|By Paul E. Plsek, MS, Paul E. Plsek & Associates, Inc.; author, Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience; former member, Innovations Exchange Editorial Board|
The health care industry can learn a lot from other industries where deliberate processes for innovation are more common.1-4 Although every organization has its own process model, language, and specific methods, innovation generally proceeds along the sequence outlined below. It is especially important to cultivate innovative thinking during the early stages of the innovation process that involve preparation and idea generation.
Natural Thinking Involves “Mental Valleys”
- Preparation. Innovative thinking requires taking a fresh look at how you do what you do, the assumptions you make, and your mental models. The potential to reframe the issue is a critical part of the innovation process that should not be glossed over.2,5,6
- Idea generation. Nobel Laureate Linus Pauling was once asked how he got such good ideas. His reply: “The way to get good ideas is to get lots of ideas, and throw the bad ones away.” Research shows that innovative individuals and teams spend time brainstorming literally hundreds of ideas, practicing what psychologists and cognitive scientists call “divergent thinking” or “fluidity.”7-9
- Selection and development. Great ideas rarely emerge fully developed in a brainstorming session. The fluid, divergent thinking of idea generation must be followed by convergent thinking. Eventually, you will need to pick out the most promising ideas and spend more time thinking about how to enhance these further and overcome potential weaknesses.1,2
- Testing and evaluation. Transitioning from the conceptual to the concrete, the next phase involves simulations and small-scale testing to overcome potential weaknesses and determine whether the ideas are truly effective.3,4
- Implementation. Small-scale trials provide proof of concept, but real impact can occur only when ideas are transferred to operations for achieving full-scale implementation.
- Sustain and spread. If an idea is successfully implemented with a positive result, then it deserves some extra effort to ensure that it is sustained and spread further. Sadly, this step is often neglected.
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 in that perception gets channeled toward existing patterns in memory, in the same 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.10,11
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.10,12 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 process relies on three deliberate mental activities: attention, escape, and movement.12
Although 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.
- 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: “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!”
Innovation Requires Cycles of Divergent and Convergent Thinking
The process of innovation also involves deliberately alternating between divergent and convergent thinking.8,13
Consider the following example of cycling through divergent and convergent thinking:
- Divergent thinking. This 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. This 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.
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 who need health information with primary care clinicians who can provide answers?”
Divergent. We might generate a lot of ideas without judgment (divergent):
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.”
- Internet Web site
- Telephone consults
- Text messaging on cell phones
- Teletransportation (as in Star Trek)
- High-tech telemedicine booths in shopping centers
Alternating cycles of divergent and convergent thinking helps get the benefits of both, while avoiding the pitfalls of each.
About the Author
Mr. Plsek is an internationally recognized consultant on innovation in complex organizations. A former research engineer at Bell Laboratories and director of corporate quality planning at AT&T, he now operates his own consulting practice and is the developer of the concept of DirectedCreativity™. His health care clients have included the National Health Service (NHS) in England, Kaiser Permanente, the Veterans Health Administration, the SSM Health Care System, and the Mayo Clinic. Mr. Plsek is the Chair of Innovation at the Virginia Mason Medical Center (Seattle), an innovator-in-residence at MedStar Health (DC–Baltimore), Director of the NHS Academy for Large-Scale Change (UK), a former senior fellow at the Institute for Healthcare Improvement, an active research investigator, a popular conference speaker, and a former member of the Innovations Exchange Editorial Board. He is the author of dozens of peer-reviewed journal articles and seven books, including Creativity, Innovation and Quality; Edgeware: Insights from Complexity Science for Health Care Leaders; and Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience.
Disclosure Statement: Mr. Plsek is an independent management consultant who advises health care organizations on innovation strategy.
1Plsek PE. Creativity, innovation and quality. Milwaukee: ASQ Quality Press; 1997.
2Kelly T, Littman J. The art of innovation. New York: Doubleday; 2001.
3Dodgson M, Rothwell R. The handbook of industrial innovation. Cheltenham, England: Edward Elgar Publishing; 1994.
4Afuah A. Innovation management: strategies, implementation and profits. 2nd ed. New York: Oxford University Press; 2003.
5Amabile TM. The social psychology of creativity. New York: Springer-Verlag; 1983.
6Amabile TM. How to kill creativity. Harvard Business Review. 1998;76(5):77-87.
7Guilford JP. Creativity. Am Psychol. 1950;5(9):444-5. [PubMed]
8Osborn A. Applied imagination. New York: Charles Scribner’s Sons; 1953.
9Osherson DN, Smith EE, editors. An invitation to cognitive science: thinking. Cambridge, MA: MIT Press; 1990.
10de Bono E. The mechanism of the mind. London: Penguin Books; 1969.
11Osherson DN, Smith EE, editors. An invitation to cognitive science: thinking. Vol 3. Cambridge, MA: MIT Press, 1990.
12Plsek PE. Innovative thinking for the improvement of medical systems. Ann Intern Med. 1999;131(6):438-44. [PubMed]
13Guilford JP. Creativity. Am Psychol. 1950;5(9):444-5. [PubMed]