Collaboration for System Leadership at a Goverance Level

Collaboration for System Leadership at a Governance Level

Edward Speicher

Board Chair, SHCHC edwardspeicher@gmail.com

Presenter Disclosure Presenter: Edward Speicher

Relationship to commercial interests: • Grants/Research support • Speakers Bureau/Honoraria • Consulting Fees • Other

None None None None

Starting Situation • City of Ottawa CHCs (Carlington, PQ, Somerset West, Centretown, South east, and Sandy Hill) • History of working together, particularly at the senior staff and ED level • Opportunity of aligning schedules for Strategic Planning and pooling resources • Realized that the challenges facing each of our organizations would be quite similar, from the overall health environment to the complex clients we were focused on.

• Commissioned an Environmental Scan for our collective use in Strategic Planning.

Timeline: How we got here

PHASE 2: Creation of Joint Strategic Planning Framework

PHASE 1: Research on the Framework 2016

2017

2018

Research ------------------------------------------------ Conceptualize--------------------- Design-----------Plan----------------------- Operationalize

Jan

Apr

Jul

Oct

Jan

Apr

June Validation

Aug-Oct 2017 Environmental Scan

Multi-Board / ED Strategic Framework Session

ED Strategic Framework Session

Research Report

Executive Summary

ED Strategic Thinking Session

Environmental Scan

Multi-Board / ED Strategic Thinking Session Collaborative Strategic Framework

CHC Staff/Board Engagements

Collaborative Strategic Plan Year 1

Documentation Toolbox Coaching

What Kind of Problem?

Simple

Complicated

Complex

Making Soup

Sending a Rocket to the Moon

Raising a Child

Right recipe essential Gives same results every time

KNOWN

Formulae & experts needed, Experience built over time and can be repeated with success

KNOWABLE

No right recipes or protocols, Outside factors influence, Experience helps, but doesn’t guarantees success

UNKNOWABLE

Source: Brenda Zimmerman, late Director of Health Industry Management Program, Schulich School of Business

5

Health System Transformation A Complex Problem  Health Spending - No new money for system alignment  Multiple inter-dependent organizations (people) involved  Evolving opinions, ideas and isolated initiatives  Current focus Emergency Department & Hospital Utilization

 Aging Population  Medical & Social Complexities – Multiple Co-Morbidities, Income, Education, Transportation, Food Security, Social Isolation  Patient Experience - Not sure where to go and why they are going Referral System - No system connectedness

6

The Collaboration Spectrum Trust Compete

Co-exist

Competition for clients, resources, partners, public attention.

No systematic connection between agencies.

Turf Loose

Communicate

Inter-agency information sharing (e.g. networking).

Cooperate As needed, often informal, interaction, on discrete activities or projects.

Coordinate

Collaborate

Integrate

Organizations systematically adjust and align work with each other for greater outcomes.

Longer term interaction based on shared mission, goals; shared decisionmakers and resources.

Fully integrated programs, planning, funding.

Tight 7

Three modes of governing Fiduciary - Oversight  Facts  Figures  Financials  Risk

Strategic - Foresight  What is happening now?  What is the desired future?  Closing the gap between the two

Generative – Digging Deeper  Have we framed the issue correctly?  How else could we look at this?  What else should we consider?  Link between organization governance & public interest 8

Characteristics of Each Mode Fiduciary

Strategic

Generative

Leadership

Hierarchal

Analytical/Visionary

Reflective Learners

Board’s Core Work

Technical – ensures accountability

Analytical – shapes strategy, review performance

Creative – discerns problems; engage in sense making

Key questions

What’s wrong?

What’s the plan?

What’s the question?

Way of deciding

Reaching resolution

Reaching consensus

Grappling and grasping

Performance Metrics

Facts, figures, finances, reports

Strategic indicators, competitive analysis

Signs of learning and discerning

9

What we have confirmed along the way

A collaborative partnership model between the 6 CHC is the right approach

Start small, build on success

Agreement on a complexitybased framework (5LF)

Change takes time

Engagement Board, EDs, Staff, Clients., Partners

•

Common Purpose

•

Resources / assets: physical, financial, knowledge and expertise, specialization

•

Scale/growth: greater impact, stronger voice, comprehensive services, efficiencies and effectiveness, leverage our strength in numbers

•

Use a comprehensive Adaptive Actions W3 model

Risk reduction: shared risks

Plan strategically in short iterations 1-3 years with a yearly reset and annual work plan

Allow for individual CHC priorities as part of the plan

• What? So What? Now What?

• Same/Different

OUR NORTH STAR “Health Equity for all members of our communities” Working as a collective to address the systemic barriers and challenges to realizing health outcomes

This definition of success is reframed in the negative as a concrete principle for planning purposes as:

“In the future, in our communities, people are not subject to systematic barriers to health” All members of our communities

These are the people we work with and for.

This is us and our work.

Other health care services provide this part.

Collaborative Strategic Priorities Access • Enhance access for people with complex needs

Quality • Demonstrate quality through impact

Enablers • Strengthen key success enablers internally

The Six Ottawa CHCs are proposing the following two strategies to address the Strategic Priorities: 1. Harmonizing data collection and analysis for Ottawa CHCs 2. Strengthening & maximizing organizational & collective capacity

Challenges • True collaboration requires similar or identical levels of commitment from all collaborators • Before any elements of a strategic framework can be put into practice, each collaborator must understand how the others functions • It is important to understand from the outset where your organization is willing to compromise and where it is not

Lessons learned • Examine your mission, what your organization’s stated goals and priorities are, and see where they overlap with a potential collaborator.

• Develop a framework for collaboration, and understand what you would be willing to trade.

• Ensure that the Board members engaging in the collaborative process know what success looks like from the Board’s point of view.

Questions / Comments?

Edward Speicher Board Chair, SHCHC edwardspeicher@gmail.com

Somerset West Community Health Centre

Collaboration for System Leadership at a Governance Level: A Board Member Perspective Janice Meisner, RN, BN Member, SWCHC Board of Directors

Presenter Disclosure

Presenter: J. Meisner, RN BN Relationship to commercial interests: • Grants/Research support • Speakers Bureau/Honoraria • Consulting Fees • Other

None None None None

Board members : How our roles and responsibilities contribute in an important way to the organization: ďƒź Advance the organizations mission ďƒź Address the needs of the clients and community ďƒź Have commitment and engagement from the board member

Governance

Leadership GENERATIVE

Generative Board Discussions  Generating discussion using the right question  Looking at an issue from different perspectives and viewpoints  Reorganizing data into different patterns, seeking different frames of reference  Thinking retrospectively to uncover patterns and to recognize the compelling stories and history

The value of working collaboratively  Resources /assets physical , financial, knowledge and expertise , specialization  Greater impact, stronger voice  Comprehensive services  Efficiencies and effectiveness  Leverage our strength in numbers  Risk reduction: shared risks (From Shared portal: 6 CHC Collaborative Strategic Planning Overview)

Contact: meisnerja36@gmail.com