Catalyze Innovation that Advances Health

Tips for Improving the Relationships Dimension


The relationships dimension refers to the patterns of interaction between people in the organization or system. Innovative ideas are rarely the product of a lone genius. Even when they might appear to be, delving further into the story nearly always reveals that the idea was formed over time and through multiple interactions with others that fuelled the process. Therefore, environments where staff are routinely exposed to a wide range of different thinking, from a wide-range of people, with a wide range of backgrounds and points of view, provide rich soil for the growth of innovation.

Of course, it is more than just exposure; one can be ‘exposed’ to a diverse group of people while riding on a train and not be stimulated to innovate. There must be a sense of common purpose; of being in a ‘team’ with others. This team environment must also enable those with different thinking to trust that their input will be honoured and explored, rather than immediately argued against.  

  • “Your only real path to innovation is through people. You can’t really do it alone”. Tom Kelly, CEO of the design firm IDEO
  • “Leadership is not about what you say, or even what you do. Leadership is how you make people feel.”
  • “Undervaluing and under investing in the human side of innovation is a common mistake.” Moss Kanter. R. (2006) Innovation: The Classic Trap. Harvard Business Review.

Create many opportunities for diverse individuals to work together and learn more about each other’s ways of thinking. One of the simplest things you can do to build relationships that favor innovation is to create more and more opportunities for multi-disciplinary interaction. Simply put, if you give a group of nurses a challenge to address, they are likely to approach it in ways traditional to nurses. The same would be true for groups of doctors, managers, housekeepers, or admin staff. Give the same challenge to a multi-disciplinary team of nurses, doctors, managers, housekeepers, and porters AND provide good team facilitation that focuses on being explicit about creating a trusting, open environment where everyone is curious and respectful of what the other thinks, and you may get a completely different set of ideas that would not have emerged from any of the individual groups alone.

The more opportunities you provide for this sort of working, the easier and more productive it becomes. It creates a mindset shift that becomes part of the prevailing culture over time.   In a true team, the old saying is often true: “The product of the whole can be greater than the sum of the parts”.   The next three tips, while useful on their own, can also be considered team-building exercises that could be productively combined with this one.  

Use one of the many personal style instruments as a way to get people to honor differences between themselves and others as refreshing and useful. Sometimes you need to ‘break the ice’ in opening up conversations about the different ways that people think. If I simply tell you my perception of how I think of you, you might feel that I am judging you; and beside, I might have it all wrong.  

There are literally dozens of simple style instruments that provide a structure and a language for beginning the exploration of one another’s differences in a more objective way. See the box for one example, and consult with your Human Resources Team who may have access to similar instruments.   Typically, one reads and responds (agree-disagree) to a series of statements, or selects or ranks preferred items from a menu of choices. These responses or choices are scored in some way that then results in a conclusion from the survey instrument. It makes a great team-building discussion if everyone completes such an instrument, gets some general feedback from a facilitator to help them interpret their own results, and then shares this information with everyone. The process gives everyone a better appreciation for differences within the team, avoiding potential frustration and enabling more understanding going forward.  

Style Instrument Example. The common Myers-Briggs Type Indicator® (MBTI) gives one feedback on her or his preferred ways of processing thoughts (mainly alone or mainly by bouncing it around with others), coming to decisions (mainly through logic or mainly through emotion), and other things. One receives feedback on one’s ‘type’ that most people find eerily accurate. A key point is that there is no right or wrong. Each type has its strengths and pitfalls. Each type is useful in some situations and less useful in others. Complete thinking is best accomplished by some combination of all types. That is the value in working together as a team.  

Note: The MBTI is a copyrighted instrument that requires the payment of a licensing fee. There are many other, similar instruments. For example, the booklet Managing the Human Dimension of Change, part of the NHS Institute’s Improvement Leaders’ Guide series, contains an instrument that works just as well for team building that is free to use. 

