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

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

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.

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

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.

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

Reason – Complex Systems

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.

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

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.

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.

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

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

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?

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?