GETTING STARTED

2 Questions that will help you co-create projects in health care

Written by Elvira H?usler , Walid Ahmed & Verena Voelter - three professionals working in the provider, pharma & policy sectors - following a Clubhouse Discussion #TuesdayTango in Health Care on August 10th 2021.

Are you sick of complaining? Tired of hearing others lament about all what’s wrong in health care? Exhausted about the zillion failed initiatives trying to fix the system? Disillusioned by a conservative culture that is built on fear and a risk to face retaliation when voicing out-of-the-box ideas??Are you instead ready to shift your energy to become part of the solution rather than the problem? Ready to try out new ideas and projects?

Well, then you feel like us.

There is good news on the horizon! More & more initiatives - small & large - are taking off. They are based on value-based principles, powered by the digital revolution and ignited by the Covid-19 pandemic. And, they are starting to make a real difference!

The opportunity? You can be part of it!

Based on our own experience, we are sharing here below some practical tips at hand on how to master roadblocks on the way to these creative new projects. More often than not, you will require multiple stakeholders to co-create your project. And very likely, these stakeholders will have varying, if not diverging interests. You may even face situations of frank conflict. We summarized our tips in two sets of questions that you can use to prepare before & utilize during your next meeting with other like-minded (or, not-so-like-minded!) partners you need to get your project done.

But before we kick it off, a quick clarification on what the heck Tango has to do with all of this? ‘It Takes 2 to Tango’ is how the saying goes. Well, in health care it’s even more complicated. It's such a fragmented & hyper-complex ecosystem that it takes (at least!) 5 to dance. If you think about it, it all starts and ends with the patient. Patients receiving care, doctors providing care, pharma developing care, payers paying for that care, and policymakers providing the ethical & regulatory frameworks. It Takes 5 to Tango - as Verena has recently written in her book - from Competition to Cooperation in Health Care.

First, start by setting the purpose.

How to make sense of this complexity in a #TangoForFive? Generally speaking, we don't lack the talent, the expertise & the imagination of new ideas on how to solve our day-job problems in health care. However, what we are lacking is a playbook, the skillset & an incentive to implement these creative ideas. How can we eventually get from our starting point idea A to our finish & implementation point B?

In our world, driven by fee-for-service & built around billing incentives, we are often trapped in snap judgments and singling out villains. "That damn greedy payer. That conservative health authority. And anyway, BAD old Pharma! They don't get it!" This is often what is thought, if not said. In the end, it must be somebody's fault on why all of this is all so damn out of control?

However, what all this finger-pointing does, is to continue deepening silo-mentality and a culture of distrust & fear.

As a consequence, we have lost the focus on the patient and the results that matter to them.

If your day-job is paved by a constant pressure to produce, there is no time left to spend quality time with patients nor to carve out time for fancy creative workshops, no time to reflect on how to change that system. We tend to go into that meeting thinking exactly the way we quoted above. "Why don't they get it?" We fall into the trap of making our judgments personal and taking criticism to our ideas personal. We lost the focus on our purpose. We kind of forgot why we got to this point and why we showed up at that meeting anyways.

So, a simple, yet impactful measure is to start asking ourselves and the others in the room: Why did we come here? What are we aiming to accomplish? Having an open discussion.

Reuniting around the common WHY and why we want to work together is a powerful way to overcome barriers & hurdles to collaboration. Reminding us how our particular project can get us closer to our North star of avoiding redundancies & repetition, increasing quality & innovation in care, and overall becoming more efficient in developing, delivering & paying for care.

No joint purpose, no success to collaboration.

Second, adopt a playbook of seven steps for multiparty collaboration.

So, now that we gained some momentum around aligning our purpose and goal of collaboration, how can we further make progress and disentangle the problem from the person? Remember, the finger-pointing? If you got your purpose, but you keep on finger-pointing, it won't bring you closer to your final point B.