Start an ongoing dialogue about what ‘teamwork’ means and what it really looks like. Beyond styles and preferences, another sort of diversity that can be explored productively in teams is differences in what are called ‘mental models’. Mental models are the images that humans naturally create in their mind’s eye when they hear a word.   Mental models drive thinking, but if we have different mental models this can lead to conflict and frustration as we try to work together.  

For example, I might say, “Let’s be a high performing team”, and you might readily agree that that sounds a good idea. But if my mental model of a ‘team’ is a sailing crew where I am the captain calling out orders which I expect you to follow, while your model of a ‘team’ is a football side where everyone is flowing and the ball is being passed around for each player to try to create something then we might find that we are not working so well together as a team! You will be frustrated with me for being directive and I will be frustrated with you for acting as if I am supposed to be passing you the ball.  

The box provides a simple exercise that you can do with a task team, leadership team, or any group of staff to begin an on-going organizational dialogue.  

Exercise: What Do We Mean By ‘Team’? A team-building exercise that can expose mental models is simply to ask everyone to think silently for a minute or two about what image, example, or analogy they would use to illustrate a high-performing team. Ask them to actually draw a picture, or at least write a few words to describe a specific example. Stress that they must think of a concrete example, not a list of characteristics. Enforce a short period of silence. Don’t let anyone say anything or give their example yet, as this might bias others or cause them to not say what they are really thinking in order to fit in. Now, ask everyone to reveal his or her paper simultaneously and allow everyone to see everyone else’s picture. Only then begin going round the group for people to explain why they have selected their example. Point out differences and similarities and note that while there is no right or wrong, it certainly is important that we have at least a somewhat similar image in mind if we are to work productively as a team.  

Start an on-going dialogue about what it means to have a ‘trusting and open environment’.Using a similar interactive process to that in the preceding tip, you might also work on the environment regarding relationships by exploring patterns of behavior rather than analogies. For example, ask people to describe specific behaviours that they think of as examples, or counter-examples, of a ‘trusting and open environment’. Talk about ways to encourage more of the behaviors that others perceive as contributing to a positive environment.  

Bring in non-traditional team members precisely for their potentially very different points of view.  By ‘non-traditional’ we mean, for example, service users, carers, people in the community, people from the private sector, someone who knows little about how you currently do things, university students, designers, engineers, family members, and so on. Be sure to prepare your staff for how to receive these new team members. If health care staff respond to every suggestion that these outsiders bring with defensive explanations about why it is the way it is and how it simply must be that way, the fresh input will soon stop. On the other hand, if the fresh perspective is greeted with genuine openness, curiosity, and a desire to see where it takes us, new approaches to issues are possible.  

Our team is a real mix of NHS improvement specialists, non healthcare improvement specialists and people new to improvement but very familiar with the hospital and the NHS. The team includes staff with improvement backgrounds in the NHS who have a balance of clinical and non-clinical expertise. In addition we have staff members who have come from the Royal Air Force, the Automotive Industry and the Financial Service Sector. The diversity of the team gives it strength and builds in challenge and creativity. Having some clinical expertise within the team is extremely helpful and lends credibility to our work. We often buddy up NHS and non-NHS people on pieces of work to make sure that nothing is overlooked and to provide fresh insights from a range of different perspectives. Sue Stanley, Director of Service Improvement, Northampton General Hospital NHS Trust  

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. These structures from workforce development enable one to gain a more diverse perspective by “walking a mile in someone else’s shoes”. For example, having doctors spending time shadowing a nurse, or the Finance Director shadowing a porter might provide new insights into how, together, they might do things differently to benefit patients and carers, as well as each other. The more you are able to do of this sort of thing, the more staff begin to value and trust one another. This creates a climate where everyone feels more comfortable sparking off colleagues to create ideas that neither party could have previously imagined on their own.  




NOTE: This content is adapted from "Creating a Culture for Innovation: A Practical Guide for Leaders", written by Lynne Maher, Paul Plsek, Jenny Price and Mark Mugglestone, and published in 2010 by the National Health Service (England) Institute for Innovation and Improvement.