What is a challenge you are bringing to this Summit? What do you hope to get from and contribute to this community of leaders? Find a partner…4 minutes sharing… then find another partner… then find another.

A Conversation with Risa Lavizzo- Mourey: Transforming Health Care Through Nursing

Risa Lavizzo-Mourey, MD, President & CEO, RWJF Linda Wright Moore Senior Communications Officer, RWJF How do you lead a transformation?

Liberating Structures can be used “back home” in your AC to: Develop ways to work together that spark more innovation and solutions Develop ways to work together that spark more innovation and solutions Individually make progress on challenges you face Individually make progress on challenges you face Help you work more effectively across functions and boundaries Help you work more effectively across functions and boundaries Learn methods to generate ownership of change efforts Learn methods to generate ownership of change efforts

Your Design Team  Pat Farmer Synthesizer  Bill Lecher Graphic Recorder  Gail Finley Harvester  Patricia Hurst Harvester  Elizabeth Sether Harvester  Deb Zimmerman  Juliana Preston Harvester  Debra Toney  Pat Crombie  Marj Dugan Synthesizer  Natalia Baronin  Cordelia Hill

Thank You to Our Sponsors

Two Attributes of a Powerful Purpose A personal touchstone for you as an individual Fundamental justification for the existence of your work to the larger community A powerful purpose attracts participation including and unleashing everyone A powerful purpose attracts participation including and unleashing everyone

9 Whys

Ask, “What do you do when you are transforming healthcare?” –Why is it important to you? –First answer, “_______….” Hmmm, why is that important to you? –Second answer, “_______….” OK, if your dream came true last night, what would be different today ? Keep asking, “Why… why… why… until you make a discovery about your partner’s bedrock purpose. Then switch roles All schedule: 1 minute quiet reflection, generating an activities list 6 minutes in a pair (asking why-why-why questions), 3 minutes each 4 minutes in a a small group (4), then, 4 minutes debriefing, “What happened?” Did a community purpose emerge in your conversation? Raise your hand if you would like to share a pithy insight Becoming Clear on Purpose

2. Where are we starting, really? 5. How are we breaking away from the current state toward the future? Next Week Next Month Next Quarter Next Year Action Task Action Task Current status: Current status: Description Measure of success GOAL 3 Description Measure of success Description Measure of success Strategy Safari G A M E P L A N GOAL 1 1. What is happening around us that demands adaptation? GOAL 2 3. Given our purpose, what seems possible now? 4.What is at stake if we do not change? Current status:

What Will Be Different ! Liberating Structures Acting Our Way Into New Thinking by Including and Unleashing Everyone Develop shared understanding of next steps and strategy Attract more diverse people to the work Restore hope for change by igniting bold action

TRIZ Designing a Perfectly Adverse System to Make Space for Innovation TRIZ Designing a Perfectly Adverse System to Make Space for Innovation Begin by defining a VERY unwanted result of your work together

TRIZ – First Step First alone, then in your small group, compile a list of todo’s in answer to: In our coalitions, how can we keep doing the same things with the same people and expect different results? 5 minutes Go wild!

TRIZ - Second Step First alone, then in your group, go down your list and ask: Is there anything we are doing that resembles in any shape or form to do’s on our list? Make a second list of those activities & talk about their impact Be unforgiving 5 minutes

TRIZ – Third Step First alone, then in your group, compile the list of what needs to be stopped or changed Take one item at a time & ask: How am I and how are we going to stop it? What is your first move? Be as concrete as you can Identify who else is needed to stop the activity 5 minutes

2. Where are we starting, really? 5. How are we breaking away from the current state toward the future? Next Week Next Month Next Quarter Next Year Action Task Action Task Current status: Current status: Description Measure of success GOAL 3 Description Measure of success Description Measure of success Strategy Safari G A M E P L A N GOAL 1 1. What is happening around us that demands adaptation? GOAL 2 3. Given our purpose, what seems possible now? 4.What is at stake if we do not change? Current status:

15% Solutions Noticing and Using the Influence, Discretion and Power Individuals Have Right Now 15% Solutions Noticing and Using the Influence, Discretion and Power Individuals Have Right Now What can YOU do now to make progress on your challenge?

