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Creativity, Innovation, and Change

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Creativity, innovation and

13 change
Vivienne Byers

Chapter topics
• Concepts of creativity and innovation
• Creativity and innovation in ‘driving’ healthcare change
• Person-centred leadership and co-production in healthcare change
• Harnessing health professionals’ creativity through leadership
• Challenges to diffusing creativity and innovation in healthcare
• Benefits of creativity, innovation and change in healthcare
• Leadership and innovation strategies for improving performance in healthcare

Introduction

According to West (2002), creativity is distinct from innovation as it encompasses

the processes leading to the generation of new ideas to create value for individu-
als, organisations and the health sector. The term innovation is used to describe
the use of these new ideas, products or methods where they have not been used
before (Eurostat Community Innovation Survey (CIS) 2015). Innovation inten-
tionally introduces ideas, processes, products or procedures which are new to
that job, work team or organisation, and which are designed to benefit the job,
the work team or the organisation. For those working in healthcare there is pres-
sure to be innovative and ‘do more with less’. Leadership of real creativity and
innovation needs to be developed throughout healthcare organisations to rise
above and beyond this challenge.
The way in which people think about innovation has radically changed over
the last two decades with the advent of open sharing, user customisation and the
idea that service users or patients are often the best placed people to proactively
assist in revising products and processes. These service users are now becoming
more and more active in engaging with the health services to meet their needs.
This chapter explores how creativity and innovation can be developed and sus-
tained through leadership, teamwork and collaboration in order to achieve a
higher performing health service.

Concepts of creativity and innovation

Creativity and innovation are seen as crucial elements for a responsive organisation
to have in changing and turbulent times. First, it is useful to define the concepts
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178 Vivienne Byers

of creativity and innovation and then examine the subtle differences between
the two. Creativity, according to West et al. (2002), comprises the processes
leading to the generation of innovations in order to create value for individuals,
organisations and the health sector itself. Somech and Drach-Zahavy’s (2013)
review of the innovation literature revealed that most studies do not differenti-
ate between the two stages of innovation: the creativity stage, as in the genera-
tion of new ideas, and the implementation stage – the successful adoption of
creative ideas. To differentiate between the two concepts, creativity can be seen
as involving intra-individual cognitive processes, whereas innovation can be
seen as comprising inter-individual social processes in the workplace (Anderson
et al. 2014).
To further elaborate on the innovation aspect, Rogers’ (2010) work emphasises
the focus on novelty and defines innovation as ‘an idea, practice, or object that
is perceived as new by an individual or other unit of adoption’. Many definitions
by early researchers emphasise the focus and form of the innovation itself.
For example, Schumpeter’s (1934) seminal work lists the existence of five
types of innovation: (1) introduction of a new good; (2) opening a new market;
(3) acquiring a new supply source; (4) introducing a new method of production;
and (5) (re)organisation of an industry. Roger (2010) views innovation both as
the process of adopting an existing idea for the first time, as well as the charac-
teristics of a new idea.
De Vries et al. (2015) undertook a systematic literature review of innovation in
public management due to the identified lack of evidence-based enquiry in the
field. Their review synthesised empirical publications on public sector innovation,
linking innovation as a process and innovation as an outcome. The innovation
articles were reviewed based on the themes of definitions, objectives, types,
influential factors in the process (including the adoption and diffusion stage) and
outcomes. Their findings identified a wide variety of innovation due to its
fragmented nature in the public arena. They developed a useful classification of
innovation in public management under four category headings:
• product innovation
• process innovation (including technological and administrative processes)
• conceptual (ideas) innovation
• governance innovation.
This categorisation is useful as it extends the focus on innovation beyond the
technological, to that of governance. This encompasses innovation in system-
wide healthcare reform (World Health Organization (WHO) 2015; Health Canada
2015) as well as organisational transformations (Greenhalgh et al. 2008; Vintar
2015). The WHO Report (2015: 206) emphasises the importance of innovating in
governance arrangements as they ‘increase coherence, reduce fragmentation in
the health sector, and contribute to the development of strong health systems’.
In the healthcare sector, the concept of innovation has been broadly embraced,
often using the term interchangeably with that of research (Health Canada
2015). Definitions of innovation in healthcare can differ from that in the general
literature, as it focuses on the importance of the recipient of healthcare services,
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Creativity, innovation and change 179

