“Sometimes change can be hard, try adopting an innovation persona to make it easier. Are you a positive deviant, systems thinker, network engineer, or operations mindset?”
Healthcare is in a cycle of paradigm-shifting change. Staffing, technology, workflow, reimbursement, and new companies are remodeling the landscape of how healthcare is delivered and how clinicians do their work. However, in healthcare change is routinely looked at as a difficult, even painful process. As nurses, we usually adapt well when it comes to our patients and yet we resist other initiatives that challenge the way we do our work. Painful change is usually due to poor change processes that we can begin to fix by being proactive and adopting innovative mindsets shown to work in high-performing teams.
How Change Occurs Now- (How We Make Change Today)
How many of you have been part of a large change initiative at your organization? Whether it’s rolling out IV pumps, updating charting systems, or redesigning workflows, change occurs frequently in our work lives. The problem with change in healthcare is that it usually follows 3 paths: LEAN/Six Sigma, innovation-like attempts, or spaghetti on the wall. Let me elaborate.
About 25% of change initiatives are structured with LEAN/Six Sigma processes which drive the PDSA (define first time introduced) cycle towards some goal. This is a great tool for improving known processes. For example, if your admission process is overly complicated and slow, a Six Sigma approach to optimize that process is a good decision.
When the traditional performance improvement plan is not used, people like to proclaim innovation. But in reality, only 5% of change processes use an innovation-like process to change. This manifests in brainstorming sessions, off-sites (define this a little more for the average reader, and other activities that loosely follow a design-thinking approach. Many times this process is simply a gathering of minds with lots of coffee and post-it notes and results in solutions that never see the light of day. Lots of creation with no implementation.
Finally, the rest of the 70% of change that occurs in healthcare is driven by the tried and true “Throw things at the wall and see what sticks”. This is the inexperienced change leaders approach to all change. Let’s try stuff, have no process to govern it, implement it without measuring or knowing desired outcomes, and hope and pray it works. For some reason, healthcare loves this approach, but as you can imagine, it is the least successful.
The need for Innovation Mindsets- Wanted: Innovative Thinkers
Change is a constant in the work of healthcare organizations. As we learned again through the pandemic, the ability to quickly change practice and adopt new ways of work including technology, are essential for our patients’ survival as well as our own. Many times the resistance to change comes because we are not included in planning change or don’t have a lens to view the change in different ways. This is when using the personas of innovation can be beneficial.
Adopting an innovation persona allows one to view processes and change through a different lens. It gives some structure to otherwise chaotic change processes and provides a way for the team experiencing the change to give feedback and be more involved. There are four innovation personas that make up high-performing and change-ready teams. They are Positive Deviance, Systems Thinker, Network Engineer, and Operations Mindset. Let’s explore each one.
Innovation Persona 1– Positive Deviance
Positive Deviance sounds like an oxymoron but it is really a persona that fits many clinical teams. Positive Deviants are those that thrive in systems that are breaking. Do you flourish despite the system failing around you? If you are a clinician, then the answer is a loud YES!
Most healthcare workers are positive deviants. So what does that mean and how does it impact change in teams? Positive deviants (described well in this book) find ways to create amazing opportunities despite their circumstances. For example, a nurse who works on a chaotic and understaffed unit but still has all their charting complete, patients supported and can take a break while the rest of the team is running around might be a positive deviant. They manage to thrive in the same chaos causing others to fold.
Why do we need positive deviants? The answer is simple: we need them because they find workarounds to broken processes in the same environments as others. One challenge with change in systems is that it is top-down. The solutions are built by others who are not embedded in the work. This results in change that may not fit the workflow of the unit, or the change misses the little nuances that will make or break its adoption. Positive deviants are the exact opposite. They are embedded in the work and culture of the unit and have created better processes with an intimate understanding of the nuances of the work. This results in the solutions being extremely relevant to the work and therefore change adoption accelerates.
For any team wanting to start better change cultures within their organization, adopt a positive deviant persona and start innovating.
Innovation Persona 2– Systems thinker
The next persona you might adopt is the system thinker. The systems thinker is like a fortune teller (here is a video explaining systems thinking). They see and predict the ripple effects of change beyond their current role in the organization. For some reason, healthcare professionals like to stay in their tribes. Physicians stay with physicians, nurses with nurses, etc. This creates a myopic lens through which teams lead change. People tend to adopt the view of their tribe instead of seeing all of the intricate connections and relationships between what is changing and the resulting impacts on the organization.
