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Leadership and digitization are the keys!

Sweden, and most other European countries, have known for a long time that the number of older people will increase significantly. Therefore, meeting Health and Social Care needs requires a big transition into new structures and approaches. It is a Demographic challenge society cannot afford to sidestep!

Leadership and Digitalization are the keys to succeed.

A significant transition has been underway in Sweden for several years, given the name “Good and Close Care.” However, it has already been established that the transition is going too slowly. The Healthcare system is complex, and changes take time. Therefore, focusing on change management and the right skills are essential to meet the challenge.

The facts of this article are coming from Sweden, but the situation is likely similar in other European countries. The article describes the conditions and suggests how a changed leadership is critical to successfully rebuilding basic structures and mastering all the uncertainties that arise.

The demographic challenge

Healthcare is an area that affects us all and is one of the most crucial issues when we elect politicians. I usually hear a positive description of the care when talking to family and friends. Still, there seems to be a lot that needs improvement, as the media reporting on Healthcare is mainly about long queues, overcrowding, understaffing, canceled surgeries, and more.

The media reporting was confirmed when the Health and Social Care Inspectorate, IVO, presented severe and worrying criticism of all emergency hospitals in Sweden [1]. As a result, responsible ministers quickly declared that they wanted to improve the supply of skills. Competence and more resources are necessary, but there has been talk about strengthening Health and Social care for a long time, and nothing seems to change.

The long-term challenge of coping with Sweden’s changing demographics is even more worrying. Among others, Emma Spak [2], from Sweden’s Municipalities and Regions, SKR, clearly describes an equation that does not add up. She highlights that between 2020 and 2030, the proportion of people over 80 is expected to double. Maintaining the current staffing density means that 65 percent of the additional working population must be recruited into Health and Social Care.

Demographic challenge Number of people over 80 will double in ten years

I am sure other parts of the welfare sector, industry, commerce, and others will also need to hire a fair share of the new workforce. If one were to succeed with such an extensive search for resources, it would require a substantial expansion of premises and equipment. And all this within just ten years! No, it is an impossible equation.

Digitization is a big part of the solution

Much of the solution can be found in the transition to “Good and Close Care” [3], which affects the entire Healthcare system. In the transition, digitization can significantly contribute to creating “opportunities for primary care to develop services that create greater accessibility for patients, enable remote monitoring and supervision in the home, streamlining work methods and processes, and information sharing between care providers” [3].

For digitization to become part of the solution, technology is needed on a significantly larger scale than we have seen so far. Changing working methods will mean new types of users and places where the technology must work. Many uncertainties exist, as with all changes to new technology and user patterns.

The following are some examples of critical areas where I believe there are both risks and opportunities:

  • Accessibility: Services that can be accessed by those who need them, updated on secure platforms.
  • Reliability: Correct and credible information.
  • Ease of use: Short start-up time, intuitive even for people over 80, and work relief.
  • Privacy: Many can access sensitive information without personal data being misused.
  • Follow-up: Possibility to measure and improve with the correct figures without employees feeling monitored.
  • Flexibility: Respond to different geographic needs or unpredictable behavior patterns.
  • Human contact: How far can technology replace the need for human contact?
Patient Self Monitoring

In addition to requirements for how the technology should work for users, there are aspects from a development and operational perspective that are well associated with costs in both the short and long term:

  • Maintainability: Modern modular and scalable architecture, with access to information and tools that enable development and maintenance.
  • Competence: Long-term supply and organization with people who can handle the technology development.
  • Delivery time: Ability to correct errors and deliver new solutions when needed.

I am convinced that even more “unknown unknowns” will emerge during the continued transition, which is expected in our complex and changing world. What is worrying is that the solution is in a hurry and that the public sector seems to hurry more slowly than other actors. IVO [4, p.22], and others, have already stated that the transition is slow and the changes in demographics will not be delayed.

“Efficiency of the working method” [3] often refers to the operational work in the business. But reasonably, improved development work must also be part of the solution. Considering the complex challenge, the usual investigations [5] have already taken too long and are not qualified to manage tricky uncertainties. Just as in research, the transition needs to be conducted fact-based to discover what works and what doesn’t early and regularly. This way, it is possible to make adjustments continuously and avoid ending up wrong.

