Quarter One Learnings

In this special episode, Kyla pauses her interviews to reflect on the key themes and insights from the first three months of the podcast.  Kyla shares what she's gleaned from conversations with Dennis, Andy, Teri, Kath and Steven - distilling the learnings from each of them into practical ideas to shift the system.  

Transcript

SPEAKER_01 0:13

Welcome to a special episode of Shift. Today I'm pressing pause on the interviews to reflect on what I've learned in the first quarter of this podcast, the patterns I've noticed, the things that have stuck with me, and what we need to consider if we really want to change our healthcare system. I launched this podcast three months ago because I felt something simple and stubborn. Systems don't change unless we do. I'm not Oprah and I don't hold a formal role in any healthcare organization. But I am someone who's spent time in and out of the mix, which has given me a unique perspective. I'm endlessly curious about health system change. I read about it, listen to things, go to conferences, and I'm always talking to people who are finding ways to make good change. So I wondered, if I opened up these conversations and ideas to others, could that help shift the system? Also, as an independent consultant, I can have conversations untethered from corporate messaging or political risk. So I thought maybe this is a role I can take that others can't. The idea started on a cold January day, the kind that makes you either hibernate or reach out. I chose to reach out. I booked coffees and conversations with people I admire, and those meetings turned into a surprising string of yeses that pushed me to try this podcast idea. I was nervous, but I asked myself, what's the worst case scenario? That no one would listen, I could live with that. What happened next was a full on-building of a living learning lab in my house. Each episode became a plan to study act cycle. Record, see how it lands, tweak the questions, learn editing, add an intro, shorten an outro, try different headphones, learn and repeat. It's been messy and uncomfortable, which is exactly what learning should be. We talk about vulnerability and leadership, but even a low-stakes project like podcasting can feel pretty exposing. Especially when you promote your podcast to every health system organization in Saskatchewan, tag the Minister of Health and the Premier, and realize you accidentally put the outro at the beginning of the episode. But how else do we learn? We fail forward fast. It's awkward, but it also keeps life interesting. So with that, here are a few core insights grounded in my conversations with Dennis, Andy, Terry, Kath, and Stephen. Number one, the energy of yes. The power of yes keeps coming up. The earliest yeses were from friends who encouraged this wacky idea. Then Dennis, a stranger, who applied within hours and volunteered to be the guinea pig for my first episode. Each of those yeses mattered. We hear so many no stories in healthcare. We can't do that. Or let me check with 19 people and get back to you, and then silence. That kills momentum. Failing to energize and mobilize people slows change. Often it's about control and fear of bad things happening. But bad things happen in our system all the time, anyways. More control and micromanagement doesn't mean better results. Stephen Lewis has an article called Three Words to Live By to Boost Health System Performance. Tight loose tight. Be tight on the vision and goals. Make them meaningful, clear, and measurable, but then be loose on the execution, giving individuals, teams, and organizations lots of latitude and freedom to figure out how to be responsive to local needs. That's where the yeses come in. But then accountability should also be tight. Shortcomings should trigger improvement efforts, and successes should be shared and scaled. Where can we loosen our grip for more experimentation and freedom to try ideas from one of the most highly educated workforces? As Steven says, trust the talent. Number two, fragmentation is the enemy. Every episode surfaced something about fragmentation. Dennis and Andy spoke about how services get sliced so thinly that we lose the forest for the trees. We stop seeing people as whole and focus more on our product than the person. Kath highlighted fragmentation and organizational structures, quality improvement versus clinical quality improvement versus safety versus patient-centered care versus innovation, all siloed with competing targets. And when it feels like it's not working, we rename and restructure, rinse and repeat. What would integration look like? How could we create structures so these silos collaborate better around a few shared aims, connected in our shared purpose? Like the collective focus during COVID, where experimentation, learning, and adaptation was happening almost hourly. What did we learn from that experience that we can continue to use and build on? Terry talked about disconnected information systems and the catastrophic gaps they create. Greg Price's story is a painful reminder that fragmentation has real life consequences. And a province-by-province approach isn't going to cut it. We need a coordinated national digital health strategy. This is essential for driving down health system costs and having a healthy workforce for a strong economy. Terry's work to build collective conversation is a social movement. Let's amplify it, pressure our MLAs and MPs and health leaders for a fully functional electronic health system in Greg's honor. Number three, it's not the what, it's the how. The what is well known. Focus on primary care, build community services, work upstream, reduce acute care dependence. The reports have said this for decades. The hard part is the how. Andy Wilkins told us the three horizon framing helps. Horizon one is the day-to-day fixes we can't ignore. Horizon three is the long-term transformation we rarely discuss. And horizon two is the messy bridge work of how. So this podcast is focusing on the how, how to reduce fragmentation, how to build connection, how to shift paradigms, to let go, to get out of our own way, to have the courage to do something different. Here are my practical ideas from this quarter of the things we can do to shift the system. Have more coffees and lunches with people you don't normally work with. Talk about the future more. Use the language of Horizon 1, 2, and 3 to have different kinds of conversations. Consider the narrative of healthcare today and ask yourself: is it really more hospital beds and long-term care beds that we want? Or do we want a different future? Let's tell politicians, providers, and health system leaders what really matters to us, what we really want. And let's consider the idea of a learning health system more and figure out what that means to us as individuals, teams, and organizations as a broader system. I know everyone is doing a lot, but what are we learning from it? Ultimately, this quarter, I've come to realize that this podcast exists to be a small piece of the learning health system. I hope with every episode you learn something new or it generates a new insight. That's my goal and what I hope to continue to do going forward. I'll return to interviews next week, and I'm excited about the upcoming guests. Please share this podcast with people who work in healthcare or anyone who cares about a better system so that we can continue to learn together. Until then, keep sharing your stories, asking good questions, listening, and remember, systems don't change unless we do. This is Shift. See you next time.