CentreonStrategiesforPublicandCivilEntrepreneurs

www.publicspace.nl

@stevendewaalDr.StevenP.MdeWaal

DisruptionofHealthcare:TherisingpowerofpatientsLectureIndustryForumHealthcare,Pfäffikon(Switzerland)

March7,2018

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Mission ’Winning strategies for the common good’. Open non-ideological inquiry, active international outlook for best practices and interdisciplinary approach. The main mission is promoting active citizenship and social entrepreneurship in public services

ThinkNetwork ThinkTank has evolved into a Think Network. Prominent executives, academics, opinion leaders and decision makers operating in strategic frontiers of public/private corporations

PublicSPACEFoundation(since2002)(www.publicspace.nl/english)

Opinion, blogs and archive on website Core Concept since 2002

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Outline1.   Commonknowledge:disruptionasthemoststrategicphenomenoninmarkets2.   Surprise:sametechnologiesalsohavedisruptiveimpactonpoliticsandpublic

servicesthroughpowerofcitizenship3.   DisruptiveCitizenship:mentality,powertoolsandorganizationcapacity4.   Revolutionsarealreadygoingoninhealthcare5.   Bigimpactonleadershipinhealthcare.Maindirection:CivilLeadership*Mainchallengeinleadershipmakeslecturesonleadershiprelativelyuseless:Youaretotallyincharge:leadershipispersonal.Onlyyourpersonality,yourleadershipabilitiesandstyleandyourpersonaleffortscount!*Dr.S.P.M.deWaal‘TheValue(s)ofCivilLeaders’,Eleven2014

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Mostimportantstrategicissueinmarkets:disruption

•  Recentdefinition:Riseofnewandunexpectedcompetitors,fromoutsidecurrentmarket,innovativeinandthroughtheirdirectaccesstoandexchangewithcustomers

•  Commonconclusionuntilrecent:CEO’sseeitlatest.Firstphase:denial,ignorance,defensive(seeminglyrational)critique.Afterthat:surprise!Thisisproofofrealpowershift

•  Directexchangeandrealtimeinformation&communicationiskey•  Economyandcompetitiondominatedanddictatedbyplatforms•  Competitionbetweenplatformsison:

sympathy,belonging,community-feeling,hands-onservice,feelingofbeing‘incharge’andeasytoolsforself-steering

•  Themarketnowteachesitscustomersthesevalues&attitude

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Platformeconomyhasalreadywon

AlsoThemeIssueofHarvardBusinessReview,April2016

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Thisisalreadychangingourviewonorganizations:theytoobecomeplatforms,internallyandexternally

Copyright:Accenture2016

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Organizationevolvestointernalplatform:frontlineworkersandexchangewithpatientscrucial

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ThedisruptivecitizenIt’snotjusttechnology(‘stupid’),it’spower-andinformationtoolsandtheirimpactonmentality!a.   Shiftinrealpower:data,knowledge,communication,peer-reviews,peer-

organizationb.   Shiftinmentality:Ipersonallycangatherinformationandopinions,steer,choose,

organize,manageandconsultpeersPublicserviceshavemoretimetoadjustbytheprotectionofstate,laws,publicfinanceandlobby’s.Notsustainable:-  Traditionalpoliticswilllearnquickly:nore-electionwithoutlisteningtothenew

publicpower-  Customersofpublicservicewilldemandchangeandchoice;haveadirectand

publicchanneltovoicetheiropinions-  Publicdebateandreputationinthesedirectchannels

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MainpowertoolsforcitizensinnewtechnologiesPublicplatform:directandpublicexchangeonallissuesandattitudes,includingamountofsupport(permanentpublicpolling):•  classicpoliticalissues(passiveinmodernculture)•  newissuesnotonagendaorcoveredscandals•  reputationandcomplaintsaboutindividualorganizations,evenpersonelbyname

Mutualorganization*:realtimelinkingofpeersinsamesituationorneedstoexchange&organize:•  onneighbourhoodissues(e.g.safetyalerts,neighbourhoodwatch)•  inassets(likehousing,gardens,cars)andhelp(likecare,shelter,repair)* NB:Mutualitieswereoncethebasisunderhealthinsuranceandalsolongtermcarein

Europe!

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Mainnewpower-sourceofcivilsociety:independent&directchannelRevolutioninpersonalICT(Information&Communication&Media):•  Smart Enormous,stillincreasingcomputingpower•  Smallandmobile Closetoperson,alwaysathand•  Notjustdata,allmedia Realtimevividactualobservation-andface-contact•  Massuseand(!)soexpected Connectionanyplaceontheearth,anytime•  Platforms DevelopandsupportexchangeservicesAnewandindependent,localandglobal,ICTandmedia-channelof,toandbetweencitizens.Noselection,reframingorcensorshipoutsidecitizensthemselvesandalgorithms!Getusedtothenewmanipulationinsteadoftheoldandnowdistrustedfilters(politicians,experts,professors,journalists,PRindustry).

