Slides Act on Data SYSTEMS THINKING LEARNING TOOL Improving Chronic Disease Coordination Learning Tool Chris Soderquist Pontifex Consulting April 16, 2014
Act on Data Project Team Kris5 Pier, Act on Data Chair and the Director, Center for Chronic Disease PrevenDon and Control at the Maryland Department of Health and Mental Hygiene (Formerly the Diabetes PrevenDon Coordinator at the Michigan Department of Community Health) Heather Devlin, Evalua5on Team, CDC Division of Diabetes Transla5on (formerly EvaluaDon Lead for the Minnesota Diabetes Program at the Minnesota Department of Health and a Research Associate with the Georgia Health Policy Center at Georgia State University) Trish Herrmann, NACDD Diabetes Consultant (formerly with the Diabetes Program Manager at the Arizona Department of Health Services)
Overview Purpose of Training Webinar Series Overview Expectations & Focus Overview of Designing Your Session with the Tool Framing Exercises Introducing mapping language Homework Plus/Delta
Question What challenges do you face that you believe using the Systems Thinking Learning Tool will help you address? Type in your answers while I continue. Thanks
Purpose of Training This training will build your capacity to facilitate high impact sessions with state coalitions/partners to TOOL improve chronic disease prevention and control by using the Systems Thinking tool
High Impact sessions will move participants to a focused, strategic, and rigorous conversation on interventions. For example, here s an exercise you can facilitate near the end of a session
EXERCISE: Building systemic understanding Directions In this exercise, you will use the handout to identify places where your mental model suggests there is an opportunity to find higher leverage with respect to reducing chronic disease and its impacts. Individual Exercise 1. Circle those areas on the map where you think there is higher leverage. 2. Write 1-2 sentences describing what could be done there and why it could generate higher leverage. Prevention Interventions Symptom Control Interventions Small Group Exercise 1. Assign the role of time keeper to one person. Assign the role of recorder to another. 2. Each person share their maps including their reasoning to the rest of the group. Just like brainstorming, there are no critiques or comments on what each person shares 3. The recorder will fill out a clean version of the exercise sheet. They may ask only questions necessary to clarify what they write. The time keeper will make sure this section takes no longer than the session facilitator prescribes. 4. Once everyone has shared their individual sheets, the group may ask questions of each other s recommendations. 5. The group then determines their top 3 recommendations. The recorder will fill out a new sheet to be presented to large group.
SKILLS Built Knowledge of Tool & Materials Components & purpose of each Designing Agendas Assembling tool components for specific meetings/ purposes 2 Hour Agenda 9:00 PURPOSE / EXPECTATIONS / PAYOFF (flip charts or slides) 9:05 INTRODUCTIONS 9:10 OBJECTIVE (flip charts or slides) LEVERAGE (flip charts or slides) 9:15 ADAPTIVE CHALLENGES CONCEPT (flip charts or slides) Facilitating Sessions Effectively delivering the agenda
TOOL & Materials DIAGRAMS TOOL SLIDES MOVIES SIMULATIONS & INTERACTIVE EXERCISES
All sessions you DESIGN will likely have the following components Using the tool & exercises participants will 1. Frame session & Identify issues 2 Hour Agenda 9:00 PURPOSE / EXPECTATIONS / PAYOFF (flip charts or slides) 9:05 INTRODUCTIONS 9:10 OBJECTIVE (flip charts or slides) LEVERAGE (flip charts or slides) 9:15 ADAPTIVE CHALLENGES CONCEPT (flip charts or slides) 9:20 WHAT IS STRUCTURAL UNDERSTANDING? (demonstrate or show video) 9:25 BASIC STRUCTURAL UNDERSTANDING MAP OF CHRONIC DISEASE (draw or use tool) 9:30 ENHANCED STRUCTURAL UNDERSTANDING SIMULATION EXERCISE (use tool) 9:45 MORE SOPHISTICATED MAP BUILD OUT (use tool) 10:00 EXERCISE SET UP (unfurl in tool, then show slide exercise) 10:10 EXERCISE (handouts) SESSION AGENDA Same Page Goal 2. Build structural understanding of cause Collective Understanding 3. Identify high leverage interventions Coordinated Action
FACILITATING Effective Meetings Practice with others Learn the material ahead of time Have your props handy TO BE EFFECTIVE Draw live in the room Apply Conversational Capacity* *Presented in an Act on Data webinar series. Described by Craig Weber (Conversational Capacity, McGraw-Hill)
