Welcome to the Blackboard Collaborate Classroom Space Webinar Tutorial 1-1:30pm EST Oct 12, 2012

1. Welcome to the Blackboard Collaborate Classroom Space Webinar Tutorial 1-1:30pm EST Oct 12, 2012 Agenda: • Testing Sound • TestingVideo • Raising your hand • Posting a message in the chat box • Troubleshooting in a breakout room with our “experts” • You must have headphones or mute your mic

2. RETHINK HEALTH: TRANSFORMING QUALITY IMPROVEMENT WEBINAR SERIES Introduction, Course Overview, Building for Collaboration and Leadership in Organizing Ruth Wageman, PhD Ella Auchincloss, MTS Oct. 12, 2012

3. Session Goals • Conduct a before-action review • Identify and anticipate key leadership challenges based on your experience • Harvest lessons from your experience about how to address key challenges, especially about how to get off to a good start • Review the coverage of the course • Connect the modules, syllabus, and overall aims of the course to key leadership challenges in your work • Introduce Organizing as a unique and distinct theory of how leaders can make change happen • Discuss the work processes and support aspects of this course • Surface key strategic questions

4. Ground Rules for Our On-line Classroom Environment • Stay focused on the classroom • Be on time • Raise your hand before you speak • Step up to be on deck • Use the chat board for questions/comments but stay on topic • Use headphones to prevent feedback • Mute if there is background noise • Others?

5. Introduction to the Key Players and Teams: ARK QIO HOU, QIO Albany QIO Baton Rouge QIO BALT QIO Santa Cruz, QIO WVA QIO Coach: PedjaStojicic Coach: Chris Lawrence-Pietroni Coach: Risa Hayes RTH Project Mgmt: Ella Auchincloss Liza Holtzman RTH Faculty: Ruth Wageman RTH Faculty: Kate Hilton CFMC Team: Lindsay Kirsch, Kim Irby, Jane Brock Other ReThink Health Faculty: S. Immediato, M. McGinnis, B. Milstein

6. Leadership is… • …Accepting responsibility to create the conditions that enable others to achieve purpose in the face of uncertainty

7. Introductions and Before Action Review • Who are you? Tell us a story from your own history that will teach us something about you: • Why you aspire to lead this change • What leadership challenges you have faced in your work that this course and this community of practice can enable you to face more effectively

8. Before Action Review: Your Story

9. Before Action Review Reflecting on the challenge before you and the obstacles your colleagues have identified… What one or two key lessons of experience would you be sure to capture? What works/does not work in leading this kind of change effort?

10. Key Lessons from your experience

11. Seeing Ourselves in the System First image of the entire Earth - 1968 Each of us is a system citizenin that we are (potential) change agentsin the systems of which we are a part.

12. The Volume of Evidence and Recommendations for Action is Expanding…Very Quickly …Raising Many Practical, Strategic, Ethical Questions • “WHAT IF…” Questions • Which policies to prioritize? • Likely consequences? • Synergies or Tradeoffs? • Sequences? • Costs? • Time-frame? • How to catalyze action? • How to chart progress?

13. ReThink Health’s Beginnings Don Berwick, CMS, IHI Elliott Fisher, The Dartmouth Institute Amory Lovins, Rocky Mountain Institute Jay Ogilvy, Global Business Network Celinda Lake, Lake Research John Sterman, MIT System Dynamics Group Marshall Ganz, Leading Change, Harvard Peter Senge, MIT and the Society for Organizational Learning ElinorOstrom, Nobel Laureate in Economics, Indiana University Laura Landy, Rippel Foundation

14. About ReThink Health

15. Organizing-Stewardship-Dynamics • Dynamics • How is the health system structured? • How and when does it change (or resist change)? • Where is the greatest leverage? • What trade-offs are involved? • What if non-experts could test possible interventions for themselves? Organizing What does it take to build the leadership for widespread engagement and shared commitment to focused campaigns? Stewardship • What conditions enable local leadership teams to develop the will and ability to act on behalf of the whole, and sustain their stewardship over time? • Right people, governance structures? • Strong starts or renewed beginnings? • Shared values, intrinsic motivations? • Collaborative muscle?

