Holistic health system change
From Greenmode by Simon Divecha:
Over the past 5 years I’ve been involved with a delightful group diving into traditionally stuck health system problems. This work is creating holistic positive change assisting individual developmental grown and answering organisational financial and care imperatives.
The initiative – An Integral Performance Framework – has seen over 200 senior managers across Country Health South Australia shift mindsets, engage with wicked problems, develop ongoing answers, grow their and our capacities all while delivering for the organisation’s bottom lines. That is, positive change for all touched by the health system in country South Australia.
We’ve been fortunate to present this publicly in several forums – e.g. the 5th Positive Psychology and Wellbeing conference.
The initiative is catalysed by two key insights.
- It is not all about the easily quantifiable system-wide and individual health metrics. Yes, it is important how long a patient spends in a hospital bed. However, there are multiple determinants of this including the quality of engagement and understanding that person receives as well as the efficiency of the hospital, doctors and staff’s technical skills. We’ve known this for years however Integral Theory puts it in an all encompassing – internal / subjective AND external / objective – theory of the world common language context.
- Many issues for Country Health were problems to manage not solve! That is they are polarities where there are upsides and downsides of each polar approach. An obvious example is regional and centralised management. Aspects of each can deliver efficiencies. Too much of either can lead to waste and other problems.
None of this is revolutionary. We know this intellectually from research and theory.
What makes the substantive difference is a deep and engaged program – one where Directors of Nursing, Community Health Managers, Medical Directors and other clinical and corporate managers in action learning groups integrate their feelings, experiences and analytical knowledge with personal and group inquiries, listening and co-created understanding.
The work is lead by Country Health staff with a little external consulting – many workshop participants volunteered, on top of normal duties, to facilitate action learning in communities of practice with their peers.
At completion of the program, 80% of participants rated their understanding very strong with the majority identifying ways to incorporate the tools into their work. The engagement and application of learning showed that observing mindsets, culture, behaviours and systems (the integral quadrants) helped people to see more than one side of a complex issue.
The program received overwhelmingly positive feedback. It engages managers by tapping into their personal motivations, helping them to see more and showing how to demonstrate this to others.
“The tools have opened up different thinking and conversations at a leadership level. We’ve all had rich individual learning which will stay with us for our whole career.” said one regional director.
Over the course of the program, at workshops and during action learning groups, managers were asked to identify complex challenges confronting them in their roles. People took a deeper look at what was really going on – seeking and taking wider perspectives.
Achieving quality health care, which is both effective and efficient, requires organisations to engage mindsets, shape culture, build capabilities and develop systems. Too often, if we ignore complexity, we fix one problem only to create another. Then we fix the next problem, the polar opposite of the first one, to recreate the original issues. That’s a debilitating cycle.
This program shows that addressing such dynamics is not only possible. Managing and engaging in complexity enriches staff, workplaces and communities. The approach began with the original program team of four, extending to 20 Executive leaders, 22 Action Learning Facilitators and over 200 senior managers. It became sustainable through leaders walking away with skills and capabilities that are deeply embedded – understanding its as much a subjective, internal experience as a set of tangible external change practice actions.
The outcomes are applied both through the established formal and informal communities of practice and codified in the Country Health SA Performance and Accountability Framework.
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We are all learning
A core of the New Republic of the Heart is an engagement in the ‘many to many’ transmission. There are multiple individuals and groups that are cascading concepts, explicitly and implicitly, aligned to those described on this site. You’ll find stories, videos, pictures and more on how we’re all developing and being developed here.
What are these stories?
The story section area features – at a level of depth and interest to do this justice and differentiate from the multitude of short snapshots that abound on the internet – people and groups that have been working on society and group problems and solutions in ways that are congruent with the New Republic of the Heart concept. It does this with a mixture of descriptive writing, videos and interviews. It aims to create a picture of how such concepts are developing and being developed by individuals within their spheres of influence, interest and engagement.
Where can I find more resources?
There is a very partial list, reflecting our imperfect memories and the limits of our personal experience in privileged USA – here. We are already expanding this online version. And none of them (even our own projects) reflects all the ideals, values and the ultimate vision of “a new republic of the heart.”
What has been included in the resources section?
This only lists initiatives that are consciously attempting to enact cultural transformation. Equally valuable dimensions of a new republic of the heart, however, are the much larger number of efforts that embody the health and wholeness and caring character of human culture—not only the international relief workers, as important as they are, but also local churches and charities and other good works; nurses and doctors and teachers and social workers and firefighters and emergency medical technicians and other first responders; the farmers and technicians; the workers and entrepreneurs; and the countless community builders and leaders who keep re-weaving the social fabric.
Help me understand the scope
When the body (or body politic) is under siege, what restores well-being is not just the immune system, but also the vastly larger number of cells that just keep pumping the blood and lymph and nerve impulses, sustaining life and health. They are not listed here, but I want to acknowledge and appreciate the widest possible spectrum of the broad and ultimately universal emergence of a new republic of the heart.