Transforming Rural Health: equipping Managers to be …€¦ · · 2017-05-11Transforming Rural Health: equipping Managers to be the change they want to see ... VUCA Volatile Change

Transforming Rural Health: equipping Managers to be the change they want to see

Tanya Lehmann

14th National Rural Health Conference, Cairns 26 – 29 April 2017

MetaIntegral Associates Be Impact

SA Health

Acknowledgement of Country

We acknowledge the traditional custodians whose ancestral lands and waters we are meeting on here today, and pay respect to the Elders, past, present and future. We acknowledge the deep feelings of attachment and relationship of Aboriginal people to country.

SA Health

SA Health

Acknowledgement of Team

> MetaIntegral Consultants • Dana Carman • Dr Simon Divecha

> CHSA Project Team • Matt Cesaro, The Change Department • Kylie Williams • Brett Humphrys • Kerry Dix • Action Learning Group Facilitators • Executive Sponsors • Managers


Organisational Context

SA Health (

Country Health South Australia

> 64 hospitals, 220 locations > 8,000 staff > Serving 486,000 people (28.9% of SA) > Approx. 1 million sq km (99% of SA)


SA Health

Strategic Directions

Vision To be the best rural health service

Mission Growing better services in country; keeping people well at home

Values • Customer Focus • Collaboration • Care • Creativity • Courage MetaIntegral

Associates Be Impact

SA Health

Challenges > Consumer needs are growing

• Ageing population • Increasing burden of chronic disease

> Consumer expectations are increasing > Growing costs of health care

• Increasing role for technology (black spots) • Consumers and resources spread over 1M sq km • Transport barriers

> Workforce recruitment, retention, capabilities > Ageing infrastructure > Health system funding reforms

• Consumer Directed Care – ageing, disability • Funding models assume market will supply • Market failure in remote & rural areas

> Politics and Culture • Privilege technical expertise (knowing over learning) • Risk aversion, risk containment • Poor track record in managing change MetaIntegral

Associates Be Impact

SA Health MetaIntegral Associates Be Impact

VUCA

Volatile Change rate and speed, flux, instability

Uncertain future is unpredictable, potential surprises, unknown outcomes

Complex challenges are complicated by many factors, multifaceted

Ambiguous little clarity on what events mean and what effect they may have

SA Health

The speed of change is accelerating. Change will never again be this slow

SA Health

> Most managers are in over their heads

> Their mindset (cognitive complexity) is not as complex as the demands of their job

> When challenges are more complex than a leader’s operating system can handle, simply learning new information or building a bigger toolkit doesn’t work

Image by Bansky

SA Health

SA Health

Technical vs Adaptive challenges

Technical: can be resolved through application of authoritative expertise, known solutions

• Eg: install a new ICT system, remodel a facility

Adaptive: requires transformation of thinking, values, strategies, methods

• Causes lie in internal & intangible aspects of human life such as beliefs, feelings, values

• Solution does not lie in what worked in the past

“The biggest waste of resources by organizations and institutions comes from trying to apply purely technical solutions to adaptive problems.” Ronald Heifetz, M.D. Kennedy School of Government Author, Leadership Without Easy Answers

SA Health

SA Health

“The challenge is often misunderstood to be a need to better ‘cope with’ or ‘deal with’ complexity. But coping and dealing are insufficient for meeting today’s complex challenges. We must adapt and evolve.”

Dr. Robert Kegan Professor in Adult Learning and Professional Development

Harvard Graduate School of Education

SA Health

“Best Rural Health Service”

SA Health

How do we build the capacity of our managers to think differently about performance and act differently in response to complex challenges that defy simple technical solutions?

SA Health

“I have one major rule: everyone is right, but only partially so” – Ken Wilbur

Adapting to Complexity: Perspectives

SA Health

New thinking: what is really going on here?

