Just A Thought!

"Unleashing Creativity" - Notes & Thoughts from A workshop on Innovative practices in HealthCare

Mon, 14 Nov 2011 17:23:00 -0800

Unleashing Creativity: Action at the Front Line

Nov 1-2, Sheraton Airport Hotel, Richmond, BC.

hosted by BC BC Patient Safety & Quality Council (BPSQC).

info: http://www.bcpsqc.ca/events/list/UnleashingCreativeAction.html

agenda: http://www.bcpsqc.ca/events/documents/UnleashingCreative_agendaFINALOct19.pdf

The day started with a very windy and overcast morning. Me and Ajay Puri - @masalapuri (Digital Media Quality Leader at BCPSQC) made our way to the workshop venue at Richmond. I was looking forward to two days of creativity, inspiration, learning, problem-solving and fun!

The workshop was facilitated by:

Keith McCandless, Social Invention Group

Dr. Michael Gardam, Safer Healthcare Now! & Director Infection Control, University Health Network

Katie Procter, BC Patient Safety & Quality Council, Quality Leader

Once I sat down at our table and fired up my laptop for ‘live’ blogging, the first thing that popped up on the radar was BC minister of Health Mike de Jong’s op-ed about the value of seniors in our communities:

*	Mike_de_Jong: My Op-Ed in today edition of @TheProvince: #Seniors are a vital part of our communities http://ht.ly/7ftPF #bcpoli #bchc

At first there was some “Speed Networking”. The purpose was to: "liberate participation for everyone and attract deeper engagement around challenges".

Keith McCandless [twitter: @KeithMcCandless] then began the workshop by providing an introduction to the “Liberating Structures" method. A detailed overview can be found here: http://socialinvention.net/Documents/Liberating%20Structures%20FAQs%209%2022%2009.pdf

Keith asked the participants to ponder what are the kind of behaviours that "Liberating Structures" influences?

Katie Procter, [twitter: @kanneprocter], workshop facilitator, explained the '9 Whys' and what they mean. These are quite useful for conducting the ‘Appreciative Interviews’ for prospective connections. Keith prodded the participants to not “let anyone get 'conceptual' on you”! Meaning always ask clarifying questions if you are not sure what the message that is being conveyed.

After the intro & explanations, participants were asked to pair up and engage in 1to1 conversation on the 9 Whys. Starting with this question: “What is your core purpose?” People started sharing their stories with their discussion partners after a while! As I myself participated in this exercise with the person sitting besid e me trying to answer: “What do you do when working with others on your challenge?”. The continuous questioning of ‘why’- especially “Why is it important to ME?” - by my companion forced me really question my own belief as to why I do what I do and rethink my answer for a more clear purpose.

*	asterix: - what is your core purpose? #bchc 'Liberating Structures' workshop.#bchealth. @BCPSQC

:
Then Katie asked us if we have found any places or instances where we can use the ‘9 Whys’? As it turns out ‘Why” can be quite a hard thing to answer! A participant commented that “'why' is a good thing to ask during meetings”. Another attendee observed that “the 9 whys are good way to understand any type of hard challenges.” Participants then proceeded to immersed into another round of 1-to-1 mini-interview session to answer remainder of the 9 Whys.

Meanwhile twittersphere informed us that @PatientsFirstBC held a virtual town hall & tweetchat! at!

*	PatientsFirstBC: mT @mystery_of_me: Join me for a #tweetchat on #BCHC on the@PatientsFirstBC today at 11am! http://ow.ly/7fCoz #patientsfirstbc

And CBC aired a segment on E-health records! seems like healthcare and patient safety was popular topic on November 1.

*	BCPSQC: Interesting! ^aj MT @plifinancial They were talking E-Health Records on#CBC this morning. Talking about challenges! #bchealth #bchc

Back to the session on appreciative inquiry! The mode of engagement for this exercise is to: Find a partner who is not known well to you and then tell a success story about working successfully on a complex challenge across functions and disciplines. After the successful interviews, participants shared their experiences with the whole group. Mark from theBC Ministry of Education told us that they used an online platform for collaborative learning which has about over thousand users. Another attendee said that going through the appreciative inquiry was really helpful as a way to get insights from a philosophical perspective.

Keith quipped that "it is nice to say 'focus on the positive'. And enquired how we could do that during a meeting?

Jill Veenendaal [twitter: @JillVeenendaal] from BCPSQC finds the workshop invigorating.

