May 27, 2020

Episode 16: Bringing more creativity and innovation to the practice of nursing

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Description

On this episode of The Handoff, Dan speaks with Dan Pesut a Professor of Nursing and Population Health and the Director of the Katharine J. Densford International Center for Nursing Leadership at the University of Minnesota. Dan has spent 43 years in academia dedicated to bringing more creativity and innovation to the practice of nursing, and activating nurses to think more about the future. 


During the conversation, he shares advice for how healthcare leaders can foster more creativity in their staff, what kinds of cultures encourage innovation and how to build a creativity mindset in nursing. He also discusses the difference between change and transformation and the roles of both leaders and managers in those respective processes. 


Resources referenced during this episode include: 

Podcast

Transcript

Dan Weberg:
Welcome to the show Dan.

Dan Pesut:
Thank you Dan, great to be here.

Dan Weberg:
Tell us a little bit about your background? You've had a lot of different roles and now you're leading Foresight Leadership at university of Minnesota, including some innovation leadership courses as well. I'd love to hear more about how you got there.

Dan Pesut:
Wow, long and varied history. I'm a product of the army student nurse program way back when in 1975, and then went on active duty in the U.S. Army Nurse Corps for three years. Worked at Brook Army Medical Center burn unit in San Antonio, Texas. Took care of burn patients and that's where I got first interested in the whole notion of self regulation and how people manage difficult and painful, dressing changes and procedures. Did some research on that, after about six months I realized I didn't have the skill I needed or the knowledge because while I did great things with the physiological aspects of burn care, what I observed was most of the patients were suffering from psychological issues about loss and body image and disfigurement and pain. So I went back and got a master's in psych mental health nursing and created the first psychiatric clinical nurse specialist position in the burn unit, at Brook Army Medical Center and really enjoyed that.

Dan Pesut:
In 1978, I got out of the service and went to the university of Michigan and took a faculty position there, teaching psychiatric mental health nursing and realized I liked the academic world and ended up getting into their PhD program in clinical nursing research and graduating in 1984. So people can do the math I'm... my... When I first went there, I teamed up with a great colleague Jean Wood, and we did do a lot of research on postoperative patients and we asked them the question are you aware of things that you do to help yourself feel better or get better? Some people knew exactly what we were talking about, other people said I don't understand the question and then another group said, "I do what the doctors and nurses tell me and as much as I can for myself." So we did a fair amount of research and even developed an instrument called the Carolina self-regulation inventory that catalogs the sorts of self regulation strategies people use in their recovery.

Dan Pesut:
But the eighties was a little bit challenging in that nursing was trying to find its way, and so I was taking a lot of philosophy of science courses in my PhD program trying to do... figure out what to do for a dissertation, and it occurred to me that science and the creating science and nursing science presupposes creativity. It presupposes an ability to think about and ask new and different questions. So I... my dissertation in 1984 the title of it is Metacognition; The Self regulation of Creative Thought and Nursing. I did a pre-test, post-test, a little intervention group with a group of 28 nurses in a small community hospital, giving them very complex challenges and then administering several creativity tests before and after. Lo and behold I discovered that you can make a difference in terms of people's creativity and innovation, fluency, flexibility, originality.

Dan Pesut:
So I went on then to become very interested in how people reason and how they think about their thinking and nursing, and that thread has been with me through time because I then went on to apply some of those learnings and lessons to a clinical reasoning model, and I've written three books on the OPT model of clinical reasoning. OPT, Outcome Present state Tests and worked on that with colleagues at the university of South Carolina and Indiana university and then now here at the university of Minnesota. So I've enjoyed my 43 years in nursing and academic life. I've had a lot of interesting experiences and in 2012 I moved from Indiana university to the university of Minnesota to be the director of the Katharine Jane Densford International Center for Nursing Leadership. She was a remarkable woman, Katharine Densford. She was dean of the school of nursing for 30 years and she always had a foresight thread, and she is known to say at one point in time that nurses need to be two generations ahead of the general public if they're going to lead and serve and make their way in the world.

