Tuesday, June 23, 2015

The Power of Partnership - Alliancing in Australian Healthcare Part III

In third and final article in a three part series, I am talking to Anthony Osborne and Sandra Quinlan, from Seeds of Possibility, about Alliancing and its potential for application in health industry projects and health organisations (Click on these links to view Article I & Article II).

Through their backgrounds in the Energy, Construction and Utilities sectors, Sandra and Anthony both have many years experience in Alliancing, a model of project management that grew, in Australia, out of the construction industry.
 
Alliancing in practice – current and future opportunities 


What are the commercial requirements of Alliancing projects?



Anthony: Alliancing in its current form is a big process. Lets say you have three organisations that get together to bid to build a hospital.  Those three bidders have to form their own alliance.  In an example alliance I was involved in there was involving three major Melbourne based multinational construction groups who agreed to bid for a $450m project. 


These individual organisations had to get agree and align about roles, responsibilities and money.  They had to agree who is going to lead and there are a whole lot of legal requirements even at this stage, just to put the tender together.  Then there is the clients bidding process with a number of different groups who have formed alliances.  This effort is multiplied as each bidding group has gone through a similar alliancing and tendering process.  Then there is this second work-shopping stage, which leads to the successful bidder being chosen. 
Once they are selected, the successful bidding alliance has to be aligned with the client.  This doesn’t happen automatically, it involves further discussions and workshops about roles and responsibilities to align everybody completely before you start.  For large-scale projects it’s an expensive process.  It generally costs over a million dollars. 

Sandra – I have coached alliancing teams on how to work together, to help them understand and learn how to behave in a different way to their normal processes that they go through, where they just stand up and do a presentation. 

One bid we did, we had to identify how we would recruit the best people out of the organisations that were there, and how we would do it to gain them to come and work on the alliance.  We had 30mins to come back with our response.  So we did a theatre production of The Hobbit!  We had Gandalf, who gave the vision, and Bilbo Baggins who was the messenger who talked to the people. 

Rather than just wanting a presentation, the client wants to see how well the teams work together and whether they can think outside of the box.

Commercial Arrangements

For large complex projects, there are legal agreements that are put in place and solicitors are involved to ensure due considerations are documented thoroughly.

There are agreed ways of working.  The partners agree formally on how they will work together.  They also agree on what the risk factors are and how the risks, the gains and the losses will be shared. 

It’s documented in the contract upfront how much money each party is going to make.  Also if there is a profit, above what the group expects, how that will be divided up.  What we’re talking about here is total commercial transparency and this is what people find the hardest. 

Sandra - I remember sitting in with two colleagues involved with Alliancing projects in Australia and in the New Zealand health industry.  What they did really well was to create a really great environment for people to say I feel really uncomfortable about telling you and about my costing details are and what my profit is. 

You might be in an alliance with other competitors, for example if you were in the construction industry you might find John Holland and Theiss – two direct and powerful competitors - working together.  These direct competitors still have to commit to showing these details.  It asks questions of peoples ethics.  You really start looking at all of the qualities that people bring to an alliance.  This element of the selection process therefore becomes very different to what you would normally have in a commercial project.

This a major change from common commercial practice in other partnerships or tender agreements.  But what it does is that it stops people from being greedy.

An example is a project that was conducted to build the Royal Children’s Hospital in which the owners did form an alliance for the project.  They would have contracted a group to facilitate the project. 

The selection process is very different from procurement or even partnering.   Bidding groups would put forward their representative teams.  Once all he bidding teams were confirmed, to start the Hospital would have first bought in solicitors and explained the process for selection to the teams.  All the different bidding teams were then taken away for a two-day program.   There are representatives from within the hospital also involved as a panel. 

The Alliancing facilitator will work with actual live scenarios.  They will then give the teams live example scenarios, to work through and demonstrate their solution.  Anthony – I was in a number of bids for alliances and I remember workshops where ‘out of the blue’ the panel would say, we’re now stuck in this scenario what would you do?  What they are actually looking for is to understand how does each team actually relate to each other.  Do they work as individuals or do they work collectively and collaboratively?  If they are coming into an alliance they need to be fully committed to the collective.  

It’s not about the skills of the teams because it’s generally assumed that if groups have got to that stage then they have the technical skills.  They are also looking to particularly see how they handle conflict.  How they resolve differences.  Interpersonal skills.  Creativity.  These are the abilities that are really important to the alliance, so that is what they are being measured against.

They would have the project manager identified and they would be watching him really carefully to see, for example, whether he takes the lead all the time or whether he shares it with his people.  Does he defer to his people and include them or does he do all the talking?  They keep them overnight because it’s different when you go to dinner.  You can put on a performance pretty well for a number of hours, but if over night you go out to dinner with everybody and then are back into it the next day, it’s harder to fake it.

How could Alliancing be applied creatively within the Health sector?

For the full formal alliancing process that we have described, with tenders and legal agreements and two-day workshops to be utilized, you would need to be building a hospital or running another big health related project, for example as it has been used by New Zealand District Health Boards.  But I do think that with a smaller team and smaller projects you can use the concept and get that process up and running with an outside facilitator. 

One interesting option that hasn’t been explored before is in the hospital environment. Hospitals would benefit from learning to aligning nurses, doctors and administration staff.  The alliance would be within the organization.   What I have observed is that they are different entities altogether.  I hear Doctors complain about nurses, nurses complain about Doctors, and they all complain about the administration staff.  It’s almost like saying 'this is the organisation, how do we create an alliance within the organization with our own people?' 