*	JillVeenendaal: At the BC Patient Safety & Quality Council's 'Unleashing Creativity”. So interesting! #bchc @BCPSQC

After a mini-break, we began with a progressive, rapid cycle conversation: 1-2-4-all group. which means the discussion now moves from individual, to peer-tp-peer, to group consultation. Repeating interviews in rapid cycles may point to positively deviant local innovations

Katie Ann Proctor asked: “who is at the centre of your practice”?. she tells us that it is our patients. “it is not the system. it is all about patients. so you have to take time to engage them, talk to them and make them part of the process.”

Marlies van Dijk shared a photo of the colorful visuals that the participants created during 1-to-2-to-All consultations.

We then learned about TRIZ - Designing a Perfectly Adverse System. It is a method where you begin by defining a VERY unwanted result of your work together.

The first step of TRIZ is to find “How can we reliably create a very unwanted result…?” After you contemplate about the preceding question by yourself.

The second step involves sitting down in groups and go over yur checklist of unwanted behaviour to identify “is there anything we are doing that resembles in any shape or form todo’s on our list?” Make a second list of those activities & talk about their impact. Be unforgiving.

The third step involves determining: “How am I and how are we going to stop it? What is our first move?” and then identify who else is needed to stop the activity. The main purpose of TRIZ is to “Make it possible to speak the unspeakable” and to lay the ground for creative destruction.

Dr. Michael Gardam (MG) of University Health Network in Toronto spoke about how to use simple solutions for complex problems. He observes that complex problems can be highly sensitive to local cultures.

People in Vancouver were following the discussion in cyberspace!

*	JeffaCubed: RT @asterix: 'progressive, rapid cycle conversation: 1-2-4-all group' #bchealth dialogue at the 'Unleashing Creativity" workshop by @BCPSQC

Dr. Gardam opined that complex problems can be very hard to decipher. by simplifying the communication process these issues be tackled efficiently. He believes social network mapping can highlight interesting connections in channels of communications between health-care stakeholders. Practice based evidence - an effective strategy to move us beyond "evidence based practice". According to Dr. Gardam, leaders take step-back than step-up. the idea that the best way to lead is to facilitate and encourage good behaviours

[We adjourned for lunch.]

after lunch we gathered for
Fishbowl Session: Share Experience and Deepen Awareness of Group Process

The main query for fishbowl was to find out “What is our experience including and unleashing everyone? Have any unusual suspects shown up? how?”

Audience observation on fishbowl exercise: 'once you start asking people questions, the open up! even quiet people would have amazing ideas!'

Fishbowl in action! via: Marlies van Dijk

*	tweetvandijk: What does 20 seconds of silence do? Reporting from unleashing creative action workshop #bchc #bchealth @BCPSQC

fishbowl example: Dr. Gardam goes to a nursing unit, and asks: how would you infect everyone in this section? he gets a list of all the ways this can be done. and this list can then be used to eliminate all these processes! “you start working with who wants to work with you. that way you can start improving things collaboratively.”

Katie Proctor: if you are working with someone who is no cooperating at first, but you keep working at the challenges, and they sees the point; that's one of the most fulfilling experiences.

Dr. Gardam: it doesn't take lot of people to make change. starts with few and then the change snowballs into action.

#fishbowl Q: any observations about the #fishbowl method or process?
answer: there was a lot of passion!
answer: if i could see the leaders in our organizations discuss things in such a transparent way, it would make such a difference!
answer: even if it's a little stories, it's really useful for support personnel to listen to these firsthand stories. it makes a lot of difference in terms of learning.

katie proctor : physicians also very much wants to engage. if we can provide them with a constructive, safe environment to share their views and listen, that would be powerful.

She then asks: what is the safest way to provide feedbacks? and puts forward another question for participants to brainstorm and discuss:
"when, where and how can you apply user's experience fishbowl?"

Answers + Insights:
"people want to have conversations. they don't want to only talked at"

"asking people questions and engaging them into meaningful conversations, can be truly a 'liberating' experience"

KM: "sometime you have to stop people and steer them to ask/answer the most important questions"

Q: any examples of when fishbowls went wrong?
Answer: one time it was shot to hell. all the feedbacks were put off!

" can you grub a nurse [or a doctor] and ask them: "did you wash your hand?"

" if there is no assurance of compliance, how do you creatively engage people to follow prescribed procedures?"

