Catalyze Innovation that Advances Health

Tips for Improving the Risk Taking Dimension

Synopsis

Risk taking is about establishing an organizational climate where people feel able to try out new ideas. While it is obviously important to avoid taking inappropriate risk, a healthy organizational culture seeks a balanced assessment that avoids prematurely rejecting ideas due to over-estimation of risk. It also requires leaders who show they are quick to provide emotional support to those willing to try something new, regardless of whether the idea is eventually judged a success or ‘failure’. Leaders in innovative organizations demonstrate that they are more interested in learning from failure than in punishing it.

  • “Management’s job is not to prevent risk but to build the capacity to recover when failures occur… if we aren’t always at least a little scared, we’re not doing our job.” Ed Catmull, cofounder of Pixar and president of Pixar and Disney Animation Studios
  • “The fastest way to succeed is to double your failure rate.” Thomas Watson, founder IBM
  • “The innovator has for enemies all who have done well under the old law.” Nicolo Machiavelli
  • “Man cannot discover new oceans unless he has the courage to lose sight of the shore.” Andre Gide
  • “Often the difference between a successful person and a failure is not one has better abilities or ideas, but the courage that one has to bet on one’s ideas, to take a calculated risk – and to act.” Andre Malraux
  • “Only those who risk going too far can possibly find out how far one can go.” TS Eliot

Capitalizing on ‘failure’

When developing the Airblade, the energy-efficient hand drier for public restrooms, the engineers at Dyson, noticed that the machine was trapping a lot of air inside and became curious about this ‘failure’ of their design. They wondered what they could do with this high-speed air. They considered lots of potential uses before looking at the typical electric fan, which uses rotating blades to hack air into pieces that are then propelled out into the room. They had found an opportunity and the bladeless fan has been created.

Share widely how the organization or system has taken reasonable risks on innovative ideas in the past. If staff don’t see leaders actively supporting reasonable risk taking, they may get the impression that it isn’t supported. The case study below illustrates the classic point that “perception is one’s reality”.

We don’t see it the same: A large acute trust convened a group or senior leaders, managers and front-line staff to discuss where the trust stood on the seven dimensions of culture in an innovative organization. The three groups sat on separate tables for the initial discussions. When each group reported out on the risk taking dimension, it became evident that there was a large difference of opinion among them.

The senior leaders who had rated the organization highly on risk taking were genuinely surprised that the managers and front-line staff had rated it lower. “We have long debates about things at board meetings, and these often result in our support of innovative pilots of ideas that have not been tried anywhere else before”.

But a member of front-line staff asked how she would ever know about these discussions. “You have to understand it from our position in the organization”, she said, “the first we hear of new ways of working is after they have been fully tested and are being spread more widely. At that point, it doesn’t seem like much of a risk to us; but more like a top-down, management-controlled culture. It certainly doesn’t suggest to me that my team would be welcomed to try something new and innovative. And we almost never hear about ideas that were piloted but did not work, even though that learning might have been useful to us”.

The leaders took her point and resolved that they needed to do a great deal more communication about all the reasonable risk taking and learning that they perceived was already going on in the organization, and how they welcomed more of it.

If the issue in your setting is about a difference in perception, the solutions are simple. For example:

  • Be transparent about how risk is embraced and assessed in the organization. Consider how you can keep staff informed about this.
  • Publicize new ideas that are being tested, outline the anticipated benefits and risks, and describe the roles of senior leaders in supporting these.
  • Talk about hard decisions made at the board level to support innovative pilots and new ways of working.
  • Be seen speaking openly about these before you are sure that they work.
  • Don’t be afraid to be quoted saying things like, “It’s never really been done like this before, and we know that it might not turn out exactly as planned, but we’re willing to give it a go on a trial basis, with good monitoring and contingency plans, and we support those who want to learn about the process.”
  • Get front-line staff involved in planning pilot efforts, and ask them to share with colleagues their experience of being supported in prudent risk taking.

Establish a process to publicize and learn from ideas that ‘fail’.

Make it routine and acceptable to talk about ideas that were tried but ‘failed’. Work from the mindset that the only ‘failure’ is the failure to learn, and that not sharing and learning from things that don’t go as planned is waste and lost productivity.

Every attempt at innovation should have some form of an After Action Review but this is even more important with ‘failures’. Gather the group together who participated in the planning and testing of the idea and work through a series of questions such as these:

  • What did we set out to do?
  • What did we actually do?
  • What did we expect to happen?
  • Why did we expect that to happen, what was our theory?
  • What actually happened?
  • What have we therefore learned?
  • What should we do now?
  • Who should we tell about what we have learned?

An SHA leader, commissioner, organizational leader, improvement adviser, manager, or clinical lead could initiate this conversation. Many organizational safety program use After Action Reviews as an essential part of their learning. Ask those involved in your organization’s safety efforts if they can help you.