Anthony: My experience is that usually in very senior roles you have functional managers and they tend to run their function separate to everybody else, and as a result they conflict with other departments, they don’t actually work together in unison.  If you just went in to a large organisation like that and said that ‘we’re going to bring principles of alliancing to this whole place and for a particular project we’re going to work towards one vision as one entity towards this outcome.  So you align all the divisions in the organisation for the outcome rather than individual outcomes for each group.

One thing that we’ve noticed, having been through major multi-million dollar alliancing projects, is that the breakdowns happen at the transition points.  So you come from one system into the next, and it’s the transitions where it all screws up.  For example, if you look at the information collection points.  If a medical record is collected well then it’s easy for it to go to the next system.  But if the initial collection is not good and clean and easily transferrable then the handover to the next department is no good and then they don’t fix it so when it goes all the way along the line inefficiencies develop.   Clinicians have to repeatedly gather the same information or they have different ways of collecting information. 

It would be much more efficient to work together right at the beginning by saying lets collect as much information as we can for all our needs at one point.  This gives stakeholders the ability to also consider new ways of getting information that they may not have considered before.  You see, they may have always been collecting it one way but simply need the opportunity to question if it needs to be done this way, or if it could be done differently. 

It’s always the same.  It’s the handover spots which is where the clunkiness happens and usually each just complains about the other, but in an alliance model they two groups have the opportunity to say ‘hey, we’re not communicating well here, lets sit down and align how we can make this work.

What are the steps involved in the alliancing process?

In summary

  1. You first need the facilitator to pull the management team together and agree on the project that the group wants to do. 
  2. A project group is then bought together 
  3. The facilitator works with the group to get the roadblock issues on the table and to agree on principles they are going to work by during the project.  
  4. They would then facilitate the rest of the project process.  First by facilitating the initial planning required by the management team. 

So we start the alliancing process, by working towards and gaining an agreement of how we are going to behave as a group and identifying a number of key principles by which the alliance operates. 


Then, because people have the opportunity to speak in a safe and trusting environment they get to unload their junk, which is a huge step forward.   In these situations, you don’t generally have to deal with every individual issue that comes up.  There are usually three or four issues that are the major ones and when you deal with them, the rest cease to be problems.

Sandra - An important part is to start of by going through all the issues that people bring to the partnership so that everything is on the table.  As a facilitator I would use four questions what are the issues here? What does it cause to the organization here? How do you fix it? If you do fix it, what does it give you and the organization?

This is done in a workshop scenario.  As this point we also generally bring in a manager to talk about the organizations expectation and vision.  From there though we run the program as a neutral facilitator.  Often what comes up are issues of confidentiality and trust.  I need to be able to re-assure a person what is said in the room is in confidence and what leaves the room is by agreement.  At the end of the day the group agrees, what is going out.  Because often people who come to join alliancing groups simply need to be able to talk about problems that are going on. 

There can be things that are considered ‘unspeakable’ within the organisation and until you get them out of the way you can’t get anybody to agree on anything.  What I have found as a facilitator is that issues that arise might have been going on for a long time, even 10 years or more, that is still playing itself out.  No matter which new manager comes along, and what they say, people are still seeing and hearing what they want based on these old longstanding issues. 

So a first step is always to get the departmental issues out in the open and simply work through them, so that the group is able to move forward.   You have to do this otherwise; you will not be able to get anybody to agree on anything. 

Once the principles have been established of how the group will work together, the primary aim of the workshops is uncovering what the issues are and coming up with solutions.  These solutions then go to management.  Ill also work with management as well because management want peoples input but when they get it they don’t always listen. 

Management can sometimes think they should have all the answers and they can sometimes think they are losing control.  This type of decision-making system can cause them to question what their job is now?  I work with them to help them understand that that they do play an important role of engaging with people, and that if they do that well they don’t have to make all the decisions.

I will be taking management through the same process so that they are also able to open up and speak candidly about the same situations about what they see as the issues.  Often they are exactly the same as what the people reporting to them are saying.  Sometimes their issue is that ‘I’m not understood upstairs and that I am working with all these rules and boundaries around me’.  They might know that what the operational workers are saying is right, but they’re limited because they’ve not got the support from above.

Within the workshop, you have to work through the layers to get to the top, because what is going on at the operational level is a reflection of what is going on at the top.   

In an alliance process, most of the work is with the leadership team so that they’re totally aligned and that they’re modeling the behavior that they want from everybody.  If they walk into a workshop and I say ‘I want you to speak openly and honestly’ they have to show that this is what they actually want and that people are not going to get punished for speaking up.  All of this stuff sounds great in a textbook but when you’re confronted it can be quite challenging to work with.

Also, how are they operating as a team?  Because they are the model of the whole workforce.  So I do one on one coaching with them and also sit in on management meetings and provide feedback on process.  Ill always ask initially whether they want feedback in the group or later in a one-on-one setting.  But later on it’ll be in the group environment.  Some can handle feedback initially others cant.

Then facilitating down through to the project teams who work through the problems and identify the solutions.  But you would treat this group as an alliance, not just as individual departments within that organisation so that the alliance principles could be utilized where the group is all working together for the good of all. 

The ongoing alliancing process involves having a number of regular facilitated workshops.  As a facilitator, I probably come in every 4-6 weeks depending on what is happening within the organisation. 

As the end of it, the individuals would have learnt about and taken on the principles and processes themselves.  It’s a facilitative way of leading.  They would start to work that way in their normal work. 

I did some work in a large construction group once and there were managers there who had been on a big alliance and they were sad that it was finishing and that they were going to be going back to doing procurements because alliance wasn’t happening and more.  I said to him ‘you are a facilitative leader!  You naturally lead this way and you don’t have to be in a formal alliance to keep doing this.  Once you have had the experience you can create it’.  I caught up with somebody last week that was on that project .  He is a very senior manager now with another multinational construction group and is very much a facilitative leader.   

