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![Making sure that only people who
should be in hospital are in hospital
• The number of hospital beds occupied by patients
whose transfer of care has been delayed should be
reduced to 3.5%
• Less than 15% of assessments [for continuing care]
should take place in an acute hospital setting;
• A standardised performance dashboard](https://image.slidesharecdn.com/catalyzingstudentsandtraineesasagentsofchange-180323100032/75/Catalyzing-students-and-trainees-as-agents-of-change-39-2048.jpg)
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Catalyzing students and trainees as agents of change
The document describes the IHI Middle East Forum held on March 23, 2018, aimed at empowering students and trainees as change agents in healthcare. It outlines session objectives, including understanding the role and skills necessary for effective change agents, alongside promoting community organizing in quality improvement efforts. The agenda features various activities focused on engaging participants and sharing insights related to healthcare transformation and education.
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Catalyzing students and trainees as agents of change
- 1. Catalyzing Students and Traineesas Agents of Change IHI Middle East Forum The presenters have nothing to disclose Friday, March 23, 2018 Dr. Kate B. Hilton & Dr. Helen Bevan @KateBHilton @HelenBevan
- 2. @KateBHilton @HelenBevan #MEForum2018 Whois in the room? Tell the people at your table: • Who you are • Where you are from • What you hope to learn today In one breath!
- 3. @KateBHilton @HelenBevan #MEForum2018 Gettingto know each other Go to the corner that identifies you Back of the room Screen and front of the room Student A Healthcare professional B Resident C Educator or something else DWhat is your role?
- 4. @KateBHilton @HelenBevan #MEForum2018 I’minvolved in quality improvement but not with students A I engage with many students in quality improvement B To what extent are you working with students? I am not involved in quality improvement project(s) C I engage with a few students in quality improvement D
- 5. @KateBHilton @HelenBevan #MEForum2018 Gettingto know each other I am familiar with community organizing principles C I look forward to learning more about community organizing D I regularly use community organizing in my improvement work A I have used community organizing in the past B
- 6. Dr. Kate Hilton,JD, MTS Faculty, IHI Open School, ReThink Health & George Washington University Kate Hilton & Helen Bevan Dr. Helen Bevan, PhD Chief Transformation Officer NHS Horizons
- 7. @KateBHilton @HelenBevan #MEForum2018 SessionObjectives Appreciate the powerful role that students and residents can play in the transformation of health and health care Understand the skills of an effective change agent and how to build them Describe the design and implementation of a community, action-oriented campaign effort in the context of quality improvement
- 8. @KateBHilton @HelenBevan #MEForum2018 Agenda TimeActivity 1:00-1:30 pm Introductions, Objectives & Agreements 1:30-2:15 pm The Role of the Change Agent 2:15-2:45 pm IHI Open School 2:45-3:15 pm Break & Randomized Coffee Trial (RCT) 3:15-4:45 pm Four Organising Practices 4:45-5:00 pm Wrap Up
- 9. @KateBHilton @HelenBevan #MEForum2018 Agreements Start/ end on time (end early whenever possible) Be as present as possible Speak for self, listen openly, embrace differences Step up, step back Lean into uncertainty & hold tension by turning to wonder “Try on” and invite “Middle East moments” Have fun!
- 10. @KateBHilton @HelenBevan #MEForum2018 “ASwedish moment” @KateBHilton @HelenBevan #MEForum2018
- 11. @KateBHilton @HelenBevan #MEForum2018 “MiddleEast moments” @KateBHilton @HelenBevan #MEForum2018
- 12. The Role ofthe Change Agent @KateBHilton @HelenBevan #MEForum2018
- 13. The Horizons team: Changeagents and change agency • We tune into the latest change thinking and practice in healthcare and other industries around the world –translating this learning into practical approaches to change • The team has emerged through years of supporting change in the NHS and health and care system • A small, diverse team of people within the English National Health Service
- 14. Change AGENCY definition: Thepower, individually and collectively, to make a positive difference. It is about pushing the boundaries of what is possible, mobilising others and making change happen more quickly Change AGENT definition: Someone who is actively developing the skills, confidence, power, relationships and courage to make a positive difference
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- 16. @helenbevan #MEForum2018 Being achange agent is about building power for change Power is one’s ability to achieve goals. Bertrand Russell
- 17. Jeremy Heimens, HenryTimms New Power: How it’s changing the 21st Century and why you need to know (2018) Current Made by many Pulled in Shared Open Relationship old power Currency Held by a few Pushed down Commanded Closed Transaction new power
- 18. If people giveto a cause, they expect a relationship, not a transaction. Nilofer Merchant
- 19. @helenbevan #MEForum2018 The NetworkSecrets of Great Change Agents Julie Battilana & Tiziana Casciaro As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy
- 20. Find the 3%! Just3% of people in the organisation or system typically influence 85% of the other people Source: Organisational Network Analysis by Innovisor
- 21. @helenbevan #MEForum2018 People whoare highly connected have twice as much power to influence change as people with hierarchical power Leandro Herrero http://t.co/Du6zCbrDBC
- 22. Starts on thefringe (at the edge) Starts with the activists Gary Hamel always
- 23. We need rebels! •Theprincipal champion of a change initiative, cause or action •Rebels don’t wait for permission to lead, innovate, strategise •They point to new horizons •They are responsible; they do what is right •They name things that others don’t see yet •Without rebels, the storyline never changes Source : @PeterVan http://t.co/6CQtA4wUv1
- 24. If you putfences around people, you get sheep. Give people the room they need. William L McKnight
- 25. What happens to rebels/heretics/radicals/mavericks inorganisations? Source of image: thinglink.com ?
