1. Creating a Culture of Innovation as a Driver for Change

2. Innovation That is … doing things differently, and doing different things, to create a true change in performance … Is essential if we are to deliver against such a rapid changing environment Maher & Plsek, 2009

3. Organizational culture is a major factor which affects the speed and frequency of innovation.

4. NHS Institute … a 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 organizational culture required to support innovation Maher & Plsek, 2009

5. Creating the Culture for Innovation – NHS Institute Literature Review –Review of research, case studies, and expert opinion –Nearly all innovation literature is outside health care –Special search for public sector literature Identified 7 dimensions that affect organizational culture for innovation

7. Portal Charts: A Visual Representation graphically show the size of the gaps among organizational performance areas. displays the important categories of performance and makes visible concentrations of strengths and weaknesses The bigger the opening the better!

8. NHS Innovation Culture Survey Tool 29 questions that measure across the 7 dimensions Scoring: -5 = outstanding negative skills, systems or experiences in this area (hampers innovation) 0 = skills, systems or experiences have no real impact (doesn’t hamper or support innovation) +5 = outstanding positive skills, systems or experiences in this area (support innovation)

9. Maher & Plsek, 2009

11. Exercise (20 min) Using the Excel worksheet provided Answer the questions using the scale of -5 to +5 Averages will be computed for you Share the results with others at your table –What contributes to your high scores?

12. What is a System?

13. An interdependent group of items, people, or processes working together towards a common purpose. Common purpose aligns the parts of the system, while interdependence considers the relationships and the interactions among them.

14. Systems Numerous Types: biological (heart), mechanical (clock), human/mechanical (riding bike); ecological (predator/prey); social systems (organizations, societies, friends); healthcare systems Made of Processes: starting your car (driving to work is a system); orientating an employee is a process (creating satisfied, happy, productive employees is a system) Simple, complicated, or complex

15. Simple, Complicated, Complex Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? Zimmerman and Glouberman 2002

16. Simple, Complicated, Complex Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? Zimmerman & Glouberman 2002

17. Simple, Complicated, Complex Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? Zimmerman and Glouberman 2002

18. Zone of creative adaptability

19. We know that … Every system is perfectly designed to get the results that it gets … The current rate of improvement is not likely to achieve the change we want and need …. If we want different results, we must change (transform) the system! Maher & Plsek, 2009

21. Complexity ‘in complex systems (such as healthcare), unpredictability and paradox are ever present, and some things will remain unknowable….new conceptual frameworks that incorporate a dynamic, emergent, creative and intuitive view of the world must replace traditional “reduce and resolve” approaches to clinical care and service organization’ (Plsek, 2001)

22. Understanding Innovation within a Complex System Relationships are central to understanding the system Need to reflect on structures, processes and patterns Actions are based on internal simple rules and mental models Desire for autonomy and enhancement of professional image define patterns of behavior Constant adaptation Experimentation and “pruning” Non-linearity Systems are embedded within other systems and co-evolve Plsek, 2003

23. What is our Current Mental Model? “Organizations as machines” (Industrial Age)

24. We design systems that: –Dictates relationships among the parts –Patterns are a “deterministic function of structure and processes” –“emergent behaviors” are a failure of the system Plsek, 2003

25. The Result in Health Care? … from the unconscious application of this “machine” metaphor in a complex adaptive system

27. Understanding Receptive Context Degree to which a group or organization naturally takes on change and new ideas Highly receptive context: – “ripe” for change – Quickly adopt innovative concepts in order to meet challenges Low receptive context: – Lack will or ability to implement new ideas Plsek, 2003

28. Some additional thinking … The context for change is different in each organization – This contrasts conflicts with the traditional way we conduct research (think RCT!) – Do question generalizability of findings … BUT we need to learn from the change ideas implemented by others – Can’t expect that an innovation successful in one place will be successful in others if only “they would just follow the model provided”. Plsek, 2003

