Tag Archives: health care

Hosting Lessons from the Field – Inviting Innovators and Pioneers in Health Care

Posted on by
5

It is just the beginning of 2012 and already the year has been rich in hosting lessons from the field, diving deep into new levels of awareness around hosting subtleties. It began in Utah early in the month, hosting Healthier Health Care Systems Now with Tenneson Woolf, Steve Ryman and Marc Parnes.

Marc Parnes

Marc, who is a physician, gynaecologist and host from Columbus Ohio, started us off on day 2 with a story intended to set the tone and challenge of the day.  He told of what was to be a routine surgery he was doing on a woman.  When he opened her up and looked inside, what he saw not only surprised him, it alarmed him.  Things that were not supposed to be stuck together were.  He could not see the path for the surgery.  He was not able to see his way.  He did not know how to proceed with the surgery as he stared at this jumble of internal organs.

All eyes were on him as he then he stood up in our circle.  We could feel the anxiety of that moment.  Standing there, Marc planted his feet shoulder width apart, just like he did on the day of the surgery, to ground himself.    As he closed his eyes, he described doing exactly this as he stood beside the woman on his operating table.  Then, with his eyes closed, he reached into the woman and began to feel his way around, searching with his hands for the openings he could not see with his eyes.

When he finished, he knew what to do.  He opened his eyes.  He could now calmly begin the surgery, having expanded his vision of what was possible by “seeing” with other senses.  The surgery was successful.

There was a collective sigh of relief in our circle.

We began to reflect on what Marc’s story had to do with innovation in health care, what it had to do with hosting.

After coming through the first day, we checked in as a host team and invited the voices of others who showed up to participate in the design process.  We tracked our day around purpose and intention.  We felt good about the design and flow of the day and we felt we had challenged people beautifully in our opening circle on day 1 by asking them to speak to the pioneer and innovator inside of them that had responded to the invitation, but not to speak too deeply to their work, promising that would come later.  We sensed that though the day had been good, something was missing.  With reflection, we realized we were still on the ground of old territory and familiar conversation, not the new conversations we had invited people into.

The invitation was to be in a different conversation about health care.  The challenge for this group was to move into what would be a new conversation for each of them. This amazing group of individuals carry in them irrepressible dreams for healthcare systems that thrive; for simplicity that doesn’t deny the complexity, yet responds well to it.  They continue to have high hopes for healthier healthcare despite having been in many, many conversations about shifting the systems within which they work and play.  Those who responded to the HHS call were already innovators and pioneers in health care.   Maybe the new conversation was not a collective conversation about a new global vision about health care but was about individual systems of influence and what was at the edges of their own learning that might be new territory.

Our challenge, as a hosting team, we realized, was in making sure we really did travel to new territory – not an easy challenge given the experience of the people who came.

We continually scanned what we knew that could invite people into new territory. We brought play into our process – a beautifully renewed learning edge.  Collaborative play, allowing us to see and experience our learning beyond the cognitive or intellect.  Then, through reflection, seeing our patterns in work and relationship in whole new ways.  Allowing inspiration to enter in.

At the end of day two, despite traveling much ground in the day, there was still a sense of restlessness in our hosting team that took awhile to fully sense into. Something edgy.  Something still not quite arrived at.

Checking in as a host team and, like the day before, with others interested in our design process, we recognized that we were happy with our design and the flow of the two days. We briefly wondered if we should be satisfied with where we were and consider how to enter and close our last day well. Yet there was something we still had not quite arrived at.  Something about the new conversation we hadn’t quite dug into.

We reflected on what we knew from our Art of Hosting experiences that would push the edges of where we were.  If we were looking for a groan zone or acupuncture point in our process, normally we would look to a point in day two.  But this timing did not show up in day two.  Were we willing to push our own learning and hosting to bring in something even  more edgy in the morning of day three?

We knew we would not get to where we wanted to go through another conversational or intellectual process.  We decided to invite this group of physicians, health care administrators and others into a guided visualization process, to invite them to explore their own future journey in healthier health care now. Following the visualization, we invited them into drawing or illustrating some representation of their experience in the visualization process, followed by a conversation with a partner to really dive into this experience in depth.

The experience was intense and provocative. It shifted the shape of some individuals.  It shifted the shape of our gathering.  It broke the pattern of the old and invited a new pattern. The World Cafe that followed was amazing.  It was sparky. Ideas flowed quickly.  There was a new quality that had entered into our space.

