1. DEFINING MOMENTS: 20 YEAR VISION FOR HEALTH
Chair: Paul Barach, MD, MPH
Facilitators: Billie Atanasova &
Vanessa Vanderhoek

2. Burning platform
Australia’s 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

3. 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
The biggest problems is that the population and its needs have changed, but the way in which we do things has remained the same since the end of the 19th century. Patients coming to a hospital today would not notice much change in terms of the use of ICTs compared with 20 or 30 years ago. The buildings would be nicer, the tools for diagnostic and treatment would be fancier, but the way in we interact with them would be basically the same.

4. Health Care is Broken-view of patients
It isn’t 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

5. 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.

6. The ACHSM’s 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

7. Reason – Complex Systems

8. 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.

9. 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

10. 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.

11. 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.

12. Value Compass Thinking
What are the outcomes in care that are important for us to measure?
Functional
Status
Satisfaction
Against Need
Clinical
Status
Costs

13. Stages in the development of a safety culture
GENERATIVE (High Reliability Orgs)
HSE is how we do business
round here
PROACTIVE
Safety leadership and values drive
continuous improvement
Increasingly Informed
CALCULATIVE
We have systems in place to
manage all hazards
Increasing Trust and Accountability
REACTIVE
Safety is important, we do a lot
every time we have an accident
PATHOLOGICAL
Who cares as long as
we're not caught

17. 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?

18. 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?