Continuous improvements and Lean

Making continuous improvements based on facts is one of the principles of Lean, an approach that has long been established in Healthcare. In the first place, Lean has been implemented within the operative business with promising results [6]. Many technical development and management initiatives in the public sector have Lean as a basis. However, I, like many, know that to succeed, it is crucial that “The managers must get on board” [6, p.15].

“An important message to those who are about to work with Lean is that competence development is required; the examples show that. It is about the development of both leadership and co-workers, and it is about methodological knowledge.” [6, p.4]

Leadership is the key to success

Leading in change requires a lot of time and competence. In line with rapid development, we are today in constant change. This means “the employee has two roles: ‘to do the job’ and ‘to develop the job'” [6, p.15].

For a long time, I have observed how people in senior positions primarily focus on leading operational activities. Most managers perform operational leadership well. The problem is that there is not enough time for strategic work. Instead, managers become too preoccupied with reactive problem-solving, especially in turbulent times.

The classic leadership quadrant that points to the importance of operating in the proactive zone has two synergies:

• Delegating operational decisions to those who do the work delivers faster results and builds trust.

• Managers and leaders get more time to work long-term with strategic challenges.

Classic leadership Quadrant Urgent Important Change Management

Long-term work means, among other things, having time for competence development. The people leading the change must be current on the latest findings on organizational development, and they need to transform theory into practice. In this way, knowledge is built on how the own organization can work in the best way.

The signal value is essential if you want employees further down the decision-making hierarchy to change behavior patterns and culture. We usually say, “Our children don’t do as we say; they do as we do.” The saying also fits well with organizational leadership. Managers and leaders need to be role models and work in the same way that is expected of the organization.

When the organization and its leaders have limited time for change management, hiring external investigators and project managers to produce decision-making documents and run projects is common. The work with transformation is then limited to budget decisions and governance via various forums such as steering or reference groups. When you do not change your way of leading yourself and hand over the practical responsibility to hired expertise, it isn’t easy to influence the organization’s ingrained behaviors, such as allocating resources to different projects.

A misplaced project culture

Projects are seen as the only way to drive development in many large organizations. Funding and budgeting are based on believing in advance what a project is to deliver and how many resources are needed. Because projects include administration, decision-making, staffing, and funding, they tend to be significantly more long-lived than the short learning cycles required to manage uncertainty.

Often, the same people are involved in multiple projects simultaneously. Different entities finance the projects, and keeping track of the total flow of ongoing initiatives is challenging. Ultimately, it is up to the individual employee to decide if there is time to “sit with” a project. Changes are also run as projects, and if the own business is to participate, it becomes an additional workload to prioritize.

In summary, the traditional project form is poorly suited to the so-called VUCA world [8], an acronym that describes our fast-moving and unpredictable world. VUCA means Volatility, Uncertainty, Complexity, and Ambiguity. When we cannot handle these four elements, as in the ongoing transition: it is slow, and the quality is too low. A change driven by multiple large projects will not be able to overcome the demographic challenge.

Flow-optimized teamwork provides better opportunities

Instead of resource-optimized projects, a flow-optimized development operation provides significantly better opportunities to respond to challenges. The reason is that with flow optimization, you control, among other things, the length of the queue, the number of simultaneously ongoing initiatives, and the size of the initiatives. Management ensures that the right things and more things get done. The basis for optimizing flow is building stable teams that take long-term responsibility for smaller deliveries.

Research and application have long demonstrated that teams are an obvious form of organization for solving complex problems. “In SKR’s work with the conversion to “Close care,” we see the same thing all over Sweden – developed teamwork not only improves quality, but it also increases efficiency” [2]. Therefore, it is crucial to create even better conditions for teamwork.

With Lean budgeting, you do not finance individual initiatives, and there is no need for project managers to request resources. Instead, you budget more long-term for the entire team and its capabilities. In an organization with high trust, self-managing teams can take responsibility for improving work and delivering Healthcare or systems. In a large organization, the teams may also take responsibility for coordinating with other teams.

The development flow in a large organization needs to be synchronized and aligned. In contrast to fragmented project management, short learning cycles can be achieved at all levels. Most people have heard the term Plan-Do-Check-Act, which describes the steps in the learning cycles that provide the valuable factual data needed to adjust delivery and work methods. The shorter the cycles are, the better and more cost-effective learning!

