Lessons Learned in changing healthcare - Softcover

Paul Batalden; Jennifer Daley; Richard A. Deyo; William H. Edwards; Linda A. Headrick; Eric S. Holmboe; Gary S. Kaplan; Carolyn Kerrigan; Harlan M. Krumholz; Thomas H. Lee Jr.; Peter Margolis; Gregg S. Meyer; David B. Pryor; Stephen J. Swensen

Softcover

ISBN 10: 0981008925 ISBN 13: 9780981008929

Publisher: Longwoods Publishing, 2010

Synopsis

The pressure for changing healthcare is evident everywhere. Newly available data on excessive variation in quality, safety and cost are present in academic publications, disease registries, national scientific organizational reports, government-mandated reports and the published articles of numerous commissions and task groups. Personal experiences of disappointed patients, families and communities add a sense of urgency to the need for change. All around us, people are at work leading change in healthcare. All of these leaders have a journey of experience from which they have learned (and are learning!) lessons. The lessons have developed in response to the wide variety of publicly available information, perceived challenges and conflicts, co-workers desire for meaning and joy in work and personal recognition of better alternatives to the present situation all part of the lived experience of leaders.

About this title

About the Author:

Paul Batalden is professionally prepared as a pediatrician. He has led in public health and private practice settings. He has developed numerous programs for learning about the improvement of healthcare and what it takes to lead change. Now he is mainly a teacher at Dartmouth and in JÃnkÃping, Sweden. He is the Director, Center for Leadership and Improvement at The Dartmouth Institute for Health Policy and Clinical Practice; the Program Director for the Leadership Preventive Medicine Residency Program at the Dartmouth-Hitchcock Medical Center and Professor of Pediatrics for the Department of Community and Family Medicine, Dartmouth Medical School

Review:

In this book, 14 American physicians from a range of disciplines, all of whom are health care leaders and change agents, reflect on what, and how, they have learned through their experiences. This is therefore a personal account of moving forward in health care and bringing about positive change. Each physician s story, circumstances, challenges and learnings are unique, and are told by them with considerable detail. Despite the uniqueness of the 14 accounts, some similarities emerge. Perhaps not surprisingly, many of the themes and lessons the physicians identify resonate with those identified in other business books or writings. Let s begin at the beginning, where in the first chapter plastic surgeon Dr. Caroline Kerrigan set the tone by succinctly listing seven lessons she has learned: 1. Work smarter, not harder. 2. Change is awkward 3. Measure 4. Innovate to customize 5. Walk the talk 6. Be tenacious 7. Engage the players The other physicians took up these themes, albeit in different ways, and raised others. Some key ones are: A compelling vision is driven by aspiration, not fear. Change is truly propelled by a burning platform. To bring about change, leaders must lead through influence rather by control. Those lessons apply to more than just health care settings. But what lessons apply only to health care? Here are some: First, doing what is right for the patient is always the number one goal of any change process. Second, pay attention to culture. In health care, culture is dominant. It plays a powerful role in dictating the adoption of change, and all leaders must understand their organization s culture. Third, the quality improvement process is a major aspect of health care change. Dr. Linda Headrick noted that the champions of quality improvement process must also demonstrate its use within their own offices or areas of responsibility. Leaders must lead by example. Four, prepare yourself to expect flak. If you are not taking flak, then you are probably not hitting the target. Five, the translation of research to the bedside is difficult and can take 10 to 15 years. Patience is thus required. Dr. Thomas Lee noted no magic breakthrough to bring about change is anticipated. Instead, we should expect door-to-door fighting for the rest of our careers. Perseverance, and working alongside a team of change champions, bolsters chances of success. Six, be transparent and honest. The latter may be difficult during the change process but is necessary. Seven, pursue innovation. Some may well fail, but without innovation, significant change is impossible. Eight, recognize that politics does matter. Finally, as a leader, this is your turn to effect change. You are not here forever, so use your time wisely. This book contains valuable information and lessons for anyone trying to lead change in health care. My only regret is that I feel the conclusion could have better summarized the key points from the 14 contributors. That said, I highly recommend this book. --Chris C Carruthers, MD