Once we saw it, experienced it, we could name it.  We had shifted from conversations that came from the head to conversations that now came from a deeper place.  The conversations were now embodied. People began to look at their own path and their own systems of influence rather than at points of the system too far beyond their own systems of influence to have any real impact.  We were in new territory.   We observed that embodiment shifted the conversation to deeper and more meaningful places.

As a hosting team we agreed to continue to push the edges of this group, knowing we still had a whole day ahead of us, even though if we had planned a visualization process, we would likely have planned it for the end of day two.  But sensing where we were, knowing what we were aiming for, keeping our essential calling questions close, we pursued our purpose and intention.  We continued to host potential right up to the moment of preparing to close our circle.

It isn’t over until it’s over.  We know that.  I have often heard it said in a hosting team.  And this time we lived it fully with a trust in each other, in what we were sensing and our willingness to flow with what was there.  Even as I write this, it is hard to describe the exact edge we were on or the truth of our experience.  But I’ve been reflecting on it a lot.  These reflections flowed into the last couple of weeks in Brazil, during Warrior of the Heart and a local Art of Hosting stewarding gathering, where we danced with flow to the most amazing degree – letting go of design to sense into what was alive and needed in any given moment.  More reflections on that later.

For now, the richness of the host team learning in Utah stays with me, embodied in my own experience in the best of ways.  I feel myself growing my capacity in hosting in the most delightful of ways, brought out by those I have the privilege to host with.  This year has started off so rich in learning, it makes me deeply curious for what the rest of 2012 will bring.

Innovators and Pioneers in Systems Change

Posted on by
15

In Utah for Healthier Health Care Systems Now (January 11-13, 2012), we used the 2 Loops Model of Systems Change as one of the framing references for why we were gathered. It is a tool and a framing to understand the work we are individually and collectively in that shifts the shape of health care.  The two loops model looks like this:

 

The first loop represents the old system, the one we often name as the dying system.  The second loop represents the new system, the one we keep claiming we want, the one we think cannot emerge by fiddling with the old, the one we believe is needed to bring our current systems out of crisis.

The problem is, when we begin to think about the complexity of something like health care, where there are so many jurisdictions, so many players, so many interlocking systems,  trying to imagine what this new system or systems could be becomes paralyzing.  The conversation often becomes philosophical and theoretical.  It largely comes from an intellectual and cognitive place focused on all the things that need to shift that are outside our circle of influence.

Some of the frustration in being innovators inside of systems is that the systems begin to push back on the work in small and large ways, leading to the exhaustion, frustration and disillusionment so many leaders in health care experience.  This is all part of the old narrative.  Of course this showed up in our conversations in Utah to greater and lesser degrees depending on the questions, depending on who was in the conversation at any given time.  Any time we were in that conversation, thinking about the new system, it didn’t feel like a new conversation.

So, how could we be in conversation about Healthier Health Care Systems Now without  focusing on the second loop or the new system?  Well, by remembering who we are – pioneers and innovators in health systems – working under the first loop – in the in-between spaces – championing the new or being championed.  We began to focus in on and explore new questions: Where are the edges of my work?  What is the new territory I could begin to walk when I go home?  How can I draw on the resources in the room to expand my thinking, even turn it upside down and on its head – like the person who relies on gift economy in her practice, for her livelihood?  What more becomes possible in generative spaces with other innovators?  This was a different conversation, in tone, texture and energy.  This one did not come from the head. It was embodied in a whole new way – the beginnings of a new narrative of health.

The awareness of the old narrative and of the stuck places infiltrated us in the best of ways at the end of the first day of our three day gathering.   Someone suggested what we needed to do was create a vision of the new.  Ordinarily I might agree.  In this case though, that didn’t feel right.  It felt like it would take us further off track given that our roomful of people were geographically stretched from coast to coast across two countries with countless “systems”?

So, without taking our eye off the intention of shifting the narrative of health, we refocused on innovating and pioneering and guerrilla tactics of  hosting, collaborating and co-creating, engaging those around us in this journey that is health.  We didn’t leave with a specified vision of the new system.  We left heartened in our respective journeys, knowing the way to the future is through new processes, deeper conversations and finding our way with as many of our friends and colleagues as we can attract, engage and embolden along the way.

As we continue to shine the light on the experiments already underway, the successes, the challenges and the “failures”, and tap into the individual and collective resilience that is fighting to emerge, we can remember it is a journey that will shift and change as we go.  We remember life actually wants to help and it wants to heal. If we focus on how to expand our individual systems of influence and share those stories with our friends, our collective system of influence automatically begins to expand.  What seems like isolated work informs pockets of work elsewhere and we grow an energetic field that is part of the new, part of the second loop and is fueled by everyone stepping into innovative, courageous and pioneering ideas and projects.

