Efnisyfirlit

• Front Matter
  • Preface: Why and How We Wrote This Book
    • Endnote
  • The Authors
• PART 1 The Challenge to Health Care Organizations and Creating the Leadership Team
  • 1 INTRODUCTION: From Management Myths to Strategic Intelligence
    • Plan of the Book
      • Part 1: The Challenge to Health Care Organizations and Creating the Leadership Team
      • Part 2: Strategic Intelligence and Profound Knowledge for Leading
      • Part 3: Learning from Other Leaders and Creating a Path Forward
    • KEY TERMS
    • ENDNOTES
  • 2 WHY AND HOW HEALTH CARE ORGANIZATIONS NEED TO CHANGE
    • Table 2.1 Modes of Production in Health Care
    • The Purpose of the Preliminary Research
      • The Model of Change
      • Changing Modes of Production in Health Care
    • Health Care in Learning Organizations
    • Leadership for Learning
    • The Human Side of Change
    • Approach to Service
    • The Role of Culture
    • The Mayo Model
    • SUMMARY
    • KEY TERMS
    • EXERCISES
    • ENDNOTES
  • 3 LEADING HEALTH CARE CHANGE
    • Figure 3.1 Integration of the Three Types of Leaders into a Leadership Team
    • SUMMARY
    • KEY TERMS
    • EXERCISES
    • ENDNOTES
  • 4 DEVELOPING A LEADERSHIP PHILOSOPHY
    • How to Develop a Philosophy
      • Purpose
      • Ethical and Moral Reasoning
      • Levels of Moral Reasoning
      • Practical Values
      • Gap Analysis
        • Table 4.1 Example of a Gap Survey
      • Definition of Results
    • Using the Purpose to Define Results: Cherokee Nation Healthcare Services
      • Table 4.2 Translation of the CNHS Purpose to System Level Measures
    • The Mayo Clinic Organization Philosophy
    • SUMMARY
    • KEY TERMS
    • EXERCISES
    • ENDNOTES
• PART 2 Strategic Intelligence and Profound Knowledge for Leading
  • 5 LEADING WITH STRATEGIC INTELLIGENCE AND PROFOUND KNOWLEDGE
    • Figure 5.1 Strategic Intelligence, Leadership Philosophy, and Profound Knowledge
    • Foresight
    • Visioning as Designing the Idealized Organization
    • Partnering
      • Figure 5.2 Partnering Continuum
      • Figure 5.3 Partnering Continuum and Health Care Examples
    • Motivating
    • Profound Knowledge
      • Figure 5.4 Lens of Profound Knowledge
    • Understanding Systems
    • Understanding Variation
    • Understanding Psychology
    • Understanding Theory of Knowledge
    • Employing Strategic Intelligence and Profound Knowledge
    • Summary
    • KEY TERMS
    • EXERCISES
    • ENDNOTES
  • 6 CHANGING HEALTH CARE SYSTEMS WITH SYSTEMS THINKING
    • Figure 6.1 Transforming from an Organizational Focus to a Health Care System Focus
    • Figure 6.2 An Organization Viewed as a System
    • Figure 6.3 Organization Chart for a Service Organization
    • Figure 6.4 Systems View of a Service Organization
    • Interdependence
      • What Do We Mean by Process?