For example, in a large academic medical center, the barcode scanning rates were very low in one unit. The management team assumed the issue was that the clinicians were not following policy, the physicians did not see it as their problem, and the nurses refused to engage in possible solutions. Each role was stuck on its limited perception. Finally, one systems thinker leader stepped up and decided to visit the unit and discover what was happening. He marched the leadership team and physicians to the unit and began asking the frontline teams what was happening. They quickly discovered that the cord for the barcode scanners did not reach the patient. A simple issue to fix but because the tribes were so focused on resisting change or operating on assumptions of their limited view, they could not solve it until a systems thinker connected the teams together.
Adopting a system thinking lens is a wonderful superpower when participating in change. By thinking about all the ways change can impact teams both locally to your unit and across the organization, you can better prepare yourself and your colleagues. This helps the change plan be more specific and accounts for possible unanticipated consequences of the effort. By contributing to better planning you are removing one of the largest reasons people fear change – uncertainty. Systems thinkers fundamentally remove uncertainty from the change process which in turn lowers the stress of those experiencing the change.
Many nurses are systems thinkers by the nature of the work we do but many times we do not use that skill set when it comes to changing our work. By leaning on our training as systems connectors, calling out the ways change will impact, and then working to support better change processes we can decrease the anxiety that change can cause because we can see where it is headed.
Innovation Persona- 3 Network engineers
Network engineers support the change process by bringing in new ideas, data, evidence, and experiences from those outside the immediate team. As a result, similarly to how systems thinkers support change, this reduces the uncertainty of the change process. How do you know if you are a network engineer? A simple and funny example may help you self-identify.
A network engineer is an Emergency Department nurse who loves to hang with the ICU nurses. In essence, a network engineer is able to build quality relationships beyond their immediate team and organization. Sometimes this manifests in the LinkedIn influencer with 20K followers, or the nurse everyone goes to for advice. Sometimes the network engineer is the quiet one in the back of meetings who happens to have a family member on the board of directors. The network engineer is well-connected and when change occurs can bring different experiences to the team. (Learn more about networking here)
Because healthcare tends to work in tribes as we discussed, outside perspectives are often rejected. But one of the reasons change fails in healthcare is our belief that healthcare itself is a special industry, no other profession could possibly solve our issues. Nothing could be further from reality. Network engineer personas can tie in the clinical know-how and the outside healthcare lens to push teams to design change better.
Here is a personal example., I worked on a project related to t patient through-put and it was struggling. We used all the healthcare data and experts we could to design the change. Then we engaged with one team member who was of the network engineer persona. This team member spoke about a visit she had in college to the Southwest Airlines command center. She described the way they manage the coordination of hundreds of flights across the country and the complexity of data they use to support travelers. These insights provided valuable information to challenge the solution we were building. It also prompted us to visit that command center in person to learn more. After that visit, we completely redesigned the process with our new knowledge and it was a great success. Without the network engineer, we would have stayed myopically focused on our healthcare solution without learning from experts who had solved similar issues in other industries.
Innovation Persona-4 Operations Mindset
Some members of the team likely self-identify as “not innovative”. They will say things like, “I don’t like technology,” or “I am just not creative.” For those that are excited about change and innovation no phrase is more frustrating. However, there is a way to engage all team members in the change process regardless of their self-identified comfort with innovation. The operations mindset persona is an excellent lens to provide real-world insights and issues with a change process. Now, this is not a license to become negative and highlight all the ways things won’t work but helps provide constructive and real-world data so that the change or innovation can become successful.
Operations mindsets bring the other innovation personas back to reality and assist the new processes being adopted successfully. Many times when teams are designing change efforts they do so without the constraints of reality. Think about the last innovation effort you participated in. Your team most likely encouraged you to “think outside the box” and create crazy ideas in order to disrupt the status quo. The secret of innovation is that it must be designed with some constraints or it will never see the light of day. In fact, building guardrails on the change process accelerates innovation work and harnesses creative energy to meet the needs of the end user who will adopt the change. Operations mindset personas cleverly highlight workflow, culture, financial, and resource boundaries helping teams be more focused on creating solutions.
The operations mindset can be used by any person on the team as each person is an expert in their own workflows. By providing constructive feedback around real-world issues, the team can solve them, choose which ones to fundamentally disrupt, and build a solution that makes sense for the team. Many times in change efforts, operations mindsets are seen as guardians of the status quo, but adopting this persona can actually advance innovation in teams much faster than those without any constraints on their processes.
Adopting innovation personas is a great way to engage those team members that might feel uncomfortable each time an innovation or change process is started. Using one of these four personas or assigning them to your team members can harness their creative energy, engage them in the change work, and ultimately make change less annoying and more valuable. With the amount of change occurring in healthcare, it’s important that we ensure it is not only innovative but also valuable to the end user. Resisting change is not an option and by using one of the personas here, healthcare leaders and direct care nurses can make participating and leading change easier.
Wanna learn more? Check out my favorite innovation resources here.