the patient, as well as value to society. Thakur et al. (2012: 564) describe innova-
tion as involving practices that have been proven to be successful, while ensur-
ing the safety and best outcomes for patients and the performance of the
organisation. In other words, innovation in healthcare is defined as those
changes that help healthcare practitioners focus on the patient by helping pro-
fessionals work faster, better and more cost-effectively. The Health Canada
Report (2015: 11) on innovation notes that this focus is important in order to
‘generate value in terms of quality and safety of care, administrative efficiency,
the patient experience, and patient outcomes’, through the ‘development and
implementation of ideas to produce new or improved strategies, capabilities,
products, services, or processes’.
Most reported research on healthcare innovation focuses on technological
innovation such as electronic health records, nanotechnology, genetic engineer-
ing, diagnostics, and so on (Omachonu and Einspruch 2010). Healthcare innova-
tion, according to Thakur et al. (2012), is driven by strategic implementation of
information communications technology (ICT) and information systems (IS) in
order to gather information, develop databases, as well as inform outcome-based
management and healthcare reform.

Creativity and innovation in ‘driving’ healthcare change

Much of the discourse at the 2016 World Economic Forum in Davos focused on
the reshaping of business and society by technology-driven forces, giving rise
to new possibilities for growth and innovation. There is fundamental change
occurring in business models and organisation structures that requires leader-
ship and a long-term, strategic perspective. Healthcare has been at the forefront
of this change. Pressure on national health systems to cope with the growth in
ageing populations and chronic disease, as well as the rise in demand and its
cost in healthcare, has increased. As a result, attention has focused on reforming
healthcare provision and developing ICT as a means to increase the efficacy of
service delivery and patient-centred care. At a health system level, there have
been reforms and innovations in health system design (Omachonu and Einspruch
2010; Frenk and Moon 2013). This has resulted in changes to accountability,
governance arrangements and integrating health services across organisations
and across levels in the system, as well as the delivery of patient-centred health-
care (Kitson et al. 2013). At an organisational level, changes include develop-
ments such as multi-disciplinary teams (MDTs), virtual wards and electronic
patient records (EPRs) in order to improve and integrate the management of
patients. Developments in telehealth and assistive technologies are yet more
examples of change and innovation in healthcare. On the healthcare delivery
front line, innovation can be seen as changes in techniques for diagnosis, treat-
ment, or prevention. Health Canada’s Report (2015: 119) identified the five most
promising areas of healthcare innovation with the potential to reduce health
spending and improve quality and accessibility. These broad areas are outlined
in Box 13.1.
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Box 13.1 Promising areas of healthcare innovation

• Patient engagement and empowerment
• Health systems integration with workforce modernisation
• Technological transformation via digital health and precision medicine
• Better value from procurement, reimbursement and regulation
• Using industry as an economic driver and innovation catalyst
Source: Based on Health Canada (2015: 119).

Part of the responsibility for the implementation and scalability of innovations

lies with healthcare professionals, as they have to adapt to new practices and
changes in organisational roles and structures, as well as provide clinical guid-
ance on how these changes should be implemented. Leadership can come from
the front line to accelerate this change, as well as from the top to set the vision for
change and reward creativity from all sources.