- 27. Source: Lois Kellyhttp://www.slideshare.net/Foghound/rocking-the-boat-without-falling-out
- 28. We need tobe boatrockers! Source: Debra Meyerson • Rock the boat but manage to stay in it • Walk the fine line between difference and fit, inside and outside • Able to challenge the status quo when we see that there could be a better way • Conform AND rebel • Capable of working with others to create success NOT perceived by others as a destructive troublemaker
- 29. Source: adapted fromRebels at Work
- 30. “A cynic, afterall, is a passionate person who does not want to be disappointed again.” Source of graphic: Benjamin Zander’s TED talk
- 31. Source of image:Tord the Meme by Marley Bryn The world feels terrible if I choose to distrust it Marcella Bremer
- 32. Reflection • What areyour insights around “boatrocking” and “falling out”? • What moves people from being “boatrockers” to “falling out”? • How do we protect against this?
- 33. Source: adapted fromRebels at Work
- 34. More reading Source ofgraphic : Umair Haque Lois Kelly and Carmen Medina The rebel at work handbook Harvey Schachter How to be a rebel, not a troublemaker at work Debra Meyerson Tempered radicals: how people use difference to inspire change at work Jane Watson A spotter’s guide to rebels and cynics Umair Haque How to be more loving in a cynical world Clark Quinn Skeptical optimist or hopeful cynic? A science mindset Marcella Bremer Cynicism or opticism?
- 35. Change starts withme Source of image: jasonkeath.com
- 36. We are notoutside of the change: we ARE the change Source of graphic: Reos Partners
- 37. The success ofour actions as change- makers does not depend on what we do or how we do it, but on the inner place from which we operate.” Otto Scharmer Leading from the emerging future
- 38. 1. able tojoin forces with others to create action 2. able to achieve small wins which create a sense of hope, possibility and confidence 3. strong sense of agency belief that I am personally able/have the power to create the change 4. more likely to view obstacles as challenges to overcome Four things we know about successful boat rockers Source: adapted from Debra E Meyerson
- 39. Making sure thatonly people who should be in hospital are in hospital • The number of hospital beds occupied by patients whose transfer of care has been delayed should be reduced to 3.5% • Less than 15% of assessments [for continuing care] should take place in an acute hospital setting; • A standardised performance dashboard
- 42. Royal Devon andExeter Hospital
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- 46. Nine hospitals inthe East of England gave patients back 91,728 days or 250 years’ worth of time
- 47. 70 day challenge:to give patients back one million days of their precious time that would otherwise be wasted in bed in a hospital or care home.
- 48. @helenbevan #MEForum2018 #endpjparalysis: connectedsocial communities
- 49.
- 50. Being a greatchange agent is about doing, seeing and being change
- 51. Avedis Donabedian Ultimately, thesecret of quality is love… If you have love, you can then work backward to monitor and improve the system
- 52. After years ofintensive analysis, Google discovered that the key to high performing teams that deliver change is being nice Project Aristotle: https://www.youtube.com/watch?v=UfGiCnhdU78&feature=youtu.be&list=PLHEw3ja- xoaZybvz9f0b1_6bJyG7zZO6L
- 53. VACANCY: seeking grittyindividuals to lead and influence change. Essential criteria: • Resilient boat-rocker • Committed to the development of others • Comfortable with contradictions and tensions • Wants to keep learning • Rolls with resistance and is resilient • Demonstrates courage in uncertainty Perks and conditions: • Extra pay: probably not • Praise and awards: unlikely • Respect from others: negotiable • Energy, purpose and a sense of meaning: guaranteed Application process: Immediate hiring. Start today. Position vacant: Change Agent Developed by Kathryn Perera from original concept by Anne Knock
- 54. Overview of the IHIOpen School @KateBHilton @HelenBevan #MEForum2018
- 55. @KateBHilton @HelenBevan #MEForum2018 IHIOpen School Mission “Advance health care improvement and patient safety competencies in the current and next generation of health professionals worldwide.”
- 56. @KateBHilton @HelenBevan #MEForum2018 IHIOpen School Strategy
- 57. @KateBHilton @HelenBevan #MEForum2018 32+ online courses developed by world- renowned experts in the following topics: Improvement Capability Patient Safety Person- and Family-Centered Care Triple Aim for Populations Leadership • Set of GME courses • More than 550,000 learners have completed a course IHI Open School Courses
- 58. @KateBHilton @HelenBevan #MEForum2018 IHIOpen School Courses by the Numbers 32 online courses More than 3.2 million courses completed More than 100,000 learners have earned the Basic Certificate Quality & Safety More than 1,500 universities & organizations use the courses for training or curriculum
- 59. Open School atHMC 0 2000 4000 6000 8000 10000 12000 14000 Launch Year 1 Year 2 Year 3 Year 4 #ofLearners Years of Subscription 2014 - 2015 7,528 2015 - 2016 9,692 2013 - 2014 5,623 2016 - 2017 11,797 HMC learners completed 110,000 courses 2018 12,303
- 60. @KateBHilton @HelenBevan #MEForum2018 IHIOpen School Video Library
- 61. Middle East Moment: Howhave/might IHI Open School courses support(ed) you and your colleagues?