        • Figure 6.5 Concept of a Process
        • Figure 6.6 Concept of a Key Process and Level of Detail in Nested Systems
      • Two Kinds of Complexity
        • Figure 6.7 Nested Systems and Change at the Detail Level
    • Classifications of Processes
      • Figure 6.8 Three Types of Processes
      • Table 6.1 Institute of Medicine's Ten Simple Rules for Delivery Systems
    • Defining the System
      • Figure 6.9 Defining the Satellites of the System for a Health Services Organization
    • Why Systems Thinking Is Difficult
      • Table 6.2 Comparison of Analysis and Systems Thinking
    • Changing a System
    • Leverage, Constraints, and Bottlenecks
    • Systems and People: Improving Behavior
    • SUMMARY
    • KEY TERMS
    • EXERCISES
      • Figure 6.10 Conceptual View of a Health Care System
    • ENDNOTES
  • 7 STATISTICAL THINKING FOR HEALTH CARE LEADERS: Knowledge About Variation
    • Figure 7.1 Control Chart for Positive Intervention by Doctor
    • Interpretation of a Control Chart
      • Figure 7.2 Rules for Determining a Special Cause
    • Avoiding the Two Kinds of Mistakes in Reacting to Variation
      • Table 7.1 Mistakes Made in Attempts to Improve Results
    • Graphical Display Using Statistical Thinking
      • Figure 7.3 Hospital Dashboard3
      • Figure 7.4 Safety Events per 10,000 Adjusted Patient Days
      • Figure 7.5 Safety Events per 10,000 Adjusted Patient Days: Control Chart
      • Figure 7.6 Control Chart of Unplanned Returns to the Emergency Department
      • Figure 7.7 Infections per 1,000 Patient Days: Total
    • Power of Simple Run Charts for Data Display
      • Figure 7.8 Reduction in Average Ventilator Days
      • Figure 7.9 Average Ventilator Days: Before and After Data from the QI Team
      • Figure 7.10 Using Bar Charts to Compare Before and After
      • Figure 7.11 Run Chart for Case 1
      • Figure 7.12 Run Charts for Cases 2–6
    • Leadership to Improve Population Health
      • Florence Nightingale: The Lady with the Stats
        • Figure 7.13 Nightingale's Causes of Death Chart
        • Figure 7.14 Run Chart of Nightingale's Data
    • SUMMARY
    • KEY TERMS
    • EXERCISES
      • Example of Case Study
    • ENDNOTES
  • 8 UNDERSTANDING THE PSYCHOLOGY OF COLLABORATORS
    • Personality Intelligence
      • Talents and Temperament
      • Social Character
        • Figure 8.1 Social Character
      • Drives
        • Figure 8.2 Seven Value-Drives
      • Motivational Types
        • Figure 8.3 Comparison and Summary of Motivation Types from Freud, Fromm, Maccoby, and Porter
        • Figure 8.4 Maccoby's Personality Viewed as a System
      • Identities and Philosophy
    • Bureaucratic and Interactive Values
      • Bureaucratic and Interactive
        • Table 8.1 Bureaucratic and Interactive Social Characters
    • Motivation: Popular Ideas to Unlearn
      • Maslow's Hierarchy of Needs Theory
        • Figure 8.5 Maslow's Hierarchy of Needs
      • Maccoby's Critique of Maslow's Theory
      • Hawthorne Experiments: Maccoby Critique
        • Figure 8.6 Hawthorne Workers: Women in the Relay Test Room 193011
    • Using Personality Intelligence
      • Creating the Environment for Intrinsic Motivation: The Five Rs of Motivation and the Seven Value-Drives
        • Figure 8.7 The Relation Between the Five Rs and the Seven Value-Drives
        • Figure 8.8 Intrinsic and Extrinsic Motivation
    • Leading with the Heart
    • Disciplines of the Heart
      • Seeing Things as They Are—Deep Listening
      • Listening and Responding to Others
    • SUMMARY
    • KEY TERMS
    • EXERCISES
    • ENDNOTES
  • 9 A HEALTH CARE LEADER'S ROLE IN BUILDING KNOWLEDGE
    • How Do Theories Evolve?
