Abstract
A pile of rocks ceases to be a rock pile when somebody contemplates it with the idea of a cathedral in mind. Antoine de Saint-Exupéry
Why innovate? Work smarter not harder
I have often wondered what makes people and teams innovate, particularly when they are busy and struggling to find time to think about problems. Steven Covey, an American educator, gives the example of someone feverishly trying to fell a tree using a saw (Covey, 1990). After 5 hours the person becomes increasingly ineffective and a passer-by asks ‘Why don’t you take a break for a few minutes and sharpen that saw?’ They reply ‘I don't have time to sharpen the saw, as I am too busy sawing’. This is a situation that many GPs and their staff will recognise. Sharpening the saw is the seventh habit Covey teaches, in order to preserve the greatest asset you have: yourself and your team. Christine Sinsky, an innovator in the United States, has consistently championed ways to help GP teams ‘work smarter, not harder’ and avoid burnout (Sinsky et al., 2013). Her focus is on teamwork, careful analysis of necessary tasks, and ensuring support staff is used effectively so that doctors’ time is spent only on activities requiring their expertise. It is precisely the times we are most busy and struggling most that we need to interact more with our colleagues and create innovations. Being able to take control strengthens the resilience of you and your team.
Where do good ideas come from?
In his TED talk, the popular science author Steven Johnson highlights that although many innovators credit their ideas to individual ‘Eureka!’ moments, historical records suggest that these are due to a much slower process (Johnson, 2010). He refers to ‘slow hunches’, which may take many years to develop, and need space to collide and conjugate with other peoples’ ‘slow hunches’. Johnson feels we need environments where ideas can be shared, and mistakes and problems exchanged. Doctors need to make time and space for regular formal and informal meetings, such as morning coffee breaks, to let these hunches breed and develop, and encourage the development of networks beyond their practice. There is value in connecting with others when developing ideas, rather than taking them on individually. The collateral benefits of interconnecting can be just as important as the innovation themselves, and give rise to invaluable social support networks.
You know the problem: So how do you start to solve it?
When considering how to make an innovation, it may help to ask these two simple questions to help clarify the path forward:
How well is the problem defined? Is it only affecting you or are others affected, if so has someone already solved it? Who is best placed to solve it? Remember, as GPs our viewpoint could be considerably different from how other members of staff see the situation. We may not be the best person to solve access and appointment systems problems, however, we can give leadership and support to staff, encouraging them to try new methods. The reception and administrative team are often able to suggest a simple solution in team meetings. Hierarchy should not be a barrier to innovation.
What innovation tools can you use to overcome the barriers?
Continuously trying to improve systems using the same method you have used before becomes less productive over time, so here are 10 ideas you could try, which I have adapted from Paul Sloane (Sloane, 2006).
Borrow from the best by adapting someone else’s idea
Arrange a visit to a nearby successful practice (armed with a large cake!) to find out what different ideas and systems work elsewhere and apply these to your own practice. Borrow from the past, which may provide useful solutions that have simply gone out-of-fashion. With antimicrobial resistance threatening the effective prevention and treatment of an ever-increasing range of infections, there may be a lot we can relearn from pre-antibiotic medicine.
Ask your patients, carers and patient participation group
As an Associate-in-Training taking the time to visit and talk to your patient participation group is well worth the investment. As well as highlighting concerns and needs, the groups will have a wide range of experience and can often provide solutions. Patients and carers need be at the centre of the changes that are needed.
Ask your staff
Your staff members are your greatest asset, they have years of untapped experience. Challenge them and encourage them to bring forward ideas, as they know, better than anyone, about our patients and the lives they lead.
Use incidents, difficulties and complaints
Themes often emerge that make innovation both apparent and necessary. Talk to GP appraisers, as they have a wealth of knowledge of common significant events and how GPs have innovated to prevent recurrence.
Combine
Consider absurd or weird combinations. Rene Theophile Hyacinthe Laënnec invented the first stethoscope in 1816 using a rolled sheet of paper to listen to a patient’s chest. Can you combine your visits to patients with multiple long-term conditions with a flu jab and care planning?
Eliminate
What can be removed to make a minimal viable product (MVP) or pathway, that will still work and allow development? Think about how you can simplify processes for patients and staff and hopefully for yourself and really make a difference.
Plan
Include innovation in your professional development plan, and talk about innovation at your appraisal, as well as including it in your practice’s business plan. I have learnt more by reflecting on my mistakes than my successes.
Brainstorm regularly
Random input can help when you are looking for new ideas and fresh ways to do things. Try to avoid just doing this once a year at the practice’s away day. Using Post-it® notes may help people who are intimidated in large groups to express their ideas. It is also more likely to result in staff buying into the solution if they have been genuinely involved in its creation, rather than having the solution imposed upon them.
Ask:What if?
See if you can think laterally to challenge every boundary and assumption that you think apply. Write down all the dominant ideas that apply to a particular situation and then deliberately challenge them.
Run a contest
Offer staff and patients prizes for their suggestions on how to improve the service offered by your practice. However, try to avoid voting on ideas or consensus decision-making, which can be innovation killers as real innovation will be different from the status quo.
Developing, measuring and evaluating your innovation
Once you have developed an innovation you will need to experiment and try to develop a minimally viable product or process to try out and evaluate. There are many potential barriers and you need to ensure participant are pulled to join, not pushed. Try to tap unused talent and energy. Start by using a limited pilot with a small team for a defined time period. This will allow you to experiment and establish if there are any immediate unintended consequences or flaws.
Quantitative and qualitative methods represent different ways data can be collected and used to inform your evaluation:
Quantitative approaches give numerical results. For example, compare the percentage of patients who did not require a follow-up appointment within the next month after seeing the new practice pharmacist (your innovation) with those who consulted you as a GP registrar. Qualitative approaches use narrative or descriptive data rather than numbers. For example, a survey of the views and attitudes of those patents seeing the new pharmacist and their thoughts on what went well and what could be improved.
Fuller details of data collection and quality improvement methodology can be found in the RCGP’s Quality Improvement Guide for General Practice (Taylor & Bircher, 2015). Once you and your staff have had time reflect on the pilot, look at rolling it out across the practice. Most successful innovators only get there after first experiencing failure and by avoiding blaming others. Your team will share your failures and must be credited when you achieve success.
Dale Carnegie highlights the fundamental techniques in handling people (Carnegie, 1937):
Do not criticise, condemn, or complain Give honest and sincere appreciation Arouse in the other person an eager want
The RCGP’s Bright Ideas website
In 2015, we launched a simple webpage to showcase examples of innovating primary care staff, it can be found at www.rcgp.org.uk/clinical-and-research/bright-ideas.aspx
At present we have 19 fresh ideas from across the UK that may help GPs reduce workload and stress within their practices. We at the RCGP’s Clinical Innovation and Research Centre want the innovative work of GPs to be recognised, celebrated and shared. We hope this will inspire other GPs to take up ideas that have been successful, and try new ones themselves.
If you have an example of innovative practice that you would like to be shown on our Bright Ideas page, please send a short write-up (500–1000 words) and any relevant images and links to: circ@rcgp.org.uk
Innovation needs skill, stamina, networking and luck. Remember Wallace’s advice from Wallace and Gromit’s World of Invention shown on the BBC in 2010: ‘Build, explore and invent your socks off’ … and do look at the Bright Ideas website.