I still can’t see what that second loop is for health care – other than it is about health and it is healthier.  I’m not sure anyone who showed up for this conversation can see the second loop either.  But I am absolutely sure that the innovators and pioneers are already prototyping what’s possible, what’s new, and in this work more and more of the new and the new narrative will show up.  I am reinvigorated by what’s possible, by the people who continue to explore these questions, who challenge the status quo, despite possible personal risks in doing so and know that there are better and more healthy ways to engage health care.

I and my hosting mates are committed to convening more of these conversations with people compelled to be in them to grow the field.  We envision large gatherings of people convening in new ways, continuing to innovate our way into the new system(s) so that maybe one day we will wake up and see in front of our eyes what we once thought impossible – a new generative system of health resilient enough and healthy enough to be sustainable in unexpected and beautiful ways.   If we take our eyes off the urgent need for something that feels impossible and put it in the places where possibility thrives… well, what more is there to imagine or say?

Steve Ryman, Tenneson Woolf, Kathy Jourdain, Marc Parnes

 

 

2 loops of systems change

Healthier Health Care – Now! A Little Taste of What’s Cooking

Posted on by
2

We wondered what would happen if we invited friends from across North America to convene in Salt Lake City, Utah around the question of Healthier Health Care Systems Now?  We were amazed.  We began by sharing who we are – the innovator and pioneer in us that  compelled us to come to this conversation.  Then we shared the exciting work we are engaged in.  We talked about the “system” and discovered “it” was never A system and “it” was not about health.  We moved from talking about systemic issues that felt as philosophical as we know they are real and moved into embodying the conversation, coming from a place of deep connection to ourselves, each other and the work that continues to call us in the worlds we work and travel in.  The insights, themes and cool learning are just beginning to percolate for each of us.  More, much more, is cooking.

It was beginning to cook before we even arrived in Salt Lake City.   We discovered healthier health care was such a compelling question people went to great lengths to get there.  Some initially said no and then found a way to come.  Others felt the question so urgently they used vacation days and airmiles to get there.  One person even crowd funded her flight.

Twenty-six of us arrived on January 11, 2012 – physicians, naturopaths, other practitioners, administrators and consultants from heath, public health, dentistry, acute and long term care from Nova Scotia, Ontario, Alberta, Ohio, Minnesota, Winsconsin, Illinois, Texas, Oregan, Washington and Utah.  Everyone an innovator or pioneer already working diligently on shifting the shape of health care within their spheres of influence.  We all brought stories of change and deep and compelling questions. We made instant connections that inspire us to go deeper and to keep at it.

This will continue to simmer and cook for quite some time to come.  I will have more to share here about this conversation at the beginning of 2012, curious to see how it might grow as we convene a community of practice for those who were there, those who wanted to be and couldn’t make it and those who begin to find their way to this particular conversation in their own way.

You can find snippets of harvest on Twitter by searching #HHSUtah.  Thanks to Amanda Fenton, who was with us from afar, for stepping in and compiling our tweets @Storify.

I offer here a little taste of a quick and fun harvest at the end of day 2 as we went around our circle and each of us added a line to the unfolding story of our journey together. I didn’t catch every word, but it will give you some small essence of the experience, recognizing some references are very specific to our experience, and it will have to tide you over til the next post.

“There were a bunch of hooligans in a house by the mountain.  They thought of themselves as pioneers, radically re-engineering, brought together by living systems that taught them how to transfer what they are learning and experiencing into what they are doing now – open to possibility.  In sharing, they saw new connections and unique opportunities.  They described them as opportunities to change and blow shit up.  These hooligans had so much to think about, they sat in circle, played, visualized and created on many levels a new vision of what they were yearning for – simplicity, wellness, with open heart toward the future to bring this new narrative to everyone.  Envisioning systems that bring forth vision and health, letting go of the old to release into timeless universe.  They pondered next action.  In the middle, they went deep into the cellar to share unique fonts and forms of creativity.  They came together to discuss the topic but it was more than the sum of its parts – human nature – own beauty, higher power and purpose run in each of them and each other with gratitude, although we do fear discovering in horror on FB the shaking moments, with brains exploding in chaos, guerrilla gardening and permaculture parties.  But then, a pause for reflection and even more to emerge.  Finished.  No shame.  Amazing thing, working hard to create something different.. but in the end, they were different, a community – and in their differences they found their common humanity from which to go back to the places they came renewed, reinvigorated, inspired to innovate on!”

