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© Copyright NHS Institute for Innovationand Improvement 2010The Creating a Culture for Innovation: A practical Guide for Leaders is published by the NHS Institute for Innovation and Improvement, Coventry House, University of Warwick Campus, Coventry, CV4 7AL.This publication may be reproduced andcirculated by and between NHS Englandstaff, related networks and officially contracted third parties only, this includestransmission in any form or by any means, including photocopying, microfilming, and recording. This publication is copyright under theCopyright, Designs and Patents Act 1988. All rights reserved. Outside of NHS Englandstaff, related networks and officially contracted third parties,no part of thispublication may be reproduced or transmitted in any form or by any means, including photocopying, microfilming, andrecording, without the written permission ofthe copyright holder, application for which should be in writing and addressed to theMarketing Department (and marked ‚re:permissions™). Such written permission must always be obtained before any part of this publication is stored in a retrieval system of any nature, or electronically. ISBN: 978-1-907045-95-0CCFI_LEADERSGUIDE_PDF:Layout 1 21/6/10 11:23 Page 2
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ContentsExecutive summary..1 Introduction.2 Innovation and the NHS today.3 Guide to cre ating the culture for innov ation.4 What do we mean by innovation?.6 What about the spre ad of change?6 Seven dimensions of culture in an innovative organisation or system: Framework and evidence.. .9Development of the culture for innov ation framework..11 Review of the literature ŒDimensions of culture for innov ation.12 Using the culture for innovation framework36 A way to visualise the conditions for innovation: portal charts..38 Application: Planning for innovation in an event, team, or project40 Application: Informal assessment of culture44 Application: Using an onŒline survey tool to assess culture..48 Tips for creatin g the culture for innovation..56 Tips for improving the risk t aking dimension..60 Tips for improving the resources dimension. ..70Tips for improving the knowledge dimension. 76Tips for improving the go als dimension.84 Tips for improving the rew ards dimension92 Tips for improving the tools dimension.. 100Tips for improving the rel ationships dimension108 Conclusion116 References 118Appendices..124 Appendix 1: Case study applying culture for innov ation framework in commissioning124 Appendix 2: Session to assess the culture for innov ation136 Appendix 3: NHS Institute™s culture for innov ation survey statements..140 CCFI_LEADERSGUIDE_PDF:Layout 1 21/6/10 11:23 Page 3
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Creating the Culture for Innov ation A Practical Guide for Leaders1This guide is a resource for clinic al leads, managers, commissioners, executives, and innovation and serviceimprovement le ads in NHS provider, commissioning, and regul ating (e.g., SHA) org anisations, who, either bythemselves or through co aching others, wish to assess and enhance the cultures for innov ation in their te ams,departments, organisations and systems.The guide describes the liter ature b ase behind the seven dimensions of culture for innov ation, gives guidanceon three applications for the fr amework, and provides 37 pr actical tips and examples of ways to enhance theculture for innov ation in organisations and systems. A shorter comp anion guide for senior leaders, Creating the Culture for Innovation: Guide for Executives , is alsoavailable from the NHS Institute. It provides an overview of the concepts, and an abbrevi ated list of practicaltips for leaders.fiStrategies and processes alone are not sufficient to drive the degreeof change we are seeking– the NHS should focus on tackling the behaviours and cultures in the system that stand in the way–fl David Nicholson, Chief Executive of the NHSNHS Annual Report 2009Executive summaryThe ability to innovate is import ant for the future success of NHS org anisations and health systems, especi allyas resources become constr ained. We h ave identified seven key dimensions of culture th at distinguish highly- innovative organisations. These dimensions form a fr amework which le aders c an use to assess and enhancethe culture for innov ation within their own org anisation. Relatively simple changes in beh aviours and leadershipprocesses c an have gre at impact on the culture for innov ation.Leaders have a disproportionately large effect on the cultures of organisations and systems. By their behaviours, leaders create the conditions that either hinder or aid innovation.CCFI_LEADERSGUIDE_PDF:Layout 1 21/6/10 11:23 Page 5
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This Guide is part of a series of resources for innov ation from the NHS Institute for Innov ation and Improvement (see box).Itis a resource for clinic al leads, managers, commissioners, executives, and innovation and serviceimprovement le ads, in NHS provider, commissioning, and regul ating (e.g., SHA) org anisations, who, either bythemselves or through co aching others, wish to assess and enhance the cultures of their te ams, departments,organisations and systems along the dimensions of culture for innov ation.A condensed Executive™s Guide is also available. Visit our website for more inform ation, www.institute.nhs.uk/innovation A word about terminology–Throughout this guide we will use the terms ‚org anisation™ and ‚system™ interch angeably. You should interpret this as it rel ates to the various settings in which you work. For example, as a clinical lead or manager, or executive in a provider org anisation, you may be mainly interested in cre ating the conditions for innovation inyour team, service, department, or Trust. Commissioners, or clinical or managerial leads of pathways of care, will be interested in cre ating the conditions across a system that spans organisational boundaries. Innovationand service improvement le ads might be working at various times on projects within or across org anisationalboundaries. The concepts, tips and tools apply equally well to all these settings.4Creating the Culture for Innov ation A Practical Guide for LeadersGuide to creating the culture for innovationThis guide describes:†the seven dimensions that impact on culture for innov ation†three w ays to use the framework of the seven dimensions to identify and address g aps†the NHS Institute™s online Culture for Innov ation survey and benchmarking tool†thirty-seven tips for enhancing the culture for innov ationCCFI_LEADERSGUIDE_PDF:Layout 1 21/6/10 11:23 Page 8
