Strategic Engagement Creating a Culture Shift

Engaging in multi-stakeholder strategic direction setting as the vehicle for integration

What

Vancouver Island Health Authority (VIHA) approached us to engage its pharmacy services at multiple sites throughout Vancouver Island in a participatory approach to strategic direction setting.  At stake was not only setting strategic directions for a single, island wide pharmacy services within the greater healthcare provider system but creating the environment for disparate pharmacy personnel to find common ground amidst the merger of three separate service delivery systems.

Vancouver Island Health Authority (VIHA) approached us to engage its pharmacy services at multiple sites throughout Vancouver Island in a participatory approach to strategic direction setting.  At stake was not only setting strategic directions for a single, island wide pharmacy services within the greater healthcare provider system but creating the environment for disparate pharmacy personnel to find common ground amidst the merger of three separate service delivery systems.

Each geographical location around the island served a very different and diverse population with distinct community issues and challenges.  Each healthcare service provider of which the pharmacy services was an integral part had previously operated under their own unique culture, processes and operating structures.  The merger into one large island-wide healthcare system had offered little effort to bring the three individual health authorities into a whole, integrated system.

How

Following exploratory conversations with senior leadership about the desire to engage the “whole system” island-wide, we suggested a modified Appreciative Inquiry approach that would serve to create conditions to set strategic direction, build relationships and find common ground across all pharmacy personnel from front line technicians and pharmacists to leaders in each location.
The approach was co-designed and implemented by a cross-system Steering Group who guided the engagement process.  This diverse group co-designed the inquiry and collected data by conducting appreciative interviews island-wide with internal and external stakeholders—pharmacy personnel and doctors/nurses respectively.  This fostered information sharing, discovery, storytelling, and relationship building across the whole system. Our role was to be design resources and coaches along the way.

Impact

Engaging the diverse perspectives and voices island-wide began a longer term shift from isolated regions without ready access to deep expertise and knowledge to a network with easy access to both, island-wide.  Relationship building began to take hold as a result of appreciative interviews up, down and across the island.  Although there continued to be pockets of resistance to having Victoria be the “hub” of VIHA, there was a growing awareness of the ease with which isolated locations could reach out to the wider network of expertise and wisdom when managing particularly challenging healthcare issues.  The emotional side of consolidating and integrating three separate, autonomous healthcare provider systems will take time and further work in building trust and openness to this new networked approach.