Jan
10

HOW TO STOP BLAMING:Six Principles For Accountability Design

by Ted Ball

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“Ted Ball’s presentation to the South West LHIN health service providers was engaging and thought-provoking, conveying a perfect mix of unbridled optimism and stark realities.”

-- Michael Barrett, CEO, South West LHIN

To view Ted's presentation at the South West LHIN, click Quality Symposium

Ted Ball is available to address conferences or design retreats for Governance & Management. Give him a call @ 416-581-8814 and explore your unique circumstances.

“After our two-year investment in capacity-building with Quantum, we had remarkable performance improvements and extraordinary value. Today, our 120 directors, managers and other key leaders are not just more strategic, more aligned and more leveraged, they are also happier, more collegial and more effective as leaders and managers. We are achieving real results with these adult learning technologies and systems thinking tools.”

Bonnie Adamson
Former CEO, North York General Hospital, 2008

TED BALL has been a coach, guide and mentor to CEOs, Ministers of Health and Executive Directors of community agencies for 20 years. Now, through the Quantum Leadership Institute, you can access Ted’s leadership coaching insights as well as the powerful learning tools from Quantum to prepare you as a 2nd Curve health system leader. Following an assessment and evaluation dialogue with Ted Ball, coachees can either co-design a leadership learning journey to match their unique needs and budget, or determine that other types of investments in their learning & growth would be more appropriate for their goals.

“Hospitals commonly espouse a commitment to patient-centred care (PCC). Most fail to achieve it.

Today’s healthcare providers were not trained to provide PCC. They lack the requisite skills, and patient empowerment unsettles them.

The term PCC does not accurately describe what modern patients seek. Patients do not want to be at “the centre” of a healthcare construct; they want to be recognized as full partners in their care, and are speaking about this with an increasingly unified and powerful voice.

Indeed, while economics, demographs, and technological advances will continue to prompt change ‘the patient voice’ is poised to become its dominant driver.”

-- Dr. Robert Bear

Is patient-centered care an outmoded concept?

“There is a clear misalignment between what Canadians value, and how Canadian health system performance is measured and funded. Canadian values have shifted substantially in recent years, towards a preference for greater autonomy and empowerment in managing their health care and management. Canadians' values reflect the desire for a more ‘personalized’ health care system, one that engages every individual patient in a collaborative partnership with health providers, to make decisions that support health, wellness, and quality of life.”
Click here for the executive summary of Measuring What Matters: The Cost vs. Values of Health Care – a must read white paper from the Ivey Centre for Health Innovation.

Become part of the worldwide movement to re-humanize healthcare. Heart In Healthcare aims to:

• To encourage health workers to reconnect to the heart of their practice
• Allow compassionate caring to rise above institutional rules and limitations
• Create the world’s most inspiring community of health professionals, students, patient advocates and leaders, working together in a worldwide movement to transform healthcare from within.

Check this out @ heartsinhealthcare.com

"In Ontario unless there is a compelling political and financial case made to restructure the system, it’s safe to assume that Ontario will not move to formalize health system integration through disbanding organizations and creating regional health authorities. The evidence is overwhelming that not only would it be an extremely expensive proposition – somewhere in the $4-5 billion range to harmonize wages – but it would also be extremely disruptive – taking some 4-5 years to re-establish some form of equilibrium – and could also have a significant negative impact on foundation fundraising on which hospitals in particular are dependent."

- Steve Elson
Shared Accountability: the next step in Ontario’s integration journey?

• There will be a 50% improvement in the number of people surveyed who say, “I can contact my primary healthcare team on my day of choice”.
• There will be a 50% reduction in the age-standardized hospitalization rate for ambulatory care sensitive conditions.
• (by March 31, 2014) All patients have the option to receive necessary surgery within three months.
• Zero surgical infections from clean surgeries.
• No adverse events related to medication errors.
• The healthcare budget increase is less than the increase to provincial revenue growth.
• The healthcare budget is strategically invested in information technology, equipment and facility renewal.
• Zero work place injuries.
• (by March 31, 2022) there will be a 5% decrease in the rate of obese children and youth.
• There will be a 50% reduction in the incidence of communicable disease.
• Seniors will have access to supports that will allow them to age within their own home and progress into other care options as their needs change.
• Patients’ ratings of exceptional overall healthcare experience are in the top 20% of scores internationally.
• There will be a 50% reduction in patient waits from General Practitioner referral to specialist and diagnostic services.
• (by March 31, 2015) all cancer surgeries or treatments are done within the consensus-based timeframes from the time of suspicion or diagnosis of cancer.
• Individuals with severe complex mental health issues with alcohol co-morbidity or acquired brain injury will have access to supportive housing in or near their community.
• No patient will wait for emergency room care (patients seeking non-emergency care will have access to more appropriate care settings).
• Employee engagement provincial average score exceeds 80%.
• Increase physician engagement score by 50%.

