Dr. Lynne Maher
Director for Innovation and Design
NHS Institute for Innovation and Improvement
@LynneMaher1
Session objectives:
• At the end of the session you will be able
to:
• Describe seven dimensions of organisational culture that
support innovation
• Understand how you can assess the culture for innovation
in teams and organisations
• Describe actions that you can take to enhance the culture
for innovation in your organisation
Life in health services…
sometimes it feels like this…
"Here is Edward Bear, coming
downstairs now, bump, bump,
bump, on the back of his head,
behind Christopher Robin. It is, as
far as he knows, the only way of
coming downstairs, but sometimes
he feels that there really is another
way, if only he could stop bumping
for a moment and think of it.”
A A Milne
There are many innovations in health care
that have resulted in increased quality and
lower cost, for example....
• The transition from traditional surgery to keyhole
methods
• Increase in diagnostic ability reducing the need for
surgery
• Use of telephone consultations to improve access
• Use of wireless technologies to aid information
transfer, & storage
11
However, when we reflect we can see
that ……..
We have innovative approaches within healthcare, but
these are not systematically applied
The current rate of innovation is not likely to achieve the
change we want and need
10-11
What is the current context for
innovation in the NHS?
“Innovation is no longer one of those ‘nice things to do’ if
we have a bit of time to spare.
It’s business critical and all of us in the NHS need to be
looking for new, improved ways of using our resources to
deliver the best services, every day.”
Sir David Nicholson,
Chief Executive of the NHS England
6
11
In England we have a
particular challenge ..................
The NHS needs to increase the
quality of care and improve patient
experience while reducing its cost by
£15 billion over the next 3 years.
This is roughly equivalent to £96
million per week.
In the middle of difficulty lies opportunity.
Albert Einstein
Leaders have a disproportionately large
effect on the cultures of organisations and
systems. By their behaviours, leaders create
the conditions that either hinder or aid
innovation.
(Maher, Plsek, Price, Mugglestone 2010)
“Senior leaders often have an
emotional investment in the status quo
without even realising it”
Gary Hamel
The leadership imperative
•
In a study undertaken by the NHS Institute two thirds of staff respondents stated
that they were not adequately supported by senior leaders to undertake innovation
and improvement activities.
www.institute.nhs.uk/innovation
•
Responses from staff undertaking the ‘Culture for Innovation’ survey in
organisations suggest that senior leaders do not make it clear that innovative new
thinking is required to meet some organisational goals and do not openly support
innovation.
“Undervaluing
and under investing in the
human side of innovation is a common mistake”
(Moss Kanter 2006)
Leaders need to create the conditions within
which innovation can flourish.
“…Strategies and processes alone are not sufficient to
drive the degree of change we are seeking....the NHS
should focus on tackling the behaviours and cultures
in the system that stand in the way.”
(Sir. David Nicholson CEO, National Health Service)
Our Hypothesis
• Despite well-articulated needs and strategies,
and the availability of methods and tools…
• Efforts at real innovation in health care will move
at the same slow pace, with the same mixed
results, as general improvement efforts have
done in the past…
• …unless we explicitly address the organisational
culture required to support innovation
Literature review finding… Organisational
culture is a major factor which affects the
speed and frequency of innovation
“Culture eats strategy
(and tools)
for lunch”
Marc Bard
Management guru
Dimensions of innovation culture
Risk Taking: Key Constructs
Trying new things is a norm
Emotional support for risk takers
Balanced assessment of risk
Learning from failure rather than
punishing it
Risk Taking- learning from industry
• In studies of innovative organizations, failure was
viewed as a learning process rather than
something to chastise – most of the organizations
planned for it and actively welcomed it as an
important part of the process
• 3M reward ‘intelligent’ risk taking
• The only possible “failure” for a test of an
innovation is the failure to learn something!
“The fastest way to succeed is to double your failure rate”
Thomas Watson, Sr.