- 62. @KateBHilton @HelenBevan #MEForum2018 SQOLA2017 update
- 63. @KateBHilton @HelenBevan #MEForum2018 InternationalPledge-A-Thon October 15 – November 15, 2015 27 Chapters representing 8 countries 5,333 pledges collected Topics included: – Flu shots – Texting and driving – Advocacy for safe and affordable housing – Suicide prevention and awareness – Access to health and wellness services for students and local community – Improving one thing for every patient
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- 66. @KateBHilton @HelenBevan #MEForum2018 550,000+students and residents registered Over 900 Chapters in more than 90 countries Allied Health Professions Business Dentistry Engineering Health Science & Administration LawMedicine Nursing Occupational & Physical Therapy Other Pharmacy Physician Assistant Social Work IHI Open School Chapter Network
- 67. @KateBHilton @HelenBevan #MEForum2018 Whatdo Chapters do? Take IHI Open School courses, and review them together Host events at their organization or with other Chapters in their region Conduct quality improvement projects Participate in national campaign efforts Facilitate activities/learning exercises with other students, residents, and health professionals Participate in educational reform to incorporate quality and safety into their formal curriculum
- 68. @KateBHilton @HelenBevan #MEForum2018 ChapterNetwork in the Middle East Region 68 Chapters started in 13 countries Chapters in Qatar, Pakistan, Jordan, Saudi Arabia, and Kuwait are hosting workshops on patient safety and quality improvement, and many are designing formal curriculum on the fundamentals for staff and/or students. All are interprofessional – nursing, medicine, health administration, pharmacy are represented
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- 70. @KateBHilton @HelenBevan #MEForum2018 Connectwith a Local Chapter with the Click of a Button
- 71. Middle East Moment: Howmight participating in a Chapter (or similar interprofessional network) support your work with (or as) students?
- 72. @KateBHilton @HelenBevan #MEForum2018 Project-BasedLearning Programs Leadership & Organizing for ChangeQuality Improvement Practicum
- 73. 73 IHI Open SchoolChange Agent Network (I-CAN) is our community of change agents who are actively applying the skills they’re learning in quality improvement, patient safety, community organising, leadership, and more to improve health and health care and lead change on their campuses, in clinical settings, and in their communities.
- 74. @KateBHilton @HelenBevan #MEForum2018 Leadership& Organising for Change 10-week semi-synchronous online course: – 30-45 minutes of video lectures – 60-minute coaching calls – 1-3 hours application Change Improvement Science Organizing & Leadership Training Subject Matter KnowledgeLearners apply leadership practices in field-based projects to improve healthLearn more at www.ihi.org/lead
- 75. @KateBHilton @HelenBevan #MEForum2018 Examplesof Projects Learners have: • Launched a student-run clinic for the homeless • Improved access to primary care for refugee families • Led a hand-washing compliance campaign • Partnered with local pharmacies to take back prescription opioids • Engaged faculty and administrators to redesign university curriculum to focus on population health • Led campaigns to reduce stigma around mental health
- 76. @KateBHilton @HelenBevan #MEForum2018 Examplesof Projects in the Middle East Farrukh Zaman, Khyber Medical University – medical students, residents, and physicians working to lower patients’ BMI Dr. Manar Khaled, Dar El Shefa Hospital – obstetricians and neonatologists collaborating with the Ministry of Health and patients and families to decrease premature births Dr. Mohammed Shahab Uddin, King Abdulaziz University Hospital – striving for 100% hand hygiene compliance in the pediatric ICU Ahmed Mustafa, Armed Forces Hospital Dhahran, Saudi Arabia – working with clinical staff and IT department to reduce time between medication ordering and administration to improve safety Dr. Matiur Rahman, Al Nafees Medical College and Hospital – reducing healthcare-associated infections through patient safety initiatives & training Mouna Ayoub Bahsoun, Hamad Medical Corporation – increasing patient attendance at labor educational sessions to reduce the C-section rate
- 77. @KateBHilton @HelenBevan #MEForum2018 GeographicDiversity by Country (Spring 2018) 39 countries represented North America 404 Middle East / Asia / Pacific 103 Latin America 61 Africa 26 UK 13 Europe 2
- 78. @KateBHilton @HelenBevan #MEForum2018 Impactof the Program Over 2,000 students, residents, faculty, and professionals have engaged with the course Learners who complete the program have higher confidence in their ability to leverage community organising and leadership skills in their day-to-day work
- 79. Building a Movementto Improve Health Pledge: >35,000 individuals made commitments to improve population health Learn: >3,000 individuals mobilized by project teams on campuses and in communities Between September 2014 and December 2015: Lead: >400 learners took the course and led a local health improvement project
- 80. Mission: 100 millionpeople living healthier lives by 2020 Vision: to fundamentally transform the way the world thinks and acts to improve health, well- being and equity to get to breakthrough results Want to get involved? Email [email protected]
- 81. Let’s engage students& residents in rotations and experiences where they can improve health and health care in our organizations and communities.
- 82. Middle East Moment: Howare you engaging (or could engage) students and residents in efforts to improve health, and how could you offer them a greater opportunity to lead?
- 83.
- 84. For our break,we will have a RCT
- 85. • Randomised CoffeeTrial! Randomized Coffee Trial!
- 86. Outcomes of RandomisedCoffee Trials
- 87.