29. “We’re Different and It Won’t Work Here” Describe the innovation plus the context in which it was successful Don’t try to convince others that they aren’t different; they’ll just put little effort into implementation! Acknowledge the difference … “Let’s discuss what are the key differences in your context relative to ours, and think about how we might adapt these ideas to your context.” Plsek, 2003

30. 5 Key Elements Affect Receptivity for Change 1.Nature of relationships →how they are built and maintained 2.Nature of decision-making →how it is done and by whom 3.Nature of power →how it is acquired and how it is used 4.Nature of conflict →how do they arise and what are the common forms of dealing with them 5.Importance placed on learning →individual and collective Plsek, 2003

31. Our traditional comfort zone … Plan and control Innovative thinking is a rare expertise Focus on structure and process Dissemination of evidence and motivation is all that is required for change Factors necessary for change are not so different across organizations Plsek, 2003

32. Where Do We Need to Go? Learn and adapt as we go along Innovative ideas can come from anyone Be informed by what worked elsewhere; but take into account local conditions Patterns of thinking and behavior are just as much a part of the system as structures and processes Spread is the result of the adoption process; not the other way around Spread results from knowledge sharing through social networks Nonlinear patterns in social networks make some individuals more essential that others to the spread of an innovation Organizational context with regards to change can differ across organizations … this matters! Plsek, 2003

33. Leadership and Innovation “Leaders have a disproportionately large effect on the cultures of organizations and systems. By their behaviours, leaders create the conditions that either hinder or aid innovation.” Maher, Plsek and Bevan, 2009 “Leadership establishes the culture of innovation through the capacity to empower individuals to improve their own work environments and systems.” Snowden, Shell and Leitch, 2010

34. Top-Down Leadership Does not … –“unleash the imagination and passions of people and enhance their ability to form shared visions”; –Increase intelligence at the front-line in an increasingly complex environment; –Foster trust and skills needed by teams at all levels to recognize and address the hidden assumptions and flawed reasoning behind certain actions. Peter Senge, 1996

35. Definition of Innovation “Intentional introduction and application within a role, group or organization, of ideas, process, products or procedures, new to the relevant unit of adoption, designed to significantly benefit the individual, the group, or wider society.” Farr, 1990

37. Incremental vs. Step Change Incremental ChangeStep Change Performance GainSmall – mediumMedium – large Underpinning thinking about the “way it has always been” Largely unchallenged and unchanged Fundamentally challenged and changed

38. In the middle of difficulty lies opportunity. Albert Einstein

39. Fleuren, Wiefferink and Paulussen, 2004

40. Dimension 1: Risk Taking –People feel free to try new ideas –Balanced assessment of risk –Don’t pre-maturely reject new ideas due to an over-estimate of risk –Ideas are supported, regardless of whether they are judged a success or ‘failure’ –Learning from failure vs punishing for it

41. “The fastest way to succeed is to double your failure rate.” Thomas Watson, founder IBM

42. Dimension #2: Resources –Access to (at least) some funding –Authority and autonomy to act on new ideas –Time to work on new ideas –Risk – staff become demoralized if they do not feel supported

43. Literature on Resources Amabile (1998) studied high-tech R&D labs and identified 6 managerial practices that affect creativity, two of which are: –Resources in the form of time and money –Freedom to decide how to meet a challenge Kanter (2002) “10 classic rules for stifling innovation”; 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 Maher & Plsek, 2009

44. Dimension 3: Knowledge –Information, from inside and outside the system, is widely gathered, accessible, rapidly transmitted and honestly communicated –Wide scope search (other industries/areas) Creative organizations are always “scanning the horizon” (Carr, 1994) –Uncensored –Not over-summarized

45. Dimension 4: Goals –Aspirational goals –Challenge others to find ways to realize the vision –What, not how –Tied to strategic priority areas –Create the case for need (framing!) –BHAG’s – Big, Hairy, Audacious Goals! (Robinson and Stern, 1998)