Person-centred leadership and co-production in healthcare change

Some models of healthcare delivery are more participatory and are provided in a
more person-centred or patient-centred manner (Moynihan et al. 2009). Person-
centred care requires knowing the patient as a person and engaging the patient as
an active participant in his or her own care (Epstein et al. 2010). Health reform
agendas support this greater participation of patients in healthcare as a potential
driver of a more responsive service and of good clinical governance (Taylor
2009), to prevent unnecessary costs and rationalise health services (Barello et al.
2014), and as a driver for quality and safety (Kitson et al. 2013).
As already noted, innovation is a complex interaction of both the situation and
the people involved. This is never more evident in healthcare where it ‘takes two to
tango’, in that the delivery of a healthcare service includes elements of co-
production. Co-producing a service requires that the patient must comply with the
requirements of the health professional to benefit from the service (i.e. take pre-
scribed medication or modify lifestyle choices), as much as the health professional
needs to be cognisant of what the patient needs. It is demanding for health profes-
sionals to have to deal with each patient as an individual with specific needs and
requirements in the delivery of a heterogeneous service (Parasuraman et al. 1985).
The co-production literature is a step closer to more equal collaboration than the
focus of the person-centred literature, placing the person ‘at the heart of any given
service and involving them in it’ (Loeffler et al. 2013). This presents a challenge
for front-line health professionals when they strive to serve clients in the best way
they can, in the context of a budget-constrained environment and reduced staffing.
Many health professionals when restricted in this way seek to adapt their practice
to contribute to their individual ownership and personal understanding. They play
leadership roles at the front line to influence and implement change practices in
advancing positive patient and organisational outcomes (Byers 2015). Leadership,
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Creativity, innovation and change 181

Table 13.1 Strategies of champions/leaders for diffusing practice change and innovation

Innovation and practice change Strategy

Dissemination of information about clinical Education and awareness

practice guidelines
Champions can act as persuasive leaders
Tailoring guideline implementation strategies
to the organisational context
Acting as a resource to support and mentor
health professionals
Working through committees
Participating in and leading interdisciplinary
teams
Exploring, auditing, monitoring of best
practices
Documentation changes to incorporate
practice recommendations

Source: Adapted from Ploeg et al. (2010: 244).

thus, becomes part of discretionary behaviour at the front line, not imposed by the
social structure, but produced through pragmatic improvisation. Ploeg et al.’s
(2010: 244) research into how these change champions or front-line leaders can dif-
fuse practice change and innovation, identifies key strategies (Table 13.1).
A further concept to address in this section is social innovation which is often
described as co-creation. This refers to the involvement of end-users in the design
and development of new goods and services (Voorberg et al. 2013). To incentivise
innovation at a local level, healthcare leaders can use mechanisms to assess how
healthcare users value and perceive innovations. Value co-creation adds to the
co-production literature using a different and yet similar lens to view the integration
of resources between the organisation and the ‘customer’. Customers are an impor-
tant source of information for an organisation as they learn while using a product
or service. A small number of empirical studies have explored co-creation in health
looking at value co-creation of services in delivering community-based aged care,
combining complementary therapies and co-creation of learning in healthcare prac-
tice, as well as value co-creation styles in cancer services (Hardyman et al. 2015).
Leaders, managers and policy-makers in healthcare promulgate person-centred
leadership at the front line. However, they need to achieve this by supporting
promising practice to drive change rather than imposing processes from above
(Essén and Lindblad 2013). Many health professionals are interested in a demo-
cratic governance model that allows them to lead from the front line in terms of
practice-driven change, in teams with their colleagues, in a strong supportive
environment and with multi-stakeholder participation.

Harnessing health professionals’ creativity through leadership

Creativity and innovation by their very nature require time, resources and
engagement. In the wider business and technology sector, much has been written
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182 Vivienne Byers

about developing employees’ creativity (Amabile et al. 1996; Amabile 1997;

