7 dimensions of culture in an innovative

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

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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

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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?