|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|
An innovative idea has no value until it is put into action. Developing and testing an idea are the initial steps in a change management process that will transform the idea into a reality that advances patient care.
Strategies for Change Management
The innovator who is preparing to develop and test an idea needs to strike a balance between creative enthusiasm and realistic assessment. During the initial stage of idea generation, it is important to suspend judgment, avoid being overly critical, and brainstorm without constraints. After all, creative thinking often requires that you temporarily escape from your organization’s structures and rules. During development and testing, however, it is time to start applying critical judgment, and ask whether an idea will actually work. In order to successfully implement an innovation, you need to engage your organization’s structures and rules—at least enough to get permission to do something that might be radically new. An effective innovator must both “rock the boat and stay in it,” in the words of Helen Bevan, a quality improvement specialist with the United Kingdom’s National Health Service.1 Development and testing are key parts of the change process, because they allow you to gradually engage the organization so it can embrace a new way of doing things.
The literature on change management (such as the work of John Kotter2) points to factors that facilitate the process of developing and testing an innovation, including the following:
- Have an idea champion. An innovative idea needs a champion to lead development and testing of the idea. The champion may be an individual or a group—or often a combination of both, such as someone who is in a leadership position. The idea champion must have enough power to allocate the necessary resources and ask for constructive participation by others.
- Communicate skillfully. The innovator who is excited about an idea may forget to answer the “why?” question. It is essential to address the concerns of those who will participate in testing and who will eventually implement the change. The innovator should be able to explain the innovative idea clearly and compellingly in 5 minutes or less. (In order to better frame and clarify the message, refer to the list of idea development questions in the next section.)
- Understand others’ reactions. The innovator must be prepared for defensive reactions and attempts to sidetrack the conversation in response to an innovative idea. People tend to be comfortable with the status quo, and they often perceive a suggestion about a new way to do something as a criticism of their current approach. The innovator should be patient with others, keep the conversation going, and insist on at least conducting a test that could convince skeptics that the idea is worthwhile.
- Set deadlines. Deadlines can help move the process forward by creating a sense of urgency about change. The innovator needs to exert a healthy pressure to move forward, but should not use deadlines as a way to run over people, remembering that involvement is critical. Obtaining constructive engagement helps ensure that the idea will at least get a trial.
When developing an idea, the innovator needs to cultivate support for it, while inviting constructive criticism. “Think before you speak” is a good motto during the development stage, because most people are better at idea criticism than idea creation. Initial criticism of an incompletely thought-through idea can dampen the innovator’s enthusiasm, encourage “piling on” by other critics, and cause those who might otherwise support the idea to withdraw. The idea champion should carefully select a small, representative group of people who can be constructively critical, and ask them to participate in developing the idea before it is shared more widely. Keep in mind that idea development takes time; shortcutting the development process is a common pitfall, and it often leads to half-baked ideas that will fail.
The goal of development is to strengthen the idea’s strong points, while shoring up its weak points. When conducting a SWOT (strengths, weaknesses, opportunities, threats) analysis of the idea, be sure to address the following questions3, many of which are derived from the work of Edward de Bono4:
- How can we enhance the idea to increase its power or value, and make it fit our needs even better?
- How can we demonstrate its value compared with the current system?
- Think about the weak points you have identified. What can you do about them?
- What weaknesses does testing reveal? What can we do to improve the idea?
- How can we test the idea on a small scale, and learn how to increase the probability of successful implementation?
- What new possibilities does the idea open up? How can we capitalize on those?
By working with a small development group to address these questions, you can refine the innovative idea before talking about it more widely. The goal is to have a well–thought-out idea that is ready for testing.
- What could go wrong when we try to implement the idea? How can we avoid anticipated problems?
- Who will raise objections, and what might the objections be? How can we modify the idea to prevent such objections?
Evaluation of an innovative idea will remain an abstract and intuitive process, until you test the idea in a concrete way to find out what will actually happen. By using the language of “testing” instead of “implementing,” you can allay fears and lower resistance to the new idea. Be sure to approach testing in a genuine way: You must be willing to abandon the idea, or dramatically modify it, if the initial test doesn’t go well. Remember that testing is a way to engage others: it gives them the opportunity to tweak the idea and make it their own. Encourage people to provide input during the testing process, and avoid reacting defensively to suggestions. When people see that their input is being used to modify the idea, they will be more likely to put in the effort required to make the idea work, implement the innovation more widely, and sustain it over time.
In order to learn and to gain confidence, start by testing the idea on a small scale. This may mean testing it for just a few hours, or during just a few cycles of the process, or with just a few patients. Here are some suggestions for planning and conducting the testing process:
- Consider conducting a simulation of the change. (For example, the Virginia Mason Medical Center in Seattle used full-scale cardboard mockups to test the configuration of inpatient units in a new hospital wing.5)
- Choose a testing approach that is appropriate for the nature of the innovation.
- Consider using plan-do-study-act (PDSA) cycles to refine a process improvement.
- Consider using a more formal, small-scale clinical trial for a therapeutic innovation. (Note that clinical innovations are outside the scope of the Health Care Innovations Exchange. Also, such a trial may require Institutional Review Board approval.)
- After completing the initial testing, go back to the development SWOT questions to address any problems that surfaced and strengthen the idea. Then do another round of testing.
- Most ideas go through several iterations of testing before a final evaluation and a decision as to whether to “abandon and learn” or “implement and spread.”
- Whatever the outcome, be sure to celebrate the result of the development and testing process as a contribution to your organization’s culture of innovation.
About Paul Plsek, MS
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.
1 Bevan H. Rocking the boat and staying in it: how to succeed as a radical in healthcare. BMJ blogs;2013. Available at: http://blogs.bmj.com/quality/2013/08/19/a-call-to-action-helen-bevans-blog-2.
2 Kotter JP. Leading change: why transformation efforts fail. Harvard Business Review. March-April 1995: 59-67.
3 Plsek PE. Creativity, innovation, and quality. Milwaukee, WI: ASQ Quality Press; 1997.
4 de Bono E. Serious creativity. New York: Harper-Collins; 1992.
5 Plsek PE. Accelerating health care transformation with lean and innovation: the Virginia Mason experience. Portland, OR: CRC Press; 2013.