Now back when he started on the alliancing project he was an environmental manager and he use to check everybody’s desk at the end of the day to see what they had been up to.  He was a total micro-manager!  He was really bright and a great guy, but everybody knew how micro-managed them and they were all complaining about it.  As a facilitator during the alliance, I had to really challenge him on what he was doing. 

When he spoke to me the other day, 6 years later - he’s just turned 40 - he highlighted how he understands the big picture and focuses the change in focus has not only freed up his workers to do their jobs, it has freed him up to focus on organizational wide issues.  He’s learnt these skills through the facilitation process from alliancing.  He said to me, I wouldn’t be doing this job if I hadn’t been through that alliance.

It’s a skill of taking people out of content, and bringing them up to context!  If you are caught up in the detail of the undergrowth you cant see above the trees to the rest of the forest.  Usually when we go to a worker about changing a system for example if we’re talking about the flow of paperwork in a hospital, they will talk to us about the detail and the individual steps.  But the overall context of how everything in this system impacts on the wider environment and vise versa is just as important, but there are not many people who can live and work in context. 

WHO ARE SEEDS OF POSSIBILITY 

Seeds of Possibility are a business performance consultancy.  They bring a wealth of experience in alliancing across different industries and Sandra has also worked closely with a Key consultant to a New Zealand District Health Board, who pioneered Alliancing within the New Zealand Health system.  What Seeds of Possibility do differently is that they work with clients to improve systems and engage people both at the same time.
  
As Anthony highlights ‘ I saw a recent Gallup poll that revealed over 70% of people in the workplace are not engaged with the work they do which astounded me.  ‘But it’s no use engaging with your people if your systems are no good, because if your systems are no good, the people disengage”.

When you get those elements right and include how you align everybody – the alliancing component - the organisation becomes powerful and strong and make a difference and get great results.  Their contact details are:
 
Anthony Osborne
Conscious Leader
anthonyosborne@seedsofpossibility.com.au
Mobile +61 413663360

Sunday, May 24, 2015

The Power of Partnership - Alliancing in Australian Healthcare Part II

This is the second article in a three part series investigating Alliance contracting within the Health sector.  I am talking to Anthony Osborne and Sandra Quinlan, from Seeds of Possibility, about Alliancing and its potential for application in Australian health industry projects and health organisations.  Through their backgrounds in the Energy, Construction and Utilities sectors, Sandra and Anthony both have many years experience in Alliancing, a model of project management that grew, in Australia, out of the construction industry.

In the first article, we reviewed how Alliances have become a significant form of contract partnership and management within the New Zealand health industry yet do not play a major role in Australian health management.



Chris: What is the most important part of the Alliancing Model?

Anthony: The essence of alliancing is the principles, rather than the legal documents.  It’s about the underlying philosophy.  We could go into a hospital right now and say that we’re going to create the whole concept of an alliance.   The legal structure is an upfront cost to an outstanding result, but will still have the vision of creating something with you and for you.  This is a structure and a process that we would be able to do, without the big set-ups that have built in New Zealand.

Some of the example principles that were held within Alliance I have been involved in include Equality, ‘best for project’ decision making, integration, open and honest conversation, a culture of ‘no-blame’ but accountability for action, trust, respect and integrity, proactive pursuit of innovation, mutual support and collective responsibility.

Anthony: Most organisations that don’t have an alliancing capability will bring a consultant in to fix the problem.  The problem doesn’t get fixed, so they sack the consultant and get anther one in.   In reality, its not the consultants job to fix these types of problems its the consultants job to facilitate a process so that the organisation can heal and grow.

Chris: Do Alliance members ever come into alliancing groups with pre-conceived notions of how problems should be solved?

Sandra: Of course!   Yes, everybody comes in with his or her beliefs and what they usually ask those around them is ‘what’s this got to do with [expletive] anything!’ 

People come in thinking that this meeting is going to be like every other meeting they have attended.  That is will be structured in a particular way and immediately focused on the project or on brainstorming ideas or whatever the usual format that is followed in the business.  When this doesn’t happen, people can get annoyed.  They can ask that we stop this nonsense and get down to business.  All sorts of stuff like this.

A good example of this was with an alliancing project for a huge multinational oil company.   It was a safety project for the tanker drivers and high crash incidences.  In the group they talked about family issues and home life and all sorts of seemingly unrelated topics.  But it worked.  In the end their safety issues were cleaned up because all sorts of ‘supposedly’ unrelated systems were improved like roster scheduling for example. 

You see the problem in this situation was not the obvious one of ‘wearing hardhats or boots or having driver training’.  The real, underlying issues was ‘why are the tanker drivers angry and therefore not concentrating and losing control of their vehicles’.  Well it turned out that they were angry because the schedules were poor and nobody had ever listened to them.  They were being sent into peak hour traffic at 8am in the morning with an excessive number of runs to do.   

But until we have the opportunity to really explore these issues to get to the bottom of them, people will ask on the surface ‘what has this got to do with safety?

This is why I always ask upfront ‘what is it what would get in the way of people speaking openly and honestly today’.  Sometimes, this is enough to open the dialogue and get productive conversations started.

Chris: Are there health organisations that are not ready for alliancing?

Sandra: Yes, there probably are.  Lets consider those organizations, whose leader is very autocratic and who has only one way of doing things.  I would doubt that this leader would even want to talk about alliancing.  I know that there are plenty of those managers out there. 