Dan Pesut:
So a few years back we created the Foresight Leadership future of nursing and health web resource, and are trying to invite and activate nurses to think more about the future and to develop what we call a nursing foresight skills, and so that brings me up to today.

Dan Weberg:
I love it, when I started as a new grad at UCLA my preceptor basically gave me the spirit animal that I had to follow which was MacGyver. So creativity in every moment but not just creativity but like looking at things around you in anticipation of how you could use them to put something that hasn't existed together quickly. So if we ran out of XYZ supply what could you use in the trauma room to actually replicate that or deliver care safely, even if you don't have the supplies. We're seeing that now in the COVID response with people hand-making masks and that type of thing. So that creativity in nursing is such a key skill and so how do you teach that, and what are some practical applications you're seeing as you build the creativity mindset within the nursing workforce?

Dan Pesut:
Well, one of the people on my dissertation committee was Dan Pelz, and he was very interested in scientists and their creativity. I can remember his definition of creativity where novel associations that are useful. I did take a diffusion of innovation course with him way back when and got very much interested in understanding how creativity is taught. Generally in the creativity literature they talk about creative people, the creative process, creative products or creative environments. Each of those has multiple dimensions in terms of some people are more creative than others. They can generate lots of ideas and they're divergent thinkers and they can kind of put these novel associations together in a rapid sort of way, other people are a little more reluctant. Then of course there're all sorts of criteria about what constitutes a creative process. There are all kinds of models and methods and in my dissertation I worked a lot with Don Meichenbaum cognitive behavioral model, and worked with creating a protocol for people to generate creative ideas in terms of fluency, flexibility, originality and elaboration. There are tests for those things, right? The Torrance Tests for Creative Thinking is one of the things that I used.

Dan Pesut:
So there are lots of different models and methods and pneumonic devices to help people generate novel associations that are useful, and so accessing those and teaching those is really I think the way forward. So I've sort of amassed a lot of resources over the years and they call me Doctor Dan the resource man-

Dan Weberg:
I love it.

Dan Pesut:
One of them is that I use all the time now is Liberating Structures. They're small micro processes that are involved with interaction and it was derived from complexity science and the work of the folks at Plexus Institute, which was all about complexity and application of complexity science principles to healthcare and the environment. Interestingly enough there are a lot of futurists that are interested in and design thinkers that are interested in ways to teach creativity. So there's the IDEO group at Stanford and the d.school, and the one I'd like the most though is this fellow from Australia, Jonathan Nadler. He has something called Future We. He's identified five domains and major concepts and then 21 literacies that he thinks people need in order to be creative and to be prepared for the future. The domains are explore, relate, design, deliver and share, and within each of those domains there is a literacy that you can develop. So for example exploration it requires that you have a sense of play, are open-minded, you have some sense of agency and resilience.

Dan Pesut:
The relate domain really requires that you have empathy and a collective mindset and really focused on teamwork and principals, agreed principles about working together. The design of course is all about visioning and it's a creation and not a fix and a set of thinking skills and planning skills that rely on feedback. Then delivery and execution is really all about piloting and rapid prototyping, acquiring and sustaining resources and leadership and using different tools to help you do that and, sharing is about story-building and communication and creating content and sharing and marketing your ideas. There are lots of models out there and we try and teach those here at the University of Minnesota School of Nursing, we have a doctorate of nursing practice in health innovation leadership. It's HIL and then as part of that doctorate of nursing practice people take in the curriculum, we have a post-baccalaureate certificate in health innovation and design and it consists of four courses, 12 credits and it's interprofessional so lots of different people take it.

Dan Pesut:
It's a course that some of the core courses in our DNP program on system's innovation, leadership and people take a course from our center for spirituality and healing here on optimal healing environments. They take a course in our college of design about service delivery design and user design experience, and then they have a practicum where they put together all of their learnings and lessons and build a portfolio of projects and do sort of a self-assessment of competencies that they've learned, competencies that people say are required in terms of leadership and innovation and design and if there are gaps, how do they fill those gaps and master the knowledge, skills and abilities they need to be more creative and innovative.