Founder, IBM
Risk Taking
Resources: Key Constructs
Access to (at least some) funding
Time to work on innovative ideas
Authority to act (empowerment, at least to test ideas)
Resources: Some Literature
• Amabile (1998) studied high-tech R&D labs and
identified 6 managerial practices that affect creativity;
two of them are:
– Resources in the form of time and money
– Freedom to decide how to meet a challenge
• Kanter (2002) identified “10 classic rules for stifling
innovation” based on her work with hundreds of
organisations; two are:
– Insist that people who need your approval to act go through
several layers of other managers first
– Make sure that requests for information are fully justified, don’t
give it out freely
Knowledge: Key Constructs
Wide scope search (beyond industry bounds)
Uncensored, unfiltered, unsummarized
Free flowing
Knowledge: Some Literature
• Carr (1994) found that “creative organizations are always
scanning the horizon”
• One of Basadur’s (2005) organizational roadblocks to
creative thinking was “inadequate outside contact”
• Robinson and Stern (1998) studied Japanese firms and
(separately) US firms implementing continuous
improvement
– one key finding was that “diverse stimuli -- openness to input and
experience from all sorts of sources, and forums in which such
input can be openly shared”….played a big role in supporting
creative thinking
Goals: Key Constructs
Specific call for innovation
What, but not how
‘Stretch’ targets (aspirational, visionary)
Tie to strategic plan (implying resources
and follow through)
Clear case for need (framing to engage)
Framing the message
We have over 400,000 nurses in the NHS. How can we
enable them all to contribute ?
The NHS needs to increase the quality of care and
improve patient experience while reducing its cost by
£20 billion over the next 2 years.
• Work with a new Cost Improvement Programme (CIP) ?
• Stop employment of all agency staff?
• Reduce consumable use including stationary ?
Lets reframe the message so that it is
more relevant to a specific context
The NHS needs to increase the quality of care and
improve patient experience while reducing its cost by
£20 billion over the next 2 years.
•
•
•
On Ward 10 – lets have a ‘call for ideas’ from all staff and patients and
their families
We need new ideas that could reduce cost by at least £11,000 this year, if
we can save more that would be even better .
These ideas could be about reducing waste, changing the way we work or
looking at the materials we use for example.
Goals: Some Literature
• Amabile (1998) studied high-tech R&D labs and clarified a
counter-intuitive relationship between goals and innovation
– “Clearly specified strategic goals often enhance people’s
creativity… Creativity thrives when managers let people decide how
to climb a mountain; they needn’t, however, let employees choose
which one.”
– Time pressures that focus attention aid innovation, while time
pressures that make people feel as though they are on treadmill
sharply hinder innovation.
• Quinn et. al. (1997) studied many organizations and
recommended that “managers must provide motivating
visions, challenging strategic goals, and figure-of-merit
targets for their operations”
• Robinson and Stern (1998) describe BHAGs --“Big, Hairy,
Audacious Goals” – and their relationship to instances of
great innovation
Rewards: Key Constructs
Recognition of innovative effort
Individualized
Appealing to intrinsic motivation and values
Aligned with organizational goals
Rewards.....
“Money incentives do not create energy for
change: the energy comes from connecting
to meaningful goals”
Ann-Charlotte Norman 2012
Rewards- learning from industry
• Recognition – Thank you is an important reward
• Gore Tex- Staff get to spend 10% of their work
hours as ‘dabble time’ to develop their own ideas.
• 3M staff spend 15% of their time on projects of
their own choosing
• Secondments/time out in other industries
Tools: Key Constructs
Deliberate process
Flexibility to adapt to
varying situations
Training
Encouragement for
skills development
Tools: Some Literature
• One of Basadur’s (1995) organisational roadblocks to creative
•
thinking is: “lack of support for training on and application of
innovation processes”
Higgins (1995) studied major commercial organizations
around the world and concluded that the most innovative and
successful provided employees “skills: the ability to do the
work they set out to do”
Relationships: Key Constructs
Diversity
Honoring everyone’s input
Trusting, open environment
Team-based work is the norm and
this includes customers
Relationships- learning from
industry
• Based on notion that:‘We all have something to give and we
all have something to learn’
• Hierarchy is often based on skills
• Diversity is a common feature
Dimensions of innovation culture
Applying the Framework
• The seven dimensions can be used in
multiple ways.
