Creativity in Health Care: The Fourth Annual Salford Research Day

September 8, 2015

Presentation by Tudor Rickards for The fourth Annual Salford Research Day, September 10th 2015

Creativity pervades the actions of health care workers. While ‘Big C creativity’ attracts the plaudits, there are many opportunities for ‘little C creativity’ in every day interactions.

I will draw on work carried out at Manchester Business School, wherever possible connecting the  concepts to practical illustrations from health care environments. The issues of creative leadership, work environment, motivation and teamwork are particularly important.

Your invitation for me to speak today came with a severe warning that I have 25 minutes to present. After 20 minutes I will receive a visual warning, and after a further five minutes I will be disconnected from the audio-visual system. This manifestation of time management reminded me of the iron laws of quality for all projects in which a balance is required between time, quality and cost.

For obvious reasons today it also reminded me of those pressures placed on GPs in the NHS so that they are able to deal with fifty of sixty people needing their services every day, a process which may be different now but used to involve flashing lights and buzzers. I am sure the illustration could be applied to the work environment of heath care workers generally.

It is worth mentioning that deadlines are as much a valuable necessity for creative action. I had been requested to fit myself into the production and consumption process. In doing so I have accept what I think of as a hard deadline. As did a lot of other contributors. According to the well-established principles of project management, the result is a rationally planned and efficient process which arrives at desired goals. Anyone who tries to design a work system without some sets of rules for negotiating interim checkpoints or hard deadlines quickly realizes the difficulties that presents.

Creativity in the work environment

This is a suitable starting point for considering creativity in the work environment. My Powerpoint for the deadline is shown above. It helps me considerably to deal with the topic I was requested to address.

However, since providing the Powerpoint I thought of two additional points, each of which I believe are worth including in my presentation. The first and more minor point requires a modification to the introductory remarks on work environment and project efficiency.

Motivation and the progress principle

The second is a wonderful summary of the work of Professor Teresa Amabile [The Progress Principle, see below] which I obtained within days of providing my own contribution to this workshop. It is a ten minute video on the fundamental principles of creativity and motivation in the workplace. I recommend you find time to take a look at it and discuss its implications for you and everyone you work with in the future.

My work may boil down to the development of ‘benign structures’ through creative leadership. Teresa shows how such benign structures support creative actions, motivation, and progress towards personal and social goals. I may have time to give some examples which are also to be found in the web-based materials below.

Web based resources

The Progress Principle

The Power of Yes And Thinking

Reflections of a medical pioneer

Creativity in Health Care

Dilemmas of Leadership

The Manchester Method


NATO Conference to take place in a fortress around a golf course

July 11, 2014

A security fortress is being built around The Celtic Manor golf course and hotel in South Wales for The NATO conference, September 4-5, 1914

The Celtic Manor resort last hit the headlines when it hosted the Ryder Cup in 2010. The event was a success, despite atrocious weather. A few years later, and the the venue has been selected for a very different event. The 2014 NATO conferencepromises to be a target for social activists. Locally, schools and businesses are preparing for major disruptions.

A little local knowledge

The Celtic Manor is located in South Wales, close to the township of Newport, and the M4 motorway which connects London to Cardiff and West Wales. It was recently voted the best hotel in the UK for the fourth time in succession.

Travelers will know of the notorious delays around the area, with its two underpasses, and the dreaded Coldra Roundabout which makes tackling the peripherique a dawdle. Security is estimated to cost £50 million. Police and security forces will be coordinated as best as can be achieved.

The Protestors

The event will be the highlight of the year for activist groups. These will have the advantage of a structure of uncoordinated coordination through social networks.

The NATO participants

The NATO participants will be headed by sixty political leaders from around the world including Barack Obama and Angela Merkel. In the event of any medical problem, The delegates have been offered the opportunity to experience the expertise of the National Health Service, although many of the leaders are likely to bring their own medical teams with them.

To be continued

Dilemmas of leadership at the NHS

September 2, 2012

Leaders in the UK’s National Health Service are facing a new (but curiously old) set of challenges, as another Government initiative is introduced to set up international profit-making hospital services

Tudor Rickards & Susan Moger

Officials from the Department of Health and UK Trade and Industry will launch the joint scheme this autumn, [2012] which will aim to build links between hospitals wishing to expand, and foreign governments which want access to British health services.

