What is it and how can it help me?

Provocations are ideas or wild scenarios that are offbeat, but which may serve as catalysts or ‘stepping stones' to help you make an intuitive leap to a really good idea. They are particularly useful if someone believes that they can only achieve an improvement by having more of something: beds, doctors, nurses, cleaners, radiographers, x-ray machines. In his 1983 book ‘A Whack on the Side of the Head', Roger von Oech suggests that if you begin with an outrageous thought, you will come up with more innovative concepts and ideas. By starting with the outrageous, you are able to suspend judgement and think more freely; making connections or associations between seemingly unrelated pieces of information. When does it work best? You have probably already identified and fixed the easy things, but now you need to improve and fine tune all the elements of the patient journey. To do this, it helps if you see things with new eyes, gathering different perspectives to tease out the alternative ways of getting things done (then you can test them out). Paul Plsek says there are five reasons why organisations should be concerned with ‘creativity and innovation'. 1. Superior long-term financial performance is associated with innovation 2. Customers ie patients and commissioners, are increasingly demanding new ways of doing things 3. Competitors are getting better at copying past innovations 4. New technologies enable innovation 5. What used to work doesn't anymore All these will have an impact on making improvements and stream-lining your services. This tool helps you unlock thinking and identify new ideas for any situation where you perceive a need for ‘more of something'. How to use it State an extreme or outrageous scenario that would necessitate completely redefining how you approach an issue. Here we use the sequence of attention and escape, (see breaking the simple rules) and pick up on the old adage that ‘necessity is the mother of invention'.  Select the ‘simple rule' that seems to be central to the way people currently think about the issue. For example, the clinician needs to see and report upon all the tests in a separate session.  Suddenly eliminate or drastically modify these elements in a scenario that describes a new situation and makes it seem real.  Be imaginative! You could pass a new law to make the current simple rule illegal, invent a mysterious and selective virus, discover some environmental hazard that forces facilities to close, create a crisis of any sort! For example, following a safety alert, a law has been passed that forbids you to do something that you would normally do. Or key staff (seemingly essential for the service) have all left and gone to Australia: you have to find alternative solutions.  Magically make something appear and ask how you would redesign the process if it were true. For example, the status of every test is shown on a big board (whilst maintaining confidentiality) where everyone can see. How would we redesign the process if that were the case?

When might I use this tool? When you feel that the group is stuck. nurses. or ask the group for some really farout ideas.  You can do a provocation spontaneously. movement. or is simply coming up with variations on the same old themes. For example. Identify elements of the system that are central to the issue: patients. How? Have fun with this tool. Use several of these provocations to make sure that you aren't just substituting one taken-for-granted resource for another. You could point out that this reaction is exactly what many people experience in times of crisis. Or. but then they have to get on with it and do something  . People may stare back at you blankly and say things like. the Government have issued a new policy. be prepared for initial incredulity. How can you rearrange services so that you have a fully functioning system providing both tests and results? 3. We want to think creatively about the current process for generating radiology reports. Stick with it. diagnostic equipment. Either suggest something off the top of your head. effective immediately. innovation. Whenever you notice that the current thinking seems to depend too heavily on certain resources or assets in the system. a mysterious virus has attacked all secretarial staff who type up diagnostics results. create an outrageous scenario removing the resource that everything is dependent upon. it did just happen. This tool is popular with healthcare teams because they are usually experienced in dealing with crisis. For example. attention.  Keep in mind the sequence escape. an inspection agency has noted the presence of a mysterious chemical in all non patient areas of radiology: only the actual diagnostic rooms can be used. consultants. It states that no one can stay in a hospital bed longer than 12 hours while waiting for diagnostic tests. radiology or pathology laboratory.  When using provocations. secretarial staff. now what are you going to do about it?'. insist that they deal with it: ‘No really.  You can also prepare provocations in advance. Or. ‘That can't possibly happen'. 1. What will you do? Try to come up with lots of ideas for each of the outrageous scenarios by using the rules of idea generation. IT equipment. it is meant to be playful and tongue-in-cheek. Take time to carefully craft the statement of focus to avoid making the new approach too obvious. Remind your group that this is play with a purpose. Can we design and direct at least eight alternative ways of reporting the results? 2. this adds to the climate of purposeful play and freethinking. but to come back to reality with some new ideas. Think through a list of things in the system that people believe are central to the 18 week target. then just go with it as described. You are the director responsible for all diagnostics. The goal is to explore the outrageous suggestion or scenario.  Write a scenario and include a statement of focus. State what you want the thinking to focus on in the new scenario. your colleagues are all asking you for answers.