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CentreonStrategiesforPublicandCivilEntrepreneurs
www.publicspace.nl
@stevendewaalDr.StevenP.MdeWaal
DisruptionofHealthcare:TherisingpowerofpatientsLectureIndustryForumHealthcare,Pfäffikon(Switzerland)
March7,2018
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Mission ’Winning strategies for the common good’. Open non-ideological inquiry, active international outlook for best practices and interdisciplinary approach. The main mission is promoting active citizenship and social entrepreneurship in public services
ThinkNetwork ThinkTank has evolved into a Think Network. Prominent executives, academics, opinion leaders and decision makers operating in strategic frontiers of public/private corporations
PublicSPACEFoundation(since2002)(www.publicspace.nl/english)
Opinion, blogs and archive on website Core Concept since 2002
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Outline1. Commonknowledge:disruptionasthemoststrategicphenomenoninmarkets2. Surprise:sametechnologiesalsohavedisruptiveimpactonpoliticsandpublic
servicesthroughpowerofcitizenship3. DisruptiveCitizenship:mentality,powertoolsandorganizationcapacity4. Revolutionsarealreadygoingoninhealthcare5. Bigimpactonleadershipinhealthcare.Maindirection:CivilLeadership*Mainchallengeinleadershipmakeslecturesonleadershiprelativelyuseless:Youaretotallyincharge:leadershipispersonal.Onlyyourpersonality,yourleadershipabilitiesandstyleandyourpersonaleffortscount!*Dr.S.P.M.deWaal‘TheValue(s)ofCivilLeaders’,Eleven2014
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Mostimportantstrategicissueinmarkets:disruption
• Recentdefinition:Riseofnewandunexpectedcompetitors,fromoutsidecurrentmarket,innovativeinandthroughtheirdirectaccesstoandexchangewithcustomers
• Commonconclusionuntilrecent:CEO’sseeitlatest.Firstphase:denial,ignorance,defensive(seeminglyrational)critique.Afterthat:surprise!Thisisproofofrealpowershift
• Directexchangeandrealtimeinformation&communicationiskey• Economyandcompetitiondominatedanddictatedbyplatforms• Competitionbetweenplatformsison:
sympathy,belonging,community-feeling,hands-onservice,feelingofbeing‘incharge’andeasytoolsforself-steering
• Themarketnowteachesitscustomersthesevalues&attitude
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Platformeconomyhasalreadywon
AlsoThemeIssueofHarvardBusinessReview,April2016
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Thisisalreadychangingourviewonorganizations:theytoobecomeplatforms,internallyandexternally
Copyright:Accenture2016
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Organizationevolvestointernalplatform:frontlineworkersandexchangewithpatientscrucial
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ThedisruptivecitizenIt’snotjusttechnology(‘stupid’),it’spower-andinformationtoolsandtheirimpactonmentality!a. Shiftinrealpower:data,knowledge,communication,peer-reviews,peer-
organizationb. Shiftinmentality:Ipersonallycangatherinformationandopinions,steer,choose,
organize,manageandconsultpeersPublicserviceshavemoretimetoadjustbytheprotectionofstate,laws,publicfinanceandlobby’s.Notsustainable:- Traditionalpoliticswilllearnquickly:nore-electionwithoutlisteningtothenew
publicpower- Customersofpublicservicewilldemandchangeandchoice;haveadirectand
publicchanneltovoicetheiropinions- Publicdebateandreputationinthesedirectchannels
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MainpowertoolsforcitizensinnewtechnologiesPublicplatform:directandpublicexchangeonallissuesandattitudes,includingamountofsupport(permanentpublicpolling):• classicpoliticalissues(passiveinmodernculture)• newissuesnotonagendaorcoveredscandals• reputationandcomplaintsaboutindividualorganizations,evenpersonelbyname
Mutualorganization*:realtimelinkingofpeersinsamesituationorneedstoexchange&organize:• onneighbourhoodissues(e.g.safetyalerts,neighbourhoodwatch)• inassets(likehousing,gardens,cars)andhelp(likecare,shelter,repair)* NB:Mutualitieswereoncethebasisunderhealthinsuranceandalsolongtermcarein
Europe!
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Mainnewpower-sourceofcivilsociety:independent&directchannelRevolutioninpersonalICT(Information&Communication&Media):• Smart Enormous,stillincreasingcomputingpower• Smallandmobile Closetoperson,alwaysathand• Notjustdata,allmedia Realtimevividactualobservation-andface-contact• Massuseand(!)soexpected Connectionanyplaceontheearth,anytime• Platforms DevelopandsupportexchangeservicesAnewandindependent,localandglobal,ICTandmedia-channelof,toandbetweencitizens.Noselection,reframingorcensorshipoutsidecitizensthemselvesandalgorithms!Getusedtothenewmanipulationinsteadoftheoldandnowdistrustedfilters(politicians,experts,professors,journalists,PRindustry).
