Why is leadership not in the dialogue of health innovation?


by Duane Attree

Originally published on Croakey, 23 December 2014.

There’s been a noticeable increase in the proliferation of views on the need for innovation, integration (still!) and the sustainability of our health system recently. All have been important, most coherent and, a few, optimistic. And yet in all these perspectives there has been very little about the role of leadership or leadership skills in achieving health innovation.

As an example, the AHHA’s integrated care simulation and post-scripts (see here and here), make mention of leadership in referring to Gough Whitlam’s passing, but not really in the context of delivering on service innovation or transformation.

Furthermore, and not to be too trite, a simplistic google search takes this view further: there is lots of health innovation, a bit of health leadership, but not a whole lot on leading health innovation…and certainly nothing that seems to reflect or represent the views of a new generation – those who will (presumably) start to take on leadership roles over coming years.

Some context for this perspective may be in order: I’ve been in the health industry for just on 15 years and have been fortunate to have attended some sort of professional event or conference in most years. While attending a recent one, I was struck by 3 things:

1      I used to be the youngest in the room

2      I still am

3      the narrative and general tone of the speakers are the same – they just seem more overt in their cynicism.

Now maybe I’m not at the right forums, perhaps I’m not actively listening, and maybe I’m outright wrong, but I reckon my views reflect more than a few of the ‘next generation’ (and given a recent piece by Ross Gittens, it seems the views in relation to health leadership apply equally in broader contexts).

Most of this future group are passionate, unfailingly optimistic and care deeply about how the future materialises – yet feel despondent when all they hear in the ‘we say – they say’ sounds convoluted, protectionist and condescending.

The people that will inherit the leadership of our system (and those following) ask lots of ‘why’ questions that challenge the status quo. Questions like: why can’t the private sector play a more active role in integrating services? Why are we waiting for the politics (which we’re continuously disheartened by) to line up to get system reform? Why do I have to fill in another form? Why isn’t there an app for that?

So in the spirit of being a part of the solution or forfeiting a right to complain, I’ve put down some interconnected thoughts on how leading health innovation might be better fostered.

1. Transferring ‘discovery’ attitudes from lab bench to board room: Australia’s knowledge, intellect and standing in research is astounding. Our brightest minds are daily challenging what we think we know. Yet in health management (in particular), there is a hierarchical, command and control culture that shies away from trying something without the three c’s (committees, consensus or conformance).

That great Australian maxim: ‘have a go’ is not foremost in our health system’s mission statements. Practically, and not to take away from good and proper governance, I hear so many stories of hindrances to changing practice, so why can’t some basic principles be put in place in your organisation as the basis for leading health innovation? So long as an initiative doesn’t a) pose a risk to safety, b) cost more or c) distract from core business, why stop it?

2. Promote forgiveness: a key phrase used in innovation is ‘fail soft, fail often and learn fast’. The ‘soft’ part, fundamentally requires some level of forgiveness. Again, not to take away from the need for robust and clear accountability, promoting a sense of forgiveness provides those people energetic and brave enough to push the boundaries with confidence to keep going. If we’re having a go, what are the next hurdles for success? As a start, surely it’s that the lessons of the attempt are circulated so that others can iterate and strive for the next breakthrough.

3. Embrace the energy in naivety: Despite some stereotypes, I believe most people working in, and certainly starting out, a health career, want to contribute and make a difference. The next generation are hungry, they want things quickly and they have little tolerance for hearing ‘it can’t happen’.

Embracing this naivety, forgiveness and supporting the reflection that leads to learning, will cause such inestimable return to the individual and their ability to one day crack the impossible.

4. Send the elevator down: a great quote has been doing the rounds recently and it says: ‘if you’re lucky enough to do well, it’s your responsibility to send the elevator back down’.

Mentoring, coaching and, at its simplest, being available, can have such an impact on those innovators seeking to change the status quo. Carving out of a busy week, 30mins to inspire and motivate a naïve, energetic innovator could be the difference.

4. Re-imagine mathematics: There’s a great clip from Robin William’s Patch Adams that beautifully shows the effect of re-imaging mathematics. The compounding nature of networks and collaboration means we simply have to do more to connect people meaningfully.

Imagine the last time you had two ‘out there’ dreamers in a conversation about making change happen – there would have been enough enthusiasm, ideas and energy to fill a room. As a leader of innovation, how can you create forums and platforms where dreamers can dream and their ideas be anchored and made practical?

It’s important to note, that while this perspective is taken from a generational lens, I know it could equally be applied to those that ‘think differently’ at the front line of service delivery. There’s plenty of clinicians driving managers crazy with their ideas for change! They’re equally seeking a leadership style that will allow their innovations to take shape and be tested, and not all of them are about more cost or more resources. This same view could no doubt be applied across a range of levels of our health system.

While not wishing to oversimplify the leadership challenges in making change happen, I hope this view provides a chance for you to reflect and initiate some small change in the degree of leadership in discussions about health innovation.

Perhaps add some action into your new years resolutions – and who knows, you might just stimulate a hair-brained idea that makes the difference that we’re all striving for.

Disclaimer: These comments are my own personal views and do not necessarily reflect the views of my employer, KPMG.

Duane Attree is a health consultant and former healthcare executive.