Coelho et al. 2011). How can health professionals’ creativity be harnessed? Those
delivering services on the front line are busy people coping with high demand,
increasing patient expectations and in situations with limited resources and sup-
port. They have valuable skill sets, experience and training that can feed in to the
creative and innovative process. They require support and a positive work cli-
mate and culture to change routines, to innovate, to collaborate and then make
health service innovations work (Tierney et al. 1999). According to Amabile
(1997), creativity is a function of three components within every individual:
expertise, creative thinking skills, and motivation. Expertise encompasses the
individual’s ability, knowledge and proficiency in their field. Creative thinking
skills encompass the ability to use analogy and see problems in a different way,
and then there is the motivation of the individual. Leaders and managers can influ-
ence these individual components and motivation in particular, through work-
place practices and conditions. Mumford et al. (2002) point out that creative people
by their very nature tend to be intrinsically motivated. They pose the question
about whether creative people require leadership at all, but their literature review
indicates that it requires a skilled leader employing a number of direct and indirect
influence tactics commensurate with their employee needs. The challenge from a
leadership perspective is to channel employee creativity by creating conditions to
focus the individual on the task at hand and structure the exercise. This must be
balanced by not allowing a top leadership vision to prevent individuals from form-
ing their own unique ideas. Leadership needs to be nuanced and multi-level with
allowance for autonomy, and yet the positive influence through sharing of exper-
tise. Leadership also needs to buffer pressures such as workload stress and pro-
vide adequate resources. Drawing on Mumford et al.’s (2002) work, the following
outlines how leaders can create a culture that enhances creativity, through:
1 Providing direction and inducing structure where there is little, as creative
efforts present novel, ill-defined tasks.
2 Not relying on position, power and conformity pressure to direct the work, as
creative people value their autonomy, professional focus and intrinsic motivation.
3 Having the requisite technical expertise and creative problem-solving skills in
order to have credibility in drive innovation.
4 Bringing about the engagement needed to stimulate effective work, through
intellectual stimulation and individualised consideration.
5 Framing vision in terms of work goals and articulating this vision through
project selection and project evaluation.
6 Using well-honed planning and sense-making skills as well as social skills;
specifically the leader’s coaching and communication skills.
7 Knowing when, who, and how to persuade.
8 Stimulating and supporting creative efforts through actions on followers. As
well as using indirect influence mechanisms to integrate people’s activities and
ensure the timely production of requisite outputs.
Although many see innovation as occurring at senior levels in healthcare, the
evidence would support that bottom-up innovations occur more frequently in the
public sector (including health) than received wisdom would have us believe
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Creativity, innovation and change 183

(Borins 2002: 475). Borins suggests creating a supportive climate, instituting for-
mal awards and informal recognition for creative innovators and championing
bottom-up innovations. It is important that an organisation’s top leaders create a
climate favourable to innovation.

Challenges to diffusing creativity and innovation in healthcare

Morris et al.’s (2011: 517) detailed review of translating healthcare research into
practice reported time lags with an average of 17 years. Despite compelling evi-
dence, innovations often do not spread. The literature uses the terms diffusion,
dissemination and implementation of innovation to describe the spread, commu-
nication and adoption of innovations. Lomas (1993), taking a communications
perspective, differentiates between the three concepts, describing diffusion as
passive, as it is largely unplanned and uncontrolled; dissemination as more active,
implying a more targeted and tailored approach to delivering the information
from the source to the intended audience; and finally implementation, described
as identifying and overcoming barriers to the use of the knowledge obtained
from a focused message. Much of the recent literature in healthcare uses the term
‘diffusion’ to describe the spread and take-up of innovations (Greenhalgh et al.
2008). It is a looser term allowing for the often messy path that complex bundles
of innovation and creativity take before being adopted. According to Rogers
(2010), the diffusion process has a number of elements which include: (1) the
innovation itself (2) communicated through certain channels (3) over time
(4) among the members of a social system. The attributes of the innovation will
determine the rate of diffusion and include its relative advantage, compatibility,
complexity and observability.

Challenges in the healthcare setting

However, the challenges to diffusing creativity and innovation in healthcare are
many. A crucial challenge is the nature of the healthcare sector itself which is
essentially pluralistic and multi-professional in nature, requiring network build-
ing and persistence to diffuse change (Langley and Denis 2011). Ferlie’s (2005)
study of the non-spread of innovations highlighted the social and cognitive
boundaries between and within the healthcare professions slowed or blocked
innovation uptake. Work by Reay et al. (2013) showed how introducing innova-
tive practices such as an interdisciplinary team approach could be institutional-
ised by managers engaging with professionals at the front line and encouraging
them to try the new practices. They advocated that this was more successful as a
top-down transformation of organisational level ideas into new practices, rather
than allowing development of bottom-up health professional initiatives. Their
position was based on the need to control health professional discretion which
may resist change in their practice. They also note that few studies of practice
innovations show that professionals themselves instigate changes through a
bottom-up process. Their study showed that managers needed to maintain atten-
tion to the ongoing process of transforming ideas into practice and limit interven-
tion focused on justifying the value of new practices. Langley and Denis (2011)
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184 Vivienne Byers

concur that organisational innovations will fail unless they are conceived and
implemented in such a way as to take into account the relevant interests, values
and power relationships.