INTEGRAL FRAMEWORK > 4 fundamental perspectives > Everyone is right, but only partially so > A framework to guide seeking, taking and

coordinating perspectives • Organise complex information • Analyse a situation • Architect an intervention

> Equal attention to subjective & objective, individual & collective factors


SA Health

Integral Framework Individual

Collective

Subj

ectiv

e

Obj

ectiv

e

SYSTEMS “its”

BEHAVIOURS “it”

INTENTIONS “I”

CULTURE “we”

Mindsets Attitudes

Self-awareness Motivations

Emotional Intelligence

Shared Values Group Norms Team Morale

Relationships Culture

Skills Capacity Behaviours Individual performance

Structures Processes Environment Strategy Policies


SA Health

SA Health

New actions: from either/or (technical) to both/and (adaptive)

PROBLEMS > Not ongoing, is an end point > Are solvable > There is no need to include

an alternative for the solution to work

> They can stand alone > They often contain mutually

exclusive opposites Examples: > Should we promote Bill? > Should we buy the new

equipment? > Should we remove 1 layer

of management?

POLARITIES > Ongoing, not solvable > Need to be skilfully

managed over time > Always contain mutually

inclusive opposites > Interdependent alternatives

need each other to optimise the situation

Examples: > Individual and team > Stability and change > Planning and action > Cost and quality > Participatory and directive


Polarity Map

Upsides Upsides

Downsides Downsides

Pole

Early Warning Signs?

Higher Purpose

Greatest Fear

High Impact Actions

Early Warning Signs?

Pole

High Impact Actions

A process to shift mindsets Move from either/or to both/and thinking Identify early warning signs and high

impact actions


Implementing an Integral Performance Framework

SA Health

We want to be here

CHSA Strategic Plan

Vision

We are here

More integral

performance

Metrics Objective Subjective LR UR UL LL

Time Connections Timeliness Interconnectedness

An Integral Approach to

Performance Improvement in CHSALHN

LR

SA Health

Country Health SA’s Integral Approach to Performance

Systems A new Framework, tools and processes to analyse & design performance improvements (make it easy for everyone to do it)

Behaviours Build Manager experience through doing, develop new knowledge , language & skills to tackle complex challenges (show me how)

Intentions / Mindsets Tap into managers’ personal aspirations to be effective, to skilfully manage real performance challenges. (give me a reason)

Culture Grow an action learning culture, working in teams on real problems, sharing stories of success and failure (show me others doing it)

SA Health

Timeline of project > MetaIntegral Leading Change workshop > Integral analysis of Strategic Plan + current

Performance Framework (the gap) > Exec approval to develop Integral

Performance Framework and prototype in 2 regions

> Prototype phase (workshop + 120 day)

> Exec approval to scale up, recruitment of Action Learning Group (ALG) facilitators, Executive workshop on KPIs • Regions 3 & 4 (workshop + 90 day ALGs) • Regions 5 & 6 (workshop + 90 day ALGs)

> Planning for post June 30 (embedding in the organisation’s DNA)

> Phase 1 implementation complete

Dec 14 Early 15 Mid 15 Oct 15 – March 16 June 16 Oct 16 Feb 17 April 17 June 17

SA Health

Examples of VUCA challenges

> Reducing hospital length of stay > Potentially preventable admissions > Emergency Department wait times > Mandatory training compliance > Achieving % Aboriginal workforce target > Managing poor performance > Data quality and timeliness > Implementing consumer directed care > Delivering safe, quality services on budget > Reintegrating ‘central’ staff into ‘regional’ teams

following a restructure > Standardised uniforms

SA Health

Case Study: Aboriginal Health, cultural safety & performance > Problem:

• Poor performance – % Aboriginal workforce, Aboriginal self-discharge, cultural competency training compliance, responding to complaints

• Limited DON engagement • Aboriginal Health Advisor reporting on under

achievement of targets, no authority, frustrated > Fresh approach:

