Chair: Paul Barach, MD, MPH Facilitators: Billie Atanasova
& Vanessa Vanderhoek DEFINING MOMENTS: 20 YEAR VISION FOR
HEALTH
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Burning platform Australias healthcare system is facing
unprecedented challenges as many other Asia-Pacific healthcare
systems Entire state budgets in Australia will be consumed by 2035
due to a rapidly ageing population and the rising cost of providing
modern health services Scale and gravity of these challenges can be
solved by transformational thinking and leadership to design a
healthcare and social system that meets the needs of tomorrow We
need to create new linkages, new structures, and new ways to work
together
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Healthcare 2013 We are an overloaded system We cannot keep up
with complex diagnostic and therapeutic technologies We have not
changed workflows and roles in the past couple of centuries We have
placed most emphasis on sickness control, not on wellness We face
the same challenges everywhere, but are tackling them independently
We are an overloaded system We cannot keep up with complex
diagnostic and therapeutic technologies We have not changed
workflows and roles in the past couple of centuries We have placed
most emphasis on sickness control, not on wellness We face the same
challenges everywhere, but are tackling them independently
Slide 4
Health Care is Broken-view of patients It isnt safe! People not
getting the care they need Secrecy and cover up of bad performers
Costs too much and riddled with waste Systems are complex,
bureaucratic We are not seen as partners in OUR care Patients and
their families are not told the truth
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Health Reform Value As the Australian health care system
continues to transform, it is only by listening to those we aim to
serve that we can ensure that changes will produce the desired
outcomes.
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The ACHSMs strategic goal of thought leadership for
transformational change and a vision to create Brilliant Leadership
for Healthy Communities ACHSM framework paves a path for how each
of the domains and elements influence one another in large- scale
transformational change The framework sets out how alignment,
collaboration and co- operation between all of the domains are
essential to achieve large- scale transformational change of the
whole healthcare system
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Reason Complex Systems
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Normalized Deviance By a deviant organizational behavior, we
refer to an event, activity or circumstance, occurring in and/or
produced by a formal organization, that deviates from both formal
design goals and normative standards or expectations, either in the
fact of its occurrence or in its consequences. Once a community
normalizes a deviant organizational practice, it is no longer
viewed as an aberrant act that elicits an exceptional response;
instead, it becomes a routine activity that is commonly anticipated
and frequently used. Diane Vaughan, 1999: 273.
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The Normalization of Deviance: Do We (Un)Knowingly Accept Doing
the Wrong Thing? Failure to wash the hands before and after patient
contact No consultant or supervision overnight or on weekends Lack
of/standardised Handovers of care at vital times (emergence,
induction, separation from cardiopulmonary bypass, etc.) Ignoring
key outcome metrics such as HSMR, patient complaints Productivity
above all
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How does it start? A permissive ethical climate, an emphasis on
financial goals at all costs, and an opportunity to act amorally or
immorally, all contribute to managerial decisions to initiate
deviance.
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The Role of Managers Normative standards of behavior are not
simply imposed on managers by more powerful organizations such as
the state or professional organizations. Managers themselves are
participants in the construction of the commonly accepted standards
of behavior under which they operate.
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Value Compass Thinking What are the outcomes in care that are
important for us to measure?FunctionalStatus Satisfaction Against
Need Costs
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Stages in the development of a safety culture CALCULATIVE We
have systems in place to manage all hazards PROACTIVE Safety
leadership and values drive continuous improvement REACTIVE Safety
is important, we do a lot every time we have an accident
PATHOLOGICAL Who cares as long as we're not caught Increasingly
Informed Increasing Trust and Accountability GENERATIVE (High
Reliability Orgs) HSE is how we do business round here
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Questions for reflection What does the system really need for
large-scale transformational change of the whole healthcare system?
What are the key issues for health leadership for health and what
should be the focus when transforming the healthcare system? What
kind of innovative initiatives should be implemented for
large-scale transformational change? What are the elements for
creating a culture of change that will lead to continuous
improvement in the healthcare system? What is the role of
consumers/patients and communities in driving healthcare
reform?
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Let the discussions begin... What policies and practices are
needed for large-scale transformational change? What is the role of
transforming health services culture and behaviours in large scale
transformational change? What is the role of prevention of disease
and improving health-related quality of life in large scale
transformational change? Who must be empowered and engaged to
change the health care system?