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ISQua Fellowship Forum

Leadership and Innovation

Phil Hassen, President of the Canadian Network for International Surgery; ISQua Fellowship Forum Moderator.


June 2016

Leaders --- whether in a formal or informal role require a set of skills, attitudes and behaviors to develop an organizations capacity to innovate and improve. The ability to innovate and to continuously improve quality and safety are keys to addressing the multitude of healthcare issues, changing demands and needs of patients, families and community served. 

For innovation to be realized a healthy workplace culture is foundationally characterized by participative leadership, creative problem-solving, collaboration, an overarching respect for diversity of thought, along with the acceptance of conflict, and realization that failure is an opportunity to learn. Successful innovation involves both a philosophy of leadership as well as a set of tools and methods. In a previous Forum, I presented the five best practices of exemplary leadership as researched by J. Kouzes and B. Posner. (Source:
The Leadership Challenge. 4th Edition 2007). These best leadership practices and associated commitments summarized below describe the kind of leadership foundational to creating a culture where innovation and improvement in care and service thrive. 



Model the Way

  1. Clarify values by finding your voice and affirming shared ideals
  2. Set the example by aligning actions with shared values

Inspire a Shared Vision

  1. Envision the future by imagining exciting and ennobling possibilities
  2. Enlist others in a common vision by appealing to shared aspirations

Challenge the Process

  1. Search for opportunities by seizing the initiative and by looking outward for innovative ways to improve
  2. Experiment and take risks by constantly generating small wins and learning from experience

Enable Others to Act

  1. Foster collaboration by building trust and facilitating relationships
  2. Strengthen others by increasing self-determination and developing competence

Encourage the Heart

  1. Recognize contributions by showing appreciation for individual excellence
  2. Celebrate the values and victories by creating a spirit of community

A leader committed to both innovation and improvement employs these five practices rather than more "traditional command and control" approaches to leadership and decision-making. In the February 2016 Forum, I discussed how there are different decision-making methods and each is beneficial for certain times or circumstances.  As I reflect on my own leadership experiences in a variety of health care organizations, I recognize the challenge and the opportunity associated with employing different decision-making approaches. In the context of today's organizations striving to innovate I suggest that more facilitative leadership approaches are most effective.

In order to better understand innovation, let us define it as creating new and novel ideas to improve patient care or the supports for patient care, and the means to make them operational. Usually innovation progresses through stages as described below:

  • Idea Generation: Define the kind of innovation that improves quality and safety and helps meet strategic goals and objectives. Look outward as well as inward for ideas.
  • Communication and Learning: Teach the tools and methods of innovation, and ensure that innovation is part of regular meetings of leaders, staff and managers.
  • Implement the Innovation(s) and Conduct Evaluation(s): Set performance measures, timelines and key targets for the innovation being advanced. Include regular times when reviews are done in order ensure progress is being made.

    (Excerpts from Joanna Barsh, Marla Capozzi and Jonathan Davidson – McKinsey Quarterly; Jan. 2008)

To generate new ideas means giving others “degrees of freedom” to think differently, to question and look for alternative ways to meet organizational goals and objectives including the provision of the best possible care and services to patients. Excellence in leadership ensures that there are mechanisms to evaluate change and regular assessment of the benefits and negative consequences of implementing innovative ideas. Leaders strengthen others and develop their capacity for innovation and improvement while at the same time demonstrate trust in other people's ideas

Moreover leaders promote a culture that realizes many good ideas come from front line staff. In one organization I led, I knew we were succeeding when staff and managers were working together - often innovatively improving performance without getting explicit approval – they clearly understood the vision, values and parameters that guided the organization, and were focused on improving patient safety and care.

Innovative leaders are forward looking and excel in providing and communicating a vision for the future of the organization. When patients and those served (as well as those serving) are at the centre of the vision and with engaged staff then stretch goals are achieved and remarkable improvements in processes and outcomes can be made. With innovation there is risk --- with risk people may fail.

Importantly leaders in pursuit of innovation engage diverse professionals and search for future trends within and outside of health that will influence how work and care gets done. Prospecting trends in fields such as business, aviation, environment, manufacturing, technology, food and agriculture may generate new and novel ideas to improve care and service. By way of an example, can you imagine the implications to health care with the progress being made in the use of solar energy worldwide and with the continued dramatic reduction in cost associated with delivering solar power? Imagine what is possible for population health when electricity becomes cheaper and anyone can have as much clean water as wanted, for minimal costs.

There are a variety of models and useful methods which can be learned to promote diverse thinking.  When I was CE0 of a large health care organization our Educational Services team introduced a model for improvement from the Health Care Improvement (IHI) and specifically promoted the "Plan-Do-Study-Act Cycle" for improvement (Source: Langley, Nolan, Nolan & Provost, The Improvement Guide, 1996). All managers and vast majority of staff were taught this model and it was extremely helpful in generating new and novel ideas and effecting both incremental and innovative change. Use of a model for improvement combined with  creative thinking tools such as the "Six Thinking Hats" as described in the work of Dr. Edward DeBono successfully assisted people in looking at a problem/issue from different viewpoints, generating ideas and accelerated both innovation and improvement in care and safety.

Undoubtedly, innovation in health care and services is very challenging. People are not always eager to create new processes – in fact, some people are discouraged to identify new ways of thinking and others are directed to carry on with the way things have always been done. As described in the January 2015 ISQua Forum on "Understanding and Resolving Conflict", I explained how leaders do not avoid conflict but appreciate how constructive differences can generate new ideas.

Successful innovation in health care organizations requires a combination of leadership skills and behaviors. Creating a culture of innovation involves a respect for constructive differences about how to achieve better processes and outcomes combined with resilience in the face of setbacks can lead to creative solutions to problems. 

In closing this Forum, and as you consider these ideas, think about leading innovation and leadership from this perspective: 

"Leading innovation is not about getting people to follow you into the future; it is about getting people to co-create it with you."

Linda A. Hill, Harvard Business School





Discussion Questions 

1. Why is innovation important focus for you as a leader or staff?

2. Have you been involved in creating or implementing what you view as any innovative improvements in patient care and safety? If so, please describe.

3. Given your experiences what have you seen to be some of the obstacles to innovation? What are some reasons leaders are reluctant to promote innovation in care and services?

4. Building a culture of innovation is challenging. In your role, of leading innovation or influencing leaders to innovate, what might be a next step for your organization?

5. What are some of the innovation trends happening in other fields such as business, aviation, environment, manufacturing, technology, food and agriculture and consider the implications for innovation and improvement in health care and services. What one trend comes to mind?

6. Does this Forum in any way, make you rethink your approach to leadership and innovation? If so, in what way?


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