Ko Awatea, a centre for innovation in South Auckland, New Zealand, is redefining challenges facing the healthcare sector globally by taking a collaborative approach. The centre, in partnership with the US-based Institute of Health Improvement (one of several strategic, academic and funding partners), is actively demonstrating three key ingredients of organisational behaviour - Disruptive Innovation, Collaborative Governance and Learning, and Transformational Leadership. The Maori meaning of the 11-month old applied innovation hub’s name is the dawning of a new light, and its fresh approach to change is welcomed by a growing fraternity of international and local partners, and a passionately committed group of engaged stakeholders.

Problem

The need to find sustainable alternatives to complex systemic problems and healthcare dilemmas - The healthcare sector globally is an increasingly complex challenge for governments and healthcare practitioners alike. Patients are demanding more sophisticated medications and treatments. Ethical dilemmas caused by a shortage of resources are a daily reality, leaving glaring gaps in care and an inability to focus on finding future business models.

Lack of leadership - In a Linked-In group called NZ Healthcare Innovation, a group of healthcare professionals took an informal survey in April 2012 on how to improve the current healthcare system in New Zealand. The survey said that it was an accepted view that the current healthcare business model wasn't sustainable. Scarcity of funding resources and a lack of collective, industry-wide, future-focused leadership were two key reasons given for a lack of change. Transformational leadership is about CEOs, boards and management teams who set a hairy audacious sustainable goal, then act as change agents and cheer leaders to their team, stakeholders and partners as they deliver to that vision. The shared success comes not from the leadership of management teams and boards alone, but rather a fresh leadership paradigm that is applauded by passionate stakeholders who give their input.

Clinical Governance needs Fresh Values-based Approach - New Zealand's healthcare governance is complex and full of regulatory requirements associated with running hospitals. In a paper titled Clinical Governance in the New Zealand Health Sector, healthcare academic, governor and social entrepreneur Dr. Lee Mathias points out that clinical goverance tends to involve a focus on compliance and risk assurance. This can mean district health boards become prone to "reinventing, double acting and other unnecessary activity in the name of safety". Quality assurance programmes as risk management tools become a major focus. The report suggests that other aspects of governance are given much less attention by the authorities or left to the traditional forms of management. The report concludes: "The moral and ethical principles in decision-making are often left to the debate of the professions. The separation of aspects of governance in clinical activity further impacts on clinical decision-making, because of incompleteness of application of the generic principles." This can breed a focus on short-term outcomes, suspicion and mistrust, which can damage the relationships and outcomes between healthcare professionals, stakeholders and patients.

Climate of Disruptive Innovation- Often Disruptive Innovations such as new products or processes are dismissed, rather than developed and adopted. This is often due to an unwillingness to try something new as it's considereed too hard. New Zealand is a smaller market economy than those of other parts of the western world where healthcare costs have spiralled out of control. Being smaller, we’ve been able to take a smaller scale approach to find new solutions or to challenge current thinking. However even in New Zealand, an emerging problem is that some of the innovations aren't adopted due to the systemic problems in the healthcare system, so innovators have sought new markets offshore.

One such example is Pictor, a blood diagnostic tool that has been developed and now manufactured in New Zealand. The company has chosen its main market as India and some third world countries. This was because the founder wants to take a social entrepreneurial approach of making a difference as well as making money innovative approach to diagnosing disease. Now an ASEAN case study, the innovative healthcare product has found a market in parts of the world where it's made available as a service rather than for profit alone.

Short-term focus, not long-term one due to current systematic requirements

Solution

Making a World of Difference through Disruptive Innovation - Several New Zealander leaders in the healthcare sector have seen opportunities to innovate and challenge healthcare norms with catalytic thinking that has changed the world of medicine.