But there will be somebody who is a leader in the industry who is prepared to take a risk, because an alliance is a risk.  But there will be somebody out there who is a leader who wants to do something really different.  But once that happens, as it happened with a Victorian Government Transport Authority that took a leap of faith and trialed it for the first time all those years ago, is that everybody watches it and they see the success and they become curious.

Anthony: The leader needs to be open to new ways of being and doing things.  They might not know what alliancing is, but they are open to new ways of doing things. 

Sandra – As an example, one of the pioneers of alliancing in Australia had been a manager at this Victorian Government Transport organisation for years. He’d always had a dream that work could be done a particular way and he just happened to be talking to someone about alliancing, and it fitted with his dream. 

He didn’t know how you could get people working together and working for something bigger than them but he knew intuitively that this was his goal.  So he just needed to come across somebody who was able to introduce him to alliancing.   Now the risk to him, and I remember him saying it, was that it would define his career.  He said ‘I am either going to go out as a hero or my reputation will be gone’. 

Anthony:  You see the normal model is that you contract out the job to somebody, and they’re an independent person doing the job for this government department so you immediately have conflict and an adversarial relationship, underpinned by an official contractual relationship.  So if anything goes wrong, people immediately point to the contractual relationship.  The different with alliancing, is that the partners come into the group and become an intimately connected part of it and what it does.

Most people don’t want to go to work to argue and fight.  There are some, but I believe that they are few and far between.  I believe most people want to work together to be productive and do something great.  People who go into the health sector generally go into the industry because the want to help and have an underlying commitment.  If you look at an A&E department in a hospital, when things go wrong people take it very seriously because they are so committed. 

If you just give them the opportunity to work together they will want to make it work.  And importantly, they will know how to do it.  You think about how innovative you have to be when you have to make split second decisions.    

Further, if you look at the highly demanding health and safety minefield that healthcare workers have to work within.  Working constantly under the threat of being sued, while also focusing on saving a persons life managing an ailment.  Health and safety rules, when done poorly, can be the biggest block to innovation and creative thinking that there is.  And yet managers sometimes impose health and safety systems without consulting the workers.

What is it about the alliance model and process that allows projects to succeed where they haven’t in the past?

Firstly, it’s about bringing the people together.  If you have systems that cross over three different departments in a hospital, its about bringing the people in those departments together to ask how can we design a new system that works for all of us.  It may be re-working the

If I think back to the alliances I have been involved in, one might involve three different companies but they will work together to decide what is the best system for this situation.

It’s got nothing to do with the division or department that the individuals may have come from.  Divisional power struggles are not allowed.  What has to happen is for people to talk about what is best for project irrespective of what is best for their department? 

It’s the way that they come together that is key in how they work together.  The success largely relates to how this process is facilitated.  From our experiences both facilitating and working in alliance groups, people need to come in with an attitude that ‘we’re going to find a solution to a problem. 

Every alliance requires a neutral facilitator because otherwise some participants wont speak up.  A facilitator has to be able to help people see what they are not currently aware of because they are caught up in the process of it.  A facilitator therefore needs to have a neutral perspective.  They need to be able to stay ‘outside’ of the process.

If a facilitator is not neutral, they also become part of the process because of their background.  This affects their ability to stay outside.  Participants will think that the facilitator has some bias.  For example, that they are aligned with the Doctors group or the Nurses group or have some bias towards the administrative component.  A good way of describing it is like coaching in a group setting.
 
INTRODUCTION TO SEEDS OF POSSIBILITY 

Seeds of Possibility are a business performance consultancy.  They bring a wealth of experience in alliancing across different industries and Sandra has also worked closely with a Key consultant to a New Zealand District Health Board, who pioneered Alliancing within the New Zealand Health system.  What Seeds of Possibility do differently is that they work with clients to improve systems and engage people both at the same time.
  
As Anthony highlights ‘ I saw a recent Gallup poll that revealed over 70% of people in the workplace are not engaged with the work they do which astounded me.  ‘But it’s no use engaging with your people if your systems are no good, because if your systems are no good, the people disengage”.

When you get those elements right and include how you align everybody – the alliancing component - the organisation becomes powerful and strong and make a difference and get great results.  Their contact details are:
 
Anthony Osborne
Conscious Leader
anthonyosborne@seedsofpossibility.com.au
Mobile +61 413663360

Thursday, May 14, 2015

The Power of Partnership - Alliancing in Australian Healthcare Part I

Since the completion of a 2010 Pilot, 'Alliance Partnerships' (commonly called Alliances) have been introduced nationwide across the New Zealand healthcare system with the aim of combining resources, jointly solving complex problems and better integrating care.  The New Zealand Ministry of Health website identifies that:

'Health alliances are nine networks of primary health care providers and district health boards that are implementing the Government’s ‘Better, Sooner, More Convenient’ care initiatives.

A tagline for the South Island Alliance proclaims 'More Efficient Through Collaboration'.  Is there any truth in this?  Robin Gould, a Professor in Health Policy certainly thinks so.  He has written extensively on the topic, including an interesting article in 20 October 2014 in theconversation.com titled NHS: Lessons from New Zealand on how to integrate care and an article in theguardian.com titled NHS Can Learn Alot From New Zealands Healthcare System.  In these articles he reviews the New Zealand Alliancing model as a mechanism to improve Care Integration in the NHS.  He argues that:

New Zealand’s nascent alliance model has yet to be fully tested. It does, however, offer a promising alternative for public health system and integrated care governance, which NHS policy makers could consider if they’re serious about finding a fair and workable system. 

Do alliance partnerships have a place in the Victorian or Australian health system?  In this three part series of articles, I am talking to Anthony Osborne and Sandra Quinlan, from Seeds of Possibility, a Melbourne based management consultancy, about Alliancing and its potential for application in Australian health industry projects and health organisations.

