The Expert:

Mike Wagner

Mike Wagner is Senior Fellow in Leadership at Ko Awatea and Executive Director of The Advisory Board Company. He regularly speaks about leadership and talent development at conferences around the globe and has presented research, provided consultant services, and conducted workshops for more than 750 organisations. Prior to joining The Advisory Board, Mike was elected to the South Dakota House of Representatives, serving as Assistant Majority Leader and Vice Chair of Health and Human Services. He was also elected to five terms as President of the Aldermanic Council, and Mayor of a small town in South Dakota, and served as Vice President of the state municipal league. His professional experience includes service as the Chief Operating Officer of an international distribution company, the Executive Director of a Habitat for Humanity agency, and a lecturer in business management and leadership. Mike earned a master’s in public administration from Harvard University, where he was named an Archibald Bush Leadership Fellow and Lucius N. Littauer Fellow for outstanding citizenship and academic achievement.

Their View:

The idea of innovation in healthcare has become so trendy and popular that almost every strategic plan, healthcare report, and job description includes some terminology that implies a focus on innovation.

Unfortunately, when efforts at innovation are analysed, they are often little more than lip service or minor efforts to improve performance.

While traditional management practices can be effective at improving the processes and services of today, they thwart the bold innovation that charts the path for tomorrow:

Process standardisation focusses on reducing or eliminating variation. Innovation is a deviation from the norm; because process standardisation focusses on eliminating deviation, it delivers improvement but discourages innovation.

Second mover paralysis is created by following the best practice of others. While copying others who perform better is good improvement practice, it is following the innovation of others rather than advancing new ideas and new innovation.

Incremental improvement effects change in small steps. Small steps are an excellent way to improve existing practice, but not to make bold innovation. Most healthcare processes are derivatives of processes that have existed for decades and are not bold moves forward.

Employee empowerment aims to empower employees to have ideas and lead change. Encouraging new ideas is a good practice. But requiring those same idea-generators to take on responsibility for leading, managing and bringing their ideas to fruition, on top of keeping up with their everyday workload, may be unrealistic and discouraging for busy employees. While leaders should acknowledge the source of an idea, they should avoid placing the entire burden of development on that person.

To be innovative, an organisation must generate new ideas, steer their development, and accept their implementation.

The first element of innovation is the ability to generate new ideas. Generating ideas requires time and space, so organisations that wish to foster innovation must allocate dedicated time and physical space for employees to work on their ideas. For example, engineers at 3M spend 15 per cent of company time working on their own projects.

To be useful, ideas generated must combine creativity with practicality. Using analogy and anomaly creates practical insights by studying analogous situations that operate in different ways. Healthcare organisations should actively look at what others are doing and consider how ideas from other industries could be adapted to the healthcare environment. For example, one healthcare organisation designed a bed placement system based on a warehouse notification system used in retail.

The second element is to steer the development of the ideas that are generated appropriately. All too often, good ideas are actually squelched by an organisation’s leadership. In fact, if an idea is not aligned with current priorities, it is often viewed as a distraction to be eliminated, rather than creativity to be encouraged. Not only does this thwart many good ideas from ever becoming reality, it also discourages idea-generators from ever submitting their ideas again in the future. When an idea is submitted or mentioned, leaders should interact with the idea-generator to explore opportunities and possibilities. The best way to structure these conversations is to follow the D.R.A.G. framework, which helps to steer ideas to useful purpose. The D.R.A.G. framework stands for:

Define – articulate ideas according to their unique value. Help idea generators to discover deeper insights in ideas.

Refine – consider ideas for full applicability. Broaden idea generators’ perspective into other areas.

Align – align refined concepts with organisational priorities. Help idea generators become attuned to organisational priorities.

Guide – orient ideas towards action with accountability. Engage idea generators in desired elements of implementation.

Many organisations focus on alignment and guidance, but do not give enough attention to defining and refining ideas. Defining enables idea-generators to understand the value of their idea, rather than just focusing on getting their proposal accepted. Refining helps to take that value and find multiple ways to impact change.

The final element of successful innovation is generating acceptance of a new way of doing things across the organisation. For most healthcare organisations, this is about generating widespread acceptance by thousands of employees.

Just like a virus creates a pandemic, three similar factors – virulence of the idea, exposure to the idea, and eliminating immunity to the idea – will enable an idea to also “go viral”. Virulence applies to early adoption, exposure to widespread adoption, and immunity to late adoption.

To be virulent, an idea must be powerful, compelling and sustainable. Techniques that can be used are scarcity and exclusivity, and attractiveness and allure.

Scarcity and exclusivity create the perception that there is a risk of missing out. The technique is used by American retailers to attract shoppers to Black Friday sales. It was applied in healthcare Sarasota Memorial Hospital to replace the overhead paging system with smartphones.

Attractiveness and allure work by making an idea fun and exciting. The technique was used by Columbia University Medical Centre, which created a team-based game called ‘SPLAT!’ to promote hand hygiene compliance.

Exposure for widespread adoption by the main staff body uses the principles of trendsetter endorsement for early adopters, and bandwagon psychology for later adopters. These principles work on the desire to be like those we admire and the fear of being left out, respectively.

Immunity is the last element of adoption. It deals with the minority of late adopters who hold out against change. Two techniques can be applied:

Fallback elimination removes alternatives to adoption. For example, Maclean Memorial Hospital dealt with a minority of staff who were resisting a shift from paper-based to electronic documentation by confiscating writing materials from all departments.

Holdout isolation shows up target individuals. For example, the St. Vincent Health System required six staff members who refused flu vaccination to wear masks.

These steps create a purposeful adoption curve. However, the sequence must be preserved. Tactics for early adoption are resource intensive, and those for late adoption are highly coercive. If used as first steps, coercive action is likely to create resistance. Immunity techniques must therefore be reserved until a change has taken hold among the majority.

This article is adapted from Mike Wagner’s intensive at Ko Awatea’s APAC Forum 2015.

The APAC Forum 2017 will be held on the Gold Coast, Australia, 20-22 September.

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