms, methods, interpretations, etc.”

Source: Dictionary.com


CreativityCreativity


y(The Impact ofTime Pressure)

Time


For more information please refer to the working paper, Time Pressure and Creativity in Organizations:A Longitudinal Field Study, Teresa M. Amabile, Jennifer S. Meuller, et al (2002)

TimePressure Creativity





InnovationInnovation


“…an idea, practice,or project that is perceived

as new by an individualor other unit of adoption ”


or other unit of adoption.Everett Rogers (2003). Diffusion of Innovations (5th ed.) (p.12)


InnovationInnovation


(Where do goodideas come from?)


Source: http://www.ted.com/talks/steven_johnson_where_good_ideas_come_from.html


FutureFuture

3.3.Orient Orient strategicallystrategicallyto the futureto the future

(Prediction Markets)



FutureFuture


(Demand Forecasting)

Quantify Extrapolate


Q yDemand

pinto the future





FutureFuture


(Predictive Modeling)

-12.14540

Orley Ashenfelter(Professor at Princeton University)


Wine Quality (average vintage price relative to 1961)=

+ 0.00117 winter rainfall (Oct-Mar)(ml)

Source: http://www.liquidasset.com/winedata.html

+ 0.16640 avg. temp. (Apr-Sept)(Celsius)- 0.00386 harvest rainfall (Aug&Sept)(ml)+ 0.02385 time since vintage (years)

Shrink theystems transformationystems transformation

ChChShrink the

4.4.Champion &Champion &Orchestrate Orchestrate ChangeChange

ChangeChange(Chip & Dan Heath)


CHANGE

Smallystems transformationystems transformation

ChChSmall


sChangeChangescan have

BIG EFFECTScan have

BIG EFFECTS


(Leverage)(Tipping Point)


ChCh


ChangeChangeAll improvementsAll improvements

are the result of changesare the result of changes


BUT…BUT…

Not all changesNot all changesresult in improvement!result in improvement!




Tests ofystems transformationystems transformation

ChChTests of


22 %

ChangeChange53 % of ideas make

NO DIFFERENCE

25 %of ideas HELP

22 %of ideas hurt


Not all changesNot all changesresult in improvement!result in improvement!

Source: Breakthrough Business Results with MVT: A Fast, Cost-Free “Secret Weapon” for Boosting Sales, Cutting Expenses, and Improving any Business Process, by Charles Holland with David Cochran (p. 22)

Tests ofystems transformationystems transformation

ChChTests of


ChangeChange(Randomized Control Trials;

Planned Experimentation;D i f E i )


Design of Experiments)

Resistance toystems transformationystems transformation

ChChResistance to


ChangeChange(Layers of Resistance)

LAYER 0


LAYER 0"We / I don't have a problem."

Source: Iowa State University – Centre for Industrial Research and Service (CIRAS) http://www.ciras.iastate.edu/library/toc/layersofresistance.asp


ChChResistance to



LAYER 1


LAYER 1"You don't understand my/our problem(s)."






ChChResistance to



LAYER 2


LAYER 2"...we don't agree on

the direction of the solution."



ChChResistance to



LAYER 3


LAYER 3"...your solution can't possibly produce

the level of results you say it can."



ChChResistance to



LAYER 4


LAYER 4"...your good solution is going

to cause some bad things to happen."



ChChResistance to



LAYER 5


LAYER 5"...there are some significant

obstacles that prevent the implementation."






ChChResistance to



LAYER 6


LAYER 6Unverbalized

FEAR



ChChResistance to


ChangeChange


Makingystems transformationystems transformation

ChChMaking


IrresistibleChangeChange

Irresistible


“We have a problem.”


ChChMaking



Irresistible


“We understand the problem.”





ChChMaking



Irresistible


“We agree on thedirection of the solution.”


ChChMaking



Irresistible


“Our solution will producethe results we need.”


ChChMaking



Irresistible


“Our solution will cause somegood things to happen.”


ChChMaking



Irresistible


“We’ve addressed the obstaclesthat will ensure our changes success.”





ChChMaking



Irresistible


“We’re confident thatwe will make progress!”


PP


ProgressProgress(What Really Motivates Workers?)

“The Progress Principle:U i S ll Wi t I it J


Source: “What Really Motivates Workers?, Breakthrough Ideas for 2010, Teresa M. Amabileand Steven J. Kramer; Harvard Business Review (February 2010). p. 1 & 2.

Using Small Wins to Ignite Joy,Engagement, and Creativity at Work”,

by Teresa M. Amabile and Steven J. Kramer(expected to be released August/September, 2011)

Health System LeadershipHealth System LeadershipCapabilities FrameworkCapabilities Framework

Source: http://www.cchl-ccls.ca/default_conferences.asp?active_page_id=6492KO Strategies Inc.

© 2011









We need to “invest in a We need to “invest in a workforce of imaginativeworkforce of imaginativeworkforce of imaginative, workforce of imaginative, inspired, capable, and inspired, capable, and (dare I say it) joyous (dare I say it) joyous people, invited to use their people, invited to use their minds and their wills tominds and their wills to



minds and their wills to minds and their wills to cooperate in reinventing cooperate in reinventing the system, itself.”the system, itself.”




“Th i t t if it i t“Th i t t if it i t“The investment, if it is to “The investment, if it is to be effective must be real. be effective must be real. Doctors, nurses, Doctors, nurses, pharmacists, therapists, pharmacists, therapists, technicians managers andtechnicians managers and


Don BerwickDon Berwicktechnicians, managers, and technicians, managers, and executives (everyone)…executives (everyone)…




“…will need to acquire “…will need to acquire qqand refine their capacities and refine their capacities to set aims, measure and to set aims, measure and interpret results, searchinterpret results, searchfor unfamiliar and for unfamiliar and


Don BerwickDon Berwick promising alternatives to promising alternatives to the status quo…”the status quo…”




“They will do so together,“They will do so together,in teams to welcomein teams to welcomein teams, to welcome in teams, to welcome failures as informative,failures as informative,to celebrate successes as to celebrate successes as collective, and to feel the collective, and to feel the excitement of [acceptingexcitement of [accepting


Don BerwickDon Berwickexcitement of [accepting excitement of [accepting responsibility for responsibility for performance]”performance]”







“…and test those “…and test those alternatives rapidly, alternatives rapidly, carefully, and constantly.”carefully, and constantly.”






“A workforce so nobly “A workforce so nobly engaged deserves no less.”engaged deserves no less.”





Health System Leadership:Health System Leadership:

Kevin Osiowy, CA, CMAKevin Osiowy, CA, CMA

What Can We Learn fromWhat Can We Learn fromLeadingLeading--Edge Business Research?Edge Business Research?

y, ,y, ,KO Strategies Inc.KO Strategies Inc.

Thank You!Thank You!

What Can We Learn from Leading-Edge Business Research?

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