With gratitude to all who were there, all who held the rim of this gathering from afar and specifically to my fellow hosts Tenneson Woolf, Steve Ryman and Marc Parnes for an experience that will be long remembered, in a gathering where the new narrative of health was activated, the field of innovation in health care where we meet was amplified and shifting the shape of health care in our spheres of influence has been accelerated.

Healthier Health Care Systems Now!

Posted on by
4

Most of us know the intractable challenges of health care, no matter where we live. Many of us are battle tested, battle weary and battle scarred.  Yet, we continue to have high hopes for healthier healthcare.  We have irrepressible dreams for healthcare systems that thrive and are committed to wellness.  Just because some of us have been in this conversation for awhile, doesn’t mean the shift won’t happen, no matter how discouraging it gets at times.  Really how do we nudge the big machine of the system when it seems to be hunkering down that much more? What is the staying power we need to do this work in the midst of chaos and serious push back?

What do we do when we are asked to be different but the “system” wants us to do all the same things?  We are being asked to transform but please don’t look any different than you do right now?  These are tough scenarios, impossible push backs from a system that is seeking its own next evolution and afraid to go there at the same time.

Just because we can’t see the way, doesn’t mean it doesn’t exist.  But what does it take to stay the path of pioneering, shift and change?

My good friends and colleagues Tenneson Woolf, Steve Ryman, Dr. Marc Parnes and I have put out a call to current day pioneers in health care systems change to gather in Salt Lake City, Utah from January 11-13th to unearth the deeper questions that sustain us and propel us forward on this mission for healthier health care systems now.

The more we are in conversation as a hosting team, with those planning to attend and those who wish they could be there but for various reasons find it impossible, the more inspired I become about how THIS conversation can and will be different and more than all the ones I’ve been in over the last 5 or 6 years.

I am particularly inspired about what connection can be made between this event and a global conversation on health care.  As we come out of a retreat together, what is it that we could collectively offer, or even teach, others about what we are leaning?  We see a Community of Practice emerging from this.  What does the CoP do together over a period of time that none of us can do alone?  What is the conversation that needs to happen in health care right now – today – that cracks it open in a new way?  What is the unifying force and what happens if it gets unleashed directionally?  How do we use the amazing technology platforms available to do this in whole new ways?

Other thought provoking questions that have been arising through the many conversations:

  • “The system doesn’t work that way” is not a good enough answer anymore.  How do we create systems that make sense to any of us?
  • Systems are more complex that we can manage – how about simpler systems?
  • What’s at the edges that if we could see it and understand it, might help us open up the middle?
  • What happens when we tell our stories of inspiration, especially the ones that are in danger of getting lost?  Can we revitalize these real world stories and our own capacity to be in the journey for the long run?

I am inspired by the Occupy movement, even as it struggles to understand what is next – like health care, like community change, like financial systems….  Charles Eisenstein writes about Occupy in this post on Where next for Occupy.  One of the things he says is, “We want to change the psychic and interpersonal substructure of the system we live in.”  Is this what we mean when we talk about health and wellness systems instead of illness systems?  What would happen if we could change the psychic and interpersonal substructure of health care?  What does that even mean?  I’m not sure but would love to be in that conversation.

Our hosting team has also been inspired by our friend Peggy Holman’s work on Journalism that Matters.  What if this gathering on health care that matters produces a similar set of principles; something like:

  • Health care professionals are stretched, refreshed and inspired to pursue innovations
  • New and often unlikely partnerships
  • Breakthrough initiatives
  • A community of health care innovators
  • A growing culture of innovative health care

We are not in this because it is easy.  We are in it because it matters.  Because we have tried many things, seen success with some and know there is what appears to be a long ways still to go.  Because “the system doesn’t work that way” is not a good enough answer anymore even if we haven’t quite seen the path forward.  Because we know we need to be in this together.

Because we feel in our very beings it is actually possible to create healthier healthcare and we know that it must happen more systemically. We are gathering with people who want to see and do leadership differently for the future of healthcare. With people who are hungry for new conversations. Who feel a responsibility for imagining and contributing what hasn’t been imagined before. With people who know that the way to take on big stuff is to turn to each other. Muck it up. Get curious. Stay focused.

I grow hungrier every day for this conversation now.  Wondering how much bolder I need to become…. we need to become… in a age that needs boldness and daring like never before.  What a good way to kick off a new year – and a prescient one at that!