- 88. @KateBHilton @HelenBevan #MEForum2018 People: Recruitingand developing leaders Power: Building a community around those leaders to create power Change: Using this power to address the challenge the constituency is called to face Community Organizing … people acting together to change the status quo Theory of Change
- 89. @KateBHilton @HelenBevan #MEForum2018 (1)Who are our People? (2) What Change do they want? (3) How can we get the Power we need to achieve that change? Organizing = People, Power & Change @KateBHilton @HelenBevan #MEForum2018
- 90. System of ProfoundKnowledge W. Edwards Deming Source: The New Economics, W. Edwards Deming Appreciation of a System Knowledge of Variation Theory of Knowledge Psychology
- 91. @KateBHilton @HelenBevan #MEForum2018 Psychology •People have an innate desire to create value and are our fundamental source of value • We must move from systems driven by fear and extrinsic motivation to those driven by people’s intrinsic motivation • Creating a culture that respects people and treats them as partners takes work and expertise W. Edwards Deming
- 92. Four Organising Skills toEffect Change @KateBHilton @HelenBevan #MEForum2018
- 93. @KateBHilton @HelenBevan #MEForum2018 FourOrganising Skills 1. Know why it matters 2. Build relationships and gain commitment 3. Take a people-based approach 4. Develop a learning community * Steps developed with Alexandra Nicholas (Ko Awatea), Kate Hilton (ReThink Health), Jackie Lynton (NHS Change Day), and Jessica Perlo (IHI Open School)
- 94. @KateBHilton @HelenBevan #MEForum2018 HonouringJackie Lynton
- 95. 1. Know WhyIt Matters
- 96. @KateBHilton @HelenBevan #MEForum2018 Deming,Bisognano & What Matters Fear-driven (extrinsic) motivation is not as generative or sustainable as intrinsic motivation To build it, we must understand what matters – what truly matters – to stakeholders When what matters is honored, it limits the fears associated with change because it makes people more likely to see and experience an improvement’s fundamental value
- 100. @KateBHilton @HelenBevan #MEForum2018 Whatis Public Narrative? A leadership skill to motivate others to join us in action
- 101. @KateBHilton @HelenBevan #MEForum2018 Elementsof Public Narrative Why me? Why now? WHY US? CALL TO ACTION Why us?
- 102. What makes astory? Challenge – Choice – Outcome
- 103. @KateBHilton @HelenBevan #MEForum2018 LeadersMotivate Action
- 104. @KateBHilton @HelenBevan #MEForum2018 Tips:Crafting an Effective Narrative Specific names Specific images Specific sound Specific smells Specific moments
- 105. Tips: Story ofSelf Share experiences. Pick 1-2 choice points that relate to your calling to be here today. Tell a personal story, in which YOU are the main character. Be specific, vivid, clear…see it, hear it, feel it. Share what gives you HOPE! X Give your resume. X Tell your whole life story from birth to now. X Tell a story about the issues only. X Be abstract. X Make it all about the nightmare. DO: DON’T:
- 106. Pair-Sharing – 10min: Turn to a partner at your table and share a story about why improvement matters to you
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- 108. @KateBHilton @HelenBevan #MEForum2018 Ina one-to-one meeting – Share yours and elicit another person’s story of self In a team setting or coalition meeting – As an exercise in a round to ground team in shared values In front of a large group – As a call to collective action When to Use Public Narrative?
- 109. 2. Build Relationships& Gain Commitment
- 110. @helenbevan #MEForum2018 Jeremy Heimens,Henry Timms New Power: How it’s changing the 21st Century and why you need to know (2018) Current Made by many Pulled in Shared Open Relationship old power Currency Held by a few Pushed down Commanded Closed Transaction new power
- 112. Short-term treatment (upto six weeks) of persistent aggression in patients with moderate to severe Alzheimer’s dementia, unresponsive to non-pharmacological approaches and when there is a risk of harm to self or others. The guidance ‘
- 113. @KateBHilton @HelenBevan #MEForum2018 TheReality Estimated 180,000 people in England with dementia were being prescribed antipsychotics Only 36,000 get any clinical benefit from the drugs Negatives far outweigh the positives Source: Bannerjee report
- 114. “I have somekey performance indicators for you” or “I have a dream” Source: @RobertVarnam
- 115. @KateBHilton @HelenBevan #MEForum2018 Whoare our people? People living with dementia, families & advocates Family physicians Psychiatrists Pharmacists Hospital nurses & doctors Leaders of care homes Senior decision makers
- 116. @KateBHilton @HelenBevan #MEForum2018 Allpeople with dementia who are receiving antipsychotic drugs will have undergone a clinical review to ensure that if they are receiving these drugs they are doing so appropriately and that alternatives to their prescription have been considered and a shared decision has been agreed regarding their future care by March 2013. What do they want?
- 117. Each group createdan ask Example: Pharmacists’ group I (we) commit to: reviewing the people under my care to identify those who are prescribed antipsychotic medication and working in partnership with my prescribing and other healthcare colleagues to review each individual
- 118. @KateBHilton @HelenBevan #MEForum2018 Whoare our people? • 120 hospital systems engaged • 700 active members of our virtual community • 1,800 registrants to our online webinar series • 2,000 attendees at the national and regional launch events • 5,000 GPs via and the Royal College of GPs special interest group • 25,000 Nurses recruited via the Chief Nursing Officer’s bulletin and linked via the hospitals group • 40,000 Pharmacists via the development of the Royal Pharmaceutical Society resources
- 119. Over the nextthree years Across the whole of England, a 51% reduction in prescriptions for antipsychotics for people living with dementia
- 121. @KateBHilton @HelenBevan #MEForum2018 Howis this approach different (or additional) ? • Recruits a broad constituency and creates a sense of “us” rather than “us and them” • Mobilises through a compelling narrative • Builds many leaders • Creates commitment to take specific actions • Seeks to utilise resources to shift power to achieve outcomes • Project team • Senior sponsorship • Engages key stakeholders • Seeks buy-in to change • Key performance indicators and milestones • Accountability through programme management system
- 122. The learning review/evaluation Todownload goo.gl/XsKZ25
- 123. Middle East Moment: Whoare your people? Who (else) does your improvement work touch?