Dan Weberg:
Yeah. I love that systems view, right? It's creativity is not just a skill set of drawing or hacking things together but it's really this system view and connecting dots to create novel solutions. We have a lot of healthcare leaders listening that are frontline managers or frontline chief nurses. What are some tools they can use every day before they come back and go to the HIL program? But what are some tools they can use on the front lines that foster creativity within their staff?

Dan Pesut:
I would send them immediately to the liberating structures website, www.liberatingstructures.com. There's so many things there that would invite engagement of staff in a new and a different way. One of the tools I think is really powerful is called the 15% Solution. This is enabling and empowering people to identify what they can control and the kinds of things that they can do without asking permission or getting authority, and this comes from the work I think of Gareth Morgan who said, "The reality is that people cannot control 85% of what goes on in their organizations, but they do probably have control of 15%." If you can figure out what your 15% solution is or how you might be able to enact a solution that is within your span of control and within your sphere of influence, it takes some of the overwhelmingness out of being swallowed up by the challenges that sometimes seem insurmountable.

Dan Pesut:
So that'd be one thing and there's lots of other things in there too. 1-2-4-ALL, Wise Crowds, Appreciative Interview, TRIS is another great one and the Liberating Structures I'm a huge fan of those.

Dan Weberg:
Yeah.

Dan Pesut:
Then of course one of the first things I did when I came here to the University of Minnesota is I invited Paul Plsek to come and do a three day workshop for us on innovation, and he's got lots of stuff from his work at Virginia Mason in Seattle about innovation and directed creativity. It's got another great model and a great website that talks about that and he did a lot of research and discovered that we're seven dimensions of the culture that support innovation and I think he's written about this book... in his book, transforming healthcare, the Virginia Mason Experience or something and one of them is risk-taking, giving people psychological support to try something new.

Dan Pesut:
The other which is within the span of control and the 15% probably of most leaders is resources, resources for innovation. Information sharing both tacit and explicit so that people can kind of understand what the challenges are and then being clear about what your outcome is and your targets, your aims or your goals. I really love the work of Chris McGoff and it's another great resource called The Primes and he's got a great video clip there about the difference between change and transformation, and he talks about change as being a fixed and geared towards the past but transformation is all about the future and it's a creation process. So he talks about change as being the work of managers and transformation being the work of leaders, and identifying a desired future and working backwards from the future to create it now as opposed to trying to fix the past.

Dan Pesut:
Then there are a lot of other tools and methods and infrastructure sorts of things that people can put into place if they are future oriented, and not sort of stuck in the present and recognizing people and developing relationships with people of course is key to all of this. When I do futurist work I talk about... one of the first things is become aware of your own personal orientation to time, and your organization's orientation to time. In the late '80s there was an article about The Time Variable of an Organization and I think these people wrote that organizations that are present focused are more interested in efficiency and exploitation as opposed to exploration and learning. Organizations that are past focused are more interested in tradition that works against innovation. Then there's this psychologist Phillip Zimbardo that talks about people's time perspective and he identified at least six.

Dan Pesut:
So some people sought for the past and it could be a positive past or a negative past. Some people sought for the present, it could be a positive present or a dark present and some people sort for the future and that too has a positive than negative spin. So just thinking about and dwelling and knowing what your orientation to time is and where your organization is, enables you to figure out what your 15% Solution is in most any project or challenge that you face.

Dan Weberg:
Yeah, I love all those behaviors because all the ones you listed off were ones that I found in my dissertation as well, which was based on complexity science and innovation leadership. So that's good that they're reiterating and consistent throughout the literature, that means that I didn't do the wrong thing.

Dan Pesut:
No.

