Key skills for #meded leaders. Produce less, co-create more

(From the EiC:  this post builds on one of my favourite [and most important?] articles I have read this year.)

By Felix Ankel (@felixankel) and Meghan Walsh (@chitipamzungu)

‘If you want to go fast, go alone. If you want to go far, go together.’ African Proverb

You are a new education leader in a hospital trying to facilitate synergies between operational and academic stakeholders. Your goal is to create an optimal clinical learning environment.  Operational leaders view learners as a barrier to high quality, cost-conscious care and contributors to suboptimal patient experience outcomes. Academic leaders view the focus on operational outcome metrics as distracting to the optimal learning environment.  How do you approach this collision of culture? Do you produce a plan and then socialize it to others? Do you co-create a plan with others from the beginning?

In the production approach, educational programs are developed with little input from participants outside of #meded.  The outside stakeholders are usually not involved at all or have little opportunity for input until late in the process.  This approach leads to silo-ed systems, where a lot of energy is spent getting buy-in from others and less energy is available to integrate #meded into care delivery systems. For example, elements of interprofessional teamwork, improvement science, patient experience, stewardship, electronic health record optimization, etc. are often missed or added late. The lack of integration leads to an academic design that does not consider the environment in which learners work.

In the co-creation approach, all stakeholders are involved up front in a process of developing programs together.  Participants are urged to let go of assumptions-as-truths and develop plans together in an open and transparent fashion.

Recently Eric Holmboe (@boedudley) and Paul Batalden co-authored a manuscript focusing on co-creation in outcomes-based medical education.  They highlight a myriad of themes that may resonate with Clinician Educators involved in leadership and education.

  1. Change is as much about letting go of assumptions as it is about creating new alternatives. For example, the success of competency-based medical education systems will be based on the ability of people to let go of assumptions-as-truths about time-based systems as much as it will be about the ability to create new competency-based models.
  1. One must have an open mind, open heart, and open will to let go of assumptions-as-truths. Otto Scharmer describes the importance of emotion and loss as part of testing assumptions-as-truths.
  1. #meded is ultimately a service rather than a product; consumers (i.e. patients) play an important role in service design. Just as the future of clinical care involves activated patients and shared decision making, the future of #meded will involve “activated” learners and non-hierarchical methods of education.
  1. Co-creation moves attention from “production to utilization, from product to process, and from transaction to relationship”.

One example of #meded co-creation occurs within the @regionsem residency.  The Minnesota-based Regions Emergency Medicine Residency is part of HealthPartners, the largest consumer-governed, non-profit health care organization in the United States. Continuous, transparent, annual strategic planning occurs with multiple operational and academic stakeholders. This has allowed for an adaptive approach that has helped move the focus of the residency program from rescue care to population health, from medical knowledge to improvement science, and from individual exceptionalism to a “teaming” culture focused on the patient. The @regionsem residency is now a strategic asset of HealthPartners.  A next step in the  @regionsem co-creative process is the inclusion of patients in #meded design.

Image by David Castillo Dominici via