Hospitals including Great Ormond Street, the Royal Marsden and Guy’s and St Thomas’ could create new branches. The proposal draws on initiatives occurring in America, including Baltimore’s John Hopkins, Hospital.

Health Minister Anne Milton is quoted as saying:

“This is good news for NHS patients who will get better services at their local hospital as a result of the work the NHS is doing abroad and the extra investment that will generate. This is also good news for the economy, which will benefit from the extra jobs and revenue created by our highly successful life sciences industries as they trade more across the globe.

The NHS has a world-class reputation, and this exciting development will make the most of that to deliver real benefits for both patients and taxpayers”.

Unsurprisingly, the announcement [21st August, 2012] attracted criticisms

Katherine Murphy, chief executive of the Patients Association, said:

“The guiding principle of the NHS must be to ensure that outcomes and care for patients come before profits. At a time of huge upheaval in the health service, when waiting times are rising and trusts are being asked to make £20 billion of efficiency savings, this is another concerning distraction. The priority of the Government, hospital trusts and clinicians should be NHS patients.”

New and curiously old dilemmas

The dilemmas for NHS leaders are in some ways new, for example in the sense that the implementation of such a scheme will involve addressing problems of untested technologies impacting on clinical, informational, and managerial actions.

In other ways the dilemmas are curiously old. There have been a series of ‘revolutions’ announced by successive Governments to reform, update, transform, the NHS. The shocks and repeated initiatives led one distinguished commentator, Professor Andrew Pettigrew, to refer to the process as one of “churning not changing”.

It would hardly be surprising if some hospital leaders will see the plan as a further temporary burden to be shouldered, or one further storm to be weathered, rather than an opportunity to be seized.

Investment from private patient profits

A deeper analysis can be found in The Independent. The proposed initiative attempts to anticipate some of the dilemmas. Investment will be allowed only if drawn from income received from private patients; and any profits made abroad would be channelled back to the UK.

Areas of the world identified as key to the success of the project include the Gulf, where British medical brands already have high recognition, and China, Brazil, Libya and India.

The marketing of the NHS ‘brand’

Media comment is describing and evaluating the intiative as an attempt to market the MBS brand. It has echoes of marketing UK plc. The enthusiasm for business school language is not without dangers. Effective implementation of innovation may require a strtegic evaluation of what the ‘brand’ will look like in th future.

An example from a related service sector is that of the universities who are discovering the challenges of establishing outposts in various international locations. The learning curve is steep and competition ferocious. The most successful UK example is the Open University, and that has one unique advantage. Its knowhow (brand?) is precisely of a kind which makes such international ventures attractive to its undergraduate students.

Earlier LWD posts of interest

Health policy

Creative leadership

Distributed leadership

When a leader says “I’m listening” why do we assume there’s a dilemma?

April 7, 2011

David Cameron has been insisting that his Government is listening over public views of his proposed changes to the National Health Service. It signals a leader who is prepared to learn while introducing change. So why does he appear to be in trouble politically over his plans?

The listening leader

The story of the listening leader was captured this week [April 7th, 2011] as the Prime Minister used a meeting with NHS professionals to convey two different messages one to the immediate gathering and the other to wider audiences outside the room. We have an example here of the dilemmas facing a leader dealing with such ambiguities.

One news account describes ‘David Cameron’s desperate bid to save his dreaded NHS reforms’ :

The dreaded reforms

David Cameron yesterday launched a desperate bid to convince voters his floundering NHS plans were needed. At a hastily-arranged “listening exercise”, the PM vowed to make changes to Health Secretary Andrew Lansley’s botched proposals. But he ruled out scrapping the potentially disastrous shake-up.

Mr Cameron hauled bungling Mr Lansley and Deputy PM Nick Clegg along to the Q&A at a hospital, [using] the event to publicly humiliate Mr Lansley – chiding him for “charging ahead” with the shake-up without public support. He faces accusations from a number of medical experts that the reforms would devastate the NHS. His proposals would see GPs given control of much of the budget and the NHS would also be opened up to greater competition.

“I hear what you say”

Managers accused of being poor listeners develop the (irritating) verbal tic of uttering the words “I hear what you say”. Listeners sometimes fill in the dots and assume this means “You can say what you like, as long as you don’t expect me to agree with you“.