Paradox in diffusion of healthcare innovation

Dixon-Woods et al. (2011) identify three paradoxes for innovation in healthcare.
The first paradox is that some innovations diffuse rapidly like consumer fads, yet
are unproven in terms of value and may pose possible risks, while other innova-
tions that could potentially be beneficial to patients are slow to achieve uptake.
The second paradox is that cooperative approaches may be the best way of
achieving sustainable innovation, yet too much involvement can inhibit positive
innovation as the collaboration can be undermined by individual or group inter-
ests. The third paradox is that improvement depends upon change, but change
always generates new challenges. For example, quality improvement systems
may struggle to keep up with the pace of innovation, yet their evaluation is usu-
ally too narrowly focused to understand the system-wide effects and unintended
consequences of new practices. Borins (2002) advocates balancing the relation-
ship between political leadership (system level) and the bureaucracy (organisation);
on the other hand, if there is distrust, bottom-up innovation will be stifled and micro-
managed. If the relationship is positive, it will encourage bottom-up innovation and
make the organisation a partner, as the public good requires this partnership.

Sustainability of diffused innovation

Many desired healthcare innovations are not sustained over the long term.
According to Fleiszer et al. (2015), sustainability or the continuity of an innova-
tion stems from three elements: its benefits, routinisation/institutionalisation, and
development. Their literature review suggests there are a number of precondi-
tions to sustainability, which include: the features of the innovation itself; the
context including the setting, situation, or conditions into which the innovation is
implemented; leadership in terms of programme champions and the involvement
of leadership and management and the process itself.
Another perspective on making innovation stick is from the literature using
the concept of positive deviancy. Sternin and Choo (2000: 15) first coined the
phrase ‘the positive deviance approach’. They contended that organisations often
try to innovate by introducing ideas from the external environment which are
subsequently resisted. Their contention was that if you look for the positive devi-
ants in an organisation, those people who are exhibiting different or better levels
of performance, then innovative behaviours or approaches can be identified.
Their work was based on a case study of combating malnutrition through the
‘Save the Children’ campaign, which noted the behaviours of positive deviants
within the community that showed innovative adaptations that were able to stick.
Positive deviants challenge or circumvent existing organisational structures and
institutional set-ups, and promote different approaches to solving seemingly
intractable problems. According to Pritchett (2013), organisations need to be
allowed the freedom to try things outside of existing practices. He notes that
positive deviancy is effective as it is embedded in an iterative process of adaptive
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Creativity, innovation and change 185

learning with incremental innovations being progressively refined within the

organisation. Thus, what is learned from positive deviants becomes horizontally
diffused through communities of practice within and across the organisation
rather than being imposed from the top down.

Benefits of creativity, innovation and change in healthcare

The benefits of creativity and innovation can be seen at a number of levels: indi-
vidual, organisational, as well as system-wide and societal. At the individual
level, creativity is intrinsically motivating (Amabile 1997). At an organisational
level, the social processes in engaging in innovating can be rewarding and har-
ness collective positive energy. Buntin et al.’s (2011) literature review identified
that the majority of recent studies show measurable benefits emerging from the
adoption of health information technology: improving the health of individuals,
the performance of providers, as well as yielding improved quality, cost savings,
and greater patient engagement. Rogers (2010) classifies the consequences of
creativity and innovation as: (1) desirable versus undesirable; (2) direct versus
indirect; and (3) anticipated versus unanticipated. Desirable consequences are
the positive effects of an innovation for an individual or for a social system.
Undesirable consequences are the dysfunctional effects. According to many stud-
ies, health information technology innovation has a lot of positive potential for
systems to enhance communication, coordination, measurement, and decision
support (Thakur et al. 2012). An example of tailored assistive technological inno-
vation is technology-enhanced speech interfaces and devices for assistance with
communication and therapy for those patients with communication difficulties
after brain trauma.

