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Facilitating Large System Change EffortsAndrea Kabcenell, RN, MPHVice President
September 22, 2016
Our Mission:To improve health and health care worldwide
2
Our VisionEveryone has the best care and health possible.
Who We AreIHI is a leading innovator in health and health care improvement worldwide, joining forces with the IHI
community to spark bold, inventive ways to improve the health of individuals and populations.
Our MissionTo improve health and health care worldwide.
Networks that
Work
Large System Change
Taking On Your
Challenges
Today
As Your Networks Evolve, Consider your Biggest Challenge…
CommunicationAgreementsMissing LinksResourcesCapability to Deliver
Consider your biggest challenge
Networks that Work
What Networks are you in? How do they work?
6
Mega Trends Map of an active and vital network
From Frick, K. Mega-trendsetters
Well connected within the network, disconnected between networks
Well connected within the network and the beginning of a connection between networks.
Growing connections within and between networks.
Changing nature of the picture of the network over time.
TIME
Supported by NIH NIDDK R01DK085719
AHRQ R01HS020024 AHRQ U18HS016957
ImproveCareNow Network Care Centers
Percent of Patients in Remission
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%Ju
l-200
7 N
=338
Aug
-200
7 N
=396
Sep
-200
7 N
=428
Oct
-200
7 N
=479
Nov
-200
7 N
=508
Dec
-200
7 N
=531
Jan-
2008
N=5
70Fe
b-20
08 N
=607
Mar
-200
8 N
=643
Apr
-200
8 N
=654
May
-200
8 N
=667
Jun-
2008
N=6
71Ju
l-200
8 N
=686
Aug
-200
8 N
=731
Sep
-200
8 N
=754
Oct
-200
8 N
=801
Nov
-200
8 N
=832
Dec
-200
8 N
=901
Jan-
2009
N=9
73
Feb-
2009
N=9
95M
ar-2
009
N=1
021
Apr
-200
9 N
=107
0M
ay-2
009
N=1
112
Jun-
2009
N=1
194
Jul-2
009
N=1
240
Aug
-200
9 N
=127
7S
ep-2
009
N=1
314
Oct
-200
9 N
=134
4N
ov-2
009
N=1
366
Dec
-200
9 N
=140
0Ja
n-20
10 N
=142
1Fe
b-20
10 N
=141
0M
ar-2
010
N=1
440
Apr
-201
0 N
=145
5M
ay-2
010
N=1
461
Jun-
2010
N=1
471
Jul-2
010
N=1
489
Aug
-201
0 N
=151
8S
ep-2
010
N=1
547
Oct
-201
0 N
=157
6N
ov-2
010
N=1
985
Dec
-201
0 N
=203
2Ja
n-20
11 N
=204
3Fe
b-20
11 N
=206
5M
ar-2
011
N=2
124
Apr
-201
1 N
=219
1M
ay-2
011
N=2
206
Jun-
2011
N=2
272
Jul-2
011
N=2
301
Aug
-201
1 N
=233
5
Perc
ent o
f Pat
ient
s
Month
Percent of IBD Patients in Remission (PGA)
Crandall, Margolis, Colletti et alPediatrics 2012;129:1030
Remission rate: 55% to 75%36 Care Sites310 physicians>10,000 patientsStandardized care
Match What We Learned With What You Have Learned
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1. Personal connections are IT!
2. Face-to-face interaction is essential
3. People are busy–make it easy
• Simple ways to communicate are essential
• Use existing ways to interact if they are already
established
4. Network governance will influence participation
What Do You Need to Do to Be a Boundary Spanning Leader?
The capability to create and support direction, alignment and commitment across boundaries in service of a higher vision or goal.Skills: – Buffering– Reflecting– Connecting– Mobilizing– Weaving– Transforming
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Ernst and Chrobot-Mason, 2011
If you want to build up your network so that it works, what should you do?
13
Large System Change
Examples of Large System Change
Campaign—Whole CountryMajor Shift in a Patient Journey or Experience Across the SystemCommunity Level Change that Extends from Health Care to All Services
POINT-Poverty Outcomes and Improvement Network Teams
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Adequate Education, Adequate Social and Human Services, Economic Self Sufficiency, Physical and Dental Health; Psychological Health and Addictions; and Family Support & Social Connectedness.
Three Communities in NE Wisconsin with Single Aim, One Common Data Set• 100 Organizations in
50 Teams• Libraries, Child Care,
Clinics, Dentists, …• Concerted Effort to
Cross Boundaries
Improvement and Large System Change
Know the Map, Know the Players
Leader Commitment
Enhance the Credibility of the Change
Simplify and Document
Find the Path:
Patients, Units
Assess Barriers &
Answer Each One
Attend the “social” Context
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What is Your Map?What Step Have You
Skipped? What are the Missing
Links?
19
From the Network You Have to the Network That Is UP to the Challenge
20
1. Set Aim
For Example:All clients have flawless transitions among settings by June, 2017
2. Understand Your Network and Map Relationships
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Identify who is in different roles: • What is working well?• Who is most
connected?• Who is the best role-
model?• Where do the best
relationships already exist?
3. Make a Reasonable Plan to Shape the Network
January May
OctoberFebruary
Create Core
Develop Prototype Teams
Peter Gloor, PhD. MIT Center for Collective Intelligence
4. Start (Improvement Skills Help) Start Small Across One Boundary—Hospital to Home; Clinic to
Social Services With people who already work together
Try over and over to get it right (reliable) When it is working, expand to other populations
and boundaries in your system: 2 places to 8 places to 32 places…..
Build in the structures to make it a win all the way around
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You are only really going to be partners if you work out the kinks together!!!!
Networks that
Work
Large System Change
Taking On Your
Challenges
Today
Resources Gloor P. Swarm Creativity. New York: Oxford University Press.
2006 Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact
Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013. (www.ihi.org)
Ernst C. and Chrobot-Mason, D. Boundary-Spanning Leadership. New York: McGraw-Hill Professional. 2011
McCannon CJ, Schall MW, Perla RJ. Planning for Scale: A Guide for Designing Large-Scale Improvement Initiatives. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2008. (www.IHI.org)
Andrea Kabcenell at akabcenell@ihi.org
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