- 124. 3. Take aPeople-Based Approach
- 126. What makes foreffective improvement? ORGANIZATION Capacity Created INDIVIDUAL Leaders Developed AIM Problem Solved
- 127. @KateBHilton @HelenBevan #MEForum2018 ThreeAims at Wright State University 1. Aims: Stabilize and reduce the number of people dying from drug overdoses in Montgomery County. 2. Capacity Built: Launch two projects in which students can get hands-on QI experience before May 31, 2017. 3. Leadership Developed: Have 20 health professional student members representing at least 3 different professional programs involved in the IHI Open School Chapter through the Student Opioid Coalition by May 31, 2017. Set a Measurable Aim
- 128. How do weunleash our people? By how we engage them in our relationships!
- 129. @KateBHilton @HelenBevan #MEForum2018 Reframingthe Question From: How can I get all these people to do what I want them to do? To: How can I get all these people to do what they want to do? Credit: McCannon & Margiotta, Billions Institute
- 130. Who Are OurPeople? Values: What matters to you? Why? Interests: What do you stand to gain (or lose)? Assets: What do you bring?
- 131. @KateBHilton @HelenBevan #MEForum2018 NarcanTraining Session Event Post Event Networking Deterra Medication Disposal System Grant Gail Dafler, Prevention Branch, COAT One to One Conversation Caleb Tang, Cedarville University School of Pharmacy Student One to One Conversation 50 First Year Pharmacy Students Relational Strategies to Gain Commitments
- 132. @KateBHilton @HelenBevan #MEForum2018 Outcomesto Date 55 students engaged in the Student Opioid Coalition 5 project leaders identified NARCAN TRAINING EVENT 7+ disciplines involved (medicine, pharmacy, nursing, SW, public health, professional psychology, pre-medicine) MEDICATION DISPOSAL KIT PROJECT 35 students attended 70 doses of Narcan distributed in the community 40 pharmacy locations 500 disposal kits stocked Underway: # kits of distributed HIGH SCHOOL ATHLETES Underway: Student talks
- 133. @KateBHilton @HelenBevan #MEForum2018 Whatis Power? The ability to achieve purpose
- 134. @KateBHilton @HelenBevan #MEForum2018 5% UntappedPotential Credit: McCannon & Margiotta, Billions Institute
- 135. @KateBHilton @HelenBevan #MEForum2018 95% UntappedPotential Credit: McCannon & Margiotta, Billions Institute
- 136. @KateBHilton @HelenBevan #MEForum2018 95% UntappedPotential Credit: McCannon & Margiotta, Billions Institute x 10
- 137. @KateBHilton @HelenBevan #MEForum2018 95% UntappedPotential Credit: McCannon & Margiotta, Billions Institute x 100
- 138. @KateBHilton @HelenBevan #MEForum2018 95% UntappedPotential Credit: McCannon & Margiotta, Billions Institute x 1,000
- 139. @KateBHilton @HelenBevan #MEForum2018 95% UntappedPotential Credit: McCannon & Margiotta, Billions Institute x 10,000
- 140. Middle East Moment: Howdoes / could taking a people-based approach advance your work?
- 141. 4. Develop aLearning Community
- 142. Build a learningcommunity
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- 144. What is thebest way to spread new knowledge? Source of data: Nick Milton http://www.nickmilton.com/2014/10 /why-knowledge-transfer- through.html Social connection/discussion is 14 times more effective than written word/best practice databases/toolkits etc. Source of image: www.happiness-one-quote-time.blogspot.com
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- 146. Source: Michael Arena,Rob Cross, Jonathan Sims, and Ma Uhl-Bien (2017) It’s about creating “adaptive spaces” that allow ideas, information, and resources to flow across the system and spur improvement Operational system Pockets of improvement activity
- 147. The NHS ContinuingHealthcare Collaborative Approach The Improvement Community 200 local groups The Development Group 10 local groups 1000 participants £100,000 saved per meeting cycle 1000 ideas and contributions in 45 minutes Designed to engage a mass of contributors right from the start and make the process of spread much easier
- 148. The School forChange Agents • A virtual learning community • Runs for 5 weeks every year • 16,000 people from 53 countries have taken part • “How to rock the boat and stay in it” • External evaluation: • Had a positive impact on every dimension studies at both individual and organisational level • What participants valued most was connecting with others
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- 154. The next offeringof the 10-week online course begins in September 2018 Contact [email protected] to learn more Take a Deeper Dive into the Concepts we Shared Today:
- 155. Key Insights & NextSteps
- 156. Did We AchieveOur Objectives? After this session, can you: Appreciate the powerful role that students and residents can play in the transformation of health and health care? Understand the skills of an effective change agent and how to build them? Describe the design and implementation of a community, action-oriented campaign effort in the context of quality improvement?
- 157. Our finale: “Snowstorm” •Write down one key thing you have learnt from this workshop on a sheet of white paper
- 158. • Write downone key thing you have learnt from this workshop on a sheet of white paper • Screw the paper up Our finale: “Snowstorm”
- 159. • Write downone key thing you have learnt from this workshop on a sheet of white paper • Screw the paper up • On the signal, throw your paper snowball in the air Our finale: “Snowstorm”
- 160. • Write downone key thing you have learnt from this workshop on a sheet of white paper • Screw the paper up • On the signal, throw your paper snowball in the air • Pick up a snowball that lands near you and read it aloud to the rest of your table Our finale: “Snowstorm”
- 161.