Through their backgrounds in the Energy, Construction and Utilities sectors, Sandra and Anthony both have many years experience in Alliancing, a model of project management that grew, in Australia, out of the construction industry.
 
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Chris: So what is alliancing and why does it have potential for health organisations?

Anthony; Alliancing is a way of managing projects that has been around in Australia for about 10 years or so.  One of the key things that alliancing is, is game breaking.  How can we not just meet what we want, but how can we exceed it.

In with alliancing model a number of organisations get together to do a piece of work and actually create a new temporary entity that will have an entirely new culture with genuine alignment to values.  

Three organisations for example might get together, and the alliancing structure means that the group can be totally focused on the project.  This new group can establish new principles, practices and processes that are ideally suited to the project.

You see there is a problem in many organisations where we employ people for their differences then we beat them into submission to think the same.  And most organisations are not good at nurturing creative innovation from within the group.  Generally the bigger the organisation the more it happens, it is more common to see a ‘don’t rock the boat’ type attitude.  

The alliancing model allows for a group of people to make a fresh start, and a combined understanding that ‘we’re all going to work together’.   

To date, in Australia alliancing has primarily been implemented in large complex projects where technology is changing quickly.  If we were to consider the relevance to hospitals, we can see that technology is ever changing and evolving.  For example the technology in an operating theatre is constantly being developed and its fast and its constant.  

Sandra: I remember recently talking to a surgeon about the changing environment of a surgery and he was saying that in a few years time there won’t be items positioned around the room, it’ll all be coming from up in the top.  The way he started talking made the room sound like a spaceship to me. 
Now he wasn’t talking about the happening in the distant future, it was in a few years time.  This sort of change can be a quantum leap for people in how they work and think.  Many have the attitude that ‘I have been doing my job for 15 years, I’m really comfortable with it and now your bringing that strange machine or technology in!’  If the culture is a blame culture, learning doesn’t thrive in that!

Chris: What are some of the advantages of Alliancing?

Creative Innovation

Anthony: Alliancing allows creative innovation to flourish.  There are times where people have been talking to their managers about doing creative things for a long time unsuccessfully.  When I was working in Health and Safety and we were using these principles of pulling the operational workers to find things, if they weren’t asked, they would generally just sit back and wait for things to go wrong.  They wouldn’t contribute unless they were convinced that management we’re listening. 
We realised that if you want people to give you ideas you need to act on it.  People need to see that happening.  For me, the important thing is working with a management team to ensure they are committed to the process and are rewarding it.  The operational people actually see their ideas becoming reality and buy in, they become more committed to the process.

With an alliance, a new entity is created, that allows for different ways of doing things.  Suddenly, people realize that they are being listened to, and this can lead to their engagement! 

This element happens right at the beginning of the alliancing process.  Right from the beginning, there is an outcome focus, so that everybody has a vested interest in the results.  For an alliancing entity, all the key areas of cost, schedule, quality have business as usual Key Performance Indicators (KPIs), but also have ‘game breaking ones’.

Sandra : When I was working with teams on this part of the alliance creation, we would be working on ideas that normally people would see as ‘totally impossible’.  If every part of the project was estimated to take 12 months, they group might look at it and set a goal of completing it all in 6 months.   They would then work towards making that happen, so that everybody gets actively involved in doing things differently.

What this creates is the possibility for people to go, well what if we could?  Its this possibility that peoples minds love to play with.  And the group might end up saving millions of dollars on a project by making a few simple but fundamental changes.

Managing conflict

Sandra : This new entity also provides the opportunity to change the way the group manages and values conflict.  In all organisations there are a mixture of people including some who like conflict and others who do anything to avoid it.  

There are often people in the room that try and quiet down conflict and anger.  As a facilitator I allow it to come out.  People that try to quiet it down need to listen and let it happen.

The alliancing entity provides an opportunity for people to discover and appreciate that there is value in conflict.  That doesn’t mean that you’re punching each other in the face, but simply that you are able to acknowledge that on a particular point or issue that I may have a different opinion to you.  As long as you are prepared to hear me and we can meet at the boundaries then this is where new ideas can come from.

Often it’s not the first workshop that people really open up, but the second one.  I have found that when I am working really closely with a team, and they are all really passionate and vocal in their opinions.

People Taking Responsibility 

Anthony : There is a really big difference between accountability and responsibility and when I run alliancing workshops we do a whole lot of work around this difference.  You see a responsibility is what somebody actually chooses to take on.  A person can be held accountable but I can’t force you to be responsible if you choose otherwise.    

Sandra : In the workshops I work with the group on owning the responsibility.  When you are part of the design of something and have input into something you are usually more willing to take more responsibility for it.  It highlights a really important concept held within those alliancing principles, which is ‘awareness of the choices and decisions that you are making’.  

In business, a lot of times, when questioned about decisions people will say that they didn’t have a choice.  In reality they did.  They may not have liked the consequences of the choices that they were making but they do have the choice.  Gaining awareness of this and appreciating how this affects a persons own behavior, particularly in conflict situations is important.  Even if you are the angriest person in the world, how I respond to you is going to either increase or decrease it.  I can’t take responsibility for you, but I can take responsibility for how I react to any situation.

Personal Growth

Anthony : An interesting advantage of this model is that it leads to personal growth.  In the alliance projects we were involved in we called it personal development.   