“I see where you are coming from”

A similar and more recent expression heard in media discussions and chat shows is “I see where you are coming from”. Like “I hear what you say” the words attempt to avoid conflict and may not always be successful. Here’s what Labour’s Shadow Health Secretary retorted when asked to comment:

“If the Prime Minister is serious about listening rather than PR spin, people will expect root and branch changes to his NHS plans.”

Listening and beyond

A major policy initiative always risks initial resistance at least part because of the difficulty in communicating more than a few broad elements to a wide set of audiences with different concerns.

As we have seen above the dilemma is how to accept that plans have to be modified without appearing to ‘flip-flop’ (an accusation aimed at politicians who are seen as changing their intentions). Dilemmas crop up when leaders face hard to resolve decisions. Creativity is often called for to avoid the most obvious and unpalatable actions. David Cameron may not have found enough creativity to go with his undoubted conviction politics on this occasion.

Creative Leadership: Where are the new IDEOs?

June 23, 2009
Prof Cheng-Hock Toh

Prof Cheng-Hock Toh

The design consultancy IDEO has been rightly praised for its innovative and creative work. But where are the new IDEOs? We identify one candidate within the British National Health Service

IDEO’s fame has spread through its high-profile image and the advocacy of such management gurus as Tom Peters and Bob Sutton. Its brand image was also helped by a TV special, showcasing its creative ‘deep diving’ approach applied to invention of a new supermarket trolley.

IDEO deserves attention not just for its award-winning product designs, but also for its creative approach to generating innovative products. A Business Week article noted

From its inception, IDEO has been a force in the world of design. It has designed hundreds of products and won more design awards over the past decade than any other firm. In the roaring ’90s, IDEO was best known for designing user-friendly computers, PDAs, and other high-tech products such as the Palm V, Polaroid’s I-Zone cameras, the Steelcase Leap Chair, and Zinio interactive magazine software.

By showing global corporations how to change their organizations to focus on the consumer, IDEO is becoming much more than a design company. Indeed, it is now a rival to the traditional purveyors of corporate advice: the management consulting companies such as McKinsey, Boston Consulting, and Bain. Management consultants tend to look at the corporate world through a business-school prism. By contrast, IDEO advises clients by teaching them about the consumer world through the eyes of anthropologists, graphic designers, engineers, and psychologists.

Where are the new IDEOs?

Where are the new IDEOs? They are out there, perhaps not yet as celebrated, but delivering creative and innovative results to their own ‘customers’.

This thought was prompted after an invitation I received to attend a Creative Leadership Forum meeting at MerseyCare, a National Health Service trust working out of the North West of England. The Trust had already drawn attention to its work, as reported in an earlier LWD post.

The Trust’s website demonstrates the pervasiveness of its innovative thinking applied to actions that make a difference.

The Creativity Forum

The Creative Leadership Forum describes itself as being designed for those interested in leadership, creativity and innovation, offering a range of stimulating, thought provoking and energising opportunities including:

Stories from leaders across a range of disciplines e.g. business, arts and science
Round table conversations on contemporary themes
Listening and contributing your own ideas
Creative events
Informal networking with colleagues.

The theme of the meeting [June 22nd 2009] was the relationship between arts and health.

The format was pretty much as described. The guest speaker was a soft-spoken and distinguished-looking gentleman who correctly conveyed the impression of being a senior medical consultant.

He was Professor Cheng-Hock Toh of Liverpool University, a pioneering researcher into intravascular coagulation (bleeding and clotting problems). This work led to the establishment of the Roald Dahl Haemostasis & Thrombosis Centre at the University’s medical school.

The Centre’s approach to comprehensive care was one focus of his talk. The other was the Centre’s engagement with the arts.
The apppropriately-named and successful New Blood exhibition captured the spirit of these ventures

It’s IDEO all over again

As I listened I was struck by the parallels with the philosophy of the IDEO organization, the that of the Creative Leadership Forum itself, and also that of such creative leaders as Professor Toh, who didn’t have to sell his ideas to implement them.

IDEO was among the first design organizations to hit on the idea of co-creation, heavy involvement of sponsors and product end-users in the creative design process. Nothing is totally new, and perhaps it is more accurate to say IDEO had re-applied some of the principles of the synectics invention approach introduced into ADL by George Prince and Bill Gordon decades earlier

No matter. The point is, that synectics, IDEO, and now networks such as Merseycare’s Creative Leadership forum, permit learning and changing work climates for innovative results.