Editor's Notes
- #2 Welcome everyone, thanks so much for joining us for Workshop D24/E24, Catalyzing Students and Trainees as Agents of Change. We’re happy to have you with us as we showcase students improvement projects that illustrate how you can apply community organizing to projects or campaigns you are working on in your own organizations or communities.
- #7 Dr. Helen is the Chief Transformation Officer at the National Health Service of England, the biggest health system in the world and looks after 54 million people and employs 1.5 million staff. Helen has spent nearly thirty years leading, facilitating and support large-scale change initiatives in the NHS. Some of her current work includes making the English NHS the most wide-spread user of genomic testing for people with cancer, improving urgent and emergency care, and transforming perceptions of nursing and midwifery. Helen runs the School for Change Agents, and I’m delighted to share that Helen has been cited as a case study of what it means to be a “bridge” in today’s New Power world by Jeremy Hiemans and Henry Timms… Helen is the #1 social influencer in healthcare improvement movement, and the sixth most influential person in patient safety in the world, below Atul, JAMA, BMJ, IHI, Kevin Pho. I’ve had the pleasure of knowing Helen since 2009 when our paths merged around organizing in health, and worked with her on large-scale change work that led to NHS Change Day Kate is Lead Faculty for the Institute for Healthcare Improvement’s Open School Change Agent Network (I-CAN), an initiative to empower health professional learners with community organizing and leadership skills to effect change in their local settings. She is also a Director of ReThink Health and a Principal in Practice for Leading Change at Harvard University. She designs organizing efforts, teaches leadership skills, and strategizes with multi-stakeholder teams to take collective action to transform health and health care. Kate taught in Dr. Marshall Ganz’s organizing course at the Harvard Kennedy School, and co-designed and led the first distance learning version for Harvard Executive Education. She works with partners like the National Health Service of England, the Centers for Medicare and Medicaid Services and others to adapt the tools of organizing to achieve the Triple Aim. Nick is a resident physician in internal medicine at the University of Texas at Austin Dell Medical School. He is in the inaugural Distinction Track in Care Transformation, in which residents receive education in design thinking, quality improvement, and care transformation. He graduated from Wright State University Boonshoft School of Medicine, where he was the former Dayton IHI Open School Chapter leader. He was a member of the Physician Leadership Development Program, through which he received an MBA. During his time in Dayton he helped form the Student Opioid Coalition, a collaborative of students working to address the opioid epidemic in Dayton, OH which you will soon hear more about. Michael is a third-year medical student at the Wright State University’s Boonshoft School of Medicine. He recently completed his MBA from Wright State University’s Raj Soin College of Business with a concentration in Healthcare Management. He has been a very active leader in his student body, serving as a student representative on the Faculty Curriculum Committee and chair of Boonshoft’s Physician Leadership Development Program. This past summer he completed IHI’s Organizing for Leadership and Change course, focusing on the newly formed Student Opioid Coalition. He is the current chapter leader for Dayton IHI Open School. Kristen Swain is a Registered Nurse with 10 years’ experience in the healthcare industry. Her career began at the bedside where she was a critical care nurse in the Emergency Room, Intensive Care Unit and the Endoscopy Suite. Driven by her passion to travel and always meet new challenges, she worked as a travel nurse across the country and around the world, allowing her the opportunity to work in all types of healthcare environments from small community hospitals and primary care practices to large academic medical centers. As a volunteer with a non-profit medical service organization, she has worked with multidisciplinary care teams in third world countries to deliver over 500 new smiles to children. Initially drawn into nursing by her passion to help others, she now works for a health system managing performance improvement initiatives and is motivated to improve the way we deliver care in order to achieve better patient outcomes. Using the science of improvement, she works across the entity with both senior leaders and frontline care providers to identify opportunities for improved efficiency, effectiveness and higher quality care. She is pursuing her Master’s in Business Administration, has Lean and Six Sigma training and also works alongside leaders at the Institute for Healthcare Improvement as a coaching fellow. This blended approach of using clinical skills, business acumen and mentoring provide her with the tools and methodologies necessary for sustained success in an ever-changing healthcare landscape.
- #8 Our objectives for today are to share with ways in which you can apply community organizing and leadership skills to your own work to improve health and health care, whether that’s in a clinical setting, on campus, or in a community
- #9 And the way we’ll achieve those objectives is through the following agenda.
- #13 Becka Thanks so much for helping us get a sense of who you are. Now, I’ll share a quick introduction to the IHI Open School.
- #55 Becka Thanks so much for helping us get a sense of who you are. Now, I’ll share a quick introduction to the IHI Open School.
- #56 Carly Strang is the Executive Director of the IHI Open School for over a decade. Carly started as an intern and worked with Don Berwick in realizing his vision for an Open School. Carly is an operations genius and has worked with HMC and others in the region to bring Open School courses to build capability. IHI Open School was launched 10 years ago Read the mission The ultimate goal is for every health professions student entering the workforce to have the necessary skills to become a change agent for quality improvement and patient safety. In most schools, there is no quality or safety curricula, which is why the Open School exists. Along with IHI, we’ve evolved from a focus on quality and safety primarily in the inpatient and outpatient clinical settings, or improving health care, to looking outside the hospital walls and towards the upstream factors that influence health where people spend the majority of their lives, or improving health. You’ll hear about our students’ work on improving both health and health care in our presentation today.