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Creating the Culture for Innov ation A Practical Guide for Leaders5Other resources available from the NHS Institute for Innovation and Improvement include– www.institute.nhs.uk/innovation Thinking Differently is a comprehensive guide, aimed prim arily at front-line st aff, th at provides a three-step process and 14 tools for stimulating innovative thinking. It is written in an engaging style and filled with im agesand examples that bring the concepts to life.Making a Bigger Difference is a resource th at describes a thinking process and tools to help assess howinnovative an idea is and to stretch thinking about what might be even more innov ative. There is a version targeted for commissioners and one for front-line st aff and leaders in provider org anisations.Creating the Culture for Innovationdescribes the necess ary elements of org anisational culture th at evidenceshows are critic al to enabling innovation. More th an a concepts-only resource, it describes how to assessorganisational culture and what actions le aders c an take to change things. There are two versions of this resource: an executives™ guide and a comprehensive pr actitioners version with even more tips, tools and examples (whichyou are re ading now).Experience Based Design(ebd) is a suite of products developed in close coll aboration with patients and stafffrom he althcare org anisations. It supports te ams to better underst and the experience of c are Œ both for p atientsand carers receiving it and staff, te ams and organisations delivering it. The suite includes an introduction and filmabout experience based design, the ebd Guide and Tools book providing a range of tools and techniques, andthe ebd Concepts and Case Studies book providing illustr ations of how people h ave used these appro aches toradically transform care. CCFI_LEADERSGUIDE_PDF:Layout 1 21/6/10 11:24 Page 9
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Performance GainUnderpinningthinking about the fiway it has always beenflIncremental change Small Œmedium Largely unchallenged and unchangedStep changeMedium Œl argeFundamentally challenged and changedThe terms ‚innov ation™ and ‚improvement™ are commonly used interch angeably and there is little v alue inanalysing this in det ail. Wh at re ally matters is whether the ch ange m akes a sm all or large difference Œ th at is,whether it is an increment al or step change in performance and thinking.Innovation:Doing things differently, and doing different things, to create a step change in performance 6Creating the Culture for Innov ation A Practical Guide for LeadersWhat do we mean by innovation?Both increment al change and step ch ange are useful and desirable. However, bec ause a step ch angechallenges fithe w ay it h as always been,fl organisational culture is an even stronger f actor in determining whether the change occurs.What about the spread of change?Spre ad is a rel ated, but independent issue that, in the end, dict ates the over all impact of a ch ange. While anincrement al change m ay have only a sm all impact in the setting in which it is first implemented, it c an have alarge imp act on the he alth system or the NHS as a whole if it is subsequently spre ad and adopted by others. Further, while a step ch ange c an make a big difference in the site th at implements it, it might m ake very littledifference in the system as a whole if it not widely spre ad. Organisations and systems with cultures th at supportinnovation also tend to be more successful at spre ading change.The NHS Institute™s guide, Making a Bigger Difference ,defines ‚innovation™ as:CCFI_LEADERSGUIDE_PDF:Layout 1 21/6/10 11:24 Page 10
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Creating the Culture for Innov ation A Practical Guide for Leaders7Navigating this guideThis guide is organised into three m ain sections, with appendices. The next section describes the seven dimensions of culture for innovation and the liter ature b ase behindeach. You c an get a quick overview by simply studying the summary diagram on page 9 and quickly re adingthe synopsis at the beginning of e ach dimension. However, we suggest th at you familiarise yourself with the details behind each dimension before you try to present the fr amework to others.This is followed by an applicationssection. It is import ant that you familiarise yourself with all of the m aterialin this section in order to get a good underst anding of the v arious w ays that you might use the seven dimensions fr amework. The appendices provide more det ail supporting each of the three applications described. The largest section is the one providing thirty-seven tipson how to enhance each dimension. While we believe that your thinking will be stimul ated by re ading this entire section, you could w ait until you h ave donean assessment of your team, department, organisation or system and then study in det ail the dimensions th atyou most need to address. CCFI_LEADERSGUIDE_PDF:Layout 1 21/6/10 11:24 Page 11
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