Dan Weberg:
The other key point I think that I've been talking about as I go around and speak to leaders around innovation is that there's this assumption, that to lead innovation you have to be an innovator and I think that's not the right frame. You can lead innovators without having to be that inventor or idea sparker you're more of a convener, and a barrier remover and those... and allowing the risk to be taken those types of things. Do you have thoughts on leadership being innovators or being able to lead innovators without being an innovator themselves?

Dan Pesut:
One I think of the significant challenges in today's world is the tension between competing values. So I have found the work of Quinn and DeGraff and Cameron I think of the competing values framework-

Dan Weberg:
Yeah.

Dan Pesut:
Pretty powerful in terms of understanding that they talk about every organization having some tensions, the tension between the external world and the internal world, the tension between being flexible and focused and they then identify four quadrants in this tension. One being innovation, the second lower right quadrant is competition, the third is control and the fourth is collaboration. So you've got polarities to manage there, oftentimes I think people who are innovative get frustrated when the control mechanisms of the organization stifled them and then people that are competitive really sometimes have a hard time playing in the sandbox and in a collaborative way. So I think that competing values framework and understanding that to be successful an organization really needs to identify, and use and maximize all of the tensions of those competing values. I think it's Jeff DeGraff written a book called the Innovation Genome, and he talks about the fact that organizations that balance and manage those tensions are much better off than organizations that don't, that might get stuck in one quadrant and you need them all.

Dan Pesut:
I mean you need the control sometimes to put brakes on people that are way out there, and you need to compete but you also need to collaborate. So how people navigate and manage the tensions among those competing value frameworks and polarities is a really crucial leadership skill to have in today's world.

Dan Weberg:
And we're seeing it in kind of the crisis mode. There're organizations who are reverting back to their traditions or is maintaining the status quo as a source of stability and certainty in an uncertain time, and then there're other organizations that have jumped on the energy that's spun up in the ability to disrupt some of those traditions, and get better and grow faster and that happens within an organization as well. You can... when there's drama or crisis or control of things, you can leverage the energy off that and actually build innovation from it. So it's really having that mindset of those competing values, it's great.

Dan Pesut:
Exactly.

Dan Weberg:
So from a Foresight Leadership perspective I know you do a lot of reading, you share a lot of resources on LinkedIn which I really appreciate. What are some of those clinical practice disruptions and maybe their themes if not specifics, that are going to happen in the next five years for nursing?

Dan Pesut:
The big one you hear a lot about is artificial intelligence AI, robotics. I think telehealth and telemedicine is going to be huge in terms of virtuality, and given the fact that we're right now in the emits of this coronavirus you can see it just taking root, and just like you said it will be interesting to see if people maximize this opportunity and do a phase shift and move on to the next level in terms of appreciating the value of the virtual communication, the distance accessibility, the big data aspects of all of this or if they will revert back to old ways and old patterns. So I do think that big data and data science and algorithms and all kinds of things are going to push us to rethink certain parameters, certain treatment procedures, certain protocols, certain drug cases. Personalized medicine genomics is going to just... it's just going to revolutionize us. I can remember Clem Beasel years ago talking about the big shift that is taking place is a move away from diagnose and treat, to a predict and manage healthcare paradigm.

Dan Weberg:
Mm-hmm.

Dan Pesut:
It's one thing when you diagnose somebody and their diabetes and that's chronicity follows them through time, and they have all of these competing and cascading events that happen to them. It's another thing when you can identify that an issue with a disease in utero, splice out that gene put in a new gene so that the disease never makes itself manifest.

Dan Weberg:
Yeah.

Dan Pesut:
That is a huge paradigm shift for people and I think we're caught right in the middle now between diagnose and treat and predict and manage, and you can kind of see it in some of the OMIX stuff that's going on and the personalized medicine and the fact now... University of Minnesota School of Nursing has a partnership with OptumLabs and some of our big data scientists have access to a million lives... data on a million lives and they're doing amazing things with looking at people's response to drugs and statins and making some discoveries there about age and sequence and dose and all kinds of other things. So boy, there's a lot happening.