      • Table 9.1 Theory Building Table
      • Figure 9.1 Single- and Double-Loop Learning
    • Learning and Continuous Improvement
    • Shared Meaning and Operational Definitions
    • Utilizing a Standard Methodology for Learning in the Organization
      • Figure 9.2 The Model for Improvement7
      • Figure 9.3 PDSA Cycle
      • Figure 9.4 PDSA, Deductive and Inductive Learning
      • Figure 9.5 Application of the PDSA Cycle to Increase Degree of Belief
      • Figure 9.6 Using Multiple PDSA Cycles to Build Knowledge
      • Using Multiple PDSA Cycles to Build Knowledge
        • Figure 9.7 Getting to Shared Meaning, Ladder of Inference, and Learning Norms11
    • The Leader as Learner and Teacher
    • SUMMARY
    • KEY TERMS
    • EXERCISES
    • ENDNOTES
• PART 3 Learning from Other Leaders and Creating a Path Forward
  • 10 THREE CASE STUDIES: MASTERING CHANGE
    • Figure 10.1 Methods for Leaders to Build a Learning Organization
    • Table 10.1 Strategic Intelligence and the Four Ps
    • CASE STUDY A: SYSTEM FOR MASTERING CHANGE IN JÖNKÖPING COUNTY COUNCIL, SWEDEN
      • Figure 10.2 Measures of Performance for Jönköping County Council
      • Figure 10.3 Chain Reaction for Health Care
      • Figure 10.4 Understanding the Flow of Patients with Esther
      • Figure 10.5 Jönköping View of the Interplay Between Professional Knowledge (Subject Matter) and Improvement Knowledge (Profound Knowledge)
      • Figure 10.6 Jönköping County Council Viewed as a System
      • Figure 10.7 CEO Sven Olaf and Big Group Healthcare
      • Figure 10.8 Communicating Progress Using Variation Tools
      • Table 10.2 Methods for Leaders to Build a System of Improvement
      • Figure 10.9 Seven Questions Showing the Way
    • CASE STUDY B: A MEDICAL DIRECTOR-LEADER IMPROVES CARE IN DIALYSIS CLINICS
      • Figure 10.10 Patient as a System Nested in the Care Delivery System
      • Figure 10.11 Run Chart with Albumin Target of 4.0 or Above
      • EXHIBIT 10.1: MODEL FOR IMPROVEMENT: ALBUMIN PROJECT CHARTER
      • Figure 10.12 Hypoalbuminemia: Related Conditions and Care Across Time for ESRD Patients on HD
    • CASE STUDY C: BUILDING A LEARNING ORGANIZATION AT OCHIN, PORTLAND, OREGON, UNITED STATES
      • Figure 10.13 Original Conceptual Framework of the OCHIN Delivery System with Two Subsystems
      • Figure 10.14 2009 OCHIN Integrated Conceptual System Map: First Draft
      • Figure 10.15 2012 OCHIN Conceptual System Map with Internal and Member Ami™ Improvement Projects
      • Figure 10.16 Skills Assessment Tools Format
      • EXHIBIT 10.2: ROLE DESCRIPTION TEMPLATE
      • Table 10.3 OCHIN Practical Values for the Individual and System
      • Figure 10.17 Member Collaboration Structure
      • Figure 10.18 Percent of Patients Diagnosed with DM with HbA1c Done Within 6 Months
      • Figure 10.19 Percent of Patients Diagnosed with DM Last HbA1c Reading <=8 Months
      • Figure 10.20 Percent of Adult Patients Diagnosed with Diabetes and Screened for Depression Within the Last 12 Months
    • KEY TERMS
    • ENDNOTES
  • 11 LEADING CHANGE: First Steps in Employing Strategic Intelligence to Get Results
    • Table 11.1 Summary of Exercises for Leading Change
    • Assessing and Defining Purpose for the Organization
      • ▪ STATEMENT OF PURPOSE EXAMPLE
      • EXERCISE 11.1 QUESTIONS FOR THE ORGANIZATION'S EXECUTIVE LEADERSHIP
    • Assessing the Learning Organization
