This article discusses several key concepts important to the first two steps in the process of innovation: preparation and idea generation.
Natural Thinking as "Mental Valleys"
Because the process steps of preparation and idea generation focus mainly on thinking differently, it is helpful to understand a few things about how we think.
We can think of the mind as a landscape with hills, valleys, and streams. Valleys represent our processes of perception such that perception gets channeled towards existing patterns in memory the way rain falling in a valley would be funneled into a stream. When we learn, we create new valleys. The more often we access that memory, the steeper the walls of the valley become, and therefore the more automatic our thought process.1,2
For example, hearing someone say "emergency department" or "ED" sends the mind naturally into a flow of thought involving a physical space… a main entrance and reception desk where you must register… waiting areas… a triage nurse who does an initial workup … and so on.
This is the usual way to think. There is nothing wrong with it, unless we need to come up with an innovative idea. Innovation involves slowing down and redirecting our perception processes rather than letting them flow automatically into our mental valleys.1,3 Thinking creatively leads us to explore mental valleys that we do not normally access in the context of emergency departments, such as connecting to the valley of "fast food restaurants" and borrowing the idea of a drive-through window as a way to challenge our existing concept of the triage nurse's station.
In summary, innovative thinking involves temporarily suspending our automatic thought processes and risking the expression of new ideas to see where they take us.
Innovative Thinking Requires Attention, Escape, and Movement
Innovation involves first recognizing, then rising out of and exploring our mental valleys. This relies on three deliberate mental activities: Attention, Escape, and Movement.3
- Attention: We acknowledge something we do not normally focus on due to the automatic nature of our mental valleys:
"Patients who come to the doctor's office must first go through the receptionist before gaining access to anyone else."
- Escape: We move beyond our mental valley by giving ourselves permission to think outside the box.
"What would we do if the government made it illegal to have reception desks and receptionists?"
- Movement: We imaginatively generate ideas without judgment or criticism.
While our usual thinking involves movement, we rarely take the time to pay explicit attention to our underlying assumptions, and we rarely challenge "the way we do things around here" or escape from our comfortable mental valley.
"Patients call from the parking lot to start the process in the office, then scan an identification card into a reader upon arrival in the office. The reader directs them to an exam room where the nurse is waiting to do intake—no receptionist involved!"
Cycles of Divergent and Convergent Thinking
The process of innovation also involves deliberately alternating between divergent and convergent thinking.4,5
- Divergent Thinking involves expanding the list of possibilities: purposefully looking for more, or looking at the issue from a variety of directions. The downside of divergent thinking is that it can go on forever without ever transitioning ideas into action.
- Convergent Thinking involves reducing the list of possibilities: purposefully looking to condense, summarize, focus, select, or take some action. The downside of convergent thinking is that we might miss a possibility, or prematurely discard one and end up being very focused on one idea, but not on the best one.
Consider the following example of cycling through both divergent and convergent thinking:
Convergent. We might start with a specific issue: "How can we help rural patients get to the primary care clinic?"
Divergent. It is useful to spend some time looking at it from a variety of angles. "What is it that we are really trying to accomplish here?" "What do we really care about?"
Convergent. This may bring a new perspective, which leads to a reframing of the issue rather than the same old way of looking at it. "How can we link rural patients with needs for health information with primary care clinicians who can provide answers?"
Divergent. We might generate a lot of ideas without judgment (divergent):
- Internet Web site
- Telephone consults
- Text messaging on cell phones
- Teletransportation (as in StarTrek)
- High-tech telemedicine booths in shopping centers
Convergent. In the end, we will need to apply some criteria to select those ideas that we wish to test. "Almost everyone has a telephone. That idea is easy, inexpensive, and familiar. Let's try that out and see if it is effective for some proportion of rural primary care needs."
Alternating cycles of divergent and convergent thinking helps get the benefits of both, while avoiding the pitfalls of each.
1 de Bono E. The mechanism of the mind. London: Penguin Books; 1969.
2 Osherson, D.N. and Smith, E.E., ed. An Invitation to Cognitive Science: Thinking, Volume 3. Cambridge, MA: MIT Press, 1990.
3 Plsek PE. Innovative thinking for the improvement of medical systems. Annals of Internal Medicine 1999 Sep 21;131(6):438-44.
4 Guilford JP. Creativity. American Psychologist 1950;5(9):444-5.
5 Osborn A. Applied imagination. New York: Charles Scribner's Sons; 1953.