Transcriber: Jing Littlejohn Reviewer: Elisabeth Buffard
Have you ever tried to change something
but failed miserably?
Most of us have.
Have you ever spent hours and hours
trying to convince somebody to try something new
only to have it fall flat?
Using the example of how health links are developing across SouthEastern Ontario,
the next few minutes, we will give you an appreciation
for how change actually happens,
and how you can be the spark that is needed.
Okay, be prepared to be shocked by some numbers.
In Ontario, just 1% of the population accounts for 1/3 of all health care costs.
To put this in a perspective,
that is 15.2 billion dollars spent on health care for only 130,000 people;
and only 5% of the population accounts for a whopping 2/3 of all health care costs.
That's 30 billion dollars.
This is simply not sustainable.
Last year, in 2013,
over 40% of all provincial dollars were consumed by health care.
In a recent landmark study, by Don Drewman,
it is suggested that by the year 2030,
if left unchecked,
health care will consume 80% of all health care dollars.
So, where does all these money go?
Well, unfortunately we have a system that is designed around rescue care.
We wait for people to get sick,
and then rush in with superb care, technology and resources,
in order to try and save them.
It's the equivalent of sitting back and watching pools developing a dam over time.
And then when it is about to burst,
rushing in with a whole fleet of engineers to try and repair it.
Our health care system must be fixed,
starting immediately.
Okay, so that's easy
(Laughter)
Get the slides working,
fix the health care system.
no problem, right?
Let me ask you a question.
How many doctors do you think it takes to change a light bulb?
Zero.
They get stuck on the word "change".
(Laughter)
Now I'm...
(Laughter)
Now I'm allowed to say this
because I am a family doctor.
There is perhaps no other profession in the world
that is so resistant to change as is the medical profession.
In fact our training drives into us the principle of
"Do No Harm.
Reduce the risks.
Avoid making mistakes at all cost,
and don't try anything new that might harm the patient."
Now this is great for patient safety,
but it also comes at a price.
Health care is slow to evolve,
especially around systems of care.
What can we do to help doctors and nurses
get prepared for and implement change?
What can you do in your work, in personal lives
to help others be a part of positive change?
Well you can.
You can be a spark for change
in just five steps.
The first and often bypassed step
is to study your environment.
You know, kids are terrifically observant.
When we as adults are to ready to move on to the next thing,
they are looking and truly seeing.
This is my son on a recent nature hike.
And I kept wanting to march on along and get to the destination,
but he kept stopping to look,
to really look at the world around him.
It's important to stop and observe
to see patterns,
to see what works, what doesn't and why.
In health care, this means taking the time to stop and ask our patients
for their perspective.
What can they see in the health care system
that we can't see as doctors and nurses?
How would they like the system to be changed?
Knowing your environment is an important first step towards change.
So what is the state of Health Care Ontario?
Well, unfortunately too many people get cared in hospital
when they could better be cared for in the community or at home.
Too many people get readmitted to hospital within days of leaving.
Too many people have trouble navigating this complex system,
and access to primary care is uneven,
across the province but also even within communities.
We are fortunate and candid to have public health care system.
But, there is little coordination or communication
between parts of that system.
Luckily, there is a health care transformation taking place in Ontario.
The vision is that in each community,
all of the providers and health care services will be integrated
in a health link.
It is an ambitious goal,
one aimed at improving patient care
and the quality of that care,
but also in ensuring a sustainable health care system.
The problem is we work in silos,
which brings us to point two.
In order to be a spark for change,
you need to help others develop relationships and trust
with one another
Now, this means actually getting out there,
and visiting people, meeting with them directly.
It may take some extra time.
You might need a flexible schedule
or some extra milage on the cars.
But, it's important to get there
and see what it is like in their environment.
Don't invite them to your meeting.
Ask for an invitation to their meeting.
Go see what it is like in their setting.
With health links,
this means traveling to region
to see what is it like to practice medicine
in a rural community health center
or urban family health team.
For you, facing your own organizational challenges,
this might mean meeting someone for coffee
to see what their perspective is,
or visiting each department within your organization.
The whole point is to develop relationships and trust
before they are even needed.
The third step in being a spark for change
is leading by example.
Now, I know this sounds cliche,
but few leaders actually follow it.
It's much more common for leaders to go around saying,
"do this, do that".
Many managers use sticks and carrots to coerce people to change.