• Equity & Equality – mindsets, assumptions • Objective map of subjective factors • Organisational support courageous AHA • Curious inquiry, less confrontation/blame • Peers co-designing strategies

SA Health

Case Study: Potentially Preventable Admissions (PPAs) > Problem:

• Stuck performance issue, unable to achieve PPA target <8.5% (>10%)

> Fresh approach: • Seek broader perspectives (redefine problem) • Highlighted role of staff mindsets & culture

(previous attempts focussed on systems) • Opened up safe ‘no blame’ inquiry • All could see their part of the problem and the

shared, co-designed solution. • New system and process implemented -

monthly multi-D sub-committee deeply analysing issues

Results

SA Health

“This gives me permission to not have to come up with solutions straight away. I can take the time to inquire from broader perspectives so I don’t need to have all of the answers.” Director of Nursing

“These tools may help us solve the problems we thought were unsolvable” Direct of Nursing

“I have worked with these Leaders for years. It’s been amazing how the frameworks have opened up new conversations about culturally safe services.” Aboriginal Health Advisor

“I have used the quadrants to help me manage HR issues within my team and also to help others see things differently.” Corporate Services Manager

“The tools have opened up different thinking and conversations at a leadership level. We’ve all had rich individual learning which will stay with us for our whole career.” Regional Director


SA Health

Outcomes > Intentional

• Leaders reported enhanced self-awareness and understanding of their own impact on performance and limitations of their own perspective

• Project Team reported significant improvement in leader acknowledgement of the influence of their own values, perspectives and biases

• Action Learning Groups noted examples of shifting mindsets (either/or to both/and; and gathering more perspectives before making plans or decisions).

> Cultural • Leaders were able to better identify organisational, team

and professional culture factors impacting on performance • Project Team reported leaders gained valuable insights

and connections with peers through Action Learning Groups, and observe an action learning culture emerging

• Action Learning Groups demonstrated value of peer learning and its impact on leadership culture


SA Health

Outcomes > Behavioural

• Significant skill development (20 Executive, 120 senior managers completed training, 18 Action Learning Group facilitators)

• Leaders reported using the integral language, perspectives and tools in their daily work

• Action Learning groups demonstrated strong engagement and psychologically safe conversations

> System • Integral tools were identified by Leaders to be key to

applying concepts to performance challenges • Over 20 integral analysis and over 50 polarity maps

developed and shared via the wiki • In Mentor groups, examples were shared of the benefit of

Leadership Groups all having new language, tools and approaches to consider complex performance challenges.

• Performance breakthroughs (improvement in KPIs)


Conclusions & Recommendations

SA Health

Conclusion We can and must build the capacity of Health

Leaders & Managers to adapt to complexity and be the change they want to see in the world

Key success factors: Executive commitment (top down), bottom up buy-in Empowerment of champions (ALG, Project Team) A long term vision, with continuous attention to

evolving the strategy as players change, opportunities and risk emerge

Embedded learning and development strategy that gives teams time to apply new learning to real performance challenges

Simple tools and a common language to facilitate fresh conversations, and safely challenge unhelpful mindsets & culture

Opportunities to share stories of both success and failures, to build a culture of learning and adaptability


“It is better to light a candle than curse the darkness” – Victor Hugo

SA Health

14NRHC Recommendation Commonwealth and State Governments, Health Service Provider Executives, Professional Bodies

Actively invest in action learning and development programs for Managers , so they can develop transformational leadership skills on the job, tackling real-life complex performance challenges. This could include scholarships, quarantined funding for PD and supported in-house development programs.

Because Managers play a crucial role in the performance of health services, and require support to develop the skills required to adapt and thrive in VUCA.

Ongoing MetaIntegral Associates Be Impact

WHO

WHAT

WHY

WHEN

Transforming Rural Health: equipping Managers to be …€¦ · · 2017-05-11Transforming Rural Health: equipping Managers to be the change they want to see ... VUCA Volatile Change

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