SESSIONS Overview April 16, 2014 Overview of training Tool purpose Framing a session Exercises to create a learning environment Introducing systems thinking as framework for developing High Leverage interventions Exercises to build understanding of chronic disease prevention and control (Part 1) Homework May 7, 2014 Exercises to build understanding of chronic disease prevention and control (Part 2) How to run simulation exercises Homework May 28, 2014 Exercises for different purposes (e.g. new funding approach, determinants of health, etc ) Designing your session Homework
EXPECTATIONS Expect to I will present materials first You ll get a sense for all the components The final session is where we ll work on putting them together Without knowing what s there, it will be hard to start with just the assembling activity
Expect to Experience new ways to communicate, teach, and facilitate SYSTEMS THINKING LEARNING TOOL EXPECTATIONS Learning this stuff can be an affront to self esteem, so Learn useful systems thinking concepts Be challenged in the process Focus on what you re learning Not what you think you ve still got to learn Do not fear I will be coaching you even after these sessions to make sure you can use the tool
Quick Walk Through of Tool & Materials
You ll note there a tons of slides and movies you could use to present concepts. I recommend you use (most of) them to learn the concepts yourself then present concepts using flip charts or other live means.
Now let s dive into each exercise / segment of the Tool
We ll introduce sections and exercises in order you d deliver them 2 Hour Agenda 9:00 PURPOSE / EXPECTATIONS / PAYOFF (flip charts or slides) 9:05 INTRODUCTIONS 9:10 OBJECTIVE (flip charts or slides) LEVERAGE (flip charts or slides) 9:15 ADAPTIVE CHALLENGES CONCEPT (flip charts or slides) 9:20 WHAT IS STRUCTURAL UNDERSTANDING? (demonstrate or show video) 9:25 BASIC STRUCTURAL UNDERSTANDING MAP OF CHRONIC DISEASE (draw or use tool) 9:30 ENHANCED STRUCTURAL UNDERSTANDING SIMULATION EXERCISE (use tool) 9:45 MORE SOPHISTICATED MAP BUILD OUT (use tool) 10:00 EXERCISE SET UP (unfurl in tool, then show slide exercise) 10:10 EXERCISE (handouts) SESSION AGENDA 1. Frame session & Identify issues Same Page Goal To be successful, you must 2. Build structural understanding of cause Collective Understanding first frame The session purpose and process 3. Identify high leverage interventions The required participant mind set Ineffective framing of any/all of the above can severely limit effectiveness Coordinated Action
Framing answers the burning questions in participants minds. Why am I here? What s the Context for this Experience? What will I Experience (Expectations)? ONE (perhaps useful) FRAME Participants are at your session to engage in a process of adaptive learning The purpose of learning is to identify high leverage interventions to improve chronic disease prevention and control Finding high leverage solutions is greatly increased by using Systems Thinking The session will include several exercises where they will apply Systems Thinking The result: Greater understanding of how to improve prevention & control
Framing Exercise 1 Establish session objective
Framing Exercise 1: ESTABLISH SESSION OBJECTIVE As individuals, have participants sketch out trends over time of what they hope will improve as a result of their efforts Price they ll pay if not addressed Have participants think Big Picture How has this trended in the past several years? How will it trend in the future (next 10-20 years) if they do nothing? How will it trend in the future (next 10-20 years) if they are wildly successful? Facilitate a large group session to combine/integrate history 2000 2014 2024 YEAR future Future trend if wildly successful Build Systemic Understanding of Coordinating Chronic Disease Care
EXAMPLE Framing Exercise 1: ESTABLISH SESSION OBJECTIVE For chronic disease, the GOAL is to reduce both 1. Annual deaths (negative impacts) from complications 2. Prevalence of the condition NOW 2. Prevalence FUTURE YEARS 1. Annual deaths from complications TRANSITION In order to understand how to avoid the price of ineffectiveness and to create the future we most want, it will be helpful to understand the distinction between routine problems and adaptive challenges Build Systemic Understanding of Coordinating Chronic Disease Care
Questions, Comments?