One example is Ray Avery, New Zealander of the Year in 2010, who is credited with saving thousands of lives in the third world. His disruptive innovations included working for the Fred Hollows Foundation in Eritrea, Nepal and other parts of the world, delivering low-cost lenses to cateract sufferers. His initial work was inspired by the invention of New Zealand opthamologist Fred Hollows, who engaged him to set up a manufacturing facility in Eritrea to make inexpensive lenses for cateract sufferers. Inspired by the resilience and creativity of the Eritreans, Ray went on to invent low-cost feeding solutions for malnourished babies and low-cost incubators for premature babies. As he invented a range of other creative scientific solutions for the third world, Ray encouraged others to get onboard and apply transformational thinking on how to tackle big problems confronting the poor in developing countries.

In his book Rebel with a Cause (Random House, 2010), Ray outlines how he became a scientist, a millionaire, a successful businessman and now someone who literally does work that helps to change the world. During the mid-nineties Ray spent most of his time working in Eritrea and Nepal, setting up two world class intraocular lens laboratories. At that time the cost of an intraocular lenses was about US$300 but through his work with the Fred Hollows Foundation, Ray managed to put the technology together to produce lenses for under US$10.00, making modern cataract surgery accessible to the poor throughout Africa and Asia.Today these laboratories produce over 10% of the world's supply of intraocular lenses and the Fred Hollows Foundation continues to run many programmes for cataract treatment throughout the world .

Collaborative Governance - Collaborative leadership embraces innovative, synthetic and integrative thinking, and it is the backbone of the new economy. As this shared approach exists comfortably with Corporate Social Responsibility and Stakeholder Engagement, this new approach brings in the values of Trust, Integrity and Authenticity. Collaborative Governance involves working together with stakeholders and partners, to address complex issues. It is the only non-replicable competitive advantage for business, government and community sectors. Multiple dividends are the new normal with this approach - economic, environmental, social and cultural. A new book on Collaborative Governance just published in Australia, takes the processes of public participation and community engagement into the corporate sector. Max Hardy, author of The Power of Co: A Smart Leader's Guide to Collaborative Governance, defines Collaborative Governance as taking a fresh shared approach to solving complex dilemmas. Max book states: "Collaboration between all stakeholders is key, to get them to agree on the nature of the problem and then work together to invent innovative solutions that never existed before. This is the only way to find enduring solutions to complex problems – the kind of solutions that stick."

Many of the major economic or industry sector problems being faced by the corporate sector qualify as complex dilemmas.Businesses in the past have become paralysed in the face of what is considered the unsolvable. The answer in the future is to engage stakeholders at all levels in determining possible solutions, rather than leaving it to management decisions, Max Hardy concludes: "Dilemmas are socially complex and solutions require coordinated actions from unrelated or unconnected organisations across different sectors. This is why they create so many problems for government, who frequently display a chronic inability to coordinate effectively or realistically across their own bureaucratic silos, let alone an ability to cooperate, coordinate or partner with non-government organisations.

Collaborative Governance can traverse from the community and not for profit sector into the corporate sector, changing managers into leaders who are passionate about Corporate Social Responsibility measures. Partnerships and strategic alliances, such as Public-Private Sector Partnerships, can have positive spin-offs for community and environmental responsibilities. They can also help reduce a government's spend in the areas of infrastructure, as PPPs are able to take a shared cost approach to delivering education or prison services.

Does this Collaborative Governance work for more than not for profits and community organisations - can it govern the way strategic partnerships are reviewed and run? In my view as head of a Stakeholder Engagement consulting firm, I believe the answer is yes. The application of the techniques can be applied across industries, between government and business organisations, or even with internal stakeholders. Having a shared approach between business leaders and political masters can have definite advantages.

Economic benefits can be derived for both parties, as there are negotiated trade-offs, benefits and conditions. A recent New Zealand example being proposed is one where Collaborative Governance on future needs has created a most interesting proposal. The operators of Auckland's casino and entertainment complex, visible on the CBD skyline, have offered to build a new convention centre for Auckland on public land, in return for some favourable changes to licencing arrangements around 'pokie' machines. While there was some considerable social debate centred around problem gambling issues, it was clear that the proposal has clear win-win outcomes for both parties. Favourable changes to licencing laws around the gambling machines can produce revenue to build a world class facility for Aucklanders. Suffice to say, Collaborative Governance was at work to stimulate the business sector and solve infrastructure needs evident in Auckland.