The holy grail leads you through understanding each other's interests, needs, constraints and pressures. Drawing a circle around what would be jointly possible and starting to map out what IT IS WE CAN DO together, rather than wasting all that time on all the reasons on what it is WE CAN't DO it together.

Curiosity, empathy & preparation are the keys to success, and the best predictors for positive outcomes in multiparty collaborations.

The formal way to approach this is by adopting a playbook that has long proven its worth in situations of large-scale conflict, be it political, legal or business, as well as in small-scale situations of simply conflicting interests. It is the playbook of 7 steps, first introduced by Roger Fisher, William Ury & colleagues some 50 years ago. There is really no reason why this wouldn't work in health care. Above figure taken from the book 'It Takes 5 to Tango' summarizes this framework of interest-based collaboration that has shown to remove massive roadblocks to common understanding whenever two or more parties are involved. By investing & building relationships that will reach way into the future, we overcome the trap of short-sighted fee-for-service transactions. By communicating with purpose & by practicing active listening with empathy, the dialogue can be fundamentally changed to focus on what we really want to accomplish together. By applying strict rules of fairness and putting forward arguments & perspectives grounded in legitimacy, the relationship can grow on the fundamentals of facts rather than judgments of people. Lastly, it is by using that emerging novel space to co-create a set of options, and taking the time to decide which ones will be the best joint solution moving forward, before jumping too quickly to commitments, is what helps us to secure a productive outcome with these stakeholders rather than opting out and choosing other alternatives outside of this group & project.

Yes, this is a complex map. It may sound complicated on its own as the skilled negotiator will juggle all 7 elements somewhat in parallel (there is no real sequence to these steps). But the beauty is that it can be done! It can be tried tomorrow and it definitely gets easier with practice. (For the interested reader, we are welcome to hear your questions, your successes and help you along the way.)

Start by trying this: at your next meeting on a project that involves multiple stakeholders, plan to ask what everyone's interests are and what the roadblocks are they are facing.

In summary, here are your 2 sets of questions you can adopt in your practice:

1. "Why did we come here in the first place?" This is what you can ask at the beginning of the meeting. Encourage everyone around the table to voice their primary intent on why working on this project together with you and the other parties is really important to them. By giving everyone the same airtime and opportunity to speak out, it creates an environment of trust and collaborative spirit. Collectively formulating your joint purpose is not only the first essential step to success. But it is also the moment when the magic starts unfolding. Pressures loosen. Fear diminishes. Space opens up to allow for creative thinking instead.
2. "What is the main barrier in your reality that gets in your way around this project and what are the pressures in your day-job you must satisfy today?" That's pretty much your next question, early in the meeting. Do another tour the table to ask: "What is it you would like to do? What is your interest & your constituents' needs? And, most importantly: What the 3 of us actually discovered during our recent #TuesdayTango discussion is that by voicing & hearing out these constraints, it helps to disentangle the problem from the person. It lowers the tendency of finger-pointing. It leads to (re)building trust. And foremost, it opens the door to creative thinking. It is the first step in the process of co-creating ideas. Crafting sets of options on what else we can do together to achieve our joint purpose.

The beauty is: you don't have to be the boss to be asking these questions. (Of course, it helps when the boss endorses the approach and ensures the time to be spent on it. Trust us, it is good time spent and a great investment on the path to success.)

Overall, let us conclude by saying what this approach will do: By (re)aligning on the common purpose and by adopting a playbook of 7 collaborative steps, it will drive a culture change and create space for innovative ideas to flourish. It will lead to abolish a culture of fear; a culture of change-resistance; and a culture of hierarchy & silo-mentality. Instead, it fosters collaborative thinking & skills that in turn allow for both bottom-up & top-down initiatives to co-exist. For the benefit of more resilient systems of health. For the benefit of better outcomes. For the benefit of patients.

Try it out! Everyone can start with a first step. Let us know how it's going.

It takes practice. It takes time. But it can be done!

Get started !