Framing Exercise 2 Frame issues as adaptive challenges
Technical (Routine) Problems vs. Adaptive Challenges reducing chronic disease and its impacts Routine/technical Problems Easily defined An obvious, proven solution Often an expert on whom we can call to solve the problem for us There is, in other words, a routine for dealing with the problem. Improving chronic disease is one issue where there is a preponderance of adaptive challenges so learning is essential Adaptive Challenges Often hard to define No clear solution, and different people hold different views about its source No expert who can solve the problem for us They are fundamentally different. 100% routine=bias for ACTION 100% routine=bias for LEARNING Few issues are 100% routine or 100% adaptive. The greater the % adaptive, the more the bias shifts from acting to learning. Build Systemic Understanding of Coordinating Chronic Disease Care
EXAMPLE Framing Exercise 2: UNDERSTAND ADAPTIVE CHALLENGES Refer to the Adaptive Challenges section in the Facilitator Guide Use flip charts if possible Engage the group in identifying the adaptive nature of addressing chronic disease issues
EXAMPLE Framing Exercise 2: UNDERSTAND ADAPTIVE CHALLENGES ROUTINE/ TECHNICAL PROBLEM EASILY DIAGNOSED OBVIOUS SOLUTION IDENTIFIABLE EXPERT ROUTINE Bias for ACTION Where do the issues just sketched fall along this continuum? ADAPTIVE CHALLENGE HARD TO DEFINE NO OBVIOUS SOLUTION NO EXPERT NO ROUTINE / PROTOCOL Bias for LEARNING TRANSITION The goal of collective learning is to identify high leverage solutions. Build Systemic Understanding of Coordinating Chronic Disease Care
Questions, Comments?
Framing Exercise 3 Approach uses Systems Thinking to identify High Leverage through a process of Adaptive Learning Someone exercising leadership is orchestrating the process of getting factions with competing definitions of the problem to start learning from one another.
WHAT IS LEVERAGE? The ability to fundamentally improve the performance / behavior of a system with minimal wasted effort / resources and unintended consequences We find leverage evasive because we are applying routine problem solving to an inherently adaptive challenge Build Systemic Understanding of Coordinating Chronic Disease Care
Someone exercising leadership is orchestrating the process of getting factions with competing definitions of the problem to start learning from one another. If leadership is about learning, what type of learning will yield high leverage insights? Ron Heifetz Kennedy School of Government (Harvard University) and expert on adaptive leadership Those responsible for system behavior must get on the same page with what we ll define as: STRUCTURAL UNDERSTANDING Build Systemic Understanding of Coordinating Chronic Disease Care
Demonstrating leverage What walks down stairs, alone or in pairs?
EXAMPLE Framing Exercise 3: APPROACH USES SYSTEMS THINKING TO IDENTIFY HIGH LEVERAGE THROUGH A PROCESS OF ADAPTIVE LEARNING Refer to the Leverage & Structural Understanding sections in the Facilitator Guide Use flip charts if possible Make sure you have a Slinky and a full glass of water handy Engage the group in identifying how many proposed (and implemented) solutions to challenges are often low leverage Structural understanding is required for High Leverage.
EXAMPLE Framing Exercise 3: APPROACH USES SYSTEMS THINKING TO IDENTIFY HIGH LEVERAGE THROUGH A PROCESS OF ADAPTIVE LEARNING 1. Write on a flip chart LEVERAGE The ability to fundamentally improve the performance / behavior of a system with minimal wasted effort / resources and unintended consequences 2. Read quote Someone exercising leadership is orchestrating the process of getting factions with competing definitions of the problem to start learning from one another. 3. Deliver Slinky ex.
WHAT IS STRUCTURAL UNDERSTANDING? The most common answers are: 1. GRAVITY 2. REMOVING THE HAND To explore the usefulness of these answers for leverage, view the following clip. What is STRUCTURAL UNDERSTANDING?