Henri Lipmanowicz & Keith McCandless Appreciative Interviews Creating Momentum by Building On and Designing With “What Works Right Now”

Tips on Interviewing Stories lets us “see” through others’ eyes 7 minutes to ask about the context –When –Where –Who –How DO NOT share your own experience Collect details of the journey: –Status quo, barriers, action, surprises, discoveries Spend time exploring the conditions and assets that made the story possible. Take Notes Story Name & Details ………………………………… Assets and Conditions

Henri Lipmanowicz & Keith McCandless Purposes: Appreciative Interviews Build positive energy & momentumBuild positive energy & momentum Solve problems by discovering what worksSolve problems by discovering what works Spark peer to peer learningSpark peer to peer learning Develop Min Specs for successDevelop Min Specs for success Get to know each other through positive storiesGet to know each other through positive stories Create a new exciting narrative about the transformationCreate a new exciting narrative about the transformation Discover collective power & adaptabilityDiscover collective power & adaptability You may discover positively deviant local innovationsYou may discover positively deviant local innovations Build positive energy & momentumBuild positive energy & momentum Solve problems by discovering what worksSolve problems by discovering what works Spark peer to peer learningSpark peer to peer learning Develop Min Specs for successDevelop Min Specs for success Get to know each other through positive storiesGet to know each other through positive stories Create a new exciting narrative about the transformationCreate a new exciting narrative about the transformation Discover collective power & adaptabilityDiscover collective power & adaptability You may discover positively deviant local innovationsYou may discover positively deviant local innovations

2. Where are we starting, really? 5. How are we breaking away from the current state toward the future? Next Week Next Month Next Quarter Next Year Action Task Action Task Current status: Current status: Description Measure of success GOAL 3 Description Measure of success Description Measure of success Strategy Safari G A M E P L A N GOAL 1 1. What is happening around us that demands adaptation? GOAL 2 3. Given our purpose, what seems possible now? 4.What is at stake if we do not change? Current status:

What³ Debrief 1. WHAT? What facts, data, & observations stand out? 2. SO WHAT? How do you explain what you see? Based on your observations, do you see a pattern? Is it important? 3. NOW WHAT? What action may help you move forward? Who else should be here?

Climbing Up & Down The Ladder of Inference Observable data and experiences Reflexive Loop Actions I take based on beliefs Beliefs I adopt about the world Conclusions I draw Assumptions I make based on meanings Meanings I add (cultural & personal) Data I select from observations Adapted from Chris Argyris, Harvard 1. What? 2. So What? 3. Now What?

Lunch 60 Minutes

Henri Lipmanowicz & Keith McCandless Open Space Technology Liberating Inherent Creativity & Leadership In Large Groups with an Action-Orientation

Henri Lipmanowicz & Keith McCandless Freedom Responsibility Open Space Boosts Freedom AND Responsibility

Sue & Susan’s Campaign Imperatives

Five Campaign Imperatives In the activation phase, to survive and succeed over the next two years, Action Coalitions: 1.Must move beyond nursing. 2.Must deliver short term results in the next 18 months even as you develop long term plans. 3.Must have courage to place the right leaders at the helm or remove weak, ineffective leaders. 4.Must have funding to sustain this work. 5.Must not ignore diverse stakeholders critical to our success.

Henri Lipmanowicz & Keith McCandless Open Space Theme What can we stop doing or start doing to move forward toward our purpose?

