Gill South: Think outside the box? Real change means going much further

RIGHT now, there are, no doubt, teams of aeronautical engineers all over the world working on ways to help aircraft cope with airborne volcanic ash.

They should forget about thinking outside the box; Harvard Business School Professor Rosabeth Moss Kanter believes organisations facing big problems should try thinking outside the building.

In her recent Harvard Business Review article, "Think outside the Building", Professor Moss Kanter urges leaders to focus on impact, not inputs.

And in light of some current severe systemic failures - the financial crisis, problems in the health system, and climate change - she says new ideas are required which are more than simply thinking outside the box.

"The greatest future breakthroughs will come from leaders who encourage thinking outside a whole building full of boxes."

Her criticism is that "inside-the- building" thinkers take industry structures for granted and can't imagine life without them. Their focus is on "enhancing the use of existing capabilities rather than developing new solutions to emerging problems".

Even small steps outside the building can facilitate productive change, she says.

For example, some technology companies have put their engineers in customers' facilities, so they can act promptly on prototyping new products.

And former Procter & Gamble chief executive Alan G. Lafley told employees to identify consumers' needs by going and living in other people's homes.

Dr Lester Levy, chairman of the Waitemata District Health Board and head of the NZ Leadership Institute, is trying to encourage innovation in business and health.

"What Rosabeth Moss Kanter is saying is that our so-called capacity for innovation is pretty limited and that most decision makers and managers are really remote from contact. Often the information they get is [flawed]," he says.

On his leadership courses, Levy talks to business leaders about creative change. "It's about giving up power, revenue streams," he tells them.

"You don't have to live in a loft and wear a beret to be creative."

A sense of urgency is important, he says, and innovation also requires experimentation and risk taking.

"It's about a mindset change."

If any industry needs to think outside the building, he says, it's health.

Traditionally, the healthcare system's problems have been seen in terms of the workforce - not enough nurses and doctors - but now, says Levy, the need is to ask how we can change the work that nurses and doctors do.

Concerned about facilities for the growing population of older people, the chairman has introduced the Special Services for Older Adults (SSOA) framework at the Waitemata DHB.

The SSOA model will integrate and streamline services and facilities for older people.

"For us, this means 'one point of entry' to all specialist services for older adults, a higher number of older patients with multi-system problems moved directly to SSOA beds from community or emergency care, reduced time spent in emergency care, effective and achievable outreach programmes, a specialised inpatient area for stroke, dementia and delirium and a co-ordinated approach to discharge planning."

Another health expert looking for some creative solutions and a culture change in medicine is Professor Des Gorman, head of the University of Auckland School of Medicine and executive chairman of Health Workforce NZ.

There is a certain urgency about his challenge - the health demands of the New Zealand population are going to double in the next decade, he says.

"How do we meet the doubled demand? By doing things differently," he says. "The mandate is not soft, it's a hard one."

And, he adds, if it's not disruptive, it's not innovative. The reform has to be informed and intelligent, he adds - you can't be guessing.

Gorman has insisted to the Government that clinicians should lead the systemic change - not the chief executives and managers of health services. Without the clinicians' buy-in, the CEOs have nothing, is his argument. They won't change their behaviour unless they are convinced of the idea. And the clinicians have plenty of ideas as to how the system should be changed.

"They have ideas. It's how we recognise them and how we support them."

One idea Gorman is keen to trial is the "practice assistant", someone who can leave the surgeon to do their surgery and diagnosis, the nurse to do their nursing, and do the jobs they don't need to do but are necessary to keep the hospital running.

Historically, nurses have done this kind of job on top of their own usual duties, but that does not make good use of their nursing skills, says Gorman.

A benefit to the business is always going to help sell a solution to a problem. In the case of that other systemic failure, climate change, there must be a change of thinking, a "reframing of the discourse," says Barry Coates, executive director of Oxfam NZ and an executive committee member of the international group Global Campaign for Climate Action.

At the Copenhagen summit, one of the main discussion topics was the need to change the way people think about climate change, says Coates. "That it is not only a threat, it is potentially the greatest opportunity in generations," he says.

This way of thinking has been backed by businesspeople such as Phillip Mills, chairman of the Les Mills Group, and Warehouse founder Stephen Tindall.

Another result of the Copenhagen summit was that disparate groups joined forces.

"People have started to come together from different perspectives - churches, trade unions, progressive business groups, scientists," says Coates. "A lot of leadership is now coming from dispersed places. I don't think that Al Gore is going to lead us into the future - it's a diffuse leadership."

In the case of climate change, scientists are not lost for technological solutions, he says. The challenge for climate change groups is more about getting the politics and the economics right.

Once these are addressed, the technology can be deployed. "On the economic side it's about understanding the potential opportunities and not just the risk."