Dr. Lynne MaherDirector for Innovation, Ko Awatea

Honorary Associate Professor of Nursing The University of Auckland

Paul PlsekChair of Innovation Virginia Mason Health System

Consultant in Innovation and Complexity

@LynneMaher1@paulplsek

Work originally undertaken within the NHS Institute for Innovation and Improvement

The concepts have been utilized and built upon within the US and New Zealand

Conflict of Interest • Who has paid you to give talks• Who has paid you for advice• Who has funded your research• Who has paid for you to attend conferences• Declare any other interests that could be

connected with work (for example share holdings in pharmaceutical companies?

Creating the Culture for Innovation

After this session participants will be able to:• Identify key factors that can influence the

culture for innovation in organisations• Describe actions that you can take to enhance

innovation your organizational culture• Share stories of success from industry and

health services • Use tips and key learning in your own

improvement and innovation journey

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

• 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

There are many innovations in health care that have resulted in increased quality and lower cost, for example....

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

However, when we reflect we can see that

Many of the ways we have implemented quality in the past need re thinking

Innovation—doing things differently, and doing different things, to create a step-

change in performance

…….is essential if we are to deliver against such a rapidly changing environment

Leadership is vital

Typically, around any change effort, there is an initial spike of tangible energy, and change, but when leadership loses interest, the momentum

of change slows down drastically.”Tara Paluck

Leaders need to create the conditions within which the 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.”

(David Nicholson former CEO, National Health Service)

In the middle of difficulty lies

opportunity.Albert Einstein

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

Marc BardManagement guru

“Culture eats strategy

(and tools)for lunch”

Literature review finding… Organisational culture is a major

factor which affects the speed and frequency of innovation

Leaders- that is you!

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, Boyle, Mugglestone 2009

Dimensions of innovation culture

• risk taking• resources• knowledge• goals• rewards and recognition• tools and methods• relationships

NHS Institute for Innovation and Improvement

Dimensions of innovation culture

NHS Institute for Innovation and Improvement

Risk Taking: Key ConstructsTrying new things is a normEmotional support for risk takersBalanced assessment of riskLearning from failure rather than punishing it

Risk Taking: Some Literature• Jaskyte’s (2009) research on innovation in 20 US human services organisations

found most innovative ones were “willing to experiment, quick to take advantage of opportunities, and risk taking”

• Miller and Oileros’ (2007) study of innovation in multi-national corporations identified factors such as “learning by doing” as key

• ATKearney’s Best Innovator 2004-2007 Competition found that “openness to new ideas” was one of the features that distinguished innovation leaders

• Dewett’s (2004) literature review concluded that the emotional support and behaviours of supervisors and peers following creative efforts played a key role in employees’ subsequent willingness to take risks

• A study undertaken by the UK National School of Government (Dennis, Tanner, Walker 2005) identified “balanced assessment of risk” as a feature common in organisations in the public sector that excelled

Risk Taking• 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

Resources: Key ConstructsAccess to (at least some) fundingTime to work on innovative ideasAuthority 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 ConstructsWide scope search (beyond industry bounds)

Uncensored, unfiltered, unsummarizedFree 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– “six elements that played a role in every unexpected creative act”– one was “diverse stimuli -- openness to input and experience from all

sorts of sources, and forums in which such input can be openly shared”

“make it easy to find and share knowledge about innovation, learn

from organisations that have a track record of innovation, and foster

links with private sector organisations”

Williams, de Silva and Ham, 2008.

Knowledge: Some Literature

Goals: Key ConstructsSpecific call for innovationWhat, but not how‘Stretch’ targets (aspirational, visionary)

Tie to strategic plan (implying resources and follow through)

Clear case for need (framing to engage)

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 effortIndividualizedAppealing to intrinsic motivation and valuesAligned with organizational goals

Rewards• 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 ConstructsDeliberate processFlexibility to adapt to

varying situationsTrainingEncouragement 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”

“formal training in cognitive abilities and formal brainstorming sessions is proven effective for increasing creativity”

Madjar 2005

Tools: Some Literature

Relationships: Key Constructs

DiversityHonoring everyone’s inputTrusting, open environmentTeam-based work is the norm

A healthy culture allows us to produce something with each other, not in spite of each other.

Relationships• 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• Seven dimensions can be applied to any

collection of individuals where innovative output is desired– A meeting or event– Project or front-line team– Department– Organization– Multi-organization system

Visualising culture for innovation:Portal charts• Used to display multi-factor information where all

factors can be related to a common scale and are roughly equal in importance

• Also called a spider chart• The greater the “opening”

the better

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

Portal Chart

Relationships

Tools

Rewards Goals

Knowledge

Resources

Risk

+5

-5

0

Using the framework• Work with your team. • Review the descriptions of each of the seven

dimensions and give your organisation a score from +5 to -5

• Connect the dots to form a portal on your chart

Representative of positive scores

Factors that lead to a high rating on this dimension

Representative of negative scores

Factors that detract from this dimension

Scoring the dimensionsIncrease the score Decrease the score

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

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’.

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.

Risk takingIncrease the score Decrease 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.

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.

ResourcesIncrease the score Decrease 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.

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.

KnowledgeIncrease the score Decrease 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.

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”.

GoalsIncrease the score Decrease 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.

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.

ToolsIncrease the score Decrease the score

Innovative teams and individuals are recognised fully for their efforts with things that are important to them; e.g., protected time, help from other areas, greater influence, etc.. We recognise and celebrate learning even if ideas are not successful in the traditional sense.

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.

Rewards and recognitionIncrease 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 organisation does not promote team-based working and does not support the development of networks across organisations and disciplines. People feel controlled. There are high level of lack of trust, respect and honesty.

RelationshipsIncrease the score Decrease the score

Review your results

• Connect the dots on your portal chart

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

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 Risk Taking

Tips on ResourcesReinforce 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

Dr. Lynne MaherDirector for Innovation, Ko Awatea

Honorary Associate Professor of Nursing The University of Auckland

Paul PlsekChair of Innovation Virginia Mason Health System

Consultant in Innovation and Complexity

@LynneMaher1@paulplsek