The KHIT Blog: #IHI25Forum Updates

Wednesday, December 11, 2013

#IHI25Forum Updates

Well, I had a choice to make. Go back to my hotel and blog my take on the day, or go to the IHI 25th anniversary pool party. What would you have done?

Asked and Answered.

Consequently, blog updates are a bit delayed. More great stuff to attend. Started my Wednesday off with this:

Dr. Nancy Snyderman and her former cancer patient the incredible Lindsay Beck. This keynote interview was beyond worth the price of attending. I'm really a bit stunned at this story. I told Dr. Synderman afterward, "OK, I gotta go lie down now. I'm completely drained."

Wow.

A recent graduate of Wharton’s Executive MBA Program based in San Francisco, Lindsay Beck had been diagnosed with a rare tongue cancer when she was 22. When the malignancy recurred and she inadvertently discovered her chemotherapy could leave her sterile, she launched into an advocacy campaign that changed the face of American medicine. Through her charity, Fertile Hope (now part of the LIVESTRONG Foundation), she co-wrote the oncology treatment guidelines to protect the reproductive rights of young patients like herself. She then lobbied among the massive health insurers and countless self-insured employers to help fund the care...

From the IHI program speaker's bio:

Available on Amazon

FRIDAY THE 13TH UPDATE

Well, [bleep], after an exhausting 15 hour trip home, replete with an anxious medical emergency diversion landing in Raleigh-Durham that caused me to miss my BOS-SFO connecting flight,

I've just spent two hours updating the blog, and had a total lockup in the blogger.com editor in the Firefox browser platform while uploading a photo, causing me to lose everything I just added. Had to do a hard-reboot, following which there was no cache recovery. Starting over. Grrr.rr.r...

TAKE 2:
"NO MORE HEROES"

Left the Snyderman-Beck Keynote after they finished and went to Dr. Toussaint's presentation.

E5: Beyond the CEO: Sustaining ThedaCare's culture

When the CEO retires or leaves, an organization changes. The culture of improvement can be destroyed overnight by the new leader. Lasting change requires that organizations hardwire improvement thinking into succession candidates. It also requires board commitment to choosing internal candidates with the characteristics required to accelerate the improvement journey. In this workshop, ThedaCare’s former CEO, John Toussaint, and present CEO, Dean Gruner, will describe the process of sustaining an improvement culture that outlives the tenure of any one CEO.

OBJECTIVES

Identify the standard work for succession planning that senior management and boards use to choose leaders with the right behavioral and management competencies to lead in an improvement culture

Implement a management system that hardwires improvement skills into all succession candidates

PRESENTERS
Dean Gruner
President & CEO, ThedaCare
John Toussaint, CEO, ThedaCare Center for Healthcare Value

I have long cited and characterized John Toussaint as "one of my heroes." (See here, my 2nd REC blog post in 2010, or just search "Toussaint" in my blog search cell at the upper left to see the many times I've referred to him in buttressing my arguments.)

So, it was interesting that he said that their upcoming book release will carry the title of "No More Heroes."

Below, Dr. Toussaint's successor as ThedaCare CEO, Dr. Dean Gruner.

Very enlightening presentation.

Dr. Gruner is an equally delightful man, and is an OLE to boot! I am a proud St. Olaf Grandparent. Great school. He gave me a big smiling High Five when I told him my grandson was a sophomore there.

apropos of CEO succession: from the conclusion of Dr. Toussaint's wonderful book "On the Mend":

In the middle of 2006, John came to a decision. After six years leading the organization and five years fighting to get lean adopted across ThedaCare hospitals, clinics, and corporate offices, John knew that he was, metaphorically at least, stuck all over with the arrows of long battles with physician groups and staff.

During those six years, ThedaCare had sold off its HMO health plan, lost all of the orthopedic surgeons in one hospital, and seen morale plummet. On the other hand, quality of care was increasing fast in 2006 and attracting notice. Morale was starting to trend upward, but John believed his personal stock had suffered in the early battles.

Also, John had a very good idea of what it took to be a transformational lean leader and what it took to be a steady-state lean manager, moving the organization incrementally but relentlessly ahead. He could recite a list of necessary attributes of a lean manager off the top of his head and he knew those qualities did not describe him.

John was a great communicator and a better instigator. He was good at lighting fires, but he was not the kind of calm and steady facilitator needed to keep the fire burning in the right direction. And he was already looking at a larger playing field, wanting to spread the lean healthcare revolution beyond ThedaCare. It was nearing time to go.

Succession planning, which had always been high on John’s agenda, now moved to the top. Preparing for a smooth transition is vital work for any business, but it is critical for lean organizations since so few experienced leaders know lean. At ThedaCare, we spent years building this nascent lean organization and knew that an autocratic outsider with a different agenda could destroy it in minutes. It was still a stretch for some people to take responsibility for their own work environment and it would have been a relief for them to fall back into the old ways, waiting for orders and keeping their heads down. But John was thinking about those at ThedaCare who had eagerly adopted lean, put themselves on the line, and applied their talents toward making real change. This group—growing in number—believed in the power of lean and John could not let them down.

ThedaCare needed to find a lean CEO—someone who embraced the principles and would use them to formulate ThedaCare’s strategy. At the time, there were no lean healthcare systems to poach for leadership, but looking at his senior executive team, John counted a number of individuals with enthusiasm and fresh energy. He quietly asked who among these wanted to be CEO and a few hands went up.

This was the beginning of a two-year PDSA cycle focused on succession in which John studied the issue of lean leadership, created individualized training programs, and personally mentored the CEO candidates. He expanded their portfolios and watched them carefully on gemba walks. Due to confidentiality and personnel concerns, we will be vague about the candidates. Still, the experience was instructive and should underline the importance of leadership transitions in a lean environment.

Ultimately, John’s goal was to present at least two internal CEO candidates to the board of directors who were well qualified, hungry for the job, and committed to lean. If he failed, his legacy would probably be an almost-lean organization, where the idea of continuous improvement had come briefly to life but then sputtered and died, leaving people reluctant to put energy into the next initiative. If he succeeded, the board would have a wealth of good choices and a leader prepared to advance the lean initiative into its second generation.

Toussaint, John; Gerard, Roger (2010-06-06). On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry (Kindle Locations 1919-1928). Lean Enterprise Institute, Inc.. Kindle Edition.

You will thoroughly enjoy this book if you've not already read it.

I simply must go visit the ThedaCare organizations soon. Hmmm... maybe in the dead of winter, so I can make another side visit to my sister's in Marquettte, MI, to celebrate my 68th birthday in February and ski their little hill. Brrr.r.r...

FINAL KEYNOTE: DR. DON BERWICK.

One inspiring man, I have to say. Check out the YouTube of his closing Keynote (Dr. Berwick is introduced at 0:59:33).

"Who's your Caleb?"

WELCOME TO THE DANCE

And so, #IHI25Forum comes to an exuberant, kinetic close, with well-deserved Props to the Blue Shirt volunteers contingent. They were fabulous.

"Well, I sat down in the very first row,

Expecting to see what was advertised,

And, the very next thing I know

The picture had become my eyes..."

Sons of Champlin, "Welcome to the Dance"

Yeah. I wrote a song about "The Dance" a third of a century ago. From my Pinterest site:

I would do well to take my own advice more consistently. Easy to lose sight of The Dance amid the daily din of contention and detail.
___

Much more to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Wednesday, December 11, 2013

#IHI25Forum Updates

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