Creating tomorrow today: a radical manifesto for leaders of health and care

Creating tomorrow today: a
for leaders of health and care
with
Helen Bevan
Chief Transformation Officer, Horizons Team, England
Goran Henriks
Chief Executive of Learning, Jonkoping Region, Sweden
@HelenBevan @GoranHenriks #Quality2020

Michael Hammer
1993
Creating tomorrow today: the Covid-19 pandemic
Methods for delivering health and care that
we took for granted as the norm have been
swept away in the Covid-19 response as
people have responded in extraordinary ways.
Yet looking back over the last 30 years, the
speed and complexity of change has been
increasing all that time. Covid-19 has
amplified what was happening already.
This is not about a pre or post-covid world; it’s
about a world that was already moving fast,
got faster as a result of Covid-19 and will
continue at speed,
The more we mobilise people around the
potential for a radically different future, the
better we prepare for the future.

The person (patient) in focus The person as a member of the team
Speeding up a change in perspective…..
Partnership
This graphic was used to describe the perspective of care for the very first
person diagnosed with Covid-19 in Jönköping on 31st January 2020

Our manifesto: some simple rules
“Simple rules” is a core principle for transforming mindsets that drive behaviours
and actions in large complex systems.
If we want to get a very large group of people, across an organisation or system, to
behave differently, with everyone moving in a coherent direction we can do this in
one of two ways:
Principles: adapted from General Stanley McChrystal Team of Teams
1. Policies, approvals and
top-down cascade
Create clear polices
and operating
systems & hold
formal leaders to
account
2. Alignment through
simple rules
Identify a few simple
rules that everyone
is accountable for,
operating in
conditions of greater
individual freedom

Background: why simple rules?
• Rather than compliance to sets of standards and policies,
we seek to identify a few simple rules so that everyone
understands why and what we are doing
• We want a situation where everyone understands the
simple rules and delivers them in their own way
Our goal with the simple rules is not to exercise control but to
establish the high level principles within which we all operate
What we are NOT saying:
• This is how you should do it
or
• Do whatever you like
What we ARE saying:
• these are the ways we
want to work– express
yourself using those
elements

8 simple rules for designing the future of
health care
1. Name the problem
2. Build on successes
3. Take leaps of faith
4. Look outside medicine
5. Set aims and show constancy of purpose
6. Understand systems
7. Make action lists
Source: Frank Davidoff : summarising the underlying in principles in the book
Escape Fire by Don Berwick, 1992-2002
8. Never, ever, lose sight of the patient as the central figure

Oldham: simple rules for Covid-19 response
*Note: the NCA is the Northern Care Alliance, the local NHS system of which Oldham is part
*

The simple rules
of Timpsons Ltd.
Source: Tweet from
John Timpson, the
CEO of Timpsons Ltd:
https://twitter.com/J
amesTCobbler/status
/1315580698447745
025
• We prefer initiatives to processes
and shop visits to meetings
• We like working hard and having fun
• We don’t have secrets and we don’t
do politics
• We like lots of ideas and very low
overheads
• We keep it simple and do it straight
away

The people
Everyone in the system who has a
right to health, healthcare and
wellbeing and seeks to be healthy
and well (on the terms by which they
define “healthy” and “well”)
Everyone who has a role,
individually and
collectively, in the service
of supporting people to
be healthy and well
Leaders of the system
The simple
rules are for
leaders, in the
context of
partnership
People who contribute to
the leadership task of
providing service and keep
people healthy and well,
within the formal and
informal system
Givers of service
Our shared
purpose

Givers of service
Learning from soccer:
the “triangle” to
minimise risk

Through co-production

Creating tomorrow today: Seven simple rules for
leaders

Jönköping: Our shared purpose
1. Define our shared purpose

leaders
2. Root our
transformation
efforts in a sense
of belonging

2. Root our transformation efforts in a sense of
belonging
What is the essence (“the
….ness”) of your place or
community that you want
to bring out in your
transformation approach?
Fairness and
justice
How are you creating a sense of
belonging so that everyone is seen
and valued for our own unique
and authentic selves?
Belonging counts more than
diversity (the facts) or inclusion (a
choice)
When we feel we belong, we
thrive, and so do the people
around us.
https://t.co/ccUwUHRMjp?amp=1https://t.co/qIpGqZBL0p?amp=1

leaders
3. Go backwards in the
care/health process as a core
principle

In Jönköping, the system for “health” starts a long
way upstream of primary care
3. Go backwards in the care/health process as a
core principle (go upstream)