But most change happens by someone having the courage
to stand up and lead by example.
Children know this.
And that change can be sparked by anyone,
not just those with power or authority.
If you watch kids on the playground,
or ropes course like this one,
if one kid starts to cross the rope,
you can be sure another will follow.
If you are truly passionate about something,
have the courage to stand up
and role model what is it you want others to do.
Ok, so you've surveyed your environment,
built relationships and trust,
and now you are that lone spark out there trying something new.
Now what?
Well, step four is critical.
Amongst the dozens, hundreds, or maybe even thousands of people
that you are trying to influence,
there'll likely actually be a couple of people that follow you.
If this happens, ignore everyone else,
focus 110% of your attention on these two individuals.
Support them, thank them,
and recognize them in front of their peers.
Experts in change management call this
"focusing on the early adopters".
In any change process,
there are different types of people.
There are the innovators,
those crazy people out there trying new things.
There is the early majority.
Sorry, there is the early adopters,
those people who follow closely behind.
Then there is majority,
a large group of people in the middle.
And finally the laggards,
the people who will likely never change
And they will certainly be the most vocal as they criticize your ideas.
What most leaders do
is make a big mistake.
They focus their attention on those that make most noise.
You will waste a ton of time and energy
trying to get the laggards to change,
and they will still not budge.
Instead, your entire laserbeam-like focus
should be on the early adopters.
But why?
Because the majority don't follow innovators.
The majority follow early adopters.
By thanking them, recognize them,
and showing them off to their peers,.
you now make it clear
that it is safe for the majority
to be a part of that change process.
In each of the seven health links
in the Southeast local health integration network,
there were one or two individuals
who very early on saw the necessity to change.
They were thanked and supported
and given strategies and tools
to implement that change.
To their pre-existing networks and relationships,
they brought others on board.
It was because of this
and only because of this,
that the number of health links in Southeast
grew from one
to three
to five
and to seven.
A very rapid change process
of a complex health care system over a couple of months
over a large geography
through a concerted effort
to support the early adopters.
So what does a health link look like?
Well, as you can see,
patients and families are clearly in the middle.
We have the primary care groups organized
and communicating with one another.
And there are easy linkages with the other aspects of the health care team:
hospitals, home care, mental health, addictions, hospice,
the list goes on.
There are so many advantages of this reorganization of health care,
such as improve communication,
improve efficiencies and transitions in care to and from hospital,
and improved and increased patient satisfaction.
The fifth and final step,
in being a spark for change
is the foster ownership.
Not buy-in, but ownership.
What's the difference?
They sound pretty similar, right?
Wrong!
Do you remember that really good idea that you had
that no one followed?
Any idea why?
It's because it was your idea,
not theirs.
You were trying to sell them something.
And because people are naturally resistant to change,
they are not gonna buy what you are selling.
No one likes change forced upon them.
I don't, you don't, no one does.
You have to try a different method if you want lasting change.
Try fostering ownership instead.
This is perhaps the single most important thing you can do
to prepare others to accept and even like change.
If anyone is gonna be affected by the change,
get them involved early in the process
to help decide what that change will actually look like.
Consult widely, involve as many people,
organizations and stake holders as you can.
Now, you will have to let go of some control,
and things might turn out slightly different than you had imagined.
But you will foster meaningful lasting change.
With health links,
we invited doctors, nurses, nurse practitioners,
dieticians, case managers, hospital administrators
and most importantly patients to be a part of this process.
They decided what the health link would look like
based on the community resources
and local knowledge.
So now,
how many doctors does it take to change that light bulb?
All of them.
Because change isn't so scary anymore.
As you sit here today,
health link is doing a number of things.
They are identifying complex patients,
that 1 to 5% of the population with most complex needs.
They are attaching them to primary care
by finding them a family doctor or a nurse practitioner.
And a developing coordinated care plan with each patient
focusing on all of the medical and mental help and social needs.
But most importantly, it's not the ministry of health
or the local health integration network telling them how to do this.
Each community in each health link
is coming up with a solution that's right for them,
their providers, and their patients.
Each of us has passions, dreams, and wild ideas.
But most of these never get out of our own head
and be put into action.
Imagine if you can take one, just one of your great ideas
and see it come true.
Well, you can.
You can be that spark for change in the world.
It might just be easier than you think.
Thank you!
(Applause)