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Myintroductionof‘DisruptiveCitizen’inDutchFinancialTimes(August2015)

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Bigimpactoutsidemarkets

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Publicservicesingeneral

Publicservicesarestilldelayingimpactbyusingprotectionofstate,lawsandlobbiesNotsustainable:traditionalpoliticswilllearnquickly:nore-electionwithoutlisteningtonewcivilchannelandpower1.   Need/demandforco-productionandco-creation;nolongerjustvoiceandpassive

consumerservice,butco-choice,co-production,partneringwith‘amateur’-cooperatives

2.   Reputationbasedonpeer-reviewsondirectchannel,bethere!3.   Monopolyisgone:civilinitiativesandcooperationsareheretostay;simple

supplysideattitudewon’twork4.   Qualitystandardsarenotonlybasedontechnical/professionalandbureaucratic

paradigm,addpeer-reviewandreputationNEWCIVILLEADERSHIP

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Mainimpactofdisruptivepatientonhealthcare

A.Newpower:1.   Independentinformationgathering(knowledgeaboutdiseaseand

treatments,personaldata&medicalfiles)2.   Choicebetweenprovidersandevenindividualprofessionalsbasedon

peerreviews3.   Self-diagnosis&shareddecisionmaking&individualco-producing

B.Newmentality:4.   Self-monitoring&personalmanagementofchainorganization(from

hometohospitalandvv.)5.   Collectivepatientandfamilyorganizing&pressureforco-production

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Newprocessingandaccesstofiles

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Directaccesspatientdata,beforethedoctor

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Self-monitoringleadstominimumofambulantcareandmaximumathomedigitalization

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Thismeansenormouslogisticalcentrestomanageandplanthetotalchain

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Evenpatientbodiesbecomemachinepark

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Ortheirhomes

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Inlovewiththenewdoctor?

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Howthischangesleadershipinhealthcare

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LeadershipLeadershipisabout:-  Authority(notformalpoweror(management-)position)-  Characterandcapacities-  Rhetoricsandcharm(spontaneousfollowers)Rootsforleadership:personalpassion,valuesandbiographya.   Noleadershipwithoutcontextandreasons:resistanceisnormalb.   Leadersmustbeascleverinpowergamesasanybodywithavisionorposition

(goodcharacterandgoodintentionsarenotenough)c.   Rules,codes,protocolsarenotenoughtogettherightthingsdone;hidingbehind

themisoftenfirststepinresistance

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Disruption:impactonleadershipinhealthcare

MAINimpact:domainofyourleadership(authority,character,followership)ispatientsandtheirfamiliesasmuchasyourprofessionalpersonelandprotocols!A.   Treatingthemequally:bridginginsteadofopposition,hierarchyorneglectB.   LearntobeassupportiveANDcriticaltowardscivilactionandself-organizationas

totheprofessionalorganizationC.   Partnershipisnecessary:lessprofessionalpower:knowledgeandreferencesare

sharedandpubliclyavailable;shareddecisionmaking

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Addendum1:Summaryofdissertation

‘TheValue(s)ofCivilleaders’(Eleven2014)

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Mydissertation,PhDinOctober2014Researchon30selectedcivilleadersandawebsurveyonapp.200executiveswithexperienceindifferentgovernancecontext.a.  Howvaluesandvalueorientations

differbetweengovernancecontexts(for-profit,non-profit,informalactivecitizenship)andinfluenceleadership

b.  Whatthevaluepatternsareofthesecivilleadersandhowitisinfluencedbytheirgovernancecontext.

Importantconceptsoutlinedinthestudy:Values,CivilSociety,ValuepatternsofMarket,StateandCivilSociety,PublicValue,GovernanceContextsandLeadership.

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Mainresults

•  Yes,thevaluepatternsofthethreegovernancecontexts(for-profit,non-profit,activecitizenship)differsubstantiallyandprobablyinfluenceleadership

•  No,thevaluepatternofthesecivilleadersdoesn’tdifferaccordingly•  Amazing:thereisacommonvaluepatternforallcivilleaders,theyare‘abreedof

theirown’Side-results:•  Civilleaders,despitetheircitizenship,areoftenseenascompetitorsbypoliticians

(whoclaimamonopolyonpublicdebateaboutpublicissues)•  Civilleadersareoftenchallengedandhavethecompetencetobeactiveinpublic

debate•  Inmostcasesofexecutivepositionstherewasatensionbetweencivilleadersand

theirnon-executiveboards,basicallyonthemanagerialtechnicalattitudeversustheirownvaluebasedattitude.Theyarenot‘easy’executives.

