Tools for Building Innovation and New Thinking into Quality Improvement

Creating Opportunities for the Team

Six Thinking Hats

Thinking Differently (NHS)

Source: www.institute.nhs.uk

Thinking Differently – the process

1. STOP before you start - understand the issue

2. Generate many IDEAS– before you begin

3. TEST these ideas – PDSA’s, etc to increase your likelihood of success

The process will be repeated many times!

Step 1: STOP before you START!

• Tool: Others’ Point of View – Move out of the “usual” thinking view of someone

from within health care, and take the time to describe the issue, opportunity or theme from a variety of perspectives

How might other people view or describe the situation?

Others’ Point of ViewOthers’ Point of View

In healthcare we should always consider:

• Service users• Families and friends of service users • Clinicians• Staff

What about those who know nothing about healthcare? For example, how might the following describe the issue?

• Manager of fast food restaurant

• 6 year old child

• Formula 1 mechanic

• Librarian

• Leisure Centre manager

• Sales and Marketing rep

• Airline flight attendant

• Stand-up comedian

• Politician

• Newspaper distributor

• Hotel manager

• Accountant

Others’ Point of ViewOthers’ Point of View- An Example- An Example

• Manager of mental health service writes the statement “improve user satisfaction” at the top of a sheet of paper.

• They start with usual point of view to create new statements: – Access is too difficult– Medical records are incomplete or unavailable– Family members also need support

• Then from unusual perspectives, manager wonders what other people might say about mental health service …

– 6 year old child: “I’m really frightened” … • Based on this Manager then asks What could we do to explain things better and

dispel myths about service?

– Stand-up comedian: “It’s not fun to be here!” • What might we do to make the experience less anxiety-producing?

– Flight Attendant: “What’s our destination?” • Do our users and caregivers really know where our treatment plan is taking them,

and is that really where they want to go?

TipsTips

• Take 3 – 5 minutes per “other view point”

• Try to avoid long explanations or problem solving

• Seek a variety of ways to “restate” and reframe the issue

• Alternate between usual (patient) and unusual (comedian) points of view

Exercise Exercise (20 minutes)(20 minutes)

Aim:Aim: Generate 5 – 10 alternative ways of framing the issue, while avoiding getting locked into the usual way we look at it.

Ask:Ask: How might that person describe some of the issues around increasing access to their primary care provider?

How would they say it? How would they say it?

Then as a group, select the 5 – 10 statements that cover the range of things you might want to explore when you move onto idea generation.

Step 2: Generate LOTS of Ideas • What are the rules of idea generation?

– No criticism– Encourage “being wild” – Build on the ideas of others– More is better at this stage– One at a time!

• Tools for idea generation:– Breaking the rules– Stepping stones– That’s impossible! – Mental benchmarking– Fresh eyes– Random word, picture or object

Step 2: Generate LOTS of ideas

• Tool: Random Word, Picture or Object – Words and images that we use in describing a topic bring us

into our usual way of thinking (mental valleys), increasing the likelihood that we will have the same kinds of ideas we have always had

– Using a random word, picture or object causes us to activate thoughts we normally don’t have with the topic, thus generating new thinking and ideas

Exercise Exercise (20 minutes)(20 minutes)

TASK: Select one of the project topic areas from someone at your table (e.g., increase hand hygiene)

1. Decide which you will use, random word or object, discuss in your group what this prompts you to think about

2. Write these down on the left hand side of your flip chart

3. Ask how each of these might translate into an idea related to your topic, record on the right hand side of the flip chart

Step 3: TEST the ideas

• Tools:– Harvesting by criteria and dot voting– Six Thinking Hats– Testing ideas on a small scale (PDSA’s)

Harvesting by Criteria and Dot Voting

• It isn’t feasible to test or try all ideas generated, need a process to narrow the list to explore ideas further or test

• Tool:– Finalize list of ideas– Agree on the number of ideas for harvesting– Agree on criteria for selecting ideas– Give participants “votes” (e.g., post-it notes, dot stickers)– Identify most popular ideas– Repeat as required

Tool: Six Thinking Hats (Edward de Bono)

• Enables the exploration of a topic from a variety of perspectives – That may differ from our preferred way of thinking!

• By “wearing” specific hats, we can direct our thinking in different ways

“The main difficulty of thinking is confusion. We try to do too much at once. Emotions, information, logic, hope and

creativity all crowd in on us. It’s like juggling too many balls.”

~ Edward de Bono

Hat Focus on … Think of …

White InformationDataFacts

Red FeelingsIntuitionEmotion

Black Negatives/RisksDownsidesCautions

Yellow PositiveOptimismBenefits

Goodness

Green Creativity New Ideas

Blue Big pictureDirection

Management of the process

Benefits

• Keeps people focused• Enables a variety of perspectives• Group thinking in parallel – keeps speed and

efficiency to the process• Ensures different modes of thinking are given

equal time• Avoids jumping to conclusions too quickly

Group Work

• Assign someone in the group to wear the Blue Hat to keep the group focused on each hat

• Faculty also wear the Blue Hat to keep time; move on when asked! – 5 minutes per hat

• Work through the hats in sequence• End with the Blue Hat – vote would you take this idea forward to test?

On what scale would you test it?

AIM: Reduce homelessness by 50% by December 31, 2011.

Our idea …

Think about … Comments …

Yellow Positives/benefits

Black Drawbacks/risks

White What further information is needed?

Red What’s does our gut say?

Blue Next Steps