Did You Know? After Action Reviews were developed by the US military in the mid-1970’s but became common during the 1990 Gulf War. Its use was popularized and spread to other setting by Harvard professor David Garvin’s writings, as summarized in his book Learning in Action: A Guide to Putting the Learning Organization to Work (Harvard Business School Press, 2000). It is now used widely in innovation and improvement efforts in many industries.

Go out of your way to provide emotional support for innovators. Leaders who understand and recognize the potential in staff make it their business to know the individuals and teams who are doing innovative things and personally connect with them. Go out to the person’s work area, or to the department or team, and take an interest. Show that you know what they are doing, ask what they are learning (reinforcing the principle “the only failure is failure to learn”), and ask what you can do to help.

Think of the difference in emotional impact on a more junior member of staff between having a senior leader seek her or him out to see how things are going, versus the anxiety that might be associated with being asked to come give a formal report to the board.

Be systematic as a leadership team about this and keep the lines of communications open. Assign leaders to be ‘supporters’ or ‘sponsors’ of specific innovations. Schedule periodic walk-arounds or phone calls to keep the lines of communications open.

These supportive behaviors will also help you create the climate for innovation in the Resources and the Rewards dimensions. They give you the opportunity to reinforce the authority to act, identify any resource constraints that might be blocking progress, and provide recognition and appreciation.

Reverse the negative, worst-case scenario culture by establishing new conversation practices when innovative ideas are presented. Most organizations do not do a balanced assessment of risks when evaluating a new idea against the status quo. When presented with a new idea, people can be quick to point out what might go wrong, ask for strong evidence to support the new idea, or note that it would not work under certain circumstances. This almost immediately kills the enthusiasm for the new idea and makes the individual who raised it feel deflated.

Take the lead in reversing this behavior and mindset by acting differently and encouraging others to do the same. For example, when presented with new ideas:

  • Create a rule that the benefits of the idea are listed first before any discussion about what could go wrong. (This is a principle behind Edward de Bono’s Six Thinking Hats ®; see the NHS Institute’s publication Thinking Differently for more information.)
  • Recognize that the new idea may not work for every patient group or situation. However, ensure that any decision is made on the benefits for the majority rather than not using the idea because it does not benefit everyone in every situation.
  • Review critically the current process that the idea relates to. Ask for the evidence that supports the status quo approach. Ask that the new idea be judged fairly to the same standard of evidence that we allow for the status quo practice. When examined more closely via this challenge, teams often find that the new idea can offer benefits that the current process does not.
  • Rather than dismissing an idea as imperfect, challenge others to think about how they might further develop it to address its weakness. (See the Enhancement Checklist in the NHS Institute’s publication Thinking Differently for more information.

Research indicates that the behaviors of formal organizational leaders have a disproportionately large effect on organizational culture (Schein 2004). Commissioners, SHAs and Chief Executives in an area can have the same effect on the culture of a health economy. If a leader starts responding differently upon hearing new ideas, others are likely to follow.

Role model personal, courageous risk taking in order to learn more about how to improve the culture. Consider exposing yourself a bit by frequently asking others for feedback on your own behavior and the culture of the organization. You might use a version of any of the questions on the culture for innovation survey as a guide. For example, you might ask staff during a walk-around “If you suggest a new idea and it fails, do you think that would make you reluctant to suggest even more ideas in future?” Appeal for an honest response, an explanation as to why they feel as they do, and suggestions for what they would like to see different.

Make a point of sharing the impressions you get from doing this with everyone, even if they are somewhat personally embarrassing for you. Experience indicates that people often give credit to a leader who is personally sincere and clearly trying to make things better.

Don’t use humor to lighten the mood when discussing the risks associated with an innovative idea. It almost never works and often has the opposite effect. The box below describes all-too-often-heard comments meant to be light-hearted in approaching the risk taking associated with innovation.

Some Things Are Just Not Funny. We cringe at some of things that we have actually heard leaders say…

  • “Jane tells us she is sure it will work, and we’ve told her we are sure she can find work elsewhere if it doesn’t (ha ha ha)”.
  • “Yes, I can remember we learned a lot from a past failure of an innovative idea. Of course that bloke no longer works here (ha ha ha)”.

The reaction is often nervous laughter and people making eye contact with one another around the room. This affirms that they believe that this gallows humor is actually true about the organization.

Don’t do this! If you are in a room where someone does, immediately speak up and say something in a serious tone like, “Actually, Jane’s confidence in leading the way on this innovative idea is just exactly the sort of thing we support around here, and we certainly wouldn’t want people like her to leave”.

Feed the rumor mill to positive effect. As you try some of these tips realize that your new behavior is likely to take others by surprise. Invariably, this will start a buzz around the organization. This will have a positive effect in terms of improving the conditions for innovation, for it has been said that the ‘rumor mill’ is often the most efficient internal communications vehicle in any organization.

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

  • Re-enforce the expectation that individuals and teams should feel they have authority to act on innovative ideas and seek to understand why they might feel they do not. 
  • 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.
  • Reward and recognize ‘failed’ attempts at innovation where you can celebrate learning.
  • 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. 

 

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