What is that box we are supposed to think outside of?

The phrase “thinking outside the box” is commonly used by organization leaders to describe everything from innovation, to recontextualizing, to doing anything that changes the status quo or how things happen.

Daniel Weberg, co-author (with Sandra Davidson) of Leadership for Evidence-based Innovation in Nursing and Health Professions, points out that if you think about innovation as something external, as outside of the day-to-day workflow in an organization, then you create yet another silo, a silo of innovation (p.5).

This blog draws heavily on Weberg’s and Davidson’s book, which is compendium of chapters written by leaders across the healthcare system. Weberg has a special connection to ASU’s Edson College of Nursing & Health Innovation: he was the first student to complete his PhD in the college, and his committee included both Tim Porter-O’Grady and Kathy Malloch when they were professors in the innovation side of things. Weberg currently works at Kaiser Permanente as Director of Innovation, and Porter-O’Grady and Malloch are the authors of four chapters in the Leadership book that describe leadership and innovation in organizations and systems.

Weberg’s premise, and that of other experts who contribute chapters to his book, is that evidence utilized by nursing and healthcare comes from hierarchies of randomized control trials and systematic reviews. But moving forward, healthcare will begin to benefit from additional sources of evidence that are outside the structure of the traditional box. Insights in treatment, for example, will be based on output from “big data analytics, wearable technology, and continuous monitoring,” all of which require a different form of analysis and interpretation, beyond what is possible with RCTs.

How should leaders respond to these new sources of evidence? Weberg suggests that leaders will develop ways to translate these new sources of evidence into new ways of clinical decision-making, and that innovation will happen when people involved with innovation are informed on the new body of evidence. Specifically he says, “It is essential that leaders stop thinking that innovation results from an “aha” moment, or from spending a day putting sticky notes on a wall, or from showing up unprepared and uninformed to a brain-storming session (p. 7,9).”

He continues quite starkly, “Cultures of nursing … that are guided by punishment for error, negative attitudes toward young innovators, and the worship of ineffective past practices may lead to stagnated care and worsening quality (49).”

The solution for Weberg is for the creation of a “leadership practice that is shared among employees, where uncertainty is normative, mutual goals are facilitated and innovation behaviors are foundational (p.40).”







Nancy Litterman Howe

Nancy Litterman Howe, M.S., C.E.S. is a cancer survivor and a 4th-year PhD student at Arizona State University, Edson College of Nursing and Health Innovation. As a 2020-2021 National Coalition of Cancer Survivorship (NCCS) Elevate Ambassador, Howe advocates for providing cancer rehabilitation services to people from the point of cancer diagnosis, through treatment, and for the balance of life. Howe lives in Phoenix, AZ. Email address: NancyLHowe@gmail.com

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