Sandra : My aim is always that if somebody has worked with me, they’ve learnt something about themselves that they didn’t know before they started the process.   I had a manager once who trusted me so much, and I didn’t think I was really worthy of that trust, but he taught me something.  But I really started to live up to that trust that he gave me.  I learnt something about myself, because I upped my standard because he trusted me.  There was an expectation that there wasn’t much I couldn’t do.  This is what Alliancing does, it lifts the bar and everybody starts to rise up to that place.
I would say that when people go through that process in the most successful projects, everybody’s taken a personal career risk of some description.  For example the quiet people in team who never contribute, might actually start contributing.  

Anthony: Another example is the principle of not taking things personally.  It sounds easy, but in practice as soon as somebody gets into a sensitive spot and pokes us we react rather than respond..  Another one is to not make assumptions.  With all these ideas its not about whether our understanding is right or wrong, its about raising our awareness to it.

Most organisations that don’t have alliancing capability, will bring a consultant in to fix the problem.  The problem doesn’t get fixed, so they sack the consultant and get anther one in.   In reality, its not the consultants job to fix these types of problems its the consultants job to facilitate a process so that the organisation can heal and grow.

Chris : Alliancing in the Health Industry – why hasn’t it taken off and what is needed?

Sandra – I simple don’t think that anybody has pushed for it.  Alliancing took off in the construction world in Australia, in around 2004, and I think consultants simply got very comfortable in construction.  

There was big money in construction and people didn’t have to move to different industries.  There was no major incentive or demand to move into health and for a consultant to go this way you would have to promote it heavily to gain acceptance.  

I remember being in an engineering conference.   We were there to talk about what we were going to do with this first alliance in Victoria.  There were managers in there saying this is never going to work and other people even laughing at us.  Gaining acceptance for a new concept takes hard work! 
I have a colleague who has gone on to do a lot of work on alliancing in the New Zealand health industry with District Health Boards, but at that time one thing led to another but Australia didn’t end up doing anything at the time.

I was reading about the vision for the Royal Women’s Hospital from the new CEO.  I am majorly impressed with her.   What she wants for her patients, clearly comes from her experiences because she talks about treating people with dignity and care.   It was clearly coming from a deep emotional place that was a fundamental driver for her. I thought, that is somebody who would be an ideal candidate who has the vision to take on a new concept like alliancing.  

When you bring in any new concept you get a lot of push back.  I know for me, that she would be a really great ally because she would want it to work.  She would be able to see the concept on how that would work.  As a facilitator, she would be able to guide me through her vision.  Her vision is strong and it’s the best one I have ever seen.

Chris : Is Australia ready for Alliancing in the health industry?

Sandra: I Iook at the hospital system in Australia now and I think that there is a readiness that wasn’t there before.  There is a level of discontent with what is happening the health system and people need a level of dissatisfaction to be able to try new things.  Also people will be aware of what has happened in New Zealand.  They will have been sitting on the fence and will have gathered the evidence that they need to be happy to make a decision.           

Author:
Christopher Eastham,
Health Industry Manager


INTRODUCTION TO SEEDS OF POSSIBILITY

Seeds of Possibility are a business performance consultancy.  They bring a wealth of experience in alliancing across different industries and Sandra has also worked closely with a Key consultant to a New Zealand District Health Board, who pioneered Alliancing within the New Zealand Health system.  What Seeds of Possibility do differently is that they work with clients to improve systems and engage people both at the same time.
  
As Anthony highlights ‘ I saw a recent Gallup poll that revealed over 70% of people in the workplace are not engaged with the work they do which astounded me.  ‘But it’s no use engaging with your people if your systems are no good, because if your systems are no good, the people disengage”.

When you get those elements right and include how you align everybody – the alliancing component - the organisation becomes powerful and strong and make a difference and get great results.  Their contact details are:
 
Anthony Osborne
Conscious Leader
anthonyosborne@seedsofpossibility.com.au
Mobile +61 413663360

Tuesday, May 12, 2015

Health Service Integration Project - a lesson in project governance


Health service integration means different things to different people.  In this article I am referring to the integration of health services between two different healthcare organisations following the commercial acquisition of one business by another.  

This is slightly different idea from the traditional concept of health service integration, which is a commonly defined as bringing about "the management and delivery of health services so that clients receive a continuum of preventative and curative services, according to their needs over time and across different levels of the health system."

I am using a bit of literary license here and have been vague on purpose to highlight the issue of good governance.  Any integration project, whether its integrating newly acquired business entities or integrating the delivery of health services, requires the foundation of good governance and seemless integration between strategy and operational activity for success.  

Project Governance is simply 'the mechanisms, processes and relations by which organisations are controlled and directed'.  A project can have a really great strategy, but if the project management mechanisms, processes and relations are not set up properly and inhibit people from actively carrying out the taking required actions then the integration of the services is blocked before its even started.

A  while ago in my career, I was involved with a health organisation that purchased another business (a commercial acquisition).  Within the new business was a unit that provided health assessment services directly related to those performed by the department that I managed.  This business unit had around $1 million revenue per annum which was not huge but still significant in relation to our department.  We were not directly involved in the commercial acquisition process, instead the integration strategy was devised by senior executives who were responsible solely for sealing the deal.  It was assumed that once the purchase went through, that my team would be able to take over the services carried out by this other team.  The strategy looked good in theory and the responsible executive had created a 90 day plan onboarding plan.

As I previously mentioned, my department which included the primary operational team were not involved in the purchasing decision or strategic planning and were only told about the purchase and planned integration two days prior to the purchase.  In addition, once it did go ahead, it seemed that nobody was responsible for the project.  The service revenues and expenses were moved onto my P&L statement, but there was nobody or no governance group ultimately responsible for signing off on major decisions.  This was pretty messy for an organisation of over 200 people. 

