I first got an inkling that I’d got it all wrong about innovation and design when I was lying in a hospital bed in April 2020.

It was during the first COVID-19 outbreak, when many suspected the NHS would collapse under the pressure.

I’d been admitted to a non COVID ward for emergency surgery. For over two weeks I got to see first hand what it looks like when bureaucracy starts to thaw.

  • Nursing staff started to openly question practices that they deemed non-value adding. They did their own thing based upon team prioritisation.
  • Cleaning staff changed their schedule around what mattered to the patient.
  • Senior clinicians mocked top down edicts that bore no relation to what they were seeing on the ground. Instead they used common sense and professional knowledge.

I got to know the staff pretty well. They told me that – outside of the COVID wards – things were working well. Without any management initiatives and interference things were already working better than under the previous NHS command and control.

Evidence suggests that the NHS frontline demonstrated significant innovation and creativity during the COVID-19 lockdowns. This was facilitated by a temporary loosening of usual rules and a sense of urgency.

The pandemic demanded swift and novel solutions to unprecedented challenges. Staff had to quickly adapt care delivery models, manage resources in new ways, and find solutions to protect themselves and patients.

The urgency of the crisis led to a temporary suspension or streamlining of some bureaucratic processes and regulations. This “unfreezing” of bureaucracy allowed for more agile and experimental approaches to service delivery.

Frontline workers had greater autonomy to make decisions and implement changes at a local level to respond effectively to immediate needs.  

The unfreezing of bureaucracy during times of crisis, like the COVID-19 pandemic, was observed in various other sectors beyond healthcare. The urgency and need for rapid solutions often led to similar adaptations.

Many government services rapidly adopted digital platforms for service delivery, sometimes bypassing usual procurement protocols in the short term.

The need to respond to the multifaceted crisis fostered increased collaboration and information sharing between different government agencies. This broke down traditional silos.  

Some regulations were temporarily eased or adapted to facilitate essential services and economic activity. For instance, rules around outdoor dining for restaurants or delivery services were often fast-tracked.

The thaw of bureaucracy didn’t last though.

Five years later most of the command and control measures are back in place.

Many of the pandemic-era adaptations were implemented as temporary fixes rather than fundamental shifts in organisational design or culture. Without formalising these changes in policies, processes, and training, they were vulnerable to being rolled back.

Bureaucracy has re-frozen.

And this is what I got wrong about innovation and design.

I used to think that innovation was something to be managed, with an idea generation phase, followed by a selection process, followed by a test and learn approach.

However all these ‘pipeline’ approaches do is support the existing system. The management may select the ‘best ideas’ but the management also maintain and control the system. The ideas that threaten the system get weeded out.

This will prioritise incremental improvements and operational efficiency within already established frameworks, rather than driving radical, systemic change. Managers will always choose to optimise what already seems to work rather than envisioning entirely new ways of delivering value.

The most effective way to innovate is to create conditions where the bureaucracy starts to thaw, and the system is updated to prevent it becoming refrozen.

This is best achieved through fundamental organisational redesign, and the enabling of people to become the innovators themselves. This is more gently disruptive that being beholden to a innovation approach managed by the managers.

Teams that are enabled to solve problems without interference thaw bureaucracy because decision-making becomes decentralised.

This fosters responsiveness and reduces reliance on any central control. Collaboration is enhanced as local partnerships and cross-functional teams break down traditional silos. Increased agility and adaptability arise from the ability to tailor solutions to specific local contexts and iterate rapidly based on feedback.

Life becomes better.

Top-down control misses what locals know.

Real change starts on the ground, with real-life experience driving new ideas. We unlock powerful, lasting progress when we support bottom-up innovation, instead of relying on sterile, centralised commands and controls.


Image by Annette Meyer from Pixabay

Paul Taylor Avatar

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7 responses to “What I Got Wrong About Innovation and Design”

  1.  Avatar
    Anonymous

    Thanks Paul. A highly relevant account of the insight into why organisations, especially the public sector, must include in their transformation methods if they wish to truly innovate. This article highlights why, when we attempt to develop new ways of working, they almost always get attacked by ‘antibodies’ of the current organisation. The new prototypes stall, and eventually wither.

    I have been working with a group of people that have been developing new ways of designing public sector services. The results have been staggering. But the sustainability and growth of this way of working is often curtained after 2-3 years. We have spent much time researching why, and the results of that research mirror those described here.

    ” Managers will always choose to optimise what already seems to work rather than envisioning entirely new ways of delivering value.”

    Is it those that control and design the current organisations that decide what is acceptable to change and the design. If the new design of the prototypes does not fall in line with their current thinking, and principles of how the work should be, then they water down that innovation, or reject it.

    We have learned to use approaches to change that mitigate this, and bring the leadership along with the change.

    So, for those of us working with test and learn, innovation, new ways of working in the public sector and the NHS. It is essential to have a change methodology that achieves this.

    1. Paul Taylor Avatar

      Interesting. Is that research available to share?

  2. johnm Avatar
    johnm

    Paul, thats a really important article, the topic which I was thinking about writing! Thanks for writing it.

    John Mortimer >

    1. Paul Taylor Avatar

      Thanks John. Been meaning to put it down for some time

  3. WhatsthePONT Avatar

    Hello Paul,
    You’ve hit the nail on the head.
    A few observations.
    1. During a stay in hospital way back in 2011 I was struck by the overwhelming amount of ‘improvementitis’ going on. I had plenty of time hanging around waiting for things to happen so I used to scan notice boards. The ones aimed at staff were overwhelming. So many initiatives, so many instructions, so many measures. Generally Forest of things to do. Quite often overlapping (literally) or stuck on top of each other.
    It’s hardly a surprise people feel overwhelmed and keep their heads down.
    2. The unfreeze and refreeze of regulation around COVID is something I can relate to.
    What used to amaze me was the utterly blank stare on the faces of improvementologists I used to get when I said something along the lines of, ‘we were at our most innovative during the first six months of COVID’. It felt like absolutely speaking a heresy. And we are back where they wanted to be now. Properly regulated.
    3. Silly Rules. This has just come back to the top of my list to write about. https://www.llaiswales.org/silly-rules
    It’s an exercise by Llais , the Patient Voice people in Wales, to help people tackle ‘silly rules’ that plague everyday operations.
    I think there’s a link to what you’ve spoken about in the post.
    The people who know the job being trusted to make small changes to do the right thing.
    I’ll write it up this week.
    Now I’ve got the Camino out of my system (for a while).
    Great post.
    Chris

    1. Paul Taylor Avatar

      You must do the Silly Rules post! Love that so much.

      I need to do a post expanding on this as I think it relates to your post about Harvard Business Review and whether they got it wrong on leadership. They idealise leaders as people who love change and are dynamic. Leaders are great the problem is that some people resist their change (or more likely, their bulllshit). I find in reality many leaders favour standardisation for predictability, control, and efficiency. They might like change but it’s change on their terms and their pace.

      At Bromford Flagship we have a real challenge with our place-based working model to push through – moving away from one size fits all means goodbye to standardisation.

      The initial COVID-19 response exemplified this default preference: urgency forced a “thaw” in bureaucracy, enabling rapid, creative solutions. However, as the crisis recedes, the inherent preference for standardisation often leads to a “refreeze,” re-establishing control but potentially limiting future agility and emergent creativity.

  4. […] Paul Taylor who prompted this post talks about his own hospital mystery shopping in, What I Got Wrong About Innovation and Design. […]

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