Henri Lipmanowicz & Keith McCandless Four Principles and One Law Be prepared to be surprised; and, let your passion guide you Law of Two Feet go to where you are learning or contributinggo to where you are learning or contributing Principles of Open Space Whoever comes is the right peopleWhoever comes is the right people Whatever happens is the only thing that could haveWhatever happens is the only thing that could have Whenever it starts is the right timeWhenever it starts is the right time When it is over it is overWhen it is over it is over Law of Two Feet go to where you are learning or contributinggo to where you are learning or contributing Principles of Open Space Whoever comes is the right peopleWhoever comes is the right people Whatever happens is the only thing that could haveWhatever happens is the only thing that could have Whenever it starts is the right timeWhenever it starts is the right time When it is over it is overWhen it is over it is over

Mad Tea Strategy Safari Rules Form two circles. You will find yourself directly across from one other person. One person facing “ out ” and the other “ in. ” Finish the sentence that appears on the screen. 1) Stay curious & dig deep 2) Switch roles ~ one ding 3) Move two spaces to the right ~ two dings

2. Where are we starting, really? 5. How are we breaking away from the current state toward the future? Next Week Next Month Next Quarter Next Year Action Task Action Task Current status: Current status: Description Measure of success GOAL 3 Description Measure of success Description Measure of success Strategy Safari G A M E P L A N GOAL 1 1. What is happening around us that demands adaptation? GOAL 2 3. Given our purpose, what seems possible now? 4.What is at stake if we do not change? Current status:

What³ Debrief 1. WHAT? What facts, data, & observations stand out? 2. SO WHAT? How do you explain what you see? Based on your observations, do you see a pattern? Is it important? 3. NOW WHAT? What action may help you move forward? Who else should be here?

Henri Lipmanowicz & Keith McCandless Open Space Technology Day 2 Open Space Technology Day 2 Liberating Inherent Creativity & Leadership In Large Groups with an Action-Orientation

Henri Lipmanowicz & Keith McCandless 25 Will Get You 10 Crowd Sourcing On index cards, each participant writes: –If you were 10 times bolder, what would you do to move forward? –A first step to act on your idea. No names Write legibly

Henri Lipmanowicz & Keith McCandless 25/10 Steps

Gallery Walk + Action Planning

What³ Debrief 1. WHAT? What facts, data, & observations stand out? 2. SO WHAT? How do you explain what you see? Based on your observations, do you see a pattern? Is it important? 3. NOW WHAT? What action may help you move forward? Who else should be here?

Henri Lipmanowicz & Keith McCandless Ecocycle

Activity List Where are you spending time? (key activities) What are your top strategic relationships? Current Activities & Strategies –… Top Relationships – … Henri Lipmanowicz & Keith McCandless

BIRTH CREATIVE DESTRUCTION MATURITYRENEWAL Exploring the Ecocycle

Henri Lipmanowicz & Keith McCandless BIRTH Adhocracies, Exploitation Entrepreneur-As-Leader GROWTH Strategic, “Rational” Management MATURITY Conservation & Routinization Bureaucrat-As-Leader Conventional Lifecycle

Henri Lipmanowicz & Keith McCandless The “Neglected” Back Loop CREATIVE DESTRUCTION Release/Crisis/Confusion Heretic-As-Leader RENEWAL Exploration/Invention/Reorganization Network Weaver-As-Leader LEADERSHIP Envisioning new options

BIRTH Entrepreneurial Action Entrepreneur-As-Leader CREATIVE DESTRUCTION Release/Crisis/Confusion Heretic-As-Leader MATURITY Conservation & Routinization Bureaucrat-As-Leader RENEWAL Exploration/Invention /Reorganization Network Weaver-As-Leader Ecocycle ~ Gathering ~ Sifting Rigidity Trap Not letting go Poverty Trap Not funding innovation Adapted from Brenda Zimmerman, EdgeWare & Getting To Maybe

Henri Lipmanowicz & Keith McCandless Ecocycle Worksheet Sample AC: ______. 4. Renewal Mobilization “Sowing” 1. Birth Exploitation “Growing” 2. Maturity Conservation “Harvesting” 3. Creative Destruction “Plowing” Activity : Relationship Relationship : Activity Activity : Relationship

Henri Lipmanowicz & Keith McCandless S T E P S part 1 Use the list of activities and relationships, reflect on your own, generating a first draft of placements With one partner, coach each other to construct an Ecocycle map – 5 minutes each (10 minutes total) In your Action Coalition, decide where to place the activities on the large wall Ecocycle “placemat”

