Catalyze Innovation that Advances Health

Tips for Improving the Knowledge Dimension

Synopsis

Broad-based knowledge is the fuel for innovation. We create better conditions for innovation when information, both from within and outside the organization or system, is widely gathered, easily accessible, rapidly transmitted, and honestly communicated. Since we cannot know in advance what knowledge might stimulate an innovative idea, censoring, filtering or over-summarizing information detracts from this dimension.

  • “Innovation is fostered by information gathered from new connections; from insights gained by journeys into other disciplines or places; from active, collegial networks and fluid, open boundaries.” Margaret Wheatley, author

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. Each of us have several encounters a week with people, businesses and services where we experience good flow as customers, have interactions that create exceptional positive experience, or see high levels of productivity via technology or job design. The simple fact is that most of us simply do not think about how the principles of successful operations in these other services might be applied to the work we do ourselves.

Capitalize on the myriad experiences of staff (and even their friends, partners and families!) by drawing attention to the need to apply ideas and principles from elsewhere to the work we do. (For more on the thinking behind this tip, see the mental valleys concept and the Fresh Eyes and Mental Benchmarking tools described in the NHS Institute’s publication Thinking Differently.)

While general awareness raising is useful, a more focused effort will have even greater benefits. For example, “This month, we are seeking ideas that we could adapt from elsewhere that will allow service users to gain greater access to services out of normal hours”. In addition to supporting the Knowledge dimension, this sets a goal, implies that there is little risk in suggesting an idea as these are welcomed, suggests that resources will be available to support some work, and provides an opportunity to recognize those who contribute. Commissioners could further encourage this sort of knowledge seeking when they work with providers seeking funding for services.

Bringing the knowledge of outsiders into the NHS to generate innovative ideas. The NHS Institute regularly invite non health related organizations to input their ideas on specific topics such as improving access for GP Surgeries, health and fitness for older populations, and creating a service delivery oriented process for hospital portering teams. Contributors have included an award winning water company, a concierge service, phone network providers, retail organizations, and hotel representatives.

Encourage staff to look for and share new ideas from other health care organizations, internal departments, or partners along pathways. Just as the previous tip encouraged greater knowledge flow from outside health and social services, this tip suggests the same, but with an internal focus. Requiring managers and clinical leads to regularly seek out and adapt ideas from other areas also encourages the more rapid spread of innovation and combats the ‘pockets of excellence’ phenomenon that we unfortunately see so often. Transferring ideas that work in a different location into your own area is a particularly important type of innovation for the NHS because there are so many examples of excellent practice available.

A good example is the recent development of 8 High Impact Actions for Nurses (Mugglestone and Baxter 2010, Maher and Fenton 2010). Based on the knowledge that within the NHS there are many examples of excellent improvements that have been made by individuals or teams of nurses and midwives, a call for evidence of all these good examples resulted in over 600 submissions within a three-week period. In addition to the actual submissions, visits to the website to look at the submissions were in the thousands.

The submissions were assessed and synthesized to create those that are believed to have the highest potential to increase quality, improve patient experience and reduce cost. This work has created massive interest and there is widespread evidence of adoption of good ideas from case studies that have been developed in each of the eight high impact areas. 

I’ve Been Noticing… You know that you are making progress in the Knowledge dimension when you regularly hear staff say things such as:

  • I have a friend who works in a neighboring hospital and what she says they do is…
  • I read about something really great in the Nursing Standard (or BMJ or HSJ)…
  • I was at a meeting with some colleagues from community services and they way handle a similar situation is…
  • I went to X-ray with a patient and I noticed that they did this great thing that I think we should consider…

Regularly share and celebrate innovations that are already happening in your organization or system. For example, develop an annual ‘innovation day’, or an innovation focus within your regular newsletter, in which teams, departments or organizations in your health economy display some of their most innovative new ways of working and pose challenges seeking innovative ideas to solve their problems. This also stimulates innovative thinking by promoting some friendly competition among departments and teams.

The periodic event becomes part of the pattern of organizational life where departments and teams know that they will be able to showcase something they have done. Everyone will be naturally curious as to how what they have done compares to peers. This idea also links with the Rewards dimension of culture; but we encourage you to read the caution there about awarding top prizes.

In addition to sharing what has already been done, such an event can also be used to stimulate wider thinking about challenges that have yet to be successfully addressed. Departments and teams could post their challenges on a board with a large space for others to post ideas and suggestions. These might become the topics for future knowledge searches to learn more about how other organizations and industries address similar challenges.

Share board information more widely and use knowledge from the workforce to support the board. While the preceding tips focus mainly on sharing knowledge about innovative solutions, this one looks more at sharing information about current performance and challenges that need to be addressed.

Look at all of the information reviewed at board level and ask: “Why can’t this information be shared more widely to stimulate broader thinking and create more urgency for change?” Boards often have information that they are reluctant to share widely for fear that it will overwhelm or upset the workforce. This creates a culture of parent-child interaction and contributes to what Harvard professor John Kotter (2008) calls the ‘complacency’ that works against the urgency for change that often fuels innovation. Sharing detailed performance information can also call attention to so-called ‘positive deviance’ – departments, teams, or individuals who seemingly have discovered something that enables them to excel on a particular dimension of performance that might be adapted and spread more widely (see box).

The Surgeon Who Knows Something. Mining the data in its Quality Observatory, a team in the South East Coast identified a consultant at one hospital site who was achieving outstanding results. His hip replacement patients had good, safe outcomes, with much shorter lengths of stay and higher satisfaction, at reduced cost and with higher staff morale than comparable sites. His better practices have now been evidenced with data, which also demonstrates the wide variation among surgeons, and work is underway to spread these practices. Source: Samantha Riley, Head of the Quality Observatory, South East Coast SHA and member of the Academy for Large-Scale Change.

While there is certainly some information at board level that must be kept confidential, in our experience far too much information is held at senior levels. This may well be holding back the organization from the innovation that would make it more successful in serving the patients, carers and public who depend upon it. Consider adding a question to each board agenda item that encourages a few minutes of reflection on the information just shared with the board to ask if it shouldn’t be more widely shared.

 

 

In addition to tapping into emerging knowledge sharing resources, consider creating your own informal mechanisms for people to share what they know. For example, ask anyone who goes away to a meeting or conference to purposefully search for and then write up 2-3 ideas that they can bring back to the organization. These short summaries could be published in existing newsletters, captured on websites, or simply shared verbally at managerial, clinical, or other staff meetings.

More tips that can also help you enhance the Knowledge dimension can be found in other sections…

  • 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. 
  • 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. 
  • Bring in non-traditional team members precisely for their potentially very different points of view. 
  • Increase the use of job shadowing, short-term work rotations, and longer-term secondments to increase individuals’ awareness and valuing of different ways of thinking and working. 

 

 

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