Leadership and innovation strategies for improving

performance in healthcare

Organisations in healthcare and in the wider business environment recognise the

importance of innovation in order to adapt to changes in the environment and to
be more effective. There is a need for innovation both at the organisational and
the individual level. The Canadian Federal Government view innovative change
in healthcare as being led not only from the top but from front-line leaders. The
Health Canada Report (2015) outlines a number of strategies that can be used in
order to develop leadership for healthcare innovation including:
• developing a larger leadership role for physicians due to their range of
experience, knowledge and skills;
• changing the culture, as leaders in the system can be reluctant to confront
those who wish to maintain the status quo;
• taking decisions that are long-term and strategic, rather than short-term and
politicised;
• enabling leaders to play a crucial role in setting the vision and direction for
change;
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186 Vivienne Byers

• rewarding leaders for judicious use of their authority to support the testing
and scaling-up of promising ideas;
• continuing commitment to accelerating bottom-up innovation.
Leadership can play a role in fostering new ideas and creativity and translating
these into innovative products and processes (Slatten and Mehmetoglu 2015).
Earlier sections in the chapter illustrated how creativity and innovation are influ-
enced by leadership that is participative and collaborative (Amabile 1997). West
et al.’s (2003) study provides compelling evidence for the need for leadership in
healthcare, as when healthcare teams lacked an identifiable champion, process
innovation suffered. They concluded this was due in part to the contribution of
leadership in supporting and guiding effective interactions among team mem-
bers.
A recent study by Slatten and Mehmetoglu (2015) examined the effects of
transformational leadership on front-line employee creativity and innovation
behaviour. They used Bass’s (1985) four behavioural dimensions: (1) intellectual
stimulation; (2) charisma or idealised influence; (3) inspirational motivation; and
(4) individualised consideration. They found links between transformational
leadership and employee creativity which influenced innovative behaviour sig-
nificantly. Their findings indicated that these leaders motivated their followers,
increased their engagement and challenged them to adopt innovative approaches.
Apart from encouraging the elements of creativity and innovation, leadership
can play a role in the process of innovation advocacy and implementation. If the
innovation aligns with the goals of both top management and middle manage-
ment and if the leaders are actively involved and frequently consulted, the inno-
vation is more likely to be routinised (Greenhalgh et al. 2004).

Innovation strategies: disruptive and open innovation

Lee and Lansky (2008) note patient-focused improvements in healthcare will only
occur when care provider interests are put second to those of the patient. There-
fore, the system must be disrupted to achieve such innovation. Disruptive innova-
tion emerged in business and put simply, it seeks to challenge current business
models and products by replacing them with more cost-effective or cheaper
alternatives. These are usually introduced by new competitors to the market. The
theory of disruptive innovation, according to Hwang and Christensen (2008),
explains how complicated, expensive products and services are eventually con-
verted into simpler, affordable ones. They use examples from the automobile
industry where Toyota entering the American market introduced less stylish but
cheaper and more efficient cars, and now Korean, Chinese, and Indian automo-
bile manufacturers are disrupting Toyota by doing the same thing. These new
entrants to a market innovate, partly because mature firms are slow to respond.
In their book outlining the application of this theory to healthcare, Christensen
et al. (2009) argue that many of the problems in the sector are the result of complex
bureaucratic structures that require significant resources to administer, which is
directed away from delivering patient care. They also believe that an outdated
business model in healthcare inhibits the development and adoption of technological
solutions, such as electronic patient records, as ‘it’s hard to build a practice
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Creativity, innovation and change 187

around activities for which you’re not paid’ (Christensen et al. 2009: 134). Garrety
et al. (2014) point out that the crucial barrier to disruptive innovation in health-
care is its threat to the personal and professional identities of all those involved,
from consumers to clinicians.
Li et al. (2012) reviewed a number of emerging disruptive innovation studies in
healthcare. Their research, examining the use of ICT by nurses in hospital settings,
found that the increased volume of patient and knowledge-based information and
its easier access freed up nurses to work directly with patients. Another potentially
disruptive innovation is the use of nurse practitioners (NPs) as a new professional
grouping. Other examples of disruptive innovation include the use of telemedi-
cine to allow care delivery in rural areas by less qualified staff, enabling remote
management of patients with support from electronic decision support software
(Pyne et al. 2010).

