NHS Health Authority puts Edward de Bono creative thinking at the heart of community healthcare
The Birmingham and Black Country Strategic Health Authority was to co-ordinate a public and professional consultation process in conjunction with the Black Country Hospital Trusts and Primary Care Trusts to plan the expenditure of up to £500 million on hospital services in the region. The Strategic Health Authority was keen to encourage the development of innovative ideas in order to address some of the challenging problems facing health services in the Black Country. The Holst Group was tasked to help manage the exercise.The result was an example of public consultation on a grand scale. A series of creative thinking seminars generated nearly 2,000 useable ideas from more than 500 people – all in just under a week. The process not only enabled a genuine consultation of community stakeholders but also helped professional groups within the NHS to work together to overcome traditional departmental barriers. Ultimately, the consultation served to refocus the review and the potential future spend on hospital services.
The Challenge
In August 2003, the world’s leading creative thinking guru Edward de Bono addressed a national conference for senior executives in the National Health Service, to introduce creative techniques which might help generate new ways of thinking.
The Birmingham and Black Country Strategic Health Authority subsequently approached The Holst Group, which represents Edward de Bono in Europe, for help in running a major public consultation process. The Authority wanted to involve a crosssection of the community and NHS professions in a review of hospital services across the region, and get radical new ideas on how best to spend their budget. The objective was to establish a long-term vision for standards of healthcare in the region, and to develop models of service across five key areas (Children, Specialised, Elderly, Elective/Diagnostics and Urgent/Emergency).
Within the National Health Service a determination to ‘keep the NHS local’ meant engaging the public and patients throughout the decision-making process - not just at the final ideas stage. The greatest challenge was to organise the
consultation to gather these many different perspectives in a meaningful way, rather than generating a series of frustrating ‘talking shop’ sessions. In reality, this required full participation from mixed groups covering the whole
spectrum of the NHS. It meant overcoming departmental barriers within the NHS to enable different professions to work together and engaging individuals and groups in the wider community, all of whom had very different perspectives.
The consultation process also had a huge scope in terms of reviewing both hospital services and the interface between these services and primary care in the community.
The Solution
The Holst Group set an objective to effectively consult over 500 people in groups of 100 across a one-week period. Five one-day seminars were set up, with each session of up to 100 attendees split into groups of 8, comprising a mix of professions and stakeholders. These included patients and patients’ representatives, surgeons, nurses, support teams, healthcare trust managers and administrators. The Holst Group worked with the SHA on the questions to be posed to each group to ensure they opened up the greatest potential for new ideas.
Success depended on participants feeling comfortable, valued and able to contribute. With help from Holst, the SHA organised pre-briefing sessions to introduce participants to the creative thinking techniques to be used. Key players in the SHA, and ‘table leaders’ nominated to facilitate each group, were trained more fully. Patients, many of whom might be unfamiliar and uncomfortable with this type of environment, were also given introductory training in the techniques and the process.
Each of the one-day seminars involved initial scene-setting by leading experts to open up the issues for consideration and avoid presenting immediate solutions. This typically took the form of an introduction from the Chief Executive of a healthcare trust, high level background information (e.g. demographics, journey-to-hospital times, medical data about the Black Country population), and inputs from visiting speakers prominent in their field.
Dr. de Bono’s Six Thinking Hats™ encourages participants to ‘think in parallel’ to overcome the problem that people tend to think ‘across’ each other when coming up with ideas as a group. Six Hats focuses on generating all the ideas first without criticism or justification, and then using each mode of thinking (imagined as colour-coded hats) to develop and evaluate them.
For example, the Yellow Hat helps to determine the benefits, the Red Hat identifies a gut feeling, etc.
A second creative thinking technique was the Lateral Thinking™ tool, Random Word. This selects one word at random from a list and uses that word as a basis to generate fresh ideas linked to the topic under discussion. This stimulates a
group to think in new ways andgenerate many more ideas.
With a range of ideas generated from these initial sessions, the challenge was to assess, select and develop the ideas with greatest potential, again using the Six Thinking Hats technique. Throughout, participants were given as many opportunities aspossible to express their ideas.
For example, blank ‘My Idea’ cards enabled participants to record ideas which might not have been relevant to the current discussion but which could be assessed later. More than 150 separate ideas were generated in this way, and every
idea was reviewed and evaluated.
All ideas that had been developed and proposed were posted on the Black Country Review website overnight as part of the project’s process of open communication.
Results
The most significant, and unexpected, result of theconsultation process was the substantial change of focus it created for the review. What began as a review of how to spend money on hospital-based services now shifted focus to how to co-ordinate services between the hospitals and the community.
This refocused on providing a system that works for both and generates models of care based in the community, rather than viewing the hospitals in isolation. This shift in emphasis was dramatic and highly productive. It came from the combination of gaining information on how services were currently performing and encouraging NHS staff and the public to think differently. Many ideas were generated on their priorities and how things could work better, using the creative thinking techniques.
Another result was to break downthe traditional boundaries between professionals within the NHS and promote networking and co-operation, and to enable patients and professionals to share ideas constructively with each other.
The SHA and the Holst Group achieved their main objective of creating a process which would help all the stakeholders contribute and ensure that their input was heard. Nearly 2000 ideas were generated over the week-long period. Rather than just remaining ideas, use of de Bono’s Six Hats techniques enabled them to be managed and assessed to impact on the decision-making process.
The Six Thinking Hats technique was used for the end-of-session plenary reviews. Together with feedback from the post-event analysis this showed that the vast majority of participants felt they had been able to express their thoughts throughout. Most importantly they felt that all perspectives had been given and valued, rather than just the dominant opinion. There were frequent references to ‘openness’, ‘co-operation’ and ‘involvement’.