      • EXERCISE 11.2 LEARNING ORGANIZATION EVALUATION
    • Aligning Roles to Support the Organization's Purpose
      • ▪ ROLE STATEMENT EXAMPLES
      • EXERCISE 11.3 DEVELOP AN INTERNAL TEAM OR DEPARTMENT ROLE STATEMENT
      • EXERCISE 11.4 DEVELOP AN INDIVIDUAL ROLE STATEMENT
      • EXERCISE 11.5 DEVELOP A ROLE DESCRIPTION
        • EXHIBIT 11.1 ROLE DESCRIPTION TEMPLATE
      • EXERCISE 11.6 INDIVIDUAL LEADERSHIP RESPONSIBILITIES
    • Developing a Leadership Philosophy and Practical Values
      • EXERCISE 11.7 INDIVIDUAL LEADERSHIP PHILOSOPHY
      • EXERCISE 11.8 TEAM LEADERSHIP PHILOSOPHY
        • Table 11.2 Gap Survey Form
        • Table 11.3 Value Gap Evidence/Action
        • Table 11.4 Aligned Values Evidence/Action
        • Table 11.5 Results Discussion
      • Summarizing and Interpreting Results from the Practical Values Gap Survey for Leadership Team Learning
        • Figure 11.1 Example of Value Gap Analysis Results
        • EXERCISE 11.9 PRACTICAL VALUES GAP ANALYSIS
    • Strategic Intelligence and Profound Knowledge for Changing Systems
      • EXERCISE 11.10 INDIVIDUAL STRATEGIC INTELLIGENCE INVENTORY
        • Table 11.6 Strategic Intelligence Inventory
      • Summarizing and Interpreting Results from the Strategic Intelligence Inventory for Leadership Team Learning
        • Figure 11.2 Strategic Intelligence Survey: Chart Display of Thirty-Eight Questions
        • Figure 11.3 Strategic Intelligence Survey: Control Chart Display (OCHIN)
        • Figure 11.4 Control Chart Organized by Leader
    • Developing Personality Intelligence
      • EXERCISE 11.11 INDIVIDUAL PERSONALITY INTELLIGENCE
      • EXERCISE 11.12 INDIVIDUAL MOTIVATION
      • EXERCISE 11.13 TEAM MOTIVATION
    • Systems Thinking: Creating a System Map of Your Organization
      • Figure 11.5 Example of a Macro-Level View of the Health Care System
      • Figure 11.6 Meso System Map for Managing a Learning Organization
      • EXERCISE 11.14 MAP STRATEGIC OBJECTIVES TO THE SYSTEM MAP TO IDENTIFY PROJECTS
      • EXERCISE 11.15 UTILIZE THE SYSTEM MAP TO CONSIDER SYSTEM CONTRIBUTIONS TO PROBLEM
    • Process of Change: Idealized Design
      • EXERCISE 11.16 USING THE FOUR Ps TO CREATE THE IDEALIZED DESIGN
        • Table 11.7 Four Ps Planning Template for 1, 3, 5 Years
        • Figure 11.7 Achieving the Vision of an Ideal Future
    • Understanding the Psychology of Partners and Collaborators
      • EXERCISE 11.17 ASSESS IDEAL FUTURE LEADERSHIP SUPPORT
      • EXERCISE 11.18 ASSESS IDEAL FUTURE ORGANIZATIONAL SUPPORT
        • Table 11.8 Four Ps Gap Survey
    • Translating the Vision and Strategy to Actionable Approaches
      • EXERCISE 11.19 STRATEGIC PLANNING ASSESSMENT
      • Figure 11.8 Driver Diagram for Achieving Improved Patient Experience, Population Health, and Reduced per Capita Cost
      • Figure 11.9 Driver Diagram Template
    • Leading Individual and Team Improvement Efforts to Achieve the Vision
      • EXERCISE 11.20 DEVELOP A DRIVER DIAGRAM
      • EXERCISE 11.21 DEVELOP AN AMI™ DRAFT PROJECT CHARTER FROM THE DRIVER DIAGRAM
      • Figure 11.10 Draft Ami™ Charter
    • The Sponsor Report: Keeping Leaders in the Communication Loop
      • Figure 11.11 Sponsor Report Example: Clinic Wait Time for Patients
      • EXERCISE 11.22 CREATE A SPONSOR REPORT
    • Learning from Improvement Efforts
      • EXERCISE 11.23 REVIEW PROJECTS USING PDSA