Short Learning Cycles PDCA Plan Do Check Act

Change management that copes with uncertainties

During my career, I have seen many organizational changes that combine an established way of working at an overall level with innovative ways of working at the level where the work is carried out. I have certainly seen teams that, along with other teams, made real improvements. But there has been much frustration because the overall culture hasn’t changed, so you don’t get all the good things within your reach.

All organizational change must deal with the uncertainty that can be managed through step-by-step implementation where the employees are involved. For quick feedback on the whole, it is essential not to go too far with the involvement of many people and without change at the highest level. Many people mean increased complexity and longer lead times. A broad change is easily limited to dealing with methods and tools because it is difficult to change the culture without involving all levels.

In-depth Organizational transformation

A deep change involves fewer people but involves more difficult strategic decisions. An in-depth change involves cultural aspects and therefore needs to include managers at all decision-making levels. You must bring in all disciplines, such as HR and Finance, to explore how collaboration should work. Finding and changing a minor part of the organization with delivery responsibility can be challenging, but it pays off because risks and complexity are reduced.

Middle managers can achieve remarkable change by leading up and thus creating the right conditions for their unit. Addressing top managers breaks norms, and it is among the most difficult, asking senior managers to make policy decisions that affect only a few individuals and local work. High up, people are used to making policy decisions that affect the entire business.

The following dialogue illustrates the challenge for middle managers or management teams to resist and break traditional decision patterns.

Senior Middle Manager:

“We have decided to start the first transformation in a section having an independent delivery responsibility, and we want to involve you in deciding on a change of the Project and the Budget Policy. For now, the decision will only apply to the affected section.”

Top Executive:

“It sounds good, but the Project and Budget Policy has been around for a long time and is a governance tool that everyone is familiar with. If we were to change this Policy, a proper investigation would be required, and then we have to look at the entire operation. I don’t have to be directly involved in a local transformation, and I trust that you can follow all the procedures. Please let me know how it goes when you get the chance.”

Senior Middle Manager:

“Without your participation, the change will not have the impact we hoped for, and in the long run, it is about creating trust throughout the entire organization. HR and the finance directors must also be involved in the whole picture”

Top Executive:

“Yes, I hear what you say, but I can’t be everywhere. Regarding trust, we have already engaged the country’s best consultants to launch a broad program with solid material. For the involvement of other members in the top management, you can have that discussion directly with them. Say you have my support! Thanks for the information. Now I have to prepare a press conference to present how our organization will handle all future challenges.”

Delegation is excellent, but not all decisions can be made locally. If top management is involved in minor changes in depth, insights are created about how strategic decisions affect practice. In this way, it is possible to avoid, sometimes serious, shortcomings before conversion is carried out on a large scale. It is also crucial that middle managers receive support and do not end up in a hopeless situation between heavy-handed management and employees who want to improve. Overall, a change is faster if the quality is built in continuously in smaller parts, compared to large rollouts and quality assurance at the end.

Correct knowledge of leadership and change management

There is no doubt that the demographic challenge is here and now and that the transition to other ways of working and new technology is going too slowly. The transition is vital for the entire society and must be taken seriously. If Health and Social care do not work, it will not only affect people over 80. New working methods and digitization are essential to succeed, but many uncertainties must be managed. Leadership focusing on organizational development and the ability to change established approaches is the key to success.

For me, Health and Social care must continue to function well. I hope managers and leaders at all levels acquire the proper knowledge of leadership and change management and have the courage to delegate as much operational work as possible.

I recommend exploring the reference material below, as it creates a good picture of the demography challenge and possible solutions.

References from Swedish sources

[1] SVT: feature on IVO press conference 2023-01-19

[2] SKR Care blog: Emma Spak’s article “We must deal with the reality of Demography.” 

[3] The Knowledge guide: Good and Close care

[4] IVO: Partial report of the national hospital inspection 

[5] SKR: Digitization in care, support, and care 

[6] SKR: LEAN Motives, initiatives, implementation, and results 

[7] Statistics Sweden: Major efforts are required to manage elderly care for the 40-year-olds 

[8] Wikipedia: Volatility, uncertainty, complexity, and ambiguity. 

About the content

The intention of the Articles published on this website is to provide exciting knowledge about organizational development in any business. BDD hopes this knowledge will help take your organization to the next level. The information is based on our experience supporting many transformations and cutting-edge sources published in books, articles, and frameworks.

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