1. Ett evidensbaserat ledarskap – Teaming vad innebär det?
Carl Savage, PhD
Medical Management Centre
Clinical Management Research Group
Mairi Savage, MPH, PhDc

2. Medical Management Centre
Research and education to contribute to evidence base(d) management practice in health care
How to best use and develop resources (material, competence and knowledge) in health care in order to improve human health?
Research areas:
Clinical management
Health System and Patient Safety
Health economics
Quality imporvement
Health informatics
Service innovation and entrepreneurship
Change and intervention management and evaluation
Development of leadership and team work
3’As I said, I work at the medical management centre at KI and our purpose is to contribute to evidence base and evidence informed management paracitce in health care. Our research areas are these and they are very much tied to the challenge of health needing to accomplish the so called Triple Aim.
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3. Clinical Management Our Aspiration
We strive to bridge the medical management know-do gap by researching and developing innovative management practices together with practitioners that generate value for staff and patients
Clinical Management
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4. Innovative management practices
Clinical management research group: developing innovative management practices
Reimbursement systems for primary care
Role of resource constraints in innovation (AUH)
Business model innovation in health care (NKS, BB Sophia, SÖS, KS)
Implementation of innovative care processes (DSAB, ALB, Legevisitten)
Alternative approach to quality improvement (SKL)
Leadership competencies in health care
Role of leadership in quality management (SÖS)
Macro
Innovative management practices
Meso
2’ MJ: Macro (system), Meso (organization), Micro (individual)
In our research group, we are curious about and want to develop innvoative management practices for health care. And these are some of the examples of our projects.
Micro
Multiprofessional group: 5 MD, 2 MPH, 1 economist, 2 post-docs, 1 professor
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5. Leadership and management practices matter on all levels of care
Doctor-patient relationship (Thygeson et al. 2010)
Improving patient health as a complex task
Organisational level (Lega et al. 2013; Tsai et al., 2015; Gilmartin & D’Aunno, 2008, Shanafelt et al., 2015 ):
Decreased mortality
Reduction in adverse events
Improved overall quality of care
Better financial outcomes
Improved work satisfaction, reduced burnout and better employee retention
Health system level
Planning and executing health system reforms CS
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6. Tänk på din egen arbetssituation…
Hur skulle du beskriva ett effektivt ledarskap, dvs ett ledarskap som hjälper dig att göra det bästa för dina patienter? CS
Tänk på din egen arbetssituation…
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7. Effektiva ledare Distinguishing competencies = some competencies matter more!EQ
Emotional self-awareness
Adaptability
Emotional self-control
Positive outlook
Achievement orientation SQ
Empathy
Team work
Relationship management
Social Awareness
IQ competencies
Systems thinking
Pattern recognition MS
(Boyatzis & McKee, 2005)
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8. Effektiva ledarskap och management utbildningsinsatser behöver fortfarande utvecklas för hälso- och sjukvården
För mycket baseras på näringslivet (e.g. MD/MBA) (Weil 2013)
Program anpassade till hälso- och sjukvården har haft blygsam effect (Straus et al. 2013)
Effektiva ansatser sker:
I miljöer där deltagarna förväntas prestera
Bygger på deltagarnas eget arbete (Day et al. 2001; Avolio et al. 2009) MS
As mentioned, the second aspect of relevance is tied to need for more effective approaches to leadership and management development in health care. The need for this is well-recognized. And to meet this need, the first step was to look towards programs which already existed in other domains (mostly business). Progress was seen when interventions adapted to the health care context were introduced but nevertheless, evaluation studies demonstrate only modest effect seeing impact mostly in terms of career progression and publishing papers but much less so in terms of actual skills. Studies on the effectiveness of leadership and management programs in other industries have shown significant impact of programs which are rooted in the environment where the participants are expected to perform and build on everyday work.
Speaking up Experimentation Collaboration Reflection
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9. Hur Blir man en effektiv ledare inom hälso- och sjukvården?
Seniora och blivande ledare MJ
Hur Blir man en effektiv ledare inom hälso- och sjukvården?
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10. Vad har fungerat för framstående och framtida ledare?
20 intervjuer med två grupper av läkare
Seniora läkare i chefspositioner
Blivande ledare som nomineradas till MedUniverse "Framtidens ledare inom läkarkåren“
Syfte: Att förstå vilka egenskaper och förmågor effektiva läkare ledare tillskriver sina framgångar i att leda förändring, och hur de utvecklade dessa MS
Aim: to understand what qualities and capabilities effective physician leaders attribute to their success in leading change, and how they developed these
(Savage, M. et al, 2017, submitted)
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11. Qualities of effective physician leaders enable a learning orientation
(Dweck, 2007)
Clarity of purpose
Positive outlook
Endurance
Authenticity MS
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12. Ability to adapt one’s knowledge, skills, and attitudes in unfamiliar environments to address unfamiliar challenges
(Fraser and Greenhalgh, 2001) CS
Capabilities
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13. Ground management practices in medicine
Identify medical consequences of management decisions through clinical knowledge
Maintain integrity of purpose tied to the Triple Aim
Identify and resonate with the mental models of different professional groups CS
(Savage, M. et al, 2017, submitted)
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14. Syftet med hälso- och sjukvården
The Triple Aim
Syftet med hälso- och sjukvården
REDUCED COST
IMPROVED PATIENT EXPERIENCE
IMPROVED POPULATION HEALTH CS
Sjukvården handlar om hälsa, kostnader, och upplevelser.
Triple Aim
Quality as STEEEP
Outcome
costs
(Berwick, 2008)
&