16. Leadership is… • …Accepting responsibility to create the conditions that enable others to achieve purpose in the face of uncertainty • Accepting responsibility: stewardship of the whole • Create the conditions: understand and act on the system in ways that enable sustainable change • Achieve purpose: shared purposes cannot be assumed, they must be built • Uncertainty: recognize that success is about building others’ adaptive capacity (not solutions)

17. Course Coverage • Beginnings • Harvesting lessons of experience • Getting ourselves oriented and on a positive trajectory • Leadership teams • Convening the right people, working toward a shared purpose, and getting them started on a healthy trajectory • We are front-loaded on organizing skills needed to launch action • Narrative: Story of self • Personal leadership practice • Enabling the identification of truly shared purpose, rooted in values

18. Course Coverage • Relationships, recruitment, and power • Understanding others’ interests and resources • Identifying and building key leadership capacity • Learning from experience • Lessons in practice: narrative, relationships, and teams • Story, strategy, structure: Story of now • Building shared aspirations for positive possible futures for the system • What happens if we don’t act?

19. Course coverage (continued) • Strategy • Building and deploying power and capacity • Timing and goals towards measurable outcomes • Structuring in learning, coaching, and measurement • Approaches to assessing capacity • Building sustainable support for leadership skills • System dynamics and campaign structure (Face to face convening in December) • Systems thinking and sustainability • Building organizing structures that expand capacity

20. Course Coverage (continued) • Leverage for sustainability • Your approach to sustainable system transformation • Aspirational model and leadership implications • Power, alliances and incentives • The enabling conditions for sustainable, collaborative stewardship of a whole system • Professionalizing stewardship • What if every community took the catalyst role seriously?

21. What is leadership? • Decision not a position • Authority is claimed, not bestowed • Focus is on developing others, not just yourself ‘Leadership is taking responsibility for enabling others to achieve shared purpose in the face of uncertainty.’

22. Organizing: People, Power and Change …people acting together to change the status quo

23. What is Power? The ability to achieve purpose The ability to grow in capacity

24. Organizing is not to be confused with… Charity: We aren’t providing a service to needy clients Marketing: selling a cause or issue Technical Innovation: We aren’t inventing a solution to a technical problem Awareness Raising: if people were informed, they would change their behavior

25. Our Goal: Interdependent Leadership People don’t burnout or flake-out Everyone has a clear role and sense of purpose The team performs better over time Leaders don’t have to “hold” everything

26. How do we build interdependent leadership? LEADERSHIP GOAL CONSTITUENCY The Five Key Leadership Practices Resources

27. Operation Safe Surgery: South Carolina The Challenge: Adoption of the Safe Surgery Checklist Mike Rose, the QI Chief at McCleod Hospital needed a way to the surgeon accountable for using the checklist, because the goal is overall patient outcome. His challenge is distributing leadership and responsibility among the OR teams. The Campaign Goal: Organizing hospital teams to achieve zero harm in surgery through 100% use of surgical safety checklist (brief, time out, debrief) in his hospital. The Intervention: Building teams around shared values for patient outcomes and giving the team the tools to hold itself accountable for using the checklist.

28. How Dr. Rose Used the Tools of Organizing

29. Outcomes • 100% of SC Hospitals are using the checklist • Higher job satisfaction reported by nurses and technicians who went through training • 80% of surgeons at McCleod Hospital are using the checklist • Dr. Rose reports that no other intervention has been more effective • SCHA featured McCleod’s work in recruiting AtulGawande to establish the Operation Safe Surgery campaign—Mike Rose is leading the way “We've been able to touch the lives many, many patients (and renewed our own spirit) as a result of learning the methods and ideas of your team.” -Dr. Mike Rose, VP Surgical Services, McLeod Regional Medical Center

30. Webinars and Coaching: Expectations • Attendance, preparedness and participation in all webinars and at the QualityNet training • Meetings with your coaching team on a weekly basis • Completion of all worksheets, readings and reflections • Commitment to “trying this on” and practicing the skill • Commitment to coaching others • Commitment to having the right technology for your meetings: headphones, webcam and strong internet access • RTH-CFMC commits to keeping emails to two or more per week—please read them

31. For next time • Read “Building Great Leadership Teams for Complex Problems” • Watch “Nobody on the Podium” video in advance • Prepare these two questions: • Positive lessons: What do you see in this unusual team that you’d want to see in any leadership team of which you are a part? • Negative lessons: What do you see that you would not want in any leadership team of which you are a part?

32. Debrief and reflections • What worked and didn’t today? • Reflection to share with the group about key challenges, new thoughts • One word about how you’re feeling now