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Civilleadersinmystudyhaveavaluepatternoftheirown(abreedoftheirown)

FreedomofChoice(13)

and

Entrepreneurialspirit(13)

Sustainability/stability(11)

and

Respect(11)

(Social)Justice(9)

Solidarity(8)

and

Self-actualization(8)

Independence(7)

and

Bonding&Bridging(7)

Theyhaveavalue-patternwithtwotracks:Ontheonehand: entrepreneurial,selfsteering,autonomous,pigheaded,

independentOntheother: sociallycommittedandpassionateaboutsocietalresultsfor

targetgroupsandvulnerablecitizensorchangingfailingpublicservices

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Wefoundfourkeydimensionsofcivilleadershipstyle

TogetherthesekeydimensionsdefinethestyleofacivilleaderEverycivilleaderhastomakechoicesonthesekeydimensionstoestablishhis/hertypicalstyleandoperateinawaythathe/shefeelsitmakeshim/hercredibleandeffectiveasacivilleader1.   Thevalue-driven-instrumental-neutralvaluestance2. Backstagetofrontstage3. Elitisttocommontouch4. Legitimizationtoinnovation

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Handlingthepublicdebateiscrucialforcivilleader.Thepublicdomainisnotjustforpoliticiansanymore.Thecivilleader’sapproach,styleandcharacterinthesepublicdebatesareasimportant,bothforthepublicacceptanceoftheirinnovativeworkasforthepossibilityoffurtherinstitutionalizingthisinnovation,astheactualpublicvalueoftheireffort.Otherlessonscanbedrawn:•  Anyissuecanbechargedwithvalues•  Purelyprivateinitiativeswithpositivepublicvaluegeneratelittlepublicdebate•  ThepublicdebateisaspecialarenawithlittlecontrolSo,thepublicdebatecanhithard,affectingcivilleaderspersonallyaswellastheirorganizations/networks,withlittleopportunitytocontroltheresult.

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MainimpactofcivilleadershiponhealthcareleadershipPowerofdisruptivecitizenshipwillcomecloserandchangeroles:•  Frontlineprofessionalsneedmoredecisionpowerin

theirinteractionwithpatients•  Thequestionwillincreasinglybe:whoknowspatient’s

opinionsbest(writtensurveyswillnothelp)?•  Howtoprovokeandevaluatethisinformation?•  Bureaucraticattitudesininteractionwithcitizens

changestocommitmentandvaluedrivencharacter.Itisrealpartnership

•  Howtochoosebetweenupcomingcivilinitiatives?Andbetweenthemandcurrentsupplyinhealthcare?

Mainpointthatwillcreateunrestandinsecurityaboutjobs:A. ThreattoprofessionalsandprofessionalismB. Threattothecurrentmonopoly

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Addendum2:FocusPublicSPACE

Foundation

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Main-topicsPublicSPACEinlecturesandliteratureCitizenforce(hasahistoricalrightastheprivatebasisformuchofpublicsector,2000)tobeextendedwithcitizenpowerlike:‘righttochallenge’,‘vouchers’andpreferenceforsocialenterprises(2015)CitizendisruptionofDemocracy:Thereisalreadyadirectandopeninformation-andmediachannelforcitizens.Itthreatenstodisruptrepresentativedemocracyifnotusedandembracedbycurrentpoliticians(2014)Citizendisruptionofpublicservicesbyriseofself-organization,demandforco-productionandinfluenceofpeer-reviews&ownchoice(2015)ChinaHealthcare:TheDutchhealthcaresystemishardlymarketlike,butverygovernmentsteeredinfinance,services,innovationandstructure.Mainfaultisthatpatientshavenotmuchinfluenceandhardlyanychoiceinprovider(since2011)Strategy:‘Beatingtheodds’Aristoteles:Virtues,Character,Balanceofmiddleinstrategiccontext,PracticalWisdom.Governancecodesmustbeprinciplebasednotrules-basedCivilLeadership:personsandpersonalbehaviourmoreimportantthaninstitutesorstructures.Citizenshipcanandmustbeintheboardroom(2014)

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Latestbook(inDutch),May2015Titletranslation:CitizeninitiativeswithCitizenpowerPresentedtoDirectorofSocialCulturalPlanbureau,amajoradviserforcentralgovernmentonhealthandsocialissuesandpolicies.Basedonlargedebates,physicalandvirtualandliteraturestudy.Mainmessage:Positiveaboutrecentpoliticalattentiontoactivecitizenshipinhealth,socialwelfareandsocialsecurity,but:-  toopoliticaltopdownandtoomuch

linkedtopoliticalagenda(budgetcuts)-  naiveaboutpowershift-  doubtsifmunicipalitiesarecloserto

citizenforce

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PreviouspublicationsPublicSPACE(Dutch)