A mindset for connecting and
improving complex care
2020-11-02

• What is best for Esther?
• Be responsible for your work,
give feedback to the step
before you and make it
easier for the next step!
• We do it together

Digital coaches
from the living
library
Digital ArthroS
school
The same digital
platform for
community care,
primary care and
specialty care
New work
processes and
micro-team
learning
Patient compact
As
expressed
in the
Jönköping
response
to
Covid-19
Supporting
community
health centres

leaders

4. Support people to build their agency (power)
at every level of the system
Source: Sir Harry Burns, Scotland

Power and flexibility to
control their working
lives, experience joy in
their work, and to
continuously learn and
improve services
4. Support
people to
build their
agency
(power) at
every level
of the
system
Leaders who coach others
and humanise work,
building collective agency,
rather than coercing,
dictating or treating people
like “resources” or
widgets
Givers of service
Different
starting points
in terms of
power and
privilege mean
we have to
address issues
of inequality
and injustice.
A system that activates health rather
than treat deficits or “fixes” people.
People grow autonomy and the right
to make their own choices about their
own health, based on “what matters
to me”, and shaped by access to
expert and collective knowledge
The people

leaders
5. Embrace
contradictions
and tensions

The covid-19 response is exposing many
polarities (paradoxes/competing tensions) in the
system
• Commanding leadership vs relational
approaches
• Upstream care vs intensive care
• Self screening vs diagnostic speed
• Self-learning vs the development of
competence
• Population health vs specialist care
• Specialist versus generalist
• Formal power versus social influence
There is rarely a
“right”, “wrong”
or “best” for all
contexts. We
have to work
comfortably with
the contradictions
of “both/and”

leaders
6. Unleash learning as a
power for transformation

Taking responsibility for
our own learning so that
personally and
collectively, we can
support people to
achieve their health
goals
6. Unleash
learning as a
power for
transformation
Supporting people and
givers of service to
grow and develop in
their own lives towards
their potential
Givers of service
Gaining power by learning about
our own health and wellbeing, in
the context of our goals in life
The people

6. Unleash learning as a power for transformation
The habit of collaborative learning
The only way we may ever get at the knowledge we
need for large scale change is through collaborative
learning with others. Improvement oriented individuals,
organisations and systems start from the premise that it
is better to be open and curious than defensive.
The habit of change
No matter how much we know, improvement only
comes about when we do something differently. People,
givers of care and leaders who are successful at
improvement know that improvement requires change.
EVIDENCE-BASED QUALITY IMPROVEMENT, PRINCIPLES, AND PERSPECTIVES, Paul Plsek,
https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.203.3566&rep=rep1&type=pdf

Unleashing learning:
“Learning through the eyes of the user”
the new era of process improvement
“The secret to building great
services is not creating
awesome features but
awesome users”
Planning, organising people,
communication and other
components of a service to
enhance the customer´s
experience of the service

6. Unleash learning as a power for transformation

leaders
7. Action
small-scale
changes within
a large-scale
framework

7. Action small-scale changes within a large-scale
framework

7. Action small-scale changes within a large-scale framework

Independent
Co-dependent
Single integrator:
IndependentCo -
Source: Stephen Covey and Bill Tolbert, From an adaption by Dave Ford. Care Oregon
Multiple co-integrators:
Vertical integration
Horizontal integration
Shared purpose, simple rules, collaboration
A vertical or network model?
Network model
Ownership
Dependent

Friendship
Love Collaboration
ArtRelationship Partnership

Creating tomorrow today: a radical manifesto for leaders of health and care

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Creating tomorrow today: a radical manifesto for leaders of health and care