– A meeting or event
– Project or front-line team
– Department
– Organization
– Multi-organization system
Uses of the framework…
• Assess current environment
– via dialogue
– via a survey tool
• Plan actions to increase likelihood of
innovation
Quick assessment of culture of
innovation in your organisation
• Have in mind the organisation that you
personally work within
• Listen to the descriptions of 2-3 of the
dimensions and give your organisation a
score from +5 to -5
• Connect the dots to partially form a portal on
your chart
Portal Chart
Risk
+5
Resources
Relationships
0
-5
Tools
Knowledge
Rewards
Goals
Scoring the dimensions
Increase the score
Decrease the score
Representative
of positive
scores
Representative of
negative scores
Factors that lead
to a high rating
on this
dimension
Factors that detract
from this dimension
Portal Chart Scale
-5 = we have outstanding negative skills, systems
or recent experiences on this dimension;
hampering innovation
0 = our skills, systems and experiences on this
dimension have no real impact; neither
hamper nor support innovation
+5 = we have outstanding positive skills, systems,
and experiences on this dimension;
supporting innovation
Risk taking
Increase the score
Leaders provide public
and private emotional
support and
encouragement to those
that want to try out new
ideas. We take
reasonable risks, are
always trying new things,
and learn from what
others might call ‘failures’.
Decrease the score
Formal leaders and opinion
leaders fear failure. There
is little or no support or
encouragement for new
ideas and we don’t try very
often. Assessment of the
risk of a new idea is
inaccurate; we fear the
worst and that is the end of
the idea.
Resources
Increase the score
Authority or autonomy to
act, protected time, and
money is available for
individuals and teams
who wish to innovate.
Some funding is available
for unusual opportunities,
experiences etc.
Decrease the score
Ideas for change must be
‘approved’ by many others
before they can even be
tested out. All resources
are tied up in delivering
services in the way we
always have; no resources
are available for innovation.
Knowledge
Increase the score
Knowledge is gathered
from a wide range of
sources and is freely
available or quickly sent
out to staff. It is circulated
widely for comments and
to stimulate thinking. Staff
are encouraged to learn
from those outside of
health.
Decrease the score
We speak only about what
is happening in our own
organization or team and
not curious about what
others do because we think
we are different.
Information is given on a
need to know basis, as
determined by leaders.
Goals
Increase the score
Leaders make clear that
innovation is highly desirable.
We have aspirational goals that
are clearly linked with
operational and strategic plans.
Innovative ideas are actively
sought, and in many areas
leaders say that they are the
only way that some of the
targets will be met.
Decrease the score
We primarily react to targets set
by others. We typically work to
achieve these by minimal
change; or we spend most our
time arguing why they cannot be
met. Targets are set and focused
without little encouragement for
new thinking. Plans stipulate how
targets must be met. We often
“hit the target, but miss the
point”.
Rewards and recognition
Increase the score
Innovative teams and
individuals are recognized
fully for their efforts with
things that are important
to them; e.g., protected
time, help from other
areas, greater influence,
etc.. We recognize and
celebrate learning even if
ideas are not successful
in the traditional sense.
Decrease the score
Teams and individuals who
want to improve something
feel isolated and
discouraged from trying
new approaches. Very little
thanks or recognition for
good ideas. What
recognition there is is
superficial and, frankly,
demotivating.
Tools
Increase the score
We have a conscious and
deliberate process for
innovation and have
invested a lot in building
capability. We know how
to set our minds to be
innovative and we have a
proven record of
delivering innovative
solutions.
Decrease the score
We have little awareness of
tools and techniques to
support creative thinking.
There is no method or
approach for innovation. If
challenged to innovate we
would have difficulty.
Relationships
Increase the score
Decrease the score
We have high levels of
honesty, respect and open
communication; even across
groups and disciplines. Many
highly motivated teams with a
good mix of skills and styles.
Teams supported in an
ongoing ‘team’ development.
Good networks of intrinsically
motivated people working
together for a common aim.
The organization does not
promote team-based working
and does not support the
development of networks across
organizations and disciplines.
People feel controlled. There are
high level of lack of trust, respect
and honesty.
Risk
+5
Relationships
Resources
0
5
Knowledge
Tools
Rewards
Goals
Connect the dots to create the portal
Survey Tool
• On line assessment tool
• 29 survey statements which participants rate according to
their assessment of the culture for innovation in the
organisation
• Results can be segmented by
– Departments / areas
• Ward, theatre, imaging
– Professional groups
• Nurses, doctors, administrative
A hospital in England
• To be added
Detailed analysis by
question and camparison
to other organisation
Theme
Knowledge
Knowledge
Knowledge
Knowledge
No
UK
statement
If I don't have the information I need, I feel comfortable
9 asking my direct supervisor for it
We are generally kept informed ofactivities in other
10 departments that affect our work.