Practical Impact

Collaborate with other like-minded partners, taking a collaborative approach to shared learnings - Ko Awatea is an innovation centre that is likely to be a model for many similar ventures. Firstly it brought together three universities as academic partners, offering them the opportunity to invest in new classrooms at the centre. Medical students from Auckland University, Manukau Institute of Technology and Auckland University of Technology can now attend lectures at Ko Awatea, which is located right next to Middlemore Hospital (which is operated by founding partner Counties Manukau District Health Board). Students can also significantly improve learning outcomes, with proximity to cutting edge IT support, a new clinical education training centre and access to healthcare professionals

Shared approach with other like-minded partners (with associated win-win outcomes)
Transformed thinking on leadership, creates an engaged, passionate workforce and stakeholders that want to contribute by having their say
Intersectoral engagement - Ko Awatea's Colllaborative Governance with multiple strategic alliances are already having a positive impact. Shared learnings are already changing the ways hospitals around New Zealand are operating, through the work on national collaboratives addressing identified challenges. Through greater sharing, academic institutions are collaborating on learning approaches and technology issues. Leading specialists are relocating to work at the centre, as they realise the problems being solved through the IHI partnershp will be of worldwide significance.
Innovative new technologies, processes and ideas through taking a cooperative approach to shared learnings

First Steps

1.Try doing some collective decision making on a current issue with a group of stakeholders. Collaboration on the decisions might not have been on the cards, maybe the issue is considered too complex for these stakeholders to understand.

2. The cost of not engaging with your stakeholder in this new paradigm is too high. If your organisation wants to be part of Collaborative Governance, Conscious Capitalism and Disruptive Innovation, it needs to engage all its stakeholders on matters that will affect them. That doesn't mean telling them what you've decided, but rather asking them for their ideas.

The Institute of Public Participation (IAP2) is a global not-for-profit organisation that runs a five-day certificate programme in how to connect community and stakeholder engagement with decision-making. A whole range of techniques are taught that are useful to engage stakeholders. Some are face-to-face engagement, such as meetings, workshops and forums. Developing transparency and accountability, and building stronger relationships are key. Learn how to engage your stakeholders by attending workshops, forums or bringing in skilled facilitators. Digital engagement, deliberative democracy and crowd sourcing are some of the many options open to businesses wanting to engage with their stakeholders.

Get a book like Putting Pen to Paper, Creating Partnering Agreement that Work. It was produced by Megan Courtney, in partnership with the former Waitakere City Council. There are many similar texts that talk about Collective Governance.

Credits

I want to express my thanks for my lecturer Dr Bernie Frey from Massey University, my lecturer on the Executive MBA paper on Organisational Behaviour. His teaching methodology and business consulting knowledge, combined to make the study most interesting.

I would personally like to acknowledge Dr Lee Mathias, an expert in healthcare governance. Dr Mathias chairs the Health Promotion Agency Establishment Board and is Deputy Chair of the Auckland District Health Board, among many other entreneurial and governance roles. I appreciated her willingness to share her knowledge in a phone conversation, and refer me to some fascinating points of reference for my research.

Thanks to the leadership team at Ko Awatea, who I worked with recently on a marketing document that captured the achievements of their first 100 Days. It was clear that this is already a world class organisation, and one that innovation centres globally will model themselves on. Through collective governance, they are making huge in-roads into applying Disruptive Innovation through a shared learning approach. Their partnerships are already paying off for district health boards around New Zealand, who are learning through regularly web-casts.

I'd also like to acknowledge the work of Max Hardy, a consultant with Australasian firm Twyford Consulting, which specialises in Collaborative Governance. Also, the work of Clayton Christensen with his books on Disruptive Innovation - The Innovators Dilemma and the Innovators Prescription. I also enjoyed making links in my research with Dr Richard Bohmer, a New Zealand doctor who is a professor at Harvard Business School and currently doing some consulting work at the Auckland District Health Board, focusing on innovative models of care. Michael Porter's Redefining Healthcare was also fascinating.

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