How you can stimulate innovation in your practice

A list of habits and practices to stimulate innovation ... Uncoupling from the dogma acquired in the university setting ... Setting up your practice like an artist's collective ... Wisdom from the book Where Good Ideas Come From by Steven Johnson...

Innovation is not something that we should leave to experts and gurus.  It’s a vital process we all must engage in to keep our physiotherapy practices healthy and to help solve all types of clinical problems.  There are ways to stimulate innovation in your own practice, and within your entire practice environment.  If you like to do the same thing always, and hate change, don't bother reading further. This blog is about how to create the conditions that spark progress, innovation and change for physiotherapists in Canada.

some thoughts on innovation (from a creative with 3 decades of experience in the field).

I've been involved in hospital and private practice physiotherapy for nearly 30 years. I'm a creative thinker and a builder. Along with my partners and colleagues, I've built and created a variety of systems, clinics, processes, flowcharts, and physical environments to support a good practice. Sometimes it's a new educational poster to translate ideas to patients (here's one on low back pain) (and here's one on hip and knee OA). Often, it's a new exercise that I invent on the spot to meet a patient's needs. When needed, I've hired interior designers, web designers and visual artists in an attempt to provide a better care experience.

Hip & Knee Osteoarthritis Guidelines

Course creation has been a particular interest of mine in the past 5 years. I've created courses on neck pain, on mastering MSK physiotherapy, on trigger points, and there are new ones coming along soon on myofascial pain and central sensitization. I can't stop creating, and the curriculum I write encourages course participants in their own creative process.

Almost always, I'm inspired by running my ideas past colleagues, including those from other fields. In fact, this kind of collaboration has been so important that I've had more than 400 breakfast and lunch meetings in my career simply to sit down, think a problem through, and find a creative solution.

Here are some of my thoughts on how you can foster creativity and innovation in your practice, for your own benefit and that of your patients.

Helping patients requires creative thought. We are not technicians.

There is no published research on exactly how to treat the unique pain experienced by each of our unique patients . On the contrary, published research applies to populations of patients. So unless we are in public health, the research only informs our practice a little bit. Each patient that comes to see us requires from us a unique experiment. The patient is the subject, and because of the infinitely multiple factors involved in each patient's pain or disability, our experiment with them requires a mix of both the scientific and the creative process.

Uncoupling from university acquired dogma

If you were given a different impression in your academic schooling, if you were encouraged to stick to published research only and put aside creative thought, you may wish to rethink. Forget not that how your patient responds to a therapy is in itself evidence. When you introduce a treatment with a sound theoretical basis, you are engaging in the scientific method, and how your patient responds will determine the next steps. If your patient does not respond to the best-evidence care, it's vital that you change the plan and go 'off-label'.

I once had a patient who had tried every evidence-based treatment for her knee pain. Nothing was working. She asked me hesitantly if she should try a certain type of alternative therapy with no research behind it. I didn't hesitate to tell her "science has failed you. We've tried everything that we know works. Why wouldn't you try something alternative?" And so off she went.

Stimulating innovation in your work environment

Some of us are natural creatives and we come up with unique solutions for our patient in the moment, on the spot. But not all of us are that way. Creative thought is often stimulated by a practice environment with cross pollination between different practitioners. We are stimulated by connecting with colleagues. Steven Johnson, in the book Where Good Ideas Come From describes this as a “Liquid Network”.

Matter is either solid, liquid, or gaseous. With that in mind, here's a physiotherapy analogy:

Large corporations are like a solid.

Ever try to move a large corporation?

Solid state matter is like a large corporate clinic setting or a hospital environment: very predictable, stable, and hard to change. I know this from experience, having worked in both. For instance, I once worked for a hospital that required the use of a four-page shoulder assessment form, which I thought was too long. I created a more condensed two-page version, but the rehab manager informed me that a committee of physiotherapists had agreed on the four-page form years ago, and there was no need to change it. I happen to be a natural innovator, so you can imagine this was very stifling, and I only lasted a few months in that environment.

If you're in a large corporation, you may feel limited in your ability to be creative and change the way things are done. Do what you can in each of your individual interactions with patients, and if you find yourself in a leadership position, put your creative thought to work.

Fledgling clinics can be more like a gas.

Ever try to contain a gas cloud?

Gases, due to their chaotic nature are great at creating new configurations, but they are highly volatile and unlikely to last.  I've been in clinics that felt just like that; lots of excitement and ideas amongst the staff, but at risk for exploding! When I became a partner in a fledgling clinic in 2002, we had so much energy and creativity. We had a shared office that we called "The War Room" because of how many strategy sessions we held in there.

Regularly we had random friends and acquaintances sitting in with us for one reason or another, batting around ideas. The chiropractor who knew more about whiplash than anyone had ever taught me … the champion hammer thrower with a penchant for philosophy... the personal trainer who disagreed with everything I had been taught in physio school, and was occasionally right. It was a magical learning environment.

