|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 innovation literature suggests that we should pause to think before rushing headlong into solving what we initially perceive to be a problem.1,2 This point is captured in a quotation that is widely credited (perhaps fancifully) to Henry Ford: “If I had asked people what they wanted, they would have said faster horses.”
We can fall into this trap when we frame our problems only in terms of needing more or less of something that we already take for granted; for example, “We need more resources…less waiting time in our clinic…more adherent patients…better access to traditional services in historically disadvantaged areas.”
No doubt, having such things would be an improvement. But it might also be a good idea to see if we could use existing resources in a more innovative way: “We could eliminate a percentage of clinic visits by providing services through other means…better align our medical advice with patients’ lives…provide care in different ways that are a more natural fit for historically disadvantaged populations.”
Reframing an Issue
Research shows that the language we use to describe an issue influences our thinking.3 Cognitive scientists call this “framing.” For example, we might initially frame our issue as, “How can we create more nursing home beds in the community?” This immediately causes us to think about ways to secure funding and other resources to establish “beds” in a facility that we call a “nursing home.” There is nothing wrong with thinking about this, and creating more such beds would likely be an improvement. But such framing could also unnecessarily limit our thinking.
It might also be profitable to explore other—reframed—questions, such as the following:
There is no right way to reframe an issue. Using divergent thinking will uncover a variety of ways of looking at a problem to see what new approaches might emerge, rather than simply rushing into problem-solving based on a traditional statement of the issue.
How can we provide great home-based care for patients who need it?
How can we support families and other caregivers to enable them to competently care for their elderly or ailing loved ones?
How can we use technology to enable existing staff in nursing homes to safely care for more patients?
- How can we help frail patients get up and out of bed so that they can better care for themselves?
How can we identify and better serve patients who are at high risk for needing nursing home care, before their condition deteriorates?
A variety of tools can help us to better prepare for innovative thinking. The following are two examples:
Tool #1: Others' Point of View4
Synopsis: List the stakeholders (people with a vested interest associated with an issue) and ask the following:
Example in health care: A group working on pediatric asthma initially stated its issue as: “How can we increase children’s compliance with the use of inhalers?”
How might they describe the problem or what is needed?
What words, phrases, and concepts might they use?
One of the team members asked her 12-year-old asthmatic daughter how she would describe the problem and got the following reframed statements:
Additional statements of the issue were generated from the points of view of others, such as parents, school staff and officials, sports coaches, and children who were not asthmatic. These statements were subsequently used in idea-generation sessions.
How can I stop other kids from picking on me and calling me a “druggie” when I use my inhaler?
I don’t like having to go to the school nurse’s office to get my inhaler, but the school won’t let me keep it in my locker or backpack. What can you do about that?
Tool #2: Pause, Notice, and Observe1,2
Synopsis: Gather a wide variety of facts and observations associated with the issue. Be curious and take nothing for granted. Look both at the problem as it occurs in the health care setting and at analogous issues faced in other settings. Compile these insights into reframed statements of the issue for use in subsequent idea-generation sessions.
The following are two examples of how “pause, notice, and observe” can generate innovative problem-solving approaches in health care.
Preventing Hospital Infections
A hospital had tried numerous approaches to raising staff awareness about infections, with only marginal reductions in infection rates. Unsure of why previous approaches did not produce desired outcomes, clinical leaders decided to pause and charter a team to notice and observe hand hygiene practices throughout the hospital. The observations included the following:
Observations from the hand hygiene project were used by clinical leaders to create improvement teams to address the specific aspects of their facility’s hand hygiene problem.
In areas where curtains were used for patient privacy, staff often washed their hands and then pulled back the curtain to access the patient. Cultures performed on the curtains identified numerous organisms.
Patients and family members who observed staff touching the patient without first washing their hands remarked about this after the staff member left. They reported that they did not feel comfortable speaking directly to the staff member.
Reducing Long Waits for Lab Tests
Patients at a large community clinic often experienced long waits in its lab when the number of patients arriving at once overwhelmed the two phlebotomists on duty. The standard statement of the problem—“We need more phlebotomists!”—was met with the predictable response that strained resources did not allow for more hiring.
While shopping at a crowded grocery store one evening, the clinic manager noticed that when the lines at the registers got long, managers and staff from other sections (e.g., produce, meats) stopped what they were doing to open new registers. Bringing this observation back to her clinic, she worked with staff and managers to institute a similar system, so that trained technicians would come from the back of the laboratory to help the phlebotomists process patients at times of heavy demand.
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, WI: ASQ Quality Press; 1997.
2Kelly T, Littman J. The art of innovation. New York, NY: Doubleday; 2001.
3Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science. 1981;211:453-8.
4de Bono E. de Bono’s thinking course. London: BBC Books; 1982.