- #57 The Open School strategy breaks down into three categories – community, online content, and project based learning
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- #59 The IHI Open School has over 30 online courses that teach the basics of quality improvement, patient safety, leadership, patient- and family-centered care, health care operations, and population health. Each course comprises 3-5 lessons that take between 1 and 2 hours to complete. Each lesson ends with some assessment questions to test the learner and help the education stick. They are completely free for students, residents, faculty, and users from the least-developed countries (as defined by the UN)
- #63 In 60 minutes, 40 students gained commitments from over 700 people to improve health around the following areas: Access to health insurance and health care services Reducing stigma around mental health Physical activity and mindfulness practices End of life care Dental care
- #64 They had the goal of 30k (set aim and communicated it), set scaffolding and had 1:1s with the team (marketing materials, etc.),
- #67 The community of learners around the world – students, residents, faculty members, professionals and practitioners – has grown dramatically over the years We now have over 500K students and residents registered on ihi.org and over 900 IHI Open School Chapters in 90 countries IHI Open School Chapters are local face-to-face groups at colleges, universities, hospitals, and health care organizations that bring together like-minded learners interested in developing skills in quality improvement, patient safety, population health, and so on. Chapters take many shapes and forms, and they engage in many activities – including taking courses together, conducting quality improvement projects, hosting events, and advocating for the inclusion of quality improvement and patient safety content into university curricula Importantly, Chapters are interprofessional – and that is a key part of the Open School’s vision, to equip future providers to learn to work in teams collaboratively with students and trainees from other professions As you can see, we have many medical students, nursing students, pharmacy students, and so on, and we also have representation from law, engineering, dentistry, and social work in our network
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- #74 A few years ago, the Open School took a look at our network of Chapters across the world and realized that we needed to do more to engage and equip our learners to lead meaningful change in their local settings. So we launched the IHI Open School Change Agent Network, a community of learners from all backgrounds and experience levels who we are training to apply leadership and community organizing skills to their work to improve health and health care wherever they are.
- #75 Core to this program is an 10-online course that we offer twice per year, Leadership and Organizing for Change. Each week involves online video lectures that course participants can watch on their own time, and every other week we convene the cohort for a Coaching Call that provides the opportunity to share our work, practice the skills we’re developing, and reinforce each others’ learning. This is project-based learning, so we expect course participants to put the skills they are learning into action each week to advance their project – such as developing your story of yourself as a call to action to others to join you in your work, having an intentional and strategic one-to-one conversation to ask for someone’s commitment, leading a team meeting, mapping stakeholders in your community, developing a distributed leadership team, and so on. These are skills you’ll learn about from the students today
- #76 Just a few examples of previous projects Launching a student-run clinic for the homeless Leading a handwashing campaign in a hospital Educating caregivers Developing a diabetes program in partnership with hospital staff and patients Working with grocers and insurers to develop a program of fulfilling healthy produce prescriptions And we can't wait to hear what you all will accomplish! As we know already, we have an incredible diversity of experiences and range of aims that we're all working towards
- #79 And I-CAN has only grown since then – we now have over 800 learners who have engaged with the course And learners who complete all ten weeks and all the requirements of the course report that they have a deeper understanding of all the factors influencing health; that they are confident that they can use community organizing approaches to lead others to create change together in their clinics, campuses, or communities; that they feel more connected to the IHI Open School Chapter network; and that they have build meaningful relationships with other organizations in their local settings
- #80 When we first launched I-CAN, we mobilized over 35,000 individuals over the course of a little over a year, to take action to improve population health in their local setting. We did this through training over 400 learners at the time who progressed through the course, leading a project and engaging others. Learners were free to choose a project that they were passionate about – whether it was educating new caregivers on how to do five minutes of “tummy time” for their newborns twice a day, or asking classmates to take a pledge to promise not to text and drive, or developing trainings on Narcan, the emergency rescue drug that can prevent death in the event of an overdose from opioids, improving access to healthy foods in an underserved neighborhood, or improving the quality of care that diabetic patients receive
- #81 Finally, we’d like to introduce 100 Million Healthier Lives, an initiative taking aim at improving the lives of 100 million people around the world, focusing on improving health, wellbeing, and equity. The Open School is a strategic partner of 100MHL, and all of you who are part of our change agent network, are contributing to 100MHL’s aims. Please let us know if you’d like to learn more.
- #84 Becka Now that you’re familiar with I-CAN, our students will share with you key skills you can take to leverage community organizing skills to lead your campaign or project
- #88 Becka Now that you’re familiar with I-CAN, our students will share with you key skills you can take to leverage community organizing skills to lead your campaign or project
- #89 Organizers exercise leadership by taking responsibility to enable others to achieve shared purpose in the face of uncertainty. * Unlike political “marketers” who sell causes, candidates, or commodities by appealing to the preferences of their customers; * unlike philanthropic “providers” who dispense services to needy clients; * unlike social “entrepreneurs” who devise technical solutions to challenging public problems. organizers identify, recruit and develop leaders. They build community around that leadership and create power from the resources of that community. Organizing is usually most appropriate where the challenge you face requires developing new collective capacity – new power – to deal with it.
- #92 James
- #93 Becka Now that you’re familiar with I-CAN, our students will share with you key skills you can take to leverage community organizing skills to lead your campaign or project
- #96 Becka Now that you’re familiar with I-CAN, our students will share with you key skills you can take to leverage community organizing skills to lead your campaign or project
- #97 Deming said that the purpose of improvement is to create systems where the work force is experiencing joy. That is the impetus for IHI’s focus on Joy in Work which Jess will lead us in.