Open innovation
The term ‘open innovation’ was used by Chesbrough (2006) to describe developing
technological and product innovation through using knowledge and expertise
from sources beyond the organisation itself. It is thus the opposite of ‘closed’
innovation where ideas are generated within the organisation itself, and these
ideas are developed into products to be introduced to the market (Reinhardt et al.
2015). Chesbrough (2006: 1) describes the open innovation process as ‘the use of
purposive inflows and outflows of knowledge to accelerate internal innovation
and to expand markets for external use of innovation, respectively’. He argues
that there is a need for companies to open their innovation process from an eco-
nomic gain perspective. In healthcare, open innovation can involve users of health
services in the innovation process through the designing, developing and validat-
ing of services, products and new technologies in real-life environments. This is a
move away from the traditional view of health professionals as the only experts
in devising, developing and disseminating novel solutions in healthcare.
Bullinger et al. (2012) describe an example of open innovation in healthcare by
the development of an open health information platform through multi-stake-
holder involvement with patients, care-givers, health professionals and the wider
public. They outline an exploratory analysis of an open health platform for rare
diseases. Due to the nature of rare diseases, information is usually limited and not
dispersed. The aim was to link various representatives of the public and to enable
them to cooperatively develop new ideas, products and approaches. The on-line
platform supports knowledge exchange and learning as face-to-face interactions
can be difficult to arrange. Their study provides evidence of the suitability of
open innovation practices to incorporate the general public in healthcare
research, in order to foster both innovation outcomes and support. However,
according to Reinhardt et al. (2015), the open innovation process has a number of
difficulties to contend with in healthcare, as it is a highly complex and controlled
regulatory environment and there is asymmetric information as the health pro-
fessional has increased or superior information compared to users. This differen-
tial in knowledge can have a number of potential outcomes: that the user demands
unnecessary treatments based on social media or anecdotal evidence; that the
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188 Vivienne Byers

health professional overwhelms the user with information and delivers unneces-
sary treatments; or that the health professional does not engage with the user
sufficiently and fails to provide necessary care.

Conclusion

Creativity and innovation are crucial to a responsive organisation in changing

times with pressures from increased global competition, new production tech-
niques, and rapid technological change. Healthcare managers are expected to be
innovative and ‘do more with less’. In this context, creativity and innovation have
contributed many changes in healthcare delivery from technological advances to
pharmaceutical developments, increases in patient engagement, as well as
changes to healthcare systems themselves. Innovations bring healthcare delivery
closer to home and make it more affordable through the use of mobile phones,
smart drug delivery systems, portable diagnostics and digital therapeutics. There
have been many developments in assistive technologies and the connected com-
munity (King’s Fund 2015). Although many variables influence creativity and
innovation in organisational settings, leaders and their behaviour represent a
particularly powerful influence. Healthcare is a complex domain, populated by a
diverse set of groups. However, health professionals seek ways in which they can
lead and be led. They are interested in a democratic governance model that allows
them to lead from the front line in terms of practice-driven innovation, in teams
with their colleagues, within a strong supportive environment and with multi-
stakeholder participation.

Key concepts discussed

• Definitions of creativity and innovation are offered and applied in the healthcare
context.
• The internal and external drivers of innovation and change in healthcare organisations
are outlined.
• It is important to recognise the role of leaders in fostering creative new ideas and
translating these ideas into healthcare innovation.
• One broad area that can change and enhance the quality of healthcare systems is that
of ‘person-centredness’. Health system improvement is best achieved collaboratively,
recognising that patients, families, and caregivers are key drivers of change.
• Empowering healthcare professionals to develop a person-centred approach to delivery
through appropriate organisational support can assist in creativity and innovation in
driving healthcare improvement.
• There is a need to increase clarity around the concept of innovation sustainability in
order to understand how healthcare-related improvements can be more successfully
maintained.

