Leadership, Organisational development, Staff development

Are human beings all just creatures of habit?

How do we foster a culture of innovation in healthcare?

I’m writing this as I fly back from my holiday in Crete. While I was there I couldn’t help noticing that every day the same people sat in the same places for each meal and lay on the same sun loungers by the pool. That started me thinking: are humans really just creatures of habit? Is change considered scary in organisations because, in reality, humans seek comfort in routine? Organisations are made up of human beings – and in order to have real, sustainable change the alternative has to be demonstrably better than the status quo.

A recent study into modern healthcare innovations by disruptive innovation guru and Harvard Professor Clayton Christensen concluded that, “Health care may be the most entrenched, change-averse industry in the United States.”[1]  England is arguably no different. Healthcare has been delivered in more or less the same way for decades, and in some cases even longer. Getting people to change their habits and move out of their comfort zone is a full-time occupation for many managers and leaders. Forward-thinking leaders have been using techniques such as visioning and future-basing[2] to try and get the workforce to ‘buy in’ to this change.

But are we just fighting against the tide? How easy is it to get people to really think about the future in a different way? What’s in it for them? Is this just working against human nature?

Virginia Mason, a world renowned leading US healthcare provider, would argue not. They have managed to transform how their people think about healthcare delivery over the past 20 years through the application of the healthcare version of the Toyota Production System method, or ‘Lean’ to you and me. This has enabled them to systematically integrate innovative structures, methods and lean cultural practices into their everyday ways of working. Their experience has increased the nursing to patient time from 40% to over 90%.[3] So, shouldn’t the NHS be beating a path to their door?

In my view, the answer is unquestionably ‘yes’. Once you get past all the usual arguments about why the ‘Virginia Mason Way’ would not work in the NHS, and when you strip it all back, it’s because their workforce all BELIEVE. They believe there is a better way, they believe they can improve patient experience and they believe they can always do things more efficiently and effectively. This means that the workforce are not only engaged in the change, they are the change they want to see.

As Mark Hutcheson (previous Virginia Mason Medical Centre Board Chair) said of the birth of the philosophy of the VM production system, “We want to make sure we are in existence 100 years from now, and you can only do that if you are innovative. You cannot just tread water and not embrace change because you will die. So, you’ve got to always be figuring out some way to grow, and that requires being willing to look at some things differently.” [4]

How do we start to engender the much needed change in the NHS to make sure it still exists in 100 years time? According to author Rolf Smith, from his book The Seven Levels of Change: Different Thinking for Different Results, the 7 levels of change are:

Level 1: Doing the right things: effectiveness, focus and working to priorities

Level 2: Doing things right: Efficiency, standards and variation reduction

Level 3: Doing things better: improving, thinking logically about what we are doing and listening to suggestions

Level 4: Doing away with things: cutting; asking ‘Why do we do this?’; simplifying and stopping what really doesn’t matter

Level 5: Doing things that other people are doing: observing, copying and seeking out best practices

Level 6: Doing things no one else is doing: being really different, combining existing concepts and asking ‘why not’

Level 7: Doing things that cannot be done: doing what is commonly thought to be impossible questioning basic assumptions, breaking the rules and being a bit crazy

The NHS is pretty good at the first three, but really needs to work on Levels 4 – 7 if it is going to see any discernible change.

Getting to Level 7 – really seeking to unleash the creative spirit of our staff and being ‘a bit crazy’ – is what the NHS needs. Trying to do that within the current regulatory and inspection regime is going to be the tricky bit.

Learning from the Virginia Mason experience is part of our strategy, as well as forming a learning collaborative with Sunderland NHS Foundation Trust, who are five years ahead of us on this journey. Underpinning all of this with a robust, organisational development programme that takes our 13,500 staff out of their comfort zone and unleashes their creativity whilst at the same time convincing our 900 strong medical workforce that (in the words of Dr Atul Gawande) “standardization has led to vastly better outcomes,” will be a tightrope that our organisation’s leadership will need to walk for the foreseeable future.

I aim to share our experiences in order to help leaders across the NHS learn from our experience and our (hopefully not too many) mistakes. For now I’ll leave the last word to a staff member from Virginia Mason who said, “To me, an innovative culture is one where anyone can bring up new, creative and sometimes even backward ideas, without fear of being thought of as crazy, strange or funny…. a culture where innovation is rewarded and celebrated.”

Now I bet they sit on a different sun lounger by the pool every day.

2015-06-23 09.28.44

[1] As quoted in Plesk, P; Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience (2014) p19 -20

[2] A organisational development technique where you get people to imagine they are in the future, what that looks and feels like and the barriers they have overcome to get there

[3] Plesk, P; Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience (2014)

[4] Plesk, P; Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience; (2014)

About the author

Sarah Morgan is the Director of Organisational Development at Guy’s and St Thomas’ NHS Foundation Trust and passionate about innovation and change.

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