Dr. Lynne Maher Director for Innovation, Ko Awatea

1. 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

2. 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

3. 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?

4. Creating the Culture for InnovationAfter 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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)

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

12. 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

13. 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 BardManagement guru

14. 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

15. Dimensions of innovation culture risk taking resources knowledge goals rewards and recognition tools and methods relationships NHS Institute for Innovation and Improvement

16. Dimensions of innovation culture NHS Institute for Innovation and Improvement

17. 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

18. 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

19. 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

20. Resources: Key Constructs Access to (at least some) funding Time to work on innovative ideas Authority to act (empowerment, at least to test ideas)

21. 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

22. Knowledge: Key Constructs Wide scope search (beyond industry bounds) Uncensored, unfiltered, unsummarized Free flowing

23. 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”

24. “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

25. 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)

26. 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

27. Rewards: Key Constructs Recognition of innovative effort Individualized Appealing to intrinsic motivation and values Aligned with organizational goals

28. 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

29. Tools: Key Constructs Deliberate process Flexibility to adapt to varying situations Training Encouragement for skills development

30. 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”

31. “formal training in cognitive abilities and formal brainstorming sessions is proven effective for increasing creativity” Madjar 2005 Tools: Some Literature

32. Relationships: Key Constructs Diversity Honoring everyone’s input Trusting, open environment Team-based work is the norm A healthy culture allows us to produce something with each other, not in spite of each other.

33. 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

34. Dimensions of innovation culture

35. 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

36. 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

37. 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

38. Portal Chart Risk +5 Resources Relationships 0 -5 Tools Knowledge Rewards Goals

39. 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

40. 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 dimensions Increase the score Decrease the score

41. 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

42. 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 taking Increase the score Decrease the score

43. 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. Resources Increase the score Decrease the score

44. 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. Knowledge Increase the score Decrease the score

45. 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”. Goals Increase the score Decrease the score

46. 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. Tools Increase the score Decrease the score

47. 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 recognition Increase the score Decrease the score

48. 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. Relationships Increase the score Decrease the score

49. Review your results Connect the dots on your portal chart