WHAT IS STRUCTURAL UNDERSTANDING? So gravity and removing the hand are necessary but insufficient to cause the oscillating behavior. Watch the clip again. What s the cause of the behavior? What is STRUCTURAL UNDERSTANDING?
WHAT IS STRUCTURAL UNDERSTANDING? The cause is the STRUCTURE of the Slinky. It s an oscillation looking for a place to happen What s the implication of assigning structural causality to leverage? What is STRUCTURAL UNDERSTANDING?
WHAT IS STRUCTURAL UNDERSTANDING? How much leverage do you have if your mental model of the cause of the oscillating behavior is 1. GRAVITY 2. REMOVING THE HAND 3. THE STRUCTURE What is STRUCTURAL UNDERSTANDING?
WHAT IS STRUCTURAL UNDERSTANDING? 1. GRAVITY If your mental model is the cause is GRAVITY, you have NO LEVERAGE. You would be trying to change an immutable law otherwise known as Fighting the Physics Policies that fight the physics achieve little to no results. The system seems impervious to their actions. Have you ever experienced a situation where you felt some health policy was fighting the physics? What is STRUCTURAL UNDERSTANDING?
WHAT IS STRUCTURAL UNDERSTANDING? 2. REMOVING THE HAND If your mental model is the cause is REMOVING THE HAND, you will also often have NO LEVERAGE. Why? Removing the hand is an external input on the system. It comes from outside the boundary of the system. In most cases, you have no control over when such an external force will appear nor how strong it will be Example: If you are trying to bolster the US economy, you have no control over European Union countries. If they have a banking crisis, that s outside your control What is STRUCTURAL UNDERSTANDING?
WHAT IS STRUCTURAL UNDERSTANDING? 3. THE STRUCTURE Watch the following clip to assess the usefulness of adopting a STRUCTURE AS CAUSE perspective. (aka SYSTEM AS CAUSE) What is STRUCTURAL UNDERSTANDING?
WHAT IS STRUCTURAL UNDERSTANDING? Mental models where the cause of the behavior we wish to improve is an external force outside our control have no leverage The only leverage for improving behavior is developing a mental model using a SYSTEM AS CAUSE view. Let us now see how to apply this perspective with Chronic Disease strategy What is STRUCTURAL UNDERSTANDING?
Questions, Comments?
Framing Exercise 4 Introduce BATHTUB DYNAMICS (Stocks & Flows)
EXAMPLE Framing Exercise 4: INTRODUCE BATHTUB DYNAMICS Refer to the BATHTUB DYNAMICS section in the Facilitator Guide Use flip charts (if possible)* Demonstrate with two glasses of water (if possible) Engage the group in identifying the adaptive nature of addressing chronic disease issues *You can use the movies in the Slides to practice or deliver this section
Point out that you are going to use a way of representing the physics of the system that is operational 1. Run the water pouring demonstration Make the point that the accumulation/stock is prevalence the flow is incidence People in the stock are treated. Prevention reduces the flow rate. 2. Draw* the three stock map up on a flip chart (a butcher block piece of paper is better) Under the stocks write characteristics of the population *You can use section A2 (in tool) to practice or deliver this section Start with the Chronic Conditions Population Work your way from Chronic back to At Risk back to Safe Assert that they will use variants of this map for the rest of the session
Have participants sketch the map in their exercise booklet *You can use section A2 (in tool) to practice or deliver this section
Questions, Comments?
Homework Before the next session Review the movie of this webinar Download the materials (link on next slide) Review all the movies in the Slides.PPT and folders that relate to these exercises (listed in table upper right) MOV files to review Objective Leverage Slinky 1 Glass Modify structure Bathtub dynamics Practice all of the framing exercises demonstrated today (with others if possible) If time permits, review all the sections in the lefthand column (A) of tool (lower right)
DOWNLOAD MATERIALS AT hsp://www.chronicdisease.org/?page=actondatast
What worked? What could we do that would improve next session?
See you on May 7th you may reach me (Chris Soderquist) at PontifexConsult@gmail.com