Are you an innovative leader? Innovative leaders create "the conditions or context for innovation to occur" (Malloch, 2010). Innovation is one of the buzzwords in healthcare these days. Healthcare systems, pharmaceutical companies, and the Centers for Medicare and Medicaid Services (CMS) all have Directors of Innovation and Innovation Centers. In January 2016, the Journal of the American Medical Association (JAMA) started a yearlong series on innovations in healthcare delivery (http://jama.jamanetwork.com/article.aspx?articleid=2480464). Although many hospitals and healthcare systems have directors of innovation or innovation centers, there are few home healthcare organizations that have an individual or department dedicated to innovation. Home healthcare leaders often take on the responsibility for creating innovations within their organizations, but they spend their days (and nights) worrying about the bottom line, the next CMS initiative designed to decrease reimbursement, how to cover those 30 home visits tomorrow, and the latest quality issue/complaint. It is unrealistic to expect senior leaders to have time in their day to think about innovation, let alone have the time to innovate. Innovation takes dedicated time; time to gather information from all the stakeholders, investigate the issues, look at all the possible solutions both inside and outside the healthcare arena, and the ability to be comfortable with risk-taking. Innovating home healthcare will be the only way home healthcare survives in this age of cost-cutting by CMS, new regulations, and a dwindling clinician pool. 21st Century home healthcare cannot be delivered the way it has been delivered the past 150 years, and those organizations that create a new vision will be the ones that survive. But innovation is not for the faint of heart and cannot be done half-heartedly. Innovation is "the introduction of something new" (Merriam-Webster, 2015). Innovation requires a willingness to take a long view of the solution. Innovation doesn't happen in one business cycle. It will never be a quick-fix. Innovation is also disruptive to usual and customary operations. Being innovative means that there will be a new product, new process, new "normal"-there is no way an innovation cannot impact current practice (or there would not be a reason for the innovation). Innovation also does not mean 100% success. Part of the innovative process is trial and error, which leads to improvements that will, ultimately, lead to a successful outcome. Change is hard. It is challenging to live with the risks and disruptions that come with innovation.
According to Stefik and Stefik (2006), all innovation is driven in various degrees by two questions: "what is possible?" and "what is needed?" (p. 27). To determine "what is possible?" one must be curious (Stefik & Stefik, p. 42). The ability to be curious allows one to think creatively and creates a willingness to ask hard questions.
As important as the questions, is the willingness of the organization to discover the answers. Hard questions are those for which there exist the real possibility that a change will be required if the question is answered. Often hard questions are thought but not verbalized because no one in the organization wants to be in a position to take action based on the answers to the questions. Gloria Ferraro Donnelly (n.d.) stated that "there is a tendency for a number of nurses to be anti-intellectual" (para. 4). Are nurses really anti-intellectual or are they just afraid to ask the hard questions because of the organization's reaction to individuals who ask hard questions? Or are they resigned to the status quo because when hard questions are raised, their organization has ignored them and "nothing will change so why bother?"
One of the first questions organizational leadership should ask itself is:
1. Are we willing to take action based on the answers to the questions we are asking?Although many will say "Yes, of course," the real answer often is "only if it's not too much work, will not cost too much money, or make us change too much." Organizations will say they want to be innovative but unless an organization is willing to ask hard questions and then find solutions, there is no reason to ask questions-the organizational resolve is not present. However, if an organization is ready to change and be open to innovation to do so, further questions should follow:
2. If we ask a question and the answer is "we don't know" are we willing to invest the time and resources to determine how to find out the answer?
3. If we get answers we don't like are we willing to accept the answers are true or will we deny the reality and ignore the findings or spin them so they don't look "that bad"?
4. Are we willing to devote the time and resources to make the changes needed to get to the answers we want?
5. Are we in a position to make changes based on the findings of our questions?
a. If we are-let's move on.
b. If we aren't-what do we need to do?
6. How long are we willing to take to move our organization in the direction we want to go?
7. Now that we have decided that we are in a position to deal with the questions-what's next?
a. Do we have the bandwidth to work on this ourselves?
b. Do we need outside help?
c. Do we need to develop resources who will focus on innovation on an ongoing basis for our organization?
Most organizations fear that asking one question they do not already know the answer to will lead to other unanswered questions, which will lead to questions that they have the answers to but do not want to deal with, so it is easier to not start the process. An organization ready to identify the true organizational issues and needs, and then find new possibilities, is an organization that is open to creative thinking and innovation. It will be willing to dig deeper to get to the essence of the issue and work its way to a solution. Along the way many questions will be raised and many answers will be given leading to an innovative solution. The final questions are:
1. Are we satisfied with what we have determined to do to solve our problem(s)/move our organization forward?
2. Are we ready to try to implement our plan?
3. What are the next steps?
Most organizations do not have the current infrastructure to work on innovative solutions. If an organization is going to be successful, asking hard questions that lead to innovation and creatively seeking solutions will be an ongoing process. Creating a space for innovation will be needed. Being an innovative leader involves dedicating the time and resources to innovation that will help the organization meet the challenges of delivering home healthcare in the 21st century.
REFERENCES