There is a lot of information available to me about what
11 other organisations are doing to meet the same sorts of
Senior leadership openly shares information that is
12 important to me and the work I do.
2.463
2.32
-0.878 -0.677
-1.268 -0.668
-0.192 0.227
-1
0
1
2
Understanding of areas of
strength and areas for
focus
Theme
Tools
Knowledge
Relationships
Goals
Risk Taking
Rewards
No
UK
statement
19 I am capable of generating creative ideas.
If I don't have the information I need, I feel comfortable
9 asking my direct supervisor for it
The teams that I work on tend to have people with a
26 diverse mix of skills and styles.
I know what the priorities or goals are in my
13 department.
My direct supervisor supports me if I wanted to try
1 something new.
I am certain that I would receive recognition or praise
21 from my direct supervisor if I put an innovative idea
2.736 2.689
2.463
2.32
2.323 2.358
1.807 1.989
1.718
1.69
1.342 1.165
-1
0
1
2
3
Tips for Improving Culture• Just a starter… use your experience and learn from others
• Select 1-3 dimension to work on and review these
• Review all the tips to see the range of things you could try
–
–
–
–
What is the basic idea behind this tip?
How do we think it would work in our context?
How might we adapt it to fit?
How might we combine thoughts from several tips in crafting
something unique for our situation?
– What additional ideas do we have beyond the ones here?
– How will we actually implement something? Who will we need to work
with to do this?
• Use a disciplined, reflective learning approach – for
example, a Plan-Do-Study-Act (PDSA) cycle – to test your
intervention
Tips on Risk Taking
 Share widely how the organisation or system has taken
reasonable risks on innovative ideas in the past
 Establish a process to publicise and learn from ideas
that ‘fail’
 Go out of your way to provide emotional support for
innovators
 Reverse a negative, worse-case scenario culture by
establishing new conversation practices when
innovative ideas are presented
 Don’t use humour to lighten the mood
when discussing the risks associated
with an innovative idea – it almost never
works and often has the opposite effect
 Feed the rumour mill to positive effect
Tips on Resources
 Reinforce 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
 Turn strategically important innovation efforts into
formal organisational projects with allocated
resources
 Link innovation efforts to waste-reduction
techniques that free up resources
 Seek resources from non-traditional channels
Tips on Knowledge
 Start a ‘not invented here’ programme where leaders,
managers and staff are supported to seek out knowledge
and ideas from outside health care that can be adapted to
address key organisational challenges
 Encourage staff to look for and share new ideas from
other health care organisations, internal departments, or
partners along pathways
 Regularly share and celebrate innovations that are
already happening in your organization or system
 Share board information more widely and
use knowledge from the workforce to
support the board
Tips on Goals
 Identify and publicise widely the strategic issues where there is a
clear case for the need for innovation and where an extension of
the current way of working is clearly inadequate to meet the need
 Set out organisation or system-wide challenge topics that call for
innovative ideas in specific areas of need
 Articulate stretch goals in the language of “How might we…?”
 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
 Test for alignment of organisational or system-level goals
for innovation by asking staff where they think innovation
is most needed
Tips on Rewards
and Recognition
 Seek to understand and work with what
intrinsically motivates innovators
 Set up structures and processes to enable peer,
patient and carer recognition for innovation
 Reward and recognise ‘failed’ attempts at
innovation where you can celebrate learning
 Grand prizes and competitions create a
few winners, but also lots of losers –
instead seek to reward all legitimate
innovations and attempts
Tips on Tools
and Methods
 Develop a cadre of people who can facilitate
creative thinking and innovation processes
 Require innovators seeking resources to
explore how innovative their idea really is and
how they might make it even more innovative
 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
publicise their many applications
Tips on Relationships
 Create many opportunities for diverse individuals to work
together and learn more about each other’s ways of thinking
 Use one of the many personal style instruments as a way to
get people to honour differences between themselves and
others as refreshing and useful
 Start an ongoing dialogue about what ‘teamwork’ or ‘a
trusting and open environment’ means and what it really
looks like
 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
Questions?
Comments?
Chat?