Like rainbows, examples of patient-centered care are few and far between, but here are some tell-tale signs:
• Providers and patients know each others’ names;
• Patients’ opinions are actively sought, listened to and honored where possible;
• Patients tell you that their doctors and other team members really listened to what they had to say;
• Patients are treated as the most important member of their health care team and taught how they can best contribute to the team’s success;
• Providers feel that their patients are actively involved in their own care; and,
• You see a significant improvement in patient health status, adherence, engagement, level of utilization and patient/provider experience.
-- Steve Wilkins
Mind the Gap

Patient-centered care means involving patients in the planning, delivery and evaluation of health care where it really counts in terms of outcomes, patient adherence, cost reduction and fewer re-hospitalizations.
Being patient-centered is like doing a market research study and then implementing the findings. Patient-centered care does not give absolute control to patients, it simply invites them into the party and gives them a place at the table. As providers, we don’t do a good job of listening to patients. We do an even worse job when it comes to acting on what patients tell us they want.
-- Steve Wilkins
Mind the Gap

1. Care is based on continuous healing relationships.
2. Care is customized and reflects patient needs, values and choices.
3. Families and friends of the patient are considered an essential part of the care team.
4. Knowledge and information are freely shared between and among patients, care partners, physicians and other caregivers.
5. Patient safety is a visible priority.
6. The patient is the source of control for his or her care.
7. All team members are considered caregivers.
8. Care is provided in a healing environment of comfort, peace and support.
9. Transparency is the rule in the care of the patient.
10. All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient. (Borrowed from Margaret Gerteis et al.(Through the Patient’s Eyes)

According to David Carnevale, author of Trustworthy Government, one of the key differences between learning organizations and traditional controlling organizations “is that deeply ingrained defensiveness so characteristic of low-trust, traditional bureaucratic organizations undermines necessary learning. Trust expedites learning.”
Carnevale says that “Healthy learning organizations are managed with the objective of liberating and using employee know-how to improve work processes. The emancipation of employee know-how is enabled through a different philosophy of organization and job design, communication patterns, labor-management relations, participatory methods, and other processes that reduce the climate of fear and allow staff the necessary psychological peace of mind to fully engage their work”.

Traditional bureaucratic organizations are dominated by the need for control and conformity -- assuming that workers are incompetent, and therefore must be carefully managed. In turn, this creates high degrees of mistrust, defensiveness and fear -- all of which undermine learning.

In learning organizations, the assumption of competence is supported through the encouragement of curiosity, creativity and innovation. The people who deliver the organization’s services directly to its customers are encouraged to use their know-how to improve work processes. While successes are a cause for celebration, learning organizations must also accept and forgive mistakes as part of the learning process. They must be open to learning from their “best mistakes”.

At its simplest level, a shared vision is the answer to the question: “What do we want to create. A shared vision is the vision that people throughout an organization or a community of organizations carry about what we want to be in the future.
Peter Senge describes the concept of a Shared Vision in his book The Fifth Discipline. He writes, “a shared vision is not an idea. It is, rather, a force in people’s hearts, a force of impressive power. It may be inspired by an idea but once it goes further - if it is compelling enough to acquire the support of more than one person - then it is no longer an abstraction. It is palpable. People begin to see it as if it exists. Few, if any, forces in human affairs are as powerful as a shared vision.”

“Devolve decision-making selectively and where appropriate. Policy makers should consider expanding the accountability functions of regional bodies, strengthening specialty care networks, and supporting organic mergers and acquisitions within the system. Any system transformation primarily focused on significant governance reforms—for example by reinventing regional bodies from scratch—could actually distract attention from the more organic reforms needed that will have a positive impact on fiscal sustainability and produce unnecessary delay in implementing transformative change.”
– University of Toronto

“A healthy economy and shrinking government debt over the past decade seem to have been the main drivers for soaring health-care spending, while the much-feared aging of the population is having relatively little impact on medicare's bottom line, a new federal-provincial report concludes.
CIHI said that total health spending - by governments as well as private individuals and health plans - is set to reach $200-billion this year, about $5,800 per person. That is an increase of 4%, the smallest one in 15 years.
A separate report looked at the drivers of health spending between 1998 and 2008, when the figure rose by an average of 7.4% per year.
Spending on physicians is the fastest-growing chunk of the budget now, with the increase for 2011 projected to slow slightly to 5.6%. More doctors are being added to the system - 6,500 between 2005 and 2009 - while their income rose by an average of 3.6% per year. That followed a period from 1975 to 1998, however, when MD compensation rose more slowly than other public goods and services.”

-- National Post Nov. 4, 2011

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