15. Don’t just follow the money!
REDUCED COST
IMPROVED PATIENT EXPERIENCE
IMPROVED POPULATION HEALTH
Nurses & midwives
Politicians
Managers
Physicians CS
Triple Aim
Quality as STEEEP
Outcome
costs
Patients
Källa: Storkholm MH, Mazzocato P, Savage M, Savage C. Money’s (not) on my mind: a qualitative study of how staff and managers understand health care’s triple Aim. BMC Health Serv Res. 2017;17(1):98.
&

16. Money’s (not) on my mind
Dominant among
Staff
Managers
What drives change in health care?
Economics of health care
Research
EBM
Technology
Socio-political discourse CS
↓ money → opportunity to ↑ quality
↓ money → ↓ quality
Källa: Storkholm MH, Mazzocato P, Savage M, Savage C. Money’s (not) on my mind: a qualitative study of how staff and managers understand health care’s triple Aim. BMC Health Serv Res. 2017;17(1):98.
&

17. Become a systems catalyst
Identify and act on interdependencies
Spot strategic opportunities
See your own role
Connect ideas and people
Use yourself as a learning tool when testing ideas
Create vision in concert with others
Embrace complexity MS
(Savage, M. et al, 2017, submitted)
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18. Develop a scientific mindset
Guide the analysis of problems and measurement of progress
Anchor decisions in evidence
In case of no evidence, use data to inform decisions and learning, i.e. generate evidence MS
(Savage, M. et al, 2017, submitted)
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19. Work with others through teaming
”The ability to quickly build resonant relationships…
with a wide range and shifting mix of colleagues…
as opposed to assuming an idea of stable teams with well-defined tasks”
(Nawaz et al, 2014) MS
(Savage, M. et al, 2017, submitted)
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20. Diagnose Design Act Reflect
Assess the situation
Design
Develop specific plan for action
Act
Execute and record process
Reflect
Evaluate process and outcome CS
----- Meeting Notes ( :35) -----
The first step of the cycle is defined as analyzing the situation and the challenge that lies ahead.
The second step is a shift from evaluating the situation to consid- ering and selecting possibilities for action. In what order will each
comorbidity be treated? In essence, this is the general plan of patient care. Which symptom is the most serious, and which aspects need to be prioritized?
The third step is the shift from talking to doing.
The final step is crucial for understanding what worked and what did not as well as for preventing any identified failures from recurring.
(Edmondson, 2012)
Nawaz et al., "Teaming: An Approach to the Growing Complexities in Health Care." The Journal of Bone & Joint Surgery 96:21 (2014)
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21. Execution- as-Learning
Teaming for learning
Execution- as-Learning
Diagnose
Design
Act
Reflect
Organizing to Learn
Reaching Across Boundaries
Learning from Failure
Creating Psychological Safety
Framing for Learning CS
Teaming
Speaking up Experimentation Collaboration Reflection
(Edmondson, 2012)
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22. How did we get into this mess?
Stress
Look to authority
Pressure on authority to ”do something”
Temptation for a ”quick fix”
(Heifetz, 1994) CS
How did we get into this mess?
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23. = A leadership challenge
Stress
Look to authority
Pressure on authority to ”do something”
Temptation for a ”quick fix”
(Heifetz, 1994) CS
= A leadership challenge
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24. What’s the [type of] problem?
Situation
Problem definition
Solution and implementation
Primary locus of responsibility for the work
Kind of work
Type I
Clear
Physician
Technical
Type II
Requires learning
Physician and patient
Technical and adaptive
Type III
Patient > physician
Adaptive
Adaptive Leadership
(Heifetz, 1994)
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25. What’s the [type of] problem?
Contextual
Situation
Problem definition
Solution
Primary locus of responsibility for the work
Kind of work
Decision
(Work) process
Type I. Simple
Clear Ordered universe with clear causality
Clear
Correct solutions are self-evident, undisputed, and can be determined based on facts and evidence. Often one best solution.
Manager
Technical
Often a question of solution implementation
Sense
Categorize
Respond
Type II. Complicated
Ordered universe with clear causality, though not perceived by everyone.
Requires learning
May contain multiple correct answers. Involves analysis, expert consultations, and the creation of working groups. Requires coordination and collaboration. It is time consuming, and often requires a tradeoff between finding the correct answer and making a decision, but complete data becomes available, eventually.
Manager and staff
Technical and adaptive
Often a question of solution implementation and evolution
Analyze
Type III. Complex
Requires learning Unordered universe with no clear causality.
No correct answers exist. Decisions often based on incomplete data.
Staff > manager
Adaptive
Often a question of solution evolution
Probe
Type IV. Chaotic
Requires action to create stability in an unordered universe.
Requires action to stabilize in order to gain perspective and enable diagnosis. No point to search for correct answers.
Act CS
(Storkholm MH, Mazzocato P, Savage C. (2017) Make it complicated. Manuscript.)
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26. ”What the best may have, above all, is a capacity to learn and change – and to do so faster than everyone else.”
– Atul Gawande CS
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27. ”Live life as a leadership laboratory”CS
Live life as a leadership laboratory. – Heifetz, Grashow, Linsky (2009)
Utveckla din förmåga att utveckla dina kompetenser genom reflektion
(Heifetz, Grashow & Linsky 2009)
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