It was assumed that the two services were similar and one could just be plugged into the other.  This was a big mistake!  Of course there were a host of relationships, systems and processes that were unique to each department and could not simply be 'plugged in' and if the operational workers has been asked about this up front they could have informed the decision makers early.  There is an interesting article from Harvard Business Review, titled When Emotional Reasoning Trumps IQ that outlines the neuro-psychology behind integrating project strategy and operations.

I did what I could to manage and lead the project from here.  I was not and still am not an accredited Project Manager but I did have a reasonable amount of experience managing small to medium sized projects.  My primary experience was in PMI project management methodology with some understanding of agile/lean working environments so I was able to prepare a framework and drive things forward to a point,  but we were playing catch up and at the time I did not have the seniority in the orgnisation or the required influence to be able to make the important decisions.  The way the organisation operated I was unable to directly influence project governance.

Here is what I did:
  1. IDENTIFIED AND ENGAGED with key stakeholders in the other team and throughout key business departments, primarily our IT and Finance departments. 
  2. DRAFTED A PROJECT PLAN with key requirements, road blocks and contingencies and created a detailed Gannt chart highlighting key dates and relationships to other major projects. 
  3. Having engaged the key stakeholders, we DEFINED THE PROJECT PHASES and required steps:
    1. Planning phase
    2. Urgent transition phase -  identifying capability required to maintain BAU Requirements
    3. Migration planning phase - preparing for overall service integration
    4. Migration of relationships, resources and materials
    5. Synchronised infrastructure switch
    6. Service integration/handover
Unfortunately though, even with a solid project plan the project was fundamentally flawed because there was nobody with clear and defined accountability.   I had taken a certain amount of responsibility but when it came time to make the major decisions there was no owner.

My manager at the time could have taken this role, but it had not been given to her and she had other reasons not to pro-actively campaign to take ownership herself.  The original project manager was leaving the company partway through the project so did not have any vested interest and had effectively signed off.

In my opinion the poor project governance derailed the project before it had even started and as a result it floundered affecting the performance of the department and the company.  The integration blew out from three months to almost one year and in that time client relationships were damaged and a lot of the value of the newly acquired business was lost.  Some entrepreneurs might argue that models of governance inhibit entrepreneurial freedom, but good governance should not be onerous and mechanisms can be built in for handing responsibility down where possible. 

So what can we learn from this?  What could we have done differently to make the project more successful? 
  1. ACCOUNTABILITY - Firstly, I believe that there should have been clear single point of accountability for the project.  By the time this finally happened, it was already 5-6 months after the acquisition
  2. STRATEGIC INTEGRATION - Operational people should have been actively consulted and included in the up front strategic planning so that strategy and operations could have been woven together more seemlessly.
  3. ALLIANCING - Finally, as a bit of a left field idea, I wonder if an 'Alliance governance model' could have been employed to carry out the project. 
What is alliancing?

Alliancing is a method of managing projects where parties work collaboratively to deliver the project.  It is a model with a defined working framework and associated agreements that is generally employed for large complex construction/infrastructure projects where risks are not well known, but interestingly has become increasingly used in the delivery of healthcare in New Zealand.  This model of project management is not generally employed for small scale projects such as this yet, but I believe it has value and should be explored as an evolution idea into the future.

Alliance contracting is characterised by a number of key features, which generally require the parties to work together in good faith, act with integrity and make best-for-project decisions. The alliance participants work as an integrated, collaborative team to deal with key project delivery matters.
Under alliance contracts, risks of project delivery are often jointly managed by the parties.

In a project such as the one I described above, stakeholders from both the departments, the one doing the acquiring and the one being acquired could form the alliance team.  In addition team members from the finance and IT departments could also be involved.  If a team like this was able to collaborate right at the beginning of the project with clear guidelines on accountability, responsibility and reporting, it might have completely changed the dynamics of the project.


  



Thursday, May 7, 2015

Chronic Musculoskeletal Condition Self-Management Resource

Its great to see organisations like Arthritis Victoria creating resources that encourage and support people to self-manage chronic conditions.

I'm excited to be able to tell people about this instructional video that I worked with Arthritis Victoria on in 2013.  It is an instructional video promoting how people with chronic musculoskeletal conditions can use of Warm Water Exercise (or Hydrotherapy) to manage their conditions.

My involvement included designing and drafting the script, and auditing the exercise science content.  I also co-presented with my colleague Renee De Silva, who was the program coordinator for the Waves program, which was a large volunteer led program involving around 120 volunteers and 1000 participants attending classes each week.  The volunteers themselves were inspirational, often having led classes every week for over 10 years and sometimes up to 30 years!

For community based health and wellness professionals working with people with Chronic Musculoskeletal conditions I highly recommend looking at this great resource.  Have a look at this short trailer for an introduction.

 
If you Want to purchase a copy for yourself or others, visit the Arthritis Victoria online store here: https://www.arthritisvic.org.au/Shop


Sunday, April 12, 2015

Reaching more people, more effectively through health technology

In a previous post from September 2014 I summarised the key innovation hotspots identified in a Price Waterhouse Coopers health industry report HealthCast: Global Best Practices in Bending the Cost Curve.  Hotspot 4, was:
  1. Care anywhere through technology development 
As an example, in 2009-10 I was involved as a provider and course facilitator with 'The Life Program' a diabetes prevention program established and operated by Diabetes Australia Victoria for people diagnosed with 'pre-diabetes' that made use of technology to enhance program reach and effectiveness.  The program was established to be run through a network of statewide providers in Victoria, with a population of over 5 million people spread throughout lots of cities, towns and regions.