As Proessor Yo put it when setting up his new Institute in 2001 “We just talked to people …then they wanted to help you”. The helpers included people from the Roald Dahl foundation, who listened and decided to do more than just provide their name among a list of sponsors.

Co-creation: In California and on Merseyside
Driving away I tried to remember what I had heard which was something else linked the IDEO approach. Professor Ho had talked about involving all his staff in creating a climate of care The Business Week article supplied the answer:

Kaiser Permanente, the largest health maintenance organization in the U.S., was developing a long-range growth plan in 2003 that would attract more patients and cut costs. Kaiser has hundreds of medical offices and hospitals and thought it might have to replace many of them with expensive next-generation buildings. It hired IDEO, the Palo Alto (Calif.) design firm, for help. Kaiser execs didn’t know it then, but they were about to go on a fascinating journey of self-discovery. That’s because of IDEO’s novel approach. For starters, Kaiser nurses, doctors, and facilities managers teamed up with IDEO’s social scientists, designers, architects, and engineers and observed patients as they made their way through their medical facilities. At times, they played the role of patient themselves

There are new IDEOs. You can find them in the most surprising places. I rest my case.

Mersey Care Health Trust: An example of distributed leadership

May 28, 2009
DIY Handbook for Action Learning

DIY Handbook for Action Learning

Mersey Care NHS Trust is developing an international reputation as a creative organization through a range of innovative projects. It also serves as an exemplar for distributed leadership processes

Mersey Care is a major National Health Service (NHS) Trust serving the sprawling region of Merseyside in North West England, and incorporating Liverpool as its major city.

Chief Executive Alan Yates realised a few years ago that a creative organisation needs more than one creative leader. In formulating and implementing a strategy for one of the country’s largest NHS institutions, he realised he would need to find ways of stimulating creativity across the organization, and out into the community. Rather that setting up a formal structure, he encouraged informal networks, giving special responsibilities to Assistant Chief Executive Mandy Chivers. Senior figures at the Trust such as Medical Director David Fearnley were to offer considerable support as the creative initiatives grew.

Liverpool: European Capital of Culture

The trust recognised special opportunities with the regional efforts to promote Liverpool as the 2008-9 European City of Culture. By working closely with other community organisations, Chivers identified a like-minded group of people interested in stimulating creativity with focus on mental health and well-being.

Julie Hanna was quick to see the benefits of such a collaboration in her role as manager for health and well-being programmes:

Creativity, arts and culture are positively impacting on people’s health and well being. Liverpool, as European Capital of Culture 2008, has acted as a catalyst bringing together artists, cultural partners, health and care practitioners. There is a willingness to explore and develop possibilities of working in partnership in a pioneering spirit of “seizing the moment” of Liverpool’s cultural significance. This is another story to tell underneath the large and crowd-pulling events. Through culture and the arts we can find meaning, make sense of our experiences, express our thoughts and emotions, make and sustain relationships, discover skills and qualities in our selves and others. These experiences provide an opportunity to integrate body, mind and spirit; to learn and to make changes in lifestyle

The work included a variety of local and regional events, and an international partnership with Stavager in Norway.

The Creativity Network

Chivers began to find like-minded individuals in and beyond her own organisation, and encouraged a range of creative initiatives grounded in the professional activities of the trust. With strong leadership from Judith Mawer, an informal creativity network developed through which individual efforts were encouraged and supported. In the period of a few years over fifty people became associated with the informal network, sharing ideas, and offering various public events.

The Action Learning Initiatives

Externally, links with Universities were strengthened, and projects sponsored. The focus was to achieve learning through doing, innovative achievements as well as spin-off staff development gains.

The involvement with the Liverpool Year of Culture projects enhanced the strategic efforts both of the trust and the Culture initiative itself.

A similar mutual reinforcement occurred when Mersey Care became involved in another regional initiative, this time around action learning. The heirs to the work of action learning pioneer Reg Revans had being trying to establish a Revans Institute. The trust was to play a major part in the formation of the institute through the efforts of an international network of action learning practitioners which established a home base at Manchester Business School.

Chivers had obtained her doctorate within an active action learning group at nearby Salford University which still houses extensive archives of the papers of Reg Revans. The Trust helped advance the cause of Action Learning substantially, and has produced a practical handbook to initiate action learning efforts.