A 1500 Day Collaborative Journey

Posted on by
3

In November 2006, the Council of the College of Registered Nurses of Nova Scotia (CRNNS) embarked on a 1500 day collaborative journey, the likes of which they could hardly imagine was possible at the time.  What was clear was that the College had a vision and a mandate to grow inter-professional collaborative practice (IPCP) from pockets here and there across the province to a more widespread practice as one of the responses to a health care system in need of shifting the way services were delivered.

They knew this was not a mandate that could be achieved alone and they weren’t quite sure how to invite other professions into the conversation.  They contacted an Art of Hosting colleague of mine who invited me into the process and we worked with a team from the College to begin to clarify the work.

Early on we identified that this would likely be a long term process that would use Theory U to define the journey and Art of Hosting as the operating system. Before the journey could even begin, others needed to be invited into the conversation so that other people and organizations could identify what contribution and what level of support or commitment they were willing and able to offer.

The College hosted its first assembly in November 2006 to announce its mandate, speak what they were hearing in the system and being called to do, invite a broad array of health care professionals into conversations using processes like Appreciative Inquiry, World Café and circle which many participants experienced for the first time ever that day.

Out of this assembly a core team of about twenty-five people and financial support from a broad range of health organizations self identified to commit to a multi-year process that included two Art of Hosting retreats (one a sensing retreat and one a presencing retreat) to train the core team, deepen their understanding of the purpose and principles of the work and identify a strategy to move this mandate forward.  We called on Art of Hosting colleagues doing similar work in Ohio and in England to come and also support this initiative, bringing with them a wealth of experience and weaving in the stories from other places that increased the anticipation of successfully shifting the shape of collaborative health care in Nova Scotia.

The collaborators included: Annapolis Valley Health, Capital Health, College of Licensed Practical Nurses of Nova Scotia, College of Physicians and Surgeons of Nova Scotia, Dalhousie University, IWK Health Centre, Nova Scotia Association of Health Organizations (now Health Association of Nova Scotia), Nova Scotia Department of Health, Pharmacy Association of Nova Scotia, Registered Nurses Professional Development Centre and the Pictou County Health Authority.  The team included people from many of these organizations and was itself inter-disciplinary.

In between the two retreats, the core team embarked on a series of sensing strategies to broaden their own understanding of the health care system in Nova Scotia, identifying challenges and opportunities without assuming they already knew all the answers.  One purpose in this was to also engage a more stakeholders and learn from them what would capture their support, interest and imagination.  Seven group interviews and thirty five individual interviews were conducted, designed to elicit their private voice more than their public voice.  It is in the private voice that deep despair and incredible hope both reside.

The information that came back from these interviews was powerful.  So powerful it was used to invite back a large assembly of stakeholders in May of 2008 to hear the results and, most importantly, to hear the voices of the system spoken back into the room.  In response, somebody said, “What we are seeing is a crisis of the soul.”

We asked people: “What would you do that you’ve never done or dreamed of doing to change the future of healthcare?” They responded:

  • Change the way we deliver health care
  • Change the focus of health care
  • Change education of practitioners
  • Change what we say to communities
  • Change governance of health care
  • Change relationships and how we work together

We asked, “What should the purpose of the health care system be?”  To which they responded:

To create and maintain holistic, accessible support and care so that Nova Scotians may live well in a place they call home.

 

To facilitate and empower the individual and the community to create and maintain

optimum health as defined by the individual.

 

The purpose of the healthcare system is evidence based, person-focused, preventative, holistic, and uses a collaborative approach to optimize the health, safety, wellbeing and environment of people within their communities.

People made commitments that day and the College made a commitment to check back in later with their last assembly to acknowledge and celebrate progress.  That day happened in June 2010.

Six champion collaborative practice teams currently providing services in Nova Scotia were invited to present at the Assembly, modeling the way and illuminating the steps to successful collaborative care in Nova Scotia.

Have all the ideas identified in May of 2008 been implemented?  No.  But in 2010, there was far more collaborative care in Nova Scotia than there was in 2006 when the College began its quest and invited in collaborators, retaining its willingness to be a champion of this work and, at the same time, “letting it go” so that it could be co-created throughout the whole journey with those who stepped forward to share the leadership and responsibility of this work in Nova Scotia.  Other initiatives focusing on Collaborative Care also emerged during this time helping to expand awareness and the field of practice and this does not lessen the impact of the Inter-Disciplinary Collaborative Practice initiative in generating impactful responses to a system in need of change.

Some things have fundamentally changed.  Some things are still to come.