STEPS part 2 For a Top Ten national map, make sticky notes for each relationship. Elect a delegate to put your post- its on the large wall tapestry 1. Insurers / Business 2. Hospitals & HC Systems 3. Healthcare Professionals 4. Physicians 5. RNs/Nursing Students 6. Consumers (the public) 7. Government 8. Colleges 9. Unions 10. Philanthropy Henri Lipmanowicz & Keith McCandless 1 OH 1 OH 2 OH 2 OH 3 OH 3 OH 1 OH 1 OH 2 OH 2 OH 3 OH 3 OH 7 7

Henri Lipmanowicz & Keith McCandless Ecocycle Insights

Transmitting Gameplans 1. to 2.Use your thumbdrive to save onto computer in foyer (save to “Gameplan” folder on desktop). 3.Hand a paper copy to a CCNA team member. PLEASE CLEARLY MARK WITH YOUR STATE NAME!! WIRELESS LOGIN: CCNA PASSCODE: CCNA

2. Where are we starting, really? 5. How are we breaking away from the current state toward the future? Next Week Next Month Next Quarter Next Year Action Task Action Task Current status: Current status: Description Measure of success GOAL 3 Description Measure of success Description Measure of success Strategy Safari G A M E P L A N GOAL 1 1. What is happening around us that demands adaptation? GOAL 2 3. Given our purpose, what seems possible now? 4.What is at stake if we do not change? Current status:

+ Strategy Safari

Mad Tea Strategy Safari Rules Form two circles. You will find yourself directly across from one other person. One person facing “ out ” and the other “ in. ” Finish the sentence that appears on the screen. 1) Stay curious & dig deep 2) Switch roles ~ one ding 3) Move two spaces to the right ~ two dings

What first inspired me in this work is…

An uncertainty we must creatively adapt to is…

What I find challenging in our current situation is…

What I hope can happen for us in this work is…

In our operating environment, something we are learning to live with is…

A courageous conversation we are not having is…

A big innovation opportunity I see for us is…

In our operating environment, an uncertainty we are learning to live with is…

A concept or practice helping us adapt creatively is…

Something I will never go back to is...

If we do nothing, the worst thing that can happen for us is…

An innovative project that gives me confidence we are transforming is…

Something we should stop doing (or divest) is…

A question that is emerging for me is…

I like a Mad Tea Party because…

Operating Environment Current State Purpose & Vision Stake Strategic Action All What shared answers are starting to emerge? Adapted from ThePrimes, Chris McGoff

1. Operating Environment What is happening around us that demands adaptation? In our operating environment, something we are learning to live with is… An uncertainty we must creatively adapt to is… Jot down the best answers you heard, pass it to your right, again, again, again…

2. Current State Where are we starting, really? What I find challenging in our current situation is… A courageous conversation we are not having about where we are now is… Jot down the best answer you heard, pass it to your right, again, again, again…

3. Vision Given our purpose, what seems possible now? What first inspired me in this work is… What I hope can happen for us in this work is… A big innovation opportunity I see for us is… Jot down the best answers you heard, pass it to your right, again, again, again …

4. Stake What is at stake if we do not change? –If we do nothing, the worst thing that can happen for us is… –Something I will never go back to is… Jot down the best answers you heard, pass it to your right, again, again, again…

5. Strategic Action How are we breaking away from the current state toward the future? –Something we must stop doing (divest) is… –Something we should start doing (invest in) is… –One innovative project that gives me confidence we are transforming now is… Jot down the best answers you heard, pass it to your right, again, again, again…

Balance Balance among the elements makes a big difference. Pitfalls to avoid: Blue Sky Dreaminess: ignoring the current state and operating environment Bad-Road Inertia: despairing over the current state; fearing what is at stake Jumping Over the Moon: moving to action without including others in conversations or agreements

Operating Environment Current State Purpose & Vision Stake Strategic Action All What shared answers are starting to emerge? Adapted from ThePrimes, Chris McGoff

Liberating Structures –Plexus Institute –LS website –Book: Liberating Structures: Including and Unleashing Everyone (in progress)