I recently attended the Sustainable Healthcare Transformation conference in Hobart, organised by the Health Services Innovation group at the University of Tasmania. I thought I’d share some of the key messages I took away from the invited speakers, who were an excellent array of local and international experts in engagement, innovation and sustainable change.
Two of the talks I (very surprisingly) liked most at Hobart were from people outside the Health Industry. They both spoke about engagement being the key to long term change – the relationships and networks that are developed between those wanting the change, those in leadership, those on the ground enacting the change, those benefiting, those losing out because of the change. Whose responsibility it is to develop those relationships, who maintains them? Understanding that none of it is linear, it’s all about complex networks.
Prof Jeffrey Braithwaite, Director Australian Institute of Health Innovation, Macquarie Uni
- Jeffrey spoke about the need to develop a resilient healthcare system – focusing on the 80% positive, rather than the 20% negative. Start to be proactive rather than reactive.
- We need to move away from a linear reductionism approach – it can no longer be about finding and fixing single issues – and realise that anything we try to influence is a complex adaptive system.
- Jeffrey did a survey of the room and found that while the health profession was widely represented, not a single
patient or patient advocate was present. Ouch.
Sir Robert Naylor, Chief Executive of University College London Hospitals.
- Sir Robert described the set-up of UCLH as an academic health science centre, and indicated he thought Australia and particularly Tasmania was well-placed for such centres
- UCLH aim to be world class, and he described how “world class” is measured – lots of ranking and benchmarking.
- The success of UCLH is largely because of specialisation. Realising what their strengths are and focusing on those. He gave the example of UCLH deciding to stop offering Cardiac services, and instead become the sole provider of cancer services in the region.
- He observed that the NHS is revered by the English people, not unlike a religion, and sweeping changes are planned by politicians only at their peril.
- Whilst it was a powerful success story, I’m not sure I agreed with his methods entirely
Mr Anthony Moorhouse, CEO Dynamiq
Anthony spoke of his experiences setting up a disaster management firm.
- He gave some examples of opportunistic innovation, and how technology is becoming a game changer in health – eg: wearables such as FitBit, and research data collected in realtime through smartphones.
- His key takeaway message: change will only happen in an environment that is willing to change. “Blind defensiveness of the status quo is the kryptonite of innovation”
Prof Andrew Pettigrew OBE FBA, Said Business School, University of Oxford
- Prof Pettigrew described his and colleague Sergio Seabra’s work looking at reform in the NHS
- Earlier eras of reform focused on targets and performance (or targets and terror!)
- But reformers made the mistake that structural change does not equal behavioural change, and the changes were not sustainable
- There are three sets of complementary capabilities that are necessary to improve: Cultural, Functional, Positioning. These capabilities must be improved in conjunction: trying to improve one without the others will fail.
- We must flip the culture to one of action rather than blame
- Beware the perils of the J curve – in order to rebuild, you must first dismantle and disrupt. This entire process can take 4-8 yrs (yet the average term for a UK politician is 700 days)!
- Avoid having short-term leaders: what happens with a 3 yr CEO term? Year 1 is spent on a steep learning curve; year 2 sees the new CEO unleash their own big change/legacy on the system; and year 3 sees them lay the minefield for their successor!
Dr David Rosengren, Director EM Greenslopes Hospital, Chair Qld Clinical Senate, Chair Qld FACEM
- David described the “perfect storm” in Qld that saw austerity measures intersect with woefully unmet targets and poor performance (which he poignantly reminded us in our industry actually means patients dying in the back of ambulances ramped in ED waiting bays) to necessitate an urgent need to address access block.
- His successful approach was engagement. With every possible stakeholder that was involved! This was hard, and increased the work, but meant that eventually everyone was in agreement and there was nobody to throw a spanner in the works.
Ms Janet Compton, CEO Northern Health, Victoria Dept Health
- Janet described her implementation of Lean methodology and a partnership with Toyota Australia to turn around the performance and image of Northern Health, which were the lowest in the state.
- Janet referred to Helen Bevan’s work in the UK, saying intellectual engagement is not enough, staff need to be emotionally engaged in the change.
Dr Anthony McCann, Director of Hummingbird Culture Change
- Anthony gave, in my opinion, one of the more interesting presentations of the conference.
- He spoke of “culture climate” being the key influencer of all behaviour, expectations and change: “The biggest driver of change, whether helpful or unhelpful, is the dominant quality of relationship within an environment, the dispositional quality of an environment – how it feels. … Until the cultural climate, the personality, of an organisation changes, nothing substantially changes.”
He described an Irish word Garaiocht: Garaíocht means, more or less, ‘being actively responsive in an atmosphere of helpfulness’. In the context of our work, garaíocht is taken to refer to the optimal conditions for creativity, imagination, interdependence, self-care, and mutual support in personal relationships or professional working life.
- He closed with a lovely thought: Trauma happens quicker than healing, we need to be patient.
A/Prof Kalyan Pasupathy; Co-Director, Healthcare Systems Engineering program, Mayo Clinic
- Kal described the Mayo Clinic’s
integration of engineering research with clinical treatment. Using data and real-time research to improve patient flow, and treatment options.
Ms Holly Ransom, HRE Global
- Holly was a Youth representative at the G20, and has been called on by CEOs to improve communications within their companies – specifically to find better ways for the senior staff to engage with those on the ground, and vice versa.
- She asked the audience members to tell the person beside them, in one minute, about an innovation they’re trying to implement in their workplace. She then asked us how many of us skipped over “Why” we’re doing the innovation, and went straight to “what” we’re implementing.
- Her key point was that if all the stakeholders (and this includes management, the staff on the ground making the changes, those benefiting and losing out from the change) weren’t convinced by the “WHY”, then the innovation is doomed. Concentrate on getting the “WHY” right, then move on to “what” and “how”.
Ms Janet Anderson, First Assistant Undersecretary – Acute Care Division, Federal Dept Health
- Eloquent as always, it was so refreshing to hear Janet, a senior DoH official, recognise that we have a serious issue with inappropriate care in Australia
- She gave many examples of where we can do better, and pointed to the OECD Healthcare Variations Study, and the ACSQHC’s Australian Atlas of Healthcare Variation, which is due for release this year.
And most importantly of all, the conference “networking” event was held at MONA which was incredible, so I’ll leave you with some pics of that. Congratulations to the University of Tasmania Health Services Innovation group for a wonderful conference. I’ll be looking forward to the next one!
AusHSI Centre Manager