Key readings

Christensen, C.M., Grossman, J.H. and Hwang, J. (2009) The Innovator’s Prescription: A Disrup-
tive Solution for Healthcare. New York: McGraw-Hill.
Copyright Open University Press (or McGraw-Hill Education Ltd)
Not for sharing or download
Creativity, innovation and change 189

This book examines the challenges facing healthcare today and proposes a set of clear,
innovative, and actionable solutions that will both reduce the cost of healthcare and lead
to improved health outcomes.
Denis, J.L. and van Gestel, N. (2015) Leadership and innovation in healthcare governance,
in E. Kuhlmann, R.H. Blank, I.L. Bourgeault and C. Wendt (eds) The Palgrave International
Handbook of Healthcare Policy and Governance. New York: Palgrave Macmillan, pp. 425–42.
This chapter outlines how healthcare systems in high-income countries are under pressure to
develop innovation in healthcare reform through leadership in order to achieve cost control
and high standards of quality and safety.
Fleiszer, A.R., Semenic, S.E., Ritchie, J.A., Richer, M.C. and Denis, J.L. (2015) The sustainability of
healthcare innovations: a concept analysis. Journal of Advanced Nursing, 71(7): 1484–98.
This article provides an interesting view arguing that the focus in research to date has been
on development and implementation of healthcare innovation, rather than on attending to the
under-explored yet very pertinent problem of sustaining these innovations over time.
Verma, J.Y., Rossiter, M., Kirvan, K., Denis, J.L., Samis, S., Phillips, K. and O’Connor, P. (2013)
Going far together: healthcare collaborations for innovation and improvement in Canada.
International Journal of Healthcare Management, 6(2): 66–76.
This article profiles collaborations in association with the Canadian Foundation for Health-
care Improvement (CFHI) which supports healthcare leaders in working together to develop,
share, implement and sustain evidence-informed and systems innovations and solutions. The
focus is on leadership and teams in innovating in the delivery of chronic disease care.

Examples of studies

Fitzgerald, L., Ferlie, E., Wood, M. and Hawkins, C. (2002) Interlocking interactions, the diffusion
of innovations in health care. Human Relations, 55(12): 1429–49.
Hendy, J. and Barlow, J. (2012) The role of the organizational champion in achieving health
system change. Social Science and Medicine, 74(3): 348–55.
Langley, A. and Denis, J.L. (2011) Beyond evidence: the micropolitics of improvement. BMJ
Quality and Safety, 20(suppl. 1): i43–i46.

Useful websites

BMJ Innovations: http://innovations.bmj.com/

Home for research that creates new, cost-effective medical devices, technologies, processes
and systems to improve patient care. The journal is a new endeavour with the All India
Institute of Medical Sciences (AIIMS) and the British Medical Journal, developed in response
to the need for a forum for the publication of medical innovations across all clinical areas of
medicine.
Canadian Foundation for Healthcare Improvement: http://www.cfhi-fcass.ca/
Identifies proven healthcare innovations and accelerates their spread across Canada by sup-
porting healthcare organisations to adapt, implement and measure improvements in patient
care, population health and value-for-money.
Eurostat Community Innovation Survey (CIS): http://ec.europa.eu/eurostat/statistics-explained/
index.php/Glossary:Community_innovation_survey_%28CIS%; King’s Fund: https://www.kingsfund.
org.uk/reports/thefutureisnow/
Identifies and reports on current innovations in healthcare with illustrative case studies.
Copyright Open University Press (or McGraw-Hill Education Ltd)
Not for sharing or download
190 Vivienne Byers

NHS England; Health and Care Innovation Expo: https://www.england.nhs.uk/expo/

Health and Care Innovation Expo is a unique annual event that showcases innovation in
healthcare and celebrates the people who are changing the NHS.
NHS Leadership Academy: http://www.leadershipacademy.nhs.uk/resources/
http://www.leadershipacademy.nhs.uk/blog/the-meaning-of-innovation/
Developing better leaders to develop innovation and better care.
WATCH (WearAble TeCHnology in Healthcare) Society: http://www.watch-society.com/
Brings together health experts, care professionals, developers, software and hardware man-
ufacturers of portable technology to form a melting pot of innovation and collaboration, with
the object to research and validate the development of portable technology for healthcare
professionals and patients, and where possible to improve and support this object by spreading
knowledge and insights gained worldwide.

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