Innovation and Design
A.K.A. get our head out of the sand
Unlocking the creative you

Every system is perfectly designed to achieve the results it gets.
- Paul Batalden, M D
New levels of performance can only be achieved through dramatic system-level redesign.
2

Domain Expertise
Those closest to the problem are more likely to know or discover the solution.

“Difficult problems can not be solved by the same level of thinking that created them”
Albert Einstein

9/11 Commission conclusion
– “The reason that our intelligence did not pick up the 9/11 plotters was a “failure of imagination.”
– What new idea can put our practice/hospital out of business?
(Called disruptive innovation)

• Innovation comes when the wrong things are used in the wrong way at the wrong time by the right people.
• This is called the “Law of Creative
Accident ”
• 3M sticky notes
• Thus, be curious first, critical second

• Look for a second right answer
• Look from a different perspective
– Patient –centered vs physician-centric
• Look for a different answer this year
• Einstein – “I have no special gift, I am just passionately curious .”
Charles Thompson

• Vision to a wayward company
• Simplicity to a complex task
• Consensus to a conflict
• Revenue to a budget cut
• Creativity most often happens when you hold opposite thoughts together.
• Polarity Management : Consider
“both/and” rather than “either/or”
Charles Thompson

• Waste of time and resources to fight market forces.
– The market moves in spite of you.
– The market wants transparency

• Mainframe computers/personal computers
• Fixed line phones/cell phones
• Full service department stores/discount retailers/Amazon
• Traditional physician office/Retail medical clinic
• Will prevail in the marketplace
Charles Thompson

Prof. Patrick Hudson, Leiden University, the Netherlands (From Shell E & P)

1. Establishing a sense of urgency
2. Forming a powerful guiding coalition
3. Creating a vision
4. Communicating the vision
5. Empowering others to act on the vision
6. Planning for and creating short-term wins
7. Consolidating improvements and producing more change
8. Institutionalizing new approaches
John P. Kotter, Leading Change. HBR, 1995.

• Key tenets:
– Create complementary second operating system - traditional hierarchy plus strategy network
– Key principles:
• Many change agents, not just the usual few appointees
• A want-to and a get-to – not just have-to mind set
• Head and heart, not just head
• Much more leadership, not just more management
• Two systems, one organization
John P. Kotter, Accelerate!, HBR, Nov. 2012

1. Create a sense of urgency around a single big opportunity
2. Build and maintain a guiding coalition
3. Formulate a strategic vision and develop change initiatives designed to capitalize on the big opportunity
4. Communicate the vision and strategy to create buy-in and attract a growing volunteer army
5. Accelerate movement toward the vision and the opportunity by ensuring that the network removes barriers
6. Celebrate visible, significant short-term wins
7.
Never let up. Keep learning from experience. Don’t declare victory too soon
8. Institutionalize strategic changes in the culture
John P. Kotter, Accelerate!, HBR, Nov. 2012

• Tolerance for change
• Willing to take calculated risks
• Focus on small tests of change to build trust
• Willingness to have several things going on at once
• Personal self-confidence to allow staff to make changes
• Being open to staff identifying ways things can be different
• Respect for professionalism of staff
• Role of teacher
• Support from upper management – allowing time for improvement
Transforming Care at the Bedside – Nursing Leader survey

• Empower multidisciplinary teams to work together in redesign efforts
• Use storytelling to connect staff to problems and solutions
• Employ direct and analogous observation
• Conduct targeted brainstorming activities to promote innovation (e.g. “snorkel”)
• Build capability of staff to test and implement changes to make improvements
16

Storytelling
• Recall an actual story or experience which relates to the specific design challenge (personal, friend or family member or work-related experience)
 Who was involved?
 What happened?
 How did individuals feel and react?
• These stories can be positive experiences in addition to highlighting areas of needed improvement
• Tell stories in small groups (not more than 2 minutes each) – Have groups nominate stories for the whole
17

How might we ….
….put patients and their family members in control of the discharge process?
….promote vitality to the workforce?
….mobilize materials management to deliver supplies to maintain needed par levels?
Ideas should be actionable & related to a story
20

Rules for Brainstorming
• Encourage wild ideas
• Go for quantity – want more than 500 ideas
• Defer judgment
• Be visual – draw pictures
• One conversation at a time
• Build on ideas of others
• Stayed focused on topic (“how might we…” scenarios)
Write each idea on post-it notes
21

Start with the end in mind
– What is the result I want to see, feel or hear? Be specific
– Why do I want to achieve this result? Be passionate!
– How am I going to achieve this? Be bold.

“ Quality improvement begins with love and vision. Love of your patients. Love of your work . If you begin with technique, improvement won ’ t be achieved.
”
--A. Donabedian, M.D

Michelangelo’s Thoughts on
Transformation
“In every block of marble I see a statue as plain as though it stood before me, shaped and perfect in attitude and action. I have only to hew away the rough walls that imprison the lovely apparition to reveal it to the other eyes as mine see it.” …. Michelangelo

“I saw the angel in the marble and carved until I set him (her) free.” .... Michelangelo

What a Great Idea!, The Key Steps
Creative People Take , Charles “Chic”
Thompson, HarperPerennial, 1992