Keith Mccandless engages in some twitter activities himself! :

*	KeithMcCandless: Day 1 Liberating Structures in full tilt at Vancouver wksp. Laugher around serious safety challenges is evidence of liftoff. #bchc

*	KeithMcCandless: Wide range of bold ideas emerging: liberation of mundane everyday meetings to Province-wide policies. Multi-scale shifts afoot. #bch

[VIDEO: Improve ]

While we took leave after the end of day 1 at “Unleashing Creativity” workshop, the twitter-o-sphere kept the discussion going re: BC+Canadian Healthcare & Patient Safety:

*	BCPSQC: RT @tweetvandijk Have u heard of "social Immune response"? A term used when culture "eats strategy for breakfast" Henry Ford #bchc @BCPSQC

*	EPCSociety: Patient Safety Advocates Talk About Access to Health Information - The Patient Factor http://bit.ly/rTRJmQ #ptsafety

*	BCPSQC: MT @KeithMcCandless Day 1 Liberating Structures in full tilt at #yvr wksp. Laughter around safety challenges is evidence of liftoff #bchc

InspireNetBC:
G&M: Province proposes increased role for nurse practitionershttp://ow.ly/7fWPd #bchc

*	Patient_Safety: Currently sharing Terri's story at Canada's Virtual Forum on Patient Safety http://ht.ly/7gLcb #hcsmca #cdnhealth #ptsafety #ptsafetyforum

Day 2 | Nov 2 |

The second day of the workshop started with a Debrief of Day 1:

•WHAT?
•What facts, data, & observations stand out?
•SO WHAT?
•Based on your observations, do you see a pattern? Is it important? Does it make a difference?
•NOW WHAT?
•What action may be advisable?

Afterwards Keith spoke about ‘network effects’ and how ideas propagate. He mentions that If you can get more than 12.5% of a population to adopt an idea, then the rest of the population would follow the idea. So it is this 'critical mass' of people or the “early adopters” are the leaders in any field that are critical for adoption of idea, processes and products.

Next Session was Wise Crowds: Group Consultation about Tapping the “Wisdom of Crowds” To Solve Problems Together.

Wise Crowds purposes: “tap intelligence of the whole group”; “avoid common traps with asking and giving help”; “generate wisdom helping one to work across disciplines and functional silos; and “actively build trust through mutual support”.

Keys to Success in “Wise Crowds”:
•Invite a very diverse crowd to help
•Take risks while maintaining empathy
•Focus on complex challenges without easy answers

Session#3 : Ecocycle session.

Attendees are engaged in group discussion re: the cycles of birth, renewal, maturity & creative destruction.

#crowdsourced ideas: 'instead of using staff meetings as a way of strictly relaying information, use that time to do teambuilding exercises that was learned

Most upvoted #crowdsourced ideas:
"engage my surgeon champion to improve"
"have a conversation about letting people die"
"have directors of VIHA to use experience #fishbowl in every meetings"
“in the morning have a leadership huddle - to improve understanding”

Some of these ideas are “quick hits” that can be implemented on the fly, while some of them are more strategic in nature.

Next Session is on Ecocycle: collective brainstorm and group discussion.
Purposes of Ecocycle
•Identify a mix of strategies
•Identify waste & innovation opportunities
•Include all and hear all perspectives at once
•To see the whole picture (forest and the trees)

In his Ecocycle talk Keith pointed out attributes of sustainable change: behaviours & routines leading to volumes of change, which is dependent on flow of resources (money, time etc.)

So how do we make people to change [behaviour, practices, processes]? 'i am not going to change unless people pay me' - how you overcome this?

Audience reactions and observations:

- “the power of functional communication is a very powerful process.”
- “i was totally blown away by the problem-solving abilities of my group and the team dynamics in place”

*	tweetvandijk: Is wise crowds as a method applicable in healthcare - where could it fit?

*	asterix: day 2 @BCPSQC w/shp. views frm floor: "it is really hard 4 getting people to share information esp. in govt/health agencies" #bchc #bchealth

Next session was about Social Network Mapping. Now this was very much into my territory!:
Participants creating legends of people that they work in particular projects.

*	JillVeenendaal: Ideal "smart network" for new ideas and implementation - needs tight core, loose periphery #bchc #Creativity @BCPSQC

*	JillVeenendaal: Smart network def'n: the environment in Whig innovation and collaboration are moat likely to occur. #networking #change #Creativity #bchc

Session | Network Mapping: Identify Connectors & Bottlenecks

- add assessment of people that may serve as connectors or bottlenecks as the work unfolds.
- create a symbol for each.
- step back...and notice what the map is illuminating

network mapping session - Ask, So What? ::

- what does this map imply? is our network smart?
- who should be included?
- examples and stories from KGH & VGH
- review of metrics
* awareness
* influence
* resiliencerkshop par
* integration

Session: TEA Party!! Finale!

The workshop participants convened for a tea party!

same church, different peers!

Final thoughts from Keith: “whatever you do, don't do it alone. do it with someone else.”

[author note: its a working draft. some revisions/addendum would be incorporated in next few days. -miraj]

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