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Myintroductionof‘DisruptiveCitizen’inDutchFinancialTimes(August2015)
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Bigimpactoutsidemarkets
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Publicservicesingeneral
Publicservicesarestilldelayingimpactbyusingprotectionofstate,lawsandlobbiesNotsustainable:traditionalpoliticswilllearnquickly:nore-electionwithoutlisteningtonewcivilchannelandpower1. Need/demandforco-productionandco-creation;nolongerjustvoiceandpassive
consumerservice,butco-choice,co-production,partneringwith‘amateur’-cooperatives
2. Reputationbasedonpeer-reviewsondirectchannel,bethere!3. Monopolyisgone:civilinitiativesandcooperationsareheretostay;simple
supplysideattitudewon’twork4. Qualitystandardsarenotonlybasedontechnical/professionalandbureaucratic
paradigm,addpeer-reviewandreputationNEWCIVILLEADERSHIP
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Mainimpactofdisruptivepatientonhealthcare
A.Newpower:1. Independentinformationgathering(knowledgeaboutdiseaseand
treatments,personaldata&medicalfiles)2. Choicebetweenprovidersandevenindividualprofessionalsbasedon
peerreviews3. Self-diagnosis&shareddecisionmaking&individualco-producing
B.Newmentality:4. Self-monitoring&personalmanagementofchainorganization(from
hometohospitalandvv.)5. Collectivepatientandfamilyorganizing&pressureforco-production
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Newprocessingandaccesstofiles
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Directaccesspatientdata,beforethedoctor
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Self-monitoringleadstominimumofambulantcareandmaximumathomedigitalization
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Thismeansenormouslogisticalcentrestomanageandplanthetotalchain
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Evenpatientbodiesbecomemachinepark
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Ortheirhomes
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Inlovewiththenewdoctor?
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Howthischangesleadershipinhealthcare
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LeadershipLeadershipisabout:- Authority(notformalpoweror(management-)position)- Characterandcapacities- Rhetoricsandcharm(spontaneousfollowers)Rootsforleadership:personalpassion,valuesandbiographya. Noleadershipwithoutcontextandreasons:resistanceisnormalb. Leadersmustbeascleverinpowergamesasanybodywithavisionorposition
(goodcharacterandgoodintentionsarenotenough)c. Rules,codes,protocolsarenotenoughtogettherightthingsdone;hidingbehind
themisoftenfirststepinresistance
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Disruption:impactonleadershipinhealthcare
MAINimpact:domainofyourleadership(authority,character,followership)ispatientsandtheirfamiliesasmuchasyourprofessionalpersonelandprotocols!A. Treatingthemequally:bridginginsteadofopposition,hierarchyorneglectB. LearntobeassupportiveANDcriticaltowardscivilactionandself-organizationas
totheprofessionalorganizationC. Partnershipisnecessary:lessprofessionalpower:knowledgeandreferencesare
sharedandpubliclyavailable;shareddecisionmaking
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Addendum1:Summaryofdissertation
‘TheValue(s)ofCivilleaders’(Eleven2014)
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Mydissertation,PhDinOctober2014Researchon30selectedcivilleadersandawebsurveyonapp.200executiveswithexperienceindifferentgovernancecontext.a. Howvaluesandvalueorientations
differbetweengovernancecontexts(for-profit,non-profit,informalactivecitizenship)andinfluenceleadership
b. Whatthevaluepatternsareofthesecivilleadersandhowitisinfluencedbytheirgovernancecontext.
Importantconceptsoutlinedinthestudy:Values,CivilSociety,ValuepatternsofMarket,StateandCivilSociety,PublicValue,GovernanceContextsandLeadership.
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Mainresults
• Yes,thevaluepatternsofthethreegovernancecontexts(for-profit,non-profit,activecitizenship)differsubstantiallyandprobablyinfluenceleadership
• No,thevaluepatternofthesecivilleadersdoesn’tdifferaccordingly• Amazing:thereisacommonvaluepatternforallcivilleaders,theyare‘abreedof
theirown’Side-results:• Civilleaders,despitetheircitizenship,areoftenseenascompetitorsbypoliticians
(whoclaimamonopolyonpublicdebateaboutpublicissues)• Civilleadersareoftenchallengedandhavethecompetencetobeactiveinpublic
debate• Inmostcasesofexecutivepositionstherewasatensionbetweencivilleadersand
theirnon-executiveboards,basicallyonthemanagerialtechnicalattitudeversustheirownvaluebasedattitude.Theyarenot‘easy’executives.