- #103 This is where stories come in. Now all great stories have the same components – they have characters a plot, and an outcome. Now what makes them interesting… How many times does the unexpected happen to you? Now these things and how we deal with them is what’s interesting to us. We seem infinitely intrigued by how other human beings overcome these challenges. The moral the story teaches is not an abstraction – it’s emotional leaerning. That’s why faith traditions all teach through stories. Who did you hear your first stories from? Yea your family…
- #105 Some tips Paint a vivid picture Tell us how you felt, what did you see Speak in the present tense What were you thinkinging at that moment? Engage our senses
- #108 Kate As for how we will learn, remember three things: (1) Organizing is a practice: It is a way of doing things. These skills are learned experientially, combining the head, heart and hands. It is like learning to ride a bike. No matter how many books we read about bicycles, they are of little use when it comes to getting on the bike. And when we get on, the first thing that happens is that we fall off. That is where the heart comes in. Either we give up or we find the courage to get back on, knowing we might fall, because that’s the only way to learn to keep our blalance. Learning a practice requires motivation, a grasp of core concepts, and simply practice – doing it again and again and again. (2) Organizing is a framework: It is a way of understanding things. Telling stories, building relationships, working on teams, strategizing, acting, learning – these are things we do all the time; but as leadership skills we treat them with mindful and intentional reflection. Our challenge is to step back from habit, reflect deeply on what we’re doing, and bring greater intentionality to our work so that these practices become tools. (3) This approach is enhanced by coaching. As when we learn any skill, it is helpful to be coached along the way to improve our practice. Coaching is also something that we should aspire to do as we take responsibility to enable others to achieve shared purpose in our work with communities. Section is a safe place for us to practice, understand, and coach one another in the practices.
- #110 Becka Now that you’re familiar with I-CAN, our students will share with you key skills you can take to leverage community organizing skills to lead your campaign or project
- #115 Link below http://www.bbc.co.uk/news/magazine-23790147 http://www.bbc.co.uk/learningzone/clips/martin-luther-king-i-have-a-dream-pt-1-2/1293.html With the brooding statue of Abraham Lincoln peering down at him, King began by telling protesters that their presence in the symbolic shadow of the "great emancipator" offered proof of the marvellous new militancy sweeping the country. For too long, he complained, black Americans had been exiles in their own land, "crippled by the manacles of segregation and the chains of discrimination". The whirlwinds of revolt would continue to shake the very foundations of the country: "And those who hope that the Negro needed to blow off steam and will now be content will have a rude awakening if the nation returns to business as normal," King said. It would be fatal for the nation "to overlook the urgency of the moment and to underestimate the determination of the Negro". “He's good - he's damned good” Kennedy on King Wearied by the suffocating heat, the crowd's initial response was muted. The speech was not going well. "Tell 'em about the dream, Martin," shouted Mahalia Jackson, referring to a rhetorical riff that King had used several times before, but which had not made it into his prepared speech because aides insisted he needed fresh material. But King decided to cast aside his prepared notes, and launched extemporaneously into the refrain for which he will forever be remembered. "I have a dream that one day this nation will rise up and live out the true meaning of its creed," he shouted, his out-stretched right arm reaching towards the sky. Soon he was hitting his rhythm, invigorated by the chants and cries of the crowd. "Dream on!" they shouted. "Dream on!" With his voice thundering down the Mall, King imagined a future in which his children could "live in a nation where they will not be judged by the colour of their skin but by the content of their character". Then he reached his impassioned finale. King asked the crowd to yell so it was heard the world over Watching at the White House, the president was riveted. Like so many Americans, it was the first time he had heard the 34-year-old preacher deliver a speech in its entirety - the first time he had taken its measure, listened to its cadence. "He's good," Kennedy told one of his advisors. "He's damned good." The aide was struck, however, that the president seemed impressed more by the quality of King's performance rather than the power of his message.
- #125 Becka Now that you’re familiar with I-CAN, our students will share with you key skills you can take to leverage community organizing skills to lead your campaign or project
- #126 Nick: Not only is our state known for flight, but Dayton, OH, the city in which I attended medical school, is named after the Wright brothers where they had their first bicycle shop. Michael: And unfortunately lately Dayton OH has been in the news for other reasons. This past September, 60 minutes ran a segment “Heroin in the Heartland,” that chronicled the prevalence and pervasiveness of the Opioid Epidemic in our home state. Though the segment featured Columbus, OH and it’s neighboring suburbs (an hour drive from Dayton, OH), a 2016 report issued by ArrestRecords.com, Dayton, OH ranked #1 worst big city for drug overdoses. Cincinnati, OH was ranked #6 and Toledo, OH was #10. This was not the list of big cities in Ohio, this was in the country. For reference, Baltimore, MD was #2. Philadelphia, PA was #3. Again, Ohio had 3 of the top 10.
- #128 MEASURABLE AIM Nick: I was a fourth year medical student, and leader of the Dayton IHI Open School Chapter. I set goals for our organization […] I had in the back of my mind an experience I had at the IHI SQLA several years prior in which I asked Marshall Ganz in front of everyone [...] He answered “you have it backwards. You should’t have to recruit resources for a cause. You should have a cause that is worthy enough that it attracts resources to itself.” I was looking for a project that would resonate with students. [...]
- #132 Michael: [not final wording, just loose at the moment for framework] ”I went to a Student Opioid Coalition Event…one of the speakers was Gail Dafler, who briefly explained a recent grant that made hundreds of the Medication Disposal System bag available…”I only need hands to help”. Etc.
- #142 Becka Now that you’re familiar with I-CAN, our students will share with you key skills you can take to leverage community organizing skills to lead your campaign or project