Organizational and system leaders – whether team leads, managers, directors, executives, or commissioners – signal that innovation is highly desirable by setting aspirational goals in specific areas and challenging others to find ways to realize the vision. Linking these to strategic priorities and being able to articulate a clear, multi-faceted case of need, further signals the importance of the call for innovation. However there is a caution. Innovative thinking is stifled when leaders go beyond statements of what needs to be achieved and also become prescriptive as to how it must be achieved.
- “Don’t stop. Keep moving towards new targets, new goals, new improvements” Stuart Rose, CEO Marks & Spencer
- “Many people fail in life, not for lack of ability or brains or even courage but simply because they have never organized their energies around a goal.” Elbert Hubbard, innovator in the field of marketing, 1880.
Identify and publicize widely the strategic issues where there is a clear case for the need for innovation and where extension of the current way of working is clearly inadequate to meet the need. While continual, incremental improvement is the ethos of the health system, this can also lead to a culture of complacency. The mindset “of course we can always do a bit better”, while good, leads to change that often does not fundamentally challenge the status quo approach. In other words, it is not really very innovative and does not achieve breakthrough results. At the same time, challenging and changing everything at once is a recipe for chaos. Somewhere in between the two extremes lies great opportunity for strategically focused innovation. Identifying those opportunities and attaching a stretch goal that captures the imagination can stimulate lots of innovative thinking.
Stretch Goals and Innovation. The classic example from NASA (the US space program) was President Kennedy’s challenge in 1963 that “we will put a man on the moon and bring him home safely by the end of the decade”. At the time, few of the technologies required were available and there were many unanswered questions. But this clearly articulated stretch target spurred massive innovation in several fields that not only benefited the space effort but also led to products that we take for granted today (for example, both cardiac pacemakers and health care telemetry had their origins in NASA innovations).
The key in articulating targets that stimulate innovation is to stick strictly to defining the ‘what’ and the ‘why’, but steadfastly avoid specifying the ‘how’. The aim is actually to have people initially react saying that it cannot be done. This then provides the opportunity to lead them to realize that what is holding them back is the way that they are thinking about it. (This is a principle behind the That’s Impossible! tool in the NHS Institute’s publication Thinking Differently.) An example of clear statements of ‘what’ and ‘why’ linked to a strategic goal is provided in the box below. The clarity of the goal, the strength of the case, and the size of gap invites people to think differently about approaches to the problem. For example, ideas about innovative partnerships with others in the health service, as well as organizations in other sectors or individuals in the community, come instantly to mind.
Setting Targets that Encourage Innovation in the Health Service
Key Principle: Clearly articulating the ‘what’ and ‘why’, but avoiding specifying the ‘how’.
Situation: 40% of unplanned admissions to our Acute Trust are alcohol related, and the percentage is rising at an alarming rate. Data also indicate that alcohol plays a role in many cases of staff abuse by patients. We have identified reduction of alcohol-related unplanned admissions as one of our strategic priorities.
What (stretch goal): We want to go beyond simply slowing the growth in alcohol-related admissions. How might we cut the actual number of unplanned alcohol-related admissions in half in 2 years?
Why (the case): We have made incremental improvements, but these are merely slowing the rate of increase. The absolute numbers of alcohol-related admissions already place an unsustainable burden on us from a finance, staff safety, and staff morale perspective. The rising burden of unplanned alcohol-related admissions will only grow more intolerable as we enter a period where resources will be further constrained. We must do something radically different now.
Set out organization- or system-wide innovation challenge topics that call for innovative ideas in specific areas of need. This straightforward approach builds on the previous tip but goes a step further to create an ‘innovation focus list’. In the spirit of focusing, this list should be specific as to topics and no more than five to seven items. For example:
- A Foundation Trust might say, “We need truly innovative ideas in the areas of: eliminating waiting, reducing stillbirths in a certain ethnic group, truly equipping and empowering patients and carers in their own self-care after discharge, etc.”
- Commissioners in a PCT might say, “We want innovations that will: cut teenage pregnancies by 70%, reduce admissions for people with diabetes by 50%,”
The specificity of the goals and targets implies attention and resource-availability. Going further, leaders could set up specific structures and processes to enhance the invitation to innovation; for example, identifying a specific senior executive as the sponsor for each item on the list, or setting up a webpage or email box that will accept ideas and respond back to the initiator.