The ideas that were produced across the five seminars have subsequently been developed by the SHA with the Hospital Trusts and Primary Care Trusts in the Black Country into models of care that will become the basis for the provision of services into the future. The review report on the outcomes of the seminars and the subsequent recommendations for future healthcare in the Black Country has now been published.
In August 2003, the world’s leading creative thinking guru Edward de Bono addressed a national conference for senior executives in the National Health Service, to introduce creative techniques which might help generate new ways of thinking.
The Birmingham and Black Country Strategic Health Authority subsequently approached The Holst Group, which represents Edward de Bono in Europe, for help in running a major public consultation process. The Authority wanted to involve a crosssection of the community and NHS professions in a review of hospital services across the region, and get radical new ideas on how best to spend their budget. The objective was to establish a long-term vision for standards of healthcare in the region, and to develop models of service across five key areas (Children, Specialised, Elderly, Elective/Diagnostics and Urgent/Emergency).
Within the National Health Service a determination to ‘keep the NHS local’ meant engaging the public and patients throughout the decision-making process - not just at the final ideas stage. The greatest challenge was to organise the
consultation to gather these many different perspectives in a meaningful way, rather than generating a series of frustrating ‘talking shop’ sessions. In reality, this required full participation from mixed groups covering the whole
spectrum of the NHS. It meant overcoming departmental barriers within the NHS to enable different professions to work together and engaging individuals and groups in the wider community, all of whom had very different perspectives.
The consultation process also had a huge scope in terms of reviewing both hospital services and the interface between these services and primary care in the community.
The Solution
The Holst Group set an objective to effectively consult over 500 people in groups of 100 across a one-week period. Five one-day seminars were set up, with each session of up to 100 attendees split into groups of 8, comprising a mix of professions and stakeholders. These included patients and patients’ representatives, surgeons, nurses, support teams, healthcare trust managers and administrators. The Holst Group worked with the SHA on the questions to be posed to each group to ensure they opened up the greatest potential for new ideas.
Success depended on participants feeling comfortable, valued and able to contribute. With help from Holst, the SHA organised pre-briefing sessions to introduce participants to the creative thinking techniques to be used. Key players in the SHA, and ‘table leaders’ nominated to facilitate each group, were trained more fully. Patients, many of whom might be unfamiliar and uncomfortable with this type of environment, were also given introductory training in the techniques and the process.
Each of the one-day seminars involved initial scene-setting by leading experts to open up the issues for consideration and avoid presenting immediate solutions. This typically took the form of an introduction from the Chief Executive of a healthcare trust, high level background information (e.g. demographics, journey-to-hospital times, medical data about the Black Country population), and inputs from visiting speakers prominent in their field.
Dr. de Bono’s Six Thinking Hats™ encourages participants to ‘think in parallel’ to overcome the problem that people tend to think ‘across’ each other when coming up with ideas as a group. Six Hats focuses on generating all the ideas first without criticism or justification, and then using each mode of thinking (imagined as colour-coded hats) to develop and evaluate them.
For example, the Yellow Hat helps to determine the benefits, the Red Hat identifies a gut feeling, etc.
A second creative thinking technique was the Lateral Thinking™ tool, Random Word. This selects one word at random from a list and uses that word as a basis to generate fresh ideas linked to the topic under discussion. This stimulates a
group to think in new ways andgenerate many more ideas.
With a range of ideas generated from these initial sessions, the challenge was to assess, select and develop the ideas with greatest potential, again using the Six Thinking Hats technique. Throughout, participants were given as many opportunities aspossible to express their ideas.
For example, blank ‘My Idea’ cards enabled participants to record ideas which might not have been relevant to the current discussion but which could be assessed later. More than 150 separate ideas were generated in this way, and every
idea was reviewed and evaluated.
All ideas that had been developed and proposed were posted on the Black Country Review website overnight as part of the project’s process of open communication.
Results
The most significant, and unexpected, result of theconsultation process was the substantial change of focus it created for the review. What began as a review of how to spend money on hospital-based services now shifted focus to how to co-ordinate services between the hospitals and the community.
This refocused on providing a system that works for both and generates models of care based in the community, rather than viewing the hospitals in isolation. This shift in emphasis was dramatic and highly productive. It came from the combination of gaining information on how services were currently performing and encouraging NHS staff and the public to think differently. Many ideas were generated on their priorities and how things could work better, using the creative thinking techniques.
Another result was to break downthe traditional boundaries between professionals within the NHS and promote networking and co-operation, and to enable patients and professionals to share ideas constructively with each other.
The SHA and the Holst Group achieved their main objective of creating a process which would help all the stakeholders contribute and ensure that their input was heard. Nearly 2000 ideas were generated over the week-long period. Rather than just remaining ideas, use of de Bono’s Six Hats techniques enabled them to be managed and assessed to impact on the decision-making process.
The Six Thinking Hats technique was used for the end-of-session plenary reviews. Together with feedback from the post-event analysis this showed that the vast majority of participants felt they had been able to express their thoughts throughout. Most importantly they felt that all perspectives had been given and valued, rather than just the dominant opinion. There were frequent references to ‘openness’, ‘co-operation’ and ‘involvement’.
The ideas that were produced across the five seminars have subsequently been developed by the SHA with the Hospital Trusts and Primary Care Trusts in the Black Country into models of care that will become the basis for the provision of services into the future. The review report on the outcomes of the seminars and the subsequent recommendations for future healthcare in the Black Country has now been published.
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