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Civilleadersinmystudyhaveavaluepatternoftheirown(abreedoftheirown)
FreedomofChoice(13)
and
Entrepreneurialspirit(13)
Sustainability/stability(11)
and
Respect(11)
(Social)Justice(9)
Solidarity(8)
and
Self-actualization(8)
Independence(7)
and
Bonding&Bridging(7)
Theyhaveavalue-patternwithtwotracks:Ontheonehand: entrepreneurial,selfsteering,autonomous,pigheaded,
independentOntheother: sociallycommittedandpassionateaboutsocietalresultsfor
targetgroupsandvulnerablecitizensorchangingfailingpublicservices
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Wefoundfourkeydimensionsofcivilleadershipstyle
TogetherthesekeydimensionsdefinethestyleofacivilleaderEverycivilleaderhastomakechoicesonthesekeydimensionstoestablishhis/hertypicalstyleandoperateinawaythathe/shefeelsitmakeshim/hercredibleandeffectiveasacivilleader1. Thevalue-driven-instrumental-neutralvaluestance2. Backstagetofrontstage3. Elitisttocommontouch4. Legitimizationtoinnovation
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Handlingthepublicdebateiscrucialforcivilleader.Thepublicdomainisnotjustforpoliticiansanymore.Thecivilleader’sapproach,styleandcharacterinthesepublicdebatesareasimportant,bothforthepublicacceptanceoftheirinnovativeworkasforthepossibilityoffurtherinstitutionalizingthisinnovation,astheactualpublicvalueoftheireffort.Otherlessonscanbedrawn:• Anyissuecanbechargedwithvalues• Purelyprivateinitiativeswithpositivepublicvaluegeneratelittlepublicdebate• ThepublicdebateisaspecialarenawithlittlecontrolSo,thepublicdebatecanhithard,affectingcivilleaderspersonallyaswellastheirorganizations/networks,withlittleopportunitytocontroltheresult.
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MainimpactofcivilleadershiponhealthcareleadershipPowerofdisruptivecitizenshipwillcomecloserandchangeroles:• Frontlineprofessionalsneedmoredecisionpowerin
theirinteractionwithpatients• Thequestionwillincreasinglybe:whoknowspatient’s
opinionsbest(writtensurveyswillnothelp)?• Howtoprovokeandevaluatethisinformation?• Bureaucraticattitudesininteractionwithcitizens
changestocommitmentandvaluedrivencharacter.Itisrealpartnership
• Howtochoosebetweenupcomingcivilinitiatives?Andbetweenthemandcurrentsupplyinhealthcare?
Mainpointthatwillcreateunrestandinsecurityaboutjobs:A. ThreattoprofessionalsandprofessionalismB. Threattothecurrentmonopoly
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Addendum2:FocusPublicSPACE
Foundation
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Main-topicsPublicSPACEinlecturesandliteratureCitizenforce(hasahistoricalrightastheprivatebasisformuchofpublicsector,2000)tobeextendedwithcitizenpowerlike:‘righttochallenge’,‘vouchers’andpreferenceforsocialenterprises(2015)CitizendisruptionofDemocracy:Thereisalreadyadirectandopeninformation-andmediachannelforcitizens.Itthreatenstodisruptrepresentativedemocracyifnotusedandembracedbycurrentpoliticians(2014)Citizendisruptionofpublicservicesbyriseofself-organization,demandforco-productionandinfluenceofpeer-reviews&ownchoice(2015)ChinaHealthcare:TheDutchhealthcaresystemishardlymarketlike,butverygovernmentsteeredinfinance,services,innovationandstructure.Mainfaultisthatpatientshavenotmuchinfluenceandhardlyanychoiceinprovider(since2011)Strategy:‘Beatingtheodds’Aristoteles:Virtues,Character,Balanceofmiddleinstrategiccontext,PracticalWisdom.Governancecodesmustbeprinciplebasednotrules-basedCivilLeadership:personsandpersonalbehaviourmoreimportantthaninstitutesorstructures.Citizenshipcanandmustbeintheboardroom(2014)
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Latestbook(inDutch),May2015Titletranslation:CitizeninitiativeswithCitizenpowerPresentedtoDirectorofSocialCulturalPlanbureau,amajoradviserforcentralgovernmentonhealthandsocialissuesandpolicies.Basedonlargedebates,physicalandvirtualandliteraturestudy.Mainmessage:Positiveaboutrecentpoliticalattentiontoactivecitizenshipinhealth,socialwelfareandsocialsecurity,but:- toopoliticaltopdownandtoomuch
linkedtopoliticalagenda(budgetcuts)- naiveaboutpowershift- doubtsifmunicipalitiesarecloserto
citizenforce
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PreviouspublicationsPublicSPACE(Dutch)