Dan Weberg:
There's a ton and as I travel around the country, I feel like there're some organizations that are ready for this. We interviewed the chief innovation officer from Geisinger, Karen Murphy and she has a whole center set up. They're actively exploring the future, breaking things, disrupting, failing fast and then there're other organizations that are really not prepared for any disruption. They're still status quo, they don't have their mind on the future. What advice would you have for leaders to get ready for this disruptive future?

Dan Pesut:
I have another guy who I really like, it's Bill Smith and he talks about the Triple Helix of leadership. The Triple Helix is appreciation, influence and control. He calls it the AIC model, The Power to Create and Transform Ourselves in Our Organization I think is the title of his book. He says, "When you create a purpose, any kind of purpose it creates automatically these three energetic fields. A field of appreciation, a field of influence and a field of control." So every situation must be examined from those three perspectives. You have the ideal, you have the real and you have what you value, you have who's going to support you and who's going to oppose you and then the control part is eventually what are you going to do about it? It goes back really sorted to that 15% Solution. So having a vision of the future of what you want to accomplish and appreciating people's contributions to that, knowing who's going to be supportive of that and who's not, and then how you make decisions about putting teams of people together to accomplish that is I think really a leadership skill that needs to be developed.

Dan Pesut:
There's another guy I really like Bob Dilts, who modeled the work of Walt Disney, and he's created a Disney Creativity Strategy and he interviewed a lot of people about Walt Disney and one guy said, "There's really three Walt Disney's, there's Walt Disney the dreamer, Walt Disney the realist and Walt Disney the critic," and Disney world is even sort of set up that way, right? This is the imaginarium, this is where you can dream up big ideas but then we turn around and take it to the lab and here's where the people turn it into reality, but then it goes to the screening room the black box where everybody criticized was what's wrong with it.

Dan Pesut:
So the Disney Creativity Strategy is essentially that each of us has a dreamer, a realist and a critic part. It's just that we have to be able to have a meta-part that organizing orchestrates that, and I think leaders in organizations need to be able to identify who are the dreamers here, who are the realists and who are the critics and how can I put them together in a strategic sort of way and appreciate respect and value all of them in service of a desired future? So you don't want a lot of realists in a room.

Dan Weberg:
Right.

Dan Pesut:
If you are looking to be innovative and creative and foresight, foresight oriented. You don't want a lot of critics either cause they're the laggards, right?

Dan Weberg:
Mm-hmm.

Dan Pesut:
You want the right mix, you need those 16% early adopters who've got the great ideas and you need to support them, so that they can kind of bring others along. So that also has been a really good model for me in terms of dreamers, realists and critics and each of them have a different orientation to time. Dreamers think about the future, they're pretty much self referenced, they are all about the what. Realists are more present oriented, they are not so much interested in the future as much as how to make it work today here and now. Critics generally oscillate back and forth between their future orientation and their past orientation and the present because they've had experiences that have caused them to be leery of things, and so they raise objections that realists and dreamers need to pay attention to. So everybody's got a part to play it's just how you appreciate them, how you think they influence each other and what you want to do about it.

Dan Weberg:
I was reading up on diffusion of innovation from Everett Rogers and I went to... Wikipedia has a great source, I know all faculty love when you cite Wikipedia, but they have a really great summary of what a laggard looks like from an interaction perspective. They don't have a big network, they only talk to close family and friends and they kind of show up to work and go home and don't do a lot of that extra stuff, and that's interesting in a complexity standpoint. They have limited information flow to make decisions on and so they're kind of stuck in this world of assumptions rather than thinking about the future possibilities. So it's just an interesting way, but they also bring up the issues, right? Like a person like myself is on the DISC assessment, I'm a D and an I so I'm always out five, seven years in the future and I need people to bring me back sometimes.

Dan Weberg:
So, it's definitely... it's all part of the team and we can't shy away from the negative critics because then you're in chaos. So you have to be able to pull yourself back just the right amount so that you're kind of a balance between future realism and what could break here.

