In high-performing organizations, innovation is the product of the deliberate use of practical tools. Imagining that innovation will happen on its own if we just have the right culture would be as naive and irresponsible as imagining that financial controls would naturally emerge without some deliberate structures.
While everyone is capable of innovative thinking, most of us have been socialized to be more conservative in our thinking in the work environment, especially in health care where there are legitimate risks that must be managed. Leaders, therefore, need to consider how they build capability and capacity in deliberate methods for creative thinking.
- 46% of respondents of the NHS Study on Innovation and Improvement said they would like to receive more support in learning about tools for innovation and improvement. Source: NHS Institute.
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. Consistent with what we have said about the goals dimension, innovation happens best when it is strategically focused. The complex organizations and systems of health care cannot sustain simultaneous, paradigm-altering change to every thing we do. It would be chaos, and there is no need to do so.
Within an organization or health system there will be services that are operating well. These may still benefit from incremental improvement and/or adoption of well-proven ideas from other NHS or international health care organizations. Methods from improvement science are already being applied in most health care organizations and systems in such situations.
It is important to have a deliberate process for identifying those strategically important few issues where fundamentally new thinking is required, in order to focus resources and efforts onto these. This should take place as part of existing operational and strategic planning structures (e.g., commissioning, the annual planning cycle). You should develop your own simple process for this, but the items in the box provide general guidelines. Build considerations such as these into a simple proforma that you can integrate into your existing planning processes.
Guidance for Identifying Issues for Application of Innovation Tools and Methods
- Ask someone to conduct a deliberate search for ideas and better practices around the challenges you face as an organization or system to see if there is something that you can learn from elsewhere. [ICON Knowledge dimension] You may need to be innovative in the way you adapt the idea to fit your context, but if the basic concept behind the idea will help you achieve your goal then a great deal of work has already been done and you have less risk because you will know that the idea has been done elsewhere. [ICON link to Risk dimension.] Ideas data bases for health care already exist (e.g., The Health Care Innovation Exchange sponsored by the US Agency for Healthcare Research and Quality and work is currently underway to create such searchable resources in the UK
- If the goal for improvement is small (e.g., single digits percentage-wise), or if you simply need to solve some problems that have crept in over time and get the service back to a level of performance that it has achieved before, you may require incremental improvement or adoption of existing better practices and should consider using traditional performance improvement methods. However, even when the current gap in performance is relatively small, you might still want to place a certain challenge in the ‘innovation needed’ category. If you know that the pressure to improve even more will simply continue year-on-year, you might want to consider launching at least some exploratory idea generation to see if you might jump to a fundamentally new level of performance through innovation.
- If the goal for performance is far from current levels and there are no existing better practices that you can adapt, this might be an area for strategically focused innovation. Compile a full list of these and do a simple, first-draft business case on each in order to prioritize your needs.
Develop a cadre of people who can facilitate creative thinking and innovation processes. Creative thinking is something that everyone can do (Plsek 1997). Providing training and facilitation resources to build this capability in staff sends a visible message that innovative ideas are desirable. Consider it a natural extension of the improvement teams, advisers, and toolkits used by many organizations.
There are many useful tools for stimulating idea generation. The NHS Institute for Innovation and Improvement has several publications and masterclasses describing such methods and a program to certify innovation practitioners.
It is important to note that idea generation alone is not the whole of the innovation process. Tools and processes for further development, testing, implementation and spread of ideas are equally important. A variety of publications and other resources from the NHS Institute provide guidance on this as well.
Require innovators seeking resources to explore how innovative their idea really is and how they might make it even more innovative. Consider each and every idea for change that comes to your attention as a ‘teachable moment’ that offers you the opportunity to further develop the culture for innovation. If someone is seeking resources, even if it is only the resource of your authority to proceed, encourage them to also stretch their thinking further.
Here’s a simple tool for guiding this reflection called a 4Ws table:
|Current Approach||Proposed New Idea|
|Who||who is involved directly in delivering the care?||Specifically, who else might do something (esp. patients themselves)?|
|What||what specifically do they do?||What else we might they do, or what might they do very differently?|
|When||when it is available?||Specifics of when else might we offer this?|
|Where||where is it done?||Specifics of where else might we extend the idea?|
Asking innovators to construct such a table to present their ideas almost always stimulates further innovative thinking. It need not be an extensive analysis. After using this tool the first few times, you will find that you can easily do this analysis in a 10-minute discussion. This simple tool and organizational ritual can go a long way toward creating conditions that favor more innovative thinking.
Plan to introduce new tools or methods for innovation periodically. Spread their use widely in simple ways that help everyone see how they might use them, and publicize their many applications. If you are already using a few tools for deliberate creative thinking and innovation, or after you have implemented some of the tips above, plan to keep the focus on innovation fresh by injecting new things into the mix. This continually communicates the value you place on new thinking. Keep it simple and seek to introduce new tools and methods as part of daily work rather then always thinking that some sort of formal training is needed (see example).
Bringing Innovation Into Day-to-Day Work of Staff. The NHS Institute’s Thinking Differently guide describes a tool called ‘Breaking the Rules’ that can easily be integrated into the daily life of an organization or system. Challenge staff for a month to purposefully notice all the ‘unwritten rules’ and traditions all around them. An easy way to spot these is to pretend that one is a man from Mars who is totally unfamiliar with health care processes and systems and keeps asking why things are as they are.
For example, “Why is it that when patients arrive we ask them to wait in an area, when actually they came to see a clinician?” The answer might be, “Well we have to manage the flow of demand in some way.” To which a response might be, “Is a waiting area the only way to manage the flow of demand? How else could you do it? How is it done elsewhere?” This invites organizational conversation with new thinking as we seek constructive and innovative ways to ‘break the rule’ about always having waiting areas for patients.
The basic idea here is to enhance the culture for innovation by encouraging more flexible mindsets, and to embed a few simple methods for innovative thinking into the organization’s or system’s culture on a regular basis. To achieve these goals, make sure that you also set up a mechanism to capture some stories of how the new methods have stimulated concrete change and publicize these widely. Your local communications staff can probably help with this.
More tips that can also help you enhance the Tools dimension can be found in other sections…
- Establish a process to publicize and learn from ideas that ‘fail’.
- Turn strategically important innovation efforts into formal organizational projects with allocated resources.
- Set out organization- or system-wide innovation challenge topics that call for innovative ideas in specific areas of need. (Goals)
- 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.
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