46. Dimension 5: Rewards Symbols and rituals to recognize innovative behaviour Signal – value of efforts to achieve new ways of thinking, doing Appeals to intrinsic and individual motivation Frequent personal expressions of appreciation are more value than financial rewards

47. Dimension 6: Tools Deliberate use Flexibility to adapt Training E.g., Thinking Differently; Six Thinking Hats

48. Maher & Plsek, 2009

49. Dimension 7: Relationships Innovation is rarely the result of a lone genius! Diversity - wide-range of backgrounds and different points of view Sense of common purpose, shared vision Those with different thinking need to be honored and explored, rather than immediately argued against “We all have something to give, and we all have something to learn.”

50. Table Activity (30 min) Each table will be assigned one Dimension. Question to be addressed: How might we improve this dimension? –Share experiences –Create new ideas to test Record your ideas on the flip chart (10 minutes) Report out to the larger group (20 minutes)

51. Tips for Improving the Risk Taking Dimension 1.Share how the organization has taken reasonable risks in the past. –Transparency on how risk is assessed –Sharing of new ideas being tested –Showing how Board is supporting innovative projects –Speaking about ideas before you are sure they will work 2.Publicize and learn from ideas that fail. 3.Show an interest in the ideas of innovators. 4.When people present new ideas: –Create a rule that the benefits are listed first before any discussion of what could go wrong –Some ideas won’t work for everyone; design for 80% rather than 20% (some ideas won’t work for everyone) –Ask for evidence that supports the status quo approach 5.Feed the rumor mill to the positive effect!

52. Tips for Improving the Resources Dimension 1.Give people the authority to test new ideas (e.g., do you require a full team meeting to “approve” a PDSA?) 2.Turn strategically important innovative efforts into formal organizational projects with dedicated resources. 3.Link innovation efforts to waste-reduction techniques that free up resources. 4.Seek resources through non-traditional channels.

53. Tips for Improving the Knowledge Dimension Start a ‘not invented here’ program –e.g., “This month, we are seeking ideas that we could adapt from elsewhere (industry, McDonald’s, etc) that would enable patients to gain access to services out of hours” Encourage others to look for and share new ideas from other health care organizations, departments, etc. Regularly share and celebrate innovations that are already happening in your own organization. Provide a forum for sharing of “positive deviance”

54. Tips for Improving the Goals Dimension Share widely the strategic issues where there is a clear need for innovation and where status quo won’t meet the need –Define the what and why … leave open the how Put out a call for innovative ideas in specific areas of need –e.g., We need innovations that will cut teenage pregnancies by 70%! Set stretch targets with the language of “how might we …” –e.g., Many diabetics in our practice have achieved their blood sugar targets. How might we maintain this outcome with half the number of visits? Include this as part of annual personal goal setting in performance reviews. To test a new innovative idea and report back on what happened.

55. Tips for Improving the Rewards Dimension Seek to understand what intrinsically motivates –e. g. Team members supported to attend conference to present their ideas and work –How to determine? “What was the best recognition you ever had in a works situation?” “What could we do to make you feel recognized and supported for the work you have done?” Set up processes for peer and/or patient recognition Celebrate learning from “failed” attempts at innovation

56. Tips for Improving the Tools Dimension Increase the number of people who can facilitate creative thinking and innovation processes Introduce new tools and methods for innovation periodically –Spread their use widely

57. Tips for Improving the Relationships Dimension Create opportunities for diverse groups to come together and learn from each other Consider using the “personal style” instruments to understand each other as a team (e.g., SDI, Myers Briggs) Start a dialogue of what is ‘teamwork’ or a ‘trusting and open environment’ and what it really looks like Bring in non-traditional team members for their viewpoints Increase the use of job-shadowing to understand and value different ways of thinking and working

58. Characteristics of Innovative Teams Tolerant of a diversity of approaches Support initiation and development of ideas Belief in and acceptance of the values and goals of the team Willingness to exert effort for the team Open communication Information sharing Mutual trust Resolve conflict by group consensus West and Wallace, 1991