Dan Pesut:
Exactly. Create, control, compete, collaborate, competing values-

Dan Weberg:
Yeah.

Dan Pesut:
How you negotiate and manage all of those.

Dan Weberg:
I love it. Just a couple of questions, healthcare is pretty insular and we like to look at ourselves and figure out how other healthcare industry experts are doing things. Are there other industries that have figured out the future and foresight? I know you look at people like Steve jobs or Google where they kind of created the thing that never existed before and they continue to do that, but are there other industries that healthcare could look to, to prepare for disruption and learn how to be more kind of future oriented?

Dan Pesut:
Well, other countries do a far better job of this than we do here in the United States. I'm a member of the Association of Professional Futurists and the World Federation Future Society, and if you look at a map of where their members are in both industry as well as in education, it's all over the world. There are only about three or four centers in the US, Canada has a whole organization, a whole policy level group that looks at the future of Canada. Africa is gangbusters. The UK, Finland, Norway, Sweden, Taiwan, Japan, China. There are so many people that are future-focused in developing foresight resources... UNESCO, United Nations Education Scientific Community takes workshops around the world to educate people about futurist literacy and futurist thinking. So obviously Google, Apple, Amazon are sort of leading the pack here but we are pretty far behind in the U S and so that's why we created this Foresight Leadership web resource to kind of help people think more about the future, and to sort of encourage people to become more future cited as opposed to future blind, and there are lots of different things happening in all kinds of organizations.

Dan Weberg:
That's great, and you mentioned a bunch of publications and websites so we'll put those in the show notes so that people can access those and look up all of those, cause they're amazing resources that even frontline leaders can use in a daily meeting even, or a huddle to be able to change the conversation towards-

Dan Pesut:
Absolutely.

Dan Weberg:
Adaptability, right? Rather than kind of the status quo.

Dan Pesut:
Exactly.

Dan Weberg:
So one of the things we like to do at the end of the podcast is kind of distill that one key point that you want to leave the listeners with, and we call it The Handoff. So what would you want to hand off to our listeners about innovation and creativity in clinical practice?

Dan Pesut:
Well, let's see, a few years back I studied with Phillip and Mikela Tarlow and they wrote a book at the turn of the century millennium, about navigating the future. One thing always stood out for me in that work and it was their quote, what the future holds for you depends on what you hold for the future. So as each person enacts and becomes clear about the future that they want to create, that is the future that will be held manifest. So I guess I would just encourage people to figure out what their red thread is, what their passion and commitment is in terms of their contribution to the world and how they can best make it manifest, because that really is a major contribution to the future and the success of nursing and healthcare and innovation and everything that we want it to be.

Dan Weberg:
I love it. It's be the change you want to see in the world and I love that. Dan, where can we find more information about foresight, about you, about the great work of the health innovation leadership program, where is all that housed?

Dan Pesut:
We have a website at the university of Minnesota school of nursing hosts. It's www.foresight-leadership.org and you can just go there and explore. It'll be self navigating and if you've got resources, I would invite people to put some resources up there. We also have a group on LinkedIn and you can get access to that through that Foresight Leadership website or just search on LinkedIn, Foresight Leadership; The Future of Nursing and Health and of course the university of Minnesota school of nursing, umn.edu there's all that information about our programs especially the health innovation and leadership, and the post-baccalaureate certificate in healthcare innovation and design.

Dan Weberg:
Awesome. Yeah, so sign up on LinkedIn and get on that group, there's some great resources shared. University of Minnesota has some amazing resources, I was out there last year I guess speaking at their conference which was amazing. So a great resource for the innovation and the future of healthcare. Dan, thank you so much for being on the show and we'll make sure we get all those links up on the show notes, but really appreciate your time.

Dan Pesut:
Thanks Dan, I appreciate it. Keep up the good work.

Dan Weberg:
Thank you so much for tuning into The Handoff. If you like what you heard today, please consider writing us a review on iTunes or wherever you listen to podcasts. This is Doctor Nurse Dan, see you next time.

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