As with Chaucer s pilgrims the importance of community emerges as a common theme of the work. Each of the authors has by hook or by crook learned the tools of improvement work (necessarily by hook and by crook because the formal education system has not incorporated these skills as part of the trade until recently). Learning the techniques and rules of improvement work is important and necessary, but what comes across in this book is the importance of intelligent improvisation, improvisation grounded in values as well as rules. Truth telling, transparency, good data, humility, and a willingness to share credit for progress and accountability for failures emerge as helpful, if not essential, traits for good healthcare leaders. To paraphrase several of the authors: Learning quality improvement requires doing quality improvement. It is understood by all that good healthcare requires two tasks: doing the work and improving the work, it is not sufficient to simply do the work and go home. Honing the skill, however, is not enough. Greg Meyer reminds us of the story about Louis Pasteur on his deathbed. When his colleagues told him that the infection he had was usually not fatal he replied: You have learned nothing. It is not the seed but the soil, i.e. not the germ but the context in which the germ functions. Several of the pilgrims confirm the truth in this story it is the communal context and not simply the introduction of quality improvement techniques that determines if the intervention succeeds. Communal context, in turn, is determined by the quality of the people in the community and the quality of the relationships they have with one another. Quality improvement requires thinking deeply about community, about people and the glue that holds them together as a community and the forces that divide them. Leaders need to know when to invite and attract the goodness in people, and when to use command and control to get over a bump in the road. They need to know how to acknowledge and manipulate drivers and barriers to change, how to manage conflict, how to detoxify the communal environment and create a place in which a person s inherent intelligence and goodness is invited to participate wholly. It is the task of leadership to create an ecology that can support life. These approaches can be applied as skillfully as the surgeon uses a scalpel, or can be used incompetently with destructive effect. Quality improvement is not for the faint of heart and paradoxically it is also everyone s work. It is another task of leadership to manage this paradox. On the cover of Lessons is a simple drawing of a thread. At the conclusion of the book Batalden quotes William Stafford s poem on the thread: The Way It Is. He invites us to think of each pilgrim as holding onto a thread: There s a thread you follow, it goes among things that change but it doesn t change....You never let go of the thread. Lessons gives us a glimpse at the threads these pilgrims hold, threads that are usually hard for others to see. He invites us further to think of these fourteen threads as forming a tapestry, a tapestry that permits a larger viewing of healthcare change and change efforts. He invites us also to contribute our thread. Such efforts will ultimately constitute healthcare in the United States we need a more beautiful tapestry. Gary Kaplan says: Leaders are dealers in hope. Lessons is dedicated to the next in line. The pilgrims have recorded their tales and there is cause for hope, but much work remains to be done. This book provides a framework robust enough to support the next in line and beyond. --David C. Leach, M.D.

This must read book is a Festschrift for Professor Paul Batalden, a great scholar and doyen of the movement for quality improvement in health care. For 30 years when the science of improvement was almost unknown in medicine, he has been its major intellectual stimulus. Inaugural Chair of the Board of the Institute for Healthcare Improvement, developing the Dartmouth Microsystem Improvement Curriculum, designing the collaboratives , and embedding training in quality improvement into the US residency programs are just four of his huge contributions. With its emphasis on experiential learning by clinical leaders, this book is classic Batalden. The book comes from a series of fourteen guest lectures given at Dartmouth Hitchcock Medical Center. The lecturers, all physicians were invited to reflect on the lessons they had learned while leading change in healthcare and how they learned them. The chapters are usually no more than five pages with a thumbnail sketch of the author and a few references. Each chapter is a unique, individual gem of insight. Free of clichés, the authors describe their own experience faithfully. Each paragraph has a heading highlighting the personal learnings of the lecturer. Some themes come through strongly; measurement, honesty, and motivating people. Some ideas are new such as the importance of positive deviance. Organizational culture gets its due attention. The last chapter is written by the maestro himself and displays the extraordinary breadth of his scholarship moving from French to Shakespeare, a quote from Pasteur and another from Tzu before settling on the importance of learning from experience. He talks about "learning buddies"- people with whom he has been able to test his thinking and reasoning over the years. Each paragraph heading is a lesson and there are thirteen of them. My favourites are: attraction and invitation are more powerful than command and control, framing and reframing are essential leadership skills, the ladder of inference melts unnecessary conflict, there is an authoring (generative) dimension to authority, spend more time removing the toxicity of current incentives than trying to create new positive ones, and, leaders usually get what they lead personally. In Germany it is traditional for the retiring academic to invite his successor to prepare the Festschrift. Fittingly Batalden finishes his chapter on the importance of developing a number of successors. Lucky are those who have been fortunate enough to have been touched by his teaching. They will keep the torch high. --Professor James A Dunbar, Flinders University School of Medicine

About this edition

• Publisher: Longwoods Publishing
• Publication date: 2010
• ISBN 10: 0981008925
• ISBN 13: 9780981008929
• Binding: Perfect Paperback
• Edition number: 1
• Number of pages: 208
• Editor: Paul Batalden