Ask people if they think they are innovative. Go on, see what they say. The reality is that we are very competent using innovations, but not very innovative ourselves. This could not be more true for healthcare. I don’t want to drop a bombshell but sorry, we don’t even know what innovation means.
Now before you get all upset at me, I would just like to clarify a few things…
As health care professionals we are trained to stay safe. We are trained to think and do things based on known, safe, evidence-based facts. We stick to the guidelines – to veer outside those tramlines could be dangerous. Our training and the health care environment beats innovation out of us – if failure is not an option then there’s no real point training people to be innovative. Instead we train people to achieve a p-value of statistical significance using huge amounts of resources over a long period of time. We celebrate that p-value but it rarely makes any difference for years.
One can certainly be made to feel like a maverick for trying something different. But we all know – if we do things the way we’ve always done them, we’ll always get what we always got.
Innovation, on the other hand, requires space, off-the-wall thinking, the ability to break the norms and try something new. Most of all one has to be prepared to fail – and learn from failure. Sir James Dyson is a big fan of failure – 5,126 times to be precise. 'Fail often to succeed quicker' is one of his mottos. David Kelley, founder of design group IDEO, coins the foundation of innovation as ‘creative confidence’.
He’s the guy who helped friend Steve Jobs produce iconic functional designs that we all know too well from our iPhones and iPods. We all have an element of creativity somewhere. Gaining creative confidence can also be learned and like everything else, practice makes, well, more streamlined innovation.
In actual fact, the process turns out to be relatively robust with the foundation of design thinking, rooted in a comprehensive understanding of the user, the challenges, the data. Immersing oneself in the user’s environment, ethnographic studies and forming a team of diverse thinkers all play a big part. (Hey, that means there will be people on your team who don’t think like you and me!) From there, it’s a case of idea generation using every prompt and stimulation available. Now reign in the ideas through diverse group analysis and theoretical testing before developing a small number of prototypes. The process is robust, but not simple. There’s good news though. We’ve discovered a shortcut to innovation.
No, it’s not thinking outside the box, it’s going outside the box.
It actually takes guts and humility to say that you may not have the answer inside yourself, your organisation or even your profession. People will criticise you for even bothering to look, say it’s a waste of resource, that anything outside the box can’t apply in the box. It’s certainly true that the people who translate out-of-the-box innovations are special people – too concrete a thinker and one won’t be able to adapt it, too abstract and the core principles will be lost.
The good news is that, combined with Quality Improvement methodology, innovation doesn’t have to be that scary. Simulation, small-scale testing, balanced measures, scale and spread plans all help in reducing the risk to patients (and of course yourself).
I had the privilege of spending some time with Steve Meuthing, who took on the quest to reduce serious safety events (SSEs) at Cincinatti Children's Hospital. An SSE is an event where an error can be directly attributed to serious harm or death. At the time these were occurring every 12 days. Steve spent 2 days on a US Navy aircraft carrier. He took back to the hospital situational awareness based on stratified huddles, and prediction and mitigation across all areas of the organisation. The result is that it’s now 273 days without an SSE (and believe me, they have a system that picks them up).
The guys at the Garfield Innovation Center wanted to assist on improving medication administration safety. Preliminary observations showed nurses were being interrupted on average 17 times a shift while dispensing medication (and 80% of these were from other nurses). They linked the pressure of getting the meds right to other transient but high pressure tasks. Together with the nurses they visited their local airport at Oakland and brought back the concept of the 'sterile cockpit' prior to takeoff. A visit to Homebase, some red duct tape on the floor and a high visibility vest were the first prototypes for what is now standard procedure for a ‘non-interrupt procedure’ across scores of hospitals.
Only a few years ago I would hear nurses say ‘If Tesco have been using bar codes for years for just selling fruit, why can’t we have bar codes for meds?’ You can, it just took far too long for health care to catch on. First off, someone has to get outside the box.
So next time you are out-and-about, ask yourself what can you transfer-back-in.
Peter is a GP and Clinical Commissioner, currently on a year’s placement at the Institute for Heathcare Improvement in the US as a Health Foundation Quality Improvement Fellow, www.twitter.com/drpjchamberlain
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