Charlotte Arvidsson presents at the annual Swedish meeting for general practitioner residents.
My colleagues and I have felt overwhelmed by the challenges facing our health care system for years, and now, we want to inspire and empower ourselves to take action. On a warm August morning, I opened the IHI newsletter and realized I had struck gold. The invitation to take part in the IHI online course, Leadership and Organizing for Change, gave me the push I needed to send out invitations to a learning network I had been working tirelessly to build over the last few months.
The learning network, “Together for the future of primary care,” would launch at the annual Swedish meeting for general practitioner (GP) residents. I was serving as a host of the three-day meeting, which would gather 350 junior physicians from across our country to collectively reflect on the future of primary health care and share ideas on how we could improve the quality of care we provide patients and the satisfaction we take in our work.
Primary care in the publicly-financed and managed Swedish health system has been chronically under-funded for decades. Many treatments formerly provided in hospitals can now take place in primary care. As more care is shifted closer to patients´ homes, budgets and hours have not changed, which leads to great frustration. Rather than debating which setting should provide care – often without the support of additional funding – we want to spend our time teaming up with colleagues and with patients to address their needs. While this problem is widely acknowledged, solutions are often rejected as too politically difficult to implement, given providers’ resistance to change.
A few years into our residency, we had not seen any collective action to reflect that GPs had the opportunity as well as responsibility to transform the system in a way that would benefit our patients and health care as a whole. Without a new way of working together to exert influence, my colleagues and I would continue overexerting ourselves, despite feeling drained of energy, disempowered, and disillusioned, to avoid letting our patients down.
As I prepared for this meeting, I was lucky enough to connect with Paul Batalden, IHI Senior Fellow and Professor at The Dartmouth Institute. He generously coached me and suggested starting a learning network to allow our network of GP residents time to share our experiences and build relationships to create a community capable of leading change together.
When only four people attended our first biweekly planning meeting, I came to realize that organizing people to lead change could be slow going. Though I was initially disappointed at the low turnout, it soon became evident that the small size of the group allowed us to get to know each other deeply. Our team met in person in October, but in the meantime, our virtual meetings allowed us to connect more easily and exchange perspectives from our work in diverse settings. Our hope is that other GP residents in our network will later form similar groups of their own.
Then, serendipitously, I learned of the IHI Leadership & Organizing for Change course and realized it offered exactly the structure and training I needed to successfully launch this learning network. One of the exercises in the course is to craft a story of your journey to leadership. This storytelling practice, called “public narrative,” invites others to join you in acting on your shared values to achieve a common vision for change. The timing of this assignment was perfect, as I had the opportunity to speak in front of the 350 attendees of the GP meeting to share my story to encourage everyone to make a change, no matter how small, because the collective impact can make a meaningful difference. 30 attendees took up the suggestion to write a letter to themselves on what they would start doing when they got back home to keep their future selves accountable to the commitments they made in the room that day.
LEARN MORE: IHI's upcoming Leadership and Organizing for Change online course
Over time, our learning network has grown and evolved. Though I’ve served a central role facilitating meetings, I have embraced the lesson from the course to distribute leadership so that I share responsibilities with my fellow GPs. Leading the work together makes it a whole lot more fun for everyone. In my journey through the course, I’m most proud that I finally let go of my need to be in control and forcefully convince others to take my view – that now I listen to others and invite them into leadership alongside me.
Looking ahead, we plan to ask hospital specialists to join us in collective action with them. Like GPs, they are dissatisfied by the current situation and are constrained by siloed organizational structures. We look to other organizations for inspiration. For example, a health clinic in Borgholm, Sweden has hired twice as many physicians per inhabitants as is customary. Patients are using fewer resources, reporting higher satisfaction, and achieving better health outcomes, and the change has fostered closer collaboration and increased joy in work among GPs and hospital physicians.
I’ve learned many valuable lessons over the past few months. That it’s important to just get started, rather than wait for permission or a perfect plan. That when you make a clear ask with an honest intention, people will step up and contribute. That keeping an open mind allows you to see that the best ideas are often not our own. That even though it takes time to change a system, the energy that taking action brings is well worth it. That what we can accomplish together through collective action to achieve our vision for change will be of greatest value and bring us the most joy.
Charlotte Arvidsson is a cardiologist and resident in general practice in County Jönköping, Sweden.