Articulate stretch goals in the language of “how might we… (do something that today seems impossible)?” In many organizations, the word ‘target’ or ‘goal’ implies that there will be negative consequences associated with not meeting it, even if one falls short by only a small amount. The natural reaction is to want to avoid setting oneself up for negative consequences. The best way to do so is to debate the specifics of the goal. Often, more thinking energy is devoted to arguing against the specific target than is given to coming up with innovative ideas. A simple way to avoid this is to state innovation goals and targets in the form of a question that begins: “How might we…?” (see box). This invites inquiry and creativity, rather than resistance and debate. It also signals that you have simply chosen a round number to shock the thinking and you don’t really mean anything more exact than that. In the end, if we achieve a 43% reduction in something that we set a goal of 50% on that is still something worth celebrating!
"How Might We…" Statement Examples
- We have reached our 18 weeks wait targets, how might we reduce that by half again?
- Our operating costs in theater are much better now, but how might we cut them an additional 30%?
- Many people with diabetes in our practice have achieved control of their blood sugar levels. How might we maintain that outcome with half the number of visits to health professionals?
- How might we achieve a 25% reduction in falls across the whole community?
Review current goals and targets and seek to remove overly-prescriptive means that are embedded within them, or make it clear that you are very open to alternative means that accomplish the same goal. For example, a target to “Reduce by 10% unplanned admissions of people with diabetes by implementing the XYZ model of care” leaves only a little space for innovative thinking. Of course, if there is good evidence for the XYZ model of care and others have routinely achieved satisfactory results with it, then this is perfectly good goal statement for the spread of an innovative practice that will lead to improvement. This is a good thing. (For more about this distinction, see the explanation at the end of the Introduction section and the first tip in the Tools section.) But leaders can enhance the conditions for further innovation by saying instead, “The goal is to reduce by 10% unplanned admissions of people with diabetes.
The XYZ care model has been shown effective in achieving this, and we might indeed decide to implement it here. But before we take that decision, let’s also consider other approaches. How might we achieve a 10% reduction in unplanned admissions for people with diabetes?” Such thinking might result in an even better approach, or some innovative building on the proposed care model. Further, even if clinical leaders and front-line staff decide after thinking about it that the XYZ care model is actually a good approach, the difference between leaders telling them they must do it versus leaders inviting them to input and chose for themselves will likely have a positive impact on ease of implementation and eventual sustainability.
Consider goals, contracts, annual appraisals, personal development plans, or job descriptions that require people to try out a number of innovative ideas annually and report back on what they have learned. A basic principle behind many of the tips in this section is to say what is expected in a high-level sense, and avoid over-specifying the details. Building on that, this tip suggests simply setting the general goal of asking for innovation of any kind.
How do you define an ‘innovative idea’? The companion guide in this series, Making a Bigger Difference, provides an approach. However, the aim of this goal is not to accumulate or judge ideas, but rather to stimulate thinking and create a conversation that encourages even more innovation. Leaders will learn something about the capability for innovation in their organizations by having this conversation and reflecting on the items that are put forward as examples of innovation. Likewise, commissioners will learn something about the innovativeness of providers in their health community. If you are truly creating the conditions for a difference, you should see a difference in the depth of challenge to status quo thinking over time. Avoid setting people up for failure and frustration. If you set such a goal, make sure you also provide tools and skill building, along with the resource of authority to act on ideas.
Test for alignment of organizational or system-level goals for innovation by asking staff where they think innovation is most needed. One of the purposes in setting goals for innovation is to communicate the need for innovative thinking. There is a timeless principle in communication that says: “if they didn’t ‘get it’ you didn’t communicate it properly”. The objective is to see whether you are communicating clearly enough to raise people’s awareness of the need for innovation so that they are constantly on the look out for innovative ideas. If they cite back to you the areas where you have set goals for innovation, then you have evidence of good communication. If they say they don’t know if innovation is really needed, or they cite completely different areas, then you have evidence that the innovation goals you have set are not necessarily accomplishing the objective of stimulating innovative thinking. You may need to communicate again, or do it better. Or, you may have targeted areas that simply do not seem that important to others. In any event, you are not fully capitalizing on the power of goals to create a culture for innovation.
More tips that can also help you enhance the Goals dimension can be found in other sections…
- Turn strategically important innovation efforts into formal organizational projects with allocated resources.
- Start a ‘Not Invented Here’ program where leaders, managers, and staff are supported to seek out knowledge and ideas from outside health care that can be adapted to address key organizational challenges.
- Grand prizes and competitions create a few winners and lots of losers; instead seek to reward all legitimate innovations and attempts.
- Distinguish between, and channel into appropriate processes and methods, issues that need (a) adoption of existing better practices from elsewhere, and (b) truly new ideas.
NOTE: All of the information on the Elements of a Culture of Innovation, Assessment, and Tips for Leaders were adapted from Maher, Lynne, Paul Plsek, Jenny Price, and Mark Mugglestone, (2010), “Creating the Culture for Innovation: A Practical Guide for Leaders” published by the National Health Service (NHS) Institute for Innovation and Improvement in the United Kingdom