As indicated on the Mersey Care website:

Action Learning is a simple but powerful approach and a discipline that supports transformational change. It is an effective way that people can learn with and from each other. Groups or sets as they are sometimes called, work through questions and challenge to understand and develop insight in order to take actions that progress complex issues [applying] a rigorous blend of critical thinking, questioning, practical action and emotional intelligence. It does not work instantly or because of something clever outside of ourselves, but because we commit to this discipline and take personal responsibility to act.

Creativity, Health and well-being

The multiplicity of activities under the creativity initiatives were captured in a document by Judith Mawer which lists no fewer than seventeen projects each demonstrating creativity being applied within the context of health and well-being.

Among them, LWD was particularly fascinated by the therapeutic applications of creativity such as the work with Judith of Lynn King and Julie Hannah. The powerful image of a treasure chest as a means of capturing creative ideas is one particularly vivid illustration of a creative methodology.

The creative organization and its leadership

Can we learn something from Mersey Care about the creative organization and creative leadership? Something interesting and rather special is emerging there. The close links between action, innovation and learning mirror the case reports of the celebrated creative organization Ideo.

Both Mersey Care and Ideo have informal structures (as well as the necessary formal ones, required by Health Service statute in the Mersey Care case) . The informal activities enable individuals to introduce creative changes within their individual professional responsibilities, from clinical dispensing innovations to imaginative ways of delivery of service care

Overall, the work of The Trust is increasingly and rightfully being recognised internationally, winning awards, and earning recognition for Mersey Care as a creative organization.

Julie Bailey, campaigning leader

March 18, 2009

A community protest contributed to exposure of shocking deficiencies of standards in a Staffordshire NHS trust. The protest was led by Julie Bailey, an exemplar of service leadership

Julie Bailey initiated and then led the community-based movement from a local cafe. It turned out that a very different kind of research would draw official attention to potentially serious problems through a sophisticated analysis of medical records. It will be difficult to assess the contributions of the team of medical analysts within the health system, and local activists outside it to the unfolding dramatic events.

I am concentrating on the leadership behaviours shown locally, which came to light as the damning report was published, [March 17th 2009] with the news of replacement of the former leadership of the trust. The report focused on lack of resources, poor management, in over-concern for to meeting various targets which were indicators of good practice while becoming in denial over actual clinical care which the targets were intended to assess.

The BBC reported that

About 400 more people died at Stafford Hospital between 2005 and 2008 than would be expected, the Healthcare Commission said. [T]here were deficiencies at “virtually every stage” of emergency care and managers pursued targets to the detriment of patient care.

Julie Bailey was interviewed for the report. She told her story in clear and calm terms which reinforced its horrific message. It began with the immediate experience she witnessed when her mother was admitted to the trust in a scene of chaotic nature which she was to discover extended to entire wards of suffering patients. Her immediate reaction was to attempt to deal with the local situation and she appears to have stayed with her mother with increasing desperation and awareness that the lack of care extended extensively within the hospital (the eventual report found extreme mis-management within the accident and emergency system, as well as on the wards.

Bailey was to see her mother die with evidential poor care within a few weeks of admission. By then, her concern and anger had led to a strong drive to obtain justice for what had happened not just to one patient but to what she saw as an entire community touched by the practices of the Trust.

Initial attempts to obtain legal advice revealed how difficult it would be for one person of limited means to change a system, Julie Bailey succeeded in mobilizing people to create pressure which eventually made a difference.

A letter to a local paper confirmed that many others confirmed Bailey’s experience was not an isolated incident. A local protest group emerged. Julie Bailey seems to have been the voice on its behalf. Its efforts are still low-key in publicity terms, and I had trouble finding out much through web searches.

Her video reveals someone who took the lead demonstrating a combination of resilience and unwavering commitment to a cause against the odds. This was in face of discouragement from experienced professionals, and apparent disinterest from politicians.

What is special about Julie Bailey?

Students of leadership will benefit from studying the case. Initial reports suggest that much more is to be learned about its context. One immediate impression is how she could stand in great contrast to the received stereotype of a charismatic leader. She has a moving personal style of delivery. But it takes its power from its ordinariness and calmness in communicating a story which is extra-ordinary. I can imagine her drawing strength through being a channel though which voices of many others touched by this episode become heard.

Charismatic leadership? Transformational leadership? Creative leadership? I’m not sure. Servant or service leadership? Maybe, although the concept needs more attention than it has received to date.