    • Redeployment of Resources
      • EXERCISE 11.24 RESOURCE ALLOCATION
    • Removing Barriers and Obstacles
      • EXERCISE 11.25 CONDUCT IMPROVEMENT TEAM REVIEW MEETING
      • Table 11.9 Building a Learning Organization Component Evaluation
      • EXERCISE 11.26 LEARNING ORGANIZATION EVALUATION
    • SUMMARY
    • KEY TERMS
    • ENDNOTES
• Back Matter
  • Appendix
    • Leadership Personality Survey
      • Table A.1 Leadership Personality Survey
      • Table A.2 Scoring Chart for Personality Survey
    • Social Character Questionnaire
      • Table A.3 Social Character Questionnaire
      • Scoring of Social Character Questionnaire
        • Table A.4 Scoring for Social Character Questionnaire
    • Understanding Leadership Personality
      • Figure A.1 Graph for Personality Type Questionnaire
    • The Caring (Freud's Erotic) Leadership Personality
      • Figure A.2 Caring Personality
      • Table A.5 Strengths and Weaknesses, Caring Personality
    • The Visionary (Freud's Narcissistic) Leadership Personality
      • Figure A.3 Visionary Personality
      • Table A.6 Strengths and Weaknesses, Visionary Personality
    • The Exacting (Freud's Obsessive) Leadership Personality
      • Figure A.4 Exacting Personality
      • Table A.7 Strengths and Weaknesses, Exacting Personality
    • The Adaptive (Fromm's Marketing) Leadership Personality
      • Figure A.5 Adaptive Personality
      • Table A.8 Strengths and Weaknesses, Adaptive Personality
    • Leadership Personality Examples
      • Table A.9 Leadership Personality Examples
    • Combinations of Types
      • Table A.10 Summary of Productive Mixed Leadership Types
      • CARING-Dominant Mixed Leadership Types
        • CARING-Visionary (Humanitarian)
          • Figure A.6 Caring-Visionary Personality
        • CARING-Exacting (Counselor)
          • Figure A.7 Caring-Exacting Personality
        • CARING-Adaptive (Helper)
          • Figure A.8 Caring-Adaptive Personality
      • VISIONARY-Dominant Mixed Leadership Types
        • VISIONARY-Caring (Institution Builder)
          • Figure A.9 Visionary-Caring Personality
        • VISIONARY-Exacting (Strategic Leader)
          • Figure A.10 Visionary-Exacting Personality
        • VISIONARY-Adaptive (Entrepreneur)
          • Figure A.11 Visionary-Adaptive Personality
      • EXACTING-Dominant Mixed Leadership Types
        • EXACTING-Caring (Exacting Teacher)
          • Figure A.12 Exacting-Caring Personality
        • EXACTING-Visionary (Process Creator)
          • Figure A.13 Exacting-Visionary Personality
        • EXACTING-Adaptive (Technical Consultant)
          • Figure A.14 Exacting-Adaptive Personality
      • ADAPTIVE-Dominant Mixed Leadership Types
        • ADAPTIVE-Caring (Consensus Builder)
          • Figure A.15 Adaptive-Caring Personality
        • ADAPTIVE-Visionary (Guru)
          • Figure A.16 Adaptive-Visionary Personality
        • ADAPTIVE-Exacting (Technical Salesperson)
          • Figure A.17 Adaptive-Exacting Personality
    • Mixed Type and Social Character
      • Farming-Craft Social Character
        • Figure A.18 Farming-Craft Social Character
      • Bureaucratic Social Character
        • Figure A.19 Bureaucratic Social Character
      • Interactive Social Character
        • Figure A.20 Interactive Social Character
  • Glossary
    • ENDNOTES
  • Index

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