The program is still running and has evolved from when I was involved, but at that time innovative solutions were employed to support program management.  An online portal was built and utilized to provide value in a number of ways.
  • The program was actively promoted through the portal.
  • Program administration was centralised through the portal with client details and medical records were securely stored, accessed and updated through it, both by a centrally located administration team and course facilitators located throughout the state.
  • The portal was also linked to a database management tool which provided ability to analyse records, compare results and identify trends which was a powerful tool for evaluating program effectiveness.
 The program also employed tele-health innovation with an telephone coaching service.  This element was in its infancy at the time I was involved with the program, but it has developed into a significant offering in its own right.  This program provides a real life example of the use of technology to provide better access to healthcare.

Having worked in occupational health over the last few years I have had the opportunity to be involved in a number of different programs that have utilized technology solutions to administer programs remotely or via networks of providers, manage cases with multiple providers and more effectively manage data and reporting.

A recent Pilot study conducted by Partners Connected Health and published in the April issue of Journal of Medical Internet Research, shows another example of technology innovation improving healthcare for cardiac patients by facilitating better remote care (Thank you to Jennifer Priester for the link).  They names their system iGetBetter, and explained how their system included: 
  • a web platform
  • interactive voice response (IVR) telephone system 
  • wireless personal connected health devices that measure and collect key vital signs. 
They further explained how patients received a Bluetooth weight scale and self-inflating blood pressure cuff to measure their weight, blood pressure and heart rate each morning. 

With the iGetBetter system participants were provided an iPad Mini tablet computer equipped with cellular connectivity to view their measurements via the Internet. The IVR system provided patients with an alternative way to manually record their measurement and care activities. 

The iGetBetter system includes a web platform, interactive voice response (IVR) telephone system and wireless personal connected health devices that measure and collect key vital signs. Patients received a Bluetooth weight scale and self-inflating blood pressure cuff to measure their weight, blood pressure and heart rate each morning. Participants were also provided an iPad Mini tablet computer equipped with cellular connectivity to view their measurements via the Internet. The IVR system provided patients with an alternative way to manually record their measurement and care activities. - See more at: http://connectedhealth.partners.org/news-and-events/media-center/announcements/mobile-web-based-remote-monitoring-study-igetbetter.aspx#sthash.KqLBooCE.dpuf
The iGetBetter system includes a web platform, interactive voice response (IVR) telephone system and wireless personal connected health devices that measure and collect key vital signs. Patients received a Bluetooth weight scale and self-inflating blood pressure cuff to measure their weight, blood pressure and heart rate each morning. Participants were also provided an iPad Mini tablet computer equipped with cellular connectivity to view their measurements via the Internet. The IVR system provided patients with an alternative way to manually record their measurement and care activities. - See more at: http://connectedhealth.partners.org/news-and-events/media-center/announcements/mobile-web-based-remote-monitoring-study-igetbetter.aspx#sthash.KqLBooCE.dpuf
The iGetBetter system includes a web platform, interactive voice response (IVR) telephone system and wireless personal connected health devices that measure and collect key vital signs. Patients received a Bluetooth weight scale and self-inflating blood pressure cuff to measure their weight, blood pressure and heart rate each morning. Participants were also provided an iPad Mini tablet computer equipped with cellular connectivity to view their measurements via the Internet. The IVR system provided patients with an alternative way to manually record their measurement and care activities. - See more at: http://connectedhealth.partners.org/news-and-events/media-center/announcements/mobile-web-based-remote-monitoring-study-igetbetter.aspx#sthash.KqLBooCE.dpuf
For more details you can Visit their website here.

Its important to acknowledge that this is a only a pilot study and too small to have statistical significance and also that there are elements of this type of program that would be difficult to replicate on a big scale (i.e. providing people with iPads).  Furthermore its important to implement technology solutions that are more appropriate for your organisation and ojectives and budget.  That said, it is useful to have awareness of the successes organisations are having with technology initiatives.


Mobile Web-Based Remote Monitoring Study Demonstrates Improved Patient Engagement - See more at: http://connectedhealth.partners.org/news-and-events/media-center/announcements/mobile-web-based-remote-monitoring-study-igetbetter.aspx#sthash.KqLBooCE.dpuf
Mobile Web-Based Remote Monitoring Study Demonstrates Improved Patient Engagement - See more at: http://connectedhealth.partners.org/news-and-events/media-center/announcements/mobile-web-based-remote-monitoring-study-igetbetter.aspx#sthash.KqLBooCE.dpuf
Study Conducted by Partners Connected Health Demonstrates Improved Patient Engagement and Self-Management in Patients with Heart Failure - See more at: http://connectedhealth.partners.org/news-and-events/media-center/announcements/mobile-web-based-remote-monitoring-study-igetbetter.aspx#sthash.KqLBooCE.dpuf
Study Conducted by Partners Connected Health Demonstrates Improved Patient Engagement and Self-Management in Patients with Heart Failure - See more at: http://connectedhealth.partners.org/news-and-events/media-center/announcements/mobile-web-based-remote-monitoring-study-igetbetter.aspx#sthash.KqLBooCE.dpufMore specifically it identifies how mobile web-based remote monitoring demonstrates improved patient engagement and self management in patients with heart failure. 
April issue of the Journal of Medical Internet Research mHealth and uHealth - See more at: http://connectedhealth.partners.org/news-and-events/media-center/announcements/mobile-web-based-remote-monitoring-study-igetbetter.aspx#sthash.KqLBooCE.dpuf
April issue of the Journal of Medical Internet Research mHealth and uHealth - See more at: http://connectedhealth.partners.org/news-and-events/media-center/announcements/mobile-web-based-remote-monitoring-study-igetbetter.aspx#sthash.KqLBooCE.dpuf