We’ve discovered a shortcut to innovation…go outside the box

Ask people if they think they are innovative. Go on, see what they say. The reality is that we are very competent USING innovations but not very innovative ourselves. This could not be more true for healthcare. I don’t want to drop a bomb shell but sorry, we don’t even know what innovation means.

Now before you get all upset at me, I would just like to clarify a few things.

Healthcare professionals are trained to stay safe. We are trained to think and do things based on known, safe, evidence-based facts. We stick to the guidelines. To veer outside those tramlines could be dangerous. Our training and the healthcare environment beats innovation out of us. If failure is not an option then there’s no real point training people to be innovative. Instead we train people to be get a p-value of <0.05 using huge amounts of resources over a long period of time. We celebrate that p-value but it rarely makes any difference for years.

 One can certainly be made to feel like a maverick for trying something different. But we all know – if we do things the way we’ve always done them, we’ll always get what we always got.

 Innovation on the other hand requires space, off the wall thinking, the ability to break the norms and try something new. Most of all one has to be prepared to fail – and learn from failure. Sir James Dyson is a big fan of failure, 5126 times to be precise. David Kelley, founder of design group IDEO, coins the foundation of innovation as creative confidence.

creative confidence

He’s the guy who helped friend Steve Jobs produce iconic functional designs that we all know too well. We all have an element of creativity somewhere. Gaining creative confidence can also be learned and like everything else, practice makes – well more streamlined innovation. In actual fact, the process turns out to be relatively robust with the foundation of design thinking rooted in a comprehensive understanding of the user, the challenges, the data. Immersing oneself in the users environment, ethnographic studies and forming a team of diverse thinkers all play a big part. (Hey, that means there will be people on your team who don’t think like you and me). From there, it’s a case of idea generation using every prompt and stimulation available. Now reign in the ideas through diverse group analysis and theoretical testing before developing a small number of prototypes.

There’s good news though. We’ve discovered a short cut to innovation.

No, it’s not thinking outside the box, it’s GOING outside the box.

It actually takes guts and humility to say that you may not have the answer inside yourself, your organisation or even your profession. People will criticize you for even bothering to look, say it’s a waste of resource, that anything outside the box can’t apply in the box. It’s certainly true that the people who translate out of the box innovations are special people. Too concrete a thinker and one won’t be able to adapt it, too abstract and the core principles will be lost.

The good news is that combined with quality improvement methodology, innovation doesn’t have to be that scary. Simulation, small scale testing, balanced measures, scale and spread plans all help in reducing the risk to patients (and of course yourself).

Maybe the hardest thing is getting the idea in the first place.

We had the privilege of spending some time with Steve Meuthing. He took this path on the quest to reduce serious safety events at Cincinatti Childrens Hospital. An SSE is an event where an error can be directly attributed to serious harm or death. At the time these were occurring every 12 days. Steve spent two days on a US Navy Aircraft carrier. He took back SITUATIONAL AWARENESS based on stratified huddles, prediction and mitigation across all areas of the organization. The result is it’s now 273 days without an SSE (and believe me, they have a system that picks them up).

aircraft carrier

The guys at the Garfield Innovation Center wanted to assist on improving medication administration safety. Preliminary observations showed nurses were being interrupted on average 17 times a shift while dispensing medication (and 80% of this were from other nurses). They linked the pressure of getting the meds right to other transient but high pressure tasks. Together with the nurses they visited their local airport at Oakland and brought back the concept of the STERILE COCKPIT prior to takeoff. A visit to Homebase, some red duck tape on the floor and a construction vest were the first prototypes for what is now standard procedure to a non-interrupt procedure across scores of hospitals

.sterile cockpitnurse_drug round

Only a few years ago I would hear nurses say “if TESCO have been using bar codes for years for just selling fruit, why can’t we have bar codes for meds?” You can, it just took far too long for healthcare to catch on. First off, someone has to get outside the box.

Just to help whet the appetite, here is a list of out-of-the-box initiatives have influenced healthcare environments that we as IHI Fellows have interacted with. The links direct you to more information on the topic.

So next time you are out-and-about ask yourself what can you transfer-back-in.







Complex Logistics



Global delivery

Major Grocers


Toyota Production System




Virginia Mason


Situational Awareness


Psychological Safety


Navy, Police

Commercial Aviation


US Aircraft Carriers

Aviation Safety Reporting System (ASRS)


Cincinnati Children’s Hospital Medical Centre



Cheesecake Factory

University Pittsburg Medical Center


Product design



Kaiser Permanente Garfield Innovation Center


No one sector


Kaiser Permanente (Career Bliss)


Product Placement



Meterological models


Camden Health Coalition








Theme parks

Gaylord Hotels


Pittsburg Medical Center

Alaska South Central

Contra Costa County


Aid Charities



Scottish Early Years Collaborative

Rancho Amigos Los Angeles


Big data, metrics, prediction

Integration and innovation

User interface


Commercial IT






Intermountain QI Analytics

EPIC + apps)

KP My Health Manager


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