As we discussed our clinic growth strategies, everyone would weigh in with an idea based on their background or experience. It was chaotic and wild and it's remarkable that the clinic lasted for two decades. Many small businesses fail under such conditions: Too many ideas, not enough focus. (incidentally, for you clinic owners, the way we held things together was by planning a weekly breakfast meeting from 7 to 9 every Friday. Only the partners would attend, and this is where we would pitch our ideas, throw out the bad ones and decide on what to proceed with for the coming week. This helped turn the clinic from a chaotic gas into a liquid network)

Clinics that last are like liquids

Liquid networks. They last, and good things come from them.

New ideas emerge and thrive when the environment is analogous to a liquid state of matter.  In liquids,

“new configurations can emerge through random connections formed between molecules, but the system isn’t so wildly unstable that it instantly destroys its new creations.” 1

Change the word “molecules” to “clinicians” in this quote, and you have the kind of work environment many of us crave.  Large institutions are often slow to change and frustrating for an employee inspired by ideas.  Chaotic clinics can be much more flexible, but can lack the cohesiveness required for a good idea to thrive.  So how do we create the right mix?

Real spark, real on-the-ground innovation occurs when we establish a culture of exchange, where we’re excited to share with our work-mates what new ideas we’ve come across, whether within our field of practice, or from far outside of it.  Here, in this “coffeehouse” of interaction is where the potential for real dynamic change and innovation occurs.

We do not need to wait for the published research in order to come up with innovative ideas to deliver effective care.

If a work environment is stagnant with no potential for cross pollination of ideas between clinicians, this can be a dead end for innovation.  Instead, our clinics and clinical networks should become

“a union of very different people who work together and discuss things. Some [therapists] can work more on [exercise] or [needling] but at the same time, everybody always discusses the entire process - like some kind of micro-society.”2

This quote is adapted from an interview with a group of 4 artists working in an art collective.  Could a rehab environment not also be considered a collective, a group of individuals that are greater than the sum of their parts?  How then to create this?

If you are a clinic owner...

Design your space with liquid networks in mind. How are you going to design the physical space of the clinic to encourage this? (hint: separate offices for everyone doesn't work well.)

Create communal areas that are conducive to conversation amongst staff.  A place away from one’s work space unlocks creative ideas that are otherwise buried in the day-to-day. 

A foosball lounge is not necessary - even just a sofa in the staff room and some refreshments to encourage staff to spend time there.  What about the lost productivity?  Not to worry; you’ll make it up in spades with the inspiration and culture of innovation you’ll create. 

Don’t stifle ideas that come to you.  That’s the wettest blanket possible for a spark.  Let your staff run with their thoughts, and guide them in it.  When staff see you encouraging a good idea, others are more likely to bring forth one of their own.

Put up a whiteboard in the common area. Encourage staff to post things or jot down ideas. You can prompt them with titles like "What do our patients like most about our physical space?" "What did you do today to provide a suprising level of service to a client?" "I wish we could change this one thing about the waiting room:"

How about off-site breakfast or lunch meetings with key personnel? This is a long-standing tradition in business and politics.

Years ago a reporter had lunch with a friend in Paris. A few tables away were the Prime Minister and Finance Minister of France, having their lunch meeting. She watched as they polished off five courses and three bottles of wine over 3 hours. Oh, France. Meals have always been a lubricant to conversation and problem solving.

If you are an employee...

Take a leadership role in bringing ideas to the group. 

How about starting a weekly lunch meeting with little or no agenda other than discussing what’s interesting that week.  Bring in a quote from a song or a podcast that struck you as profound, and draw parallels to your practice.

Draw a quick illustration or infographic to describe a truth you’ve discovered, and post it on the whiteboard. 

Set up a social network online for your colleagues to post ideas and share links.  Once you set the bar a little higher, other people are sure to raise their game a little.  Be patient though.  It takes time, and not everyone will share your enthusiasm.

Get a good pen and a great notebook. Write your ideas down, and plan to cross out at least half of them. It's ok to come up with ideas that are not feasible. That's not a failure, that's part of the process.

Midori notebooks - my current favourite

Here's my current favourite notebook company (nobody makes paper products like the Japanese)

Spend some money. Sometimes you need to have your ideas printed on poster board to share with others. Sometimes you need to hire someone to help with the design. That's the cost of doing business when it comes to creativity.

What's your clinical environment like? Solid and heavy and hard to change? Wild and chaotic and hard to control? Maybe you need to get innovative and find or create your liquid network.

Jeff Begg, PT

1 Johnson, Steven. Where Good Ideas Come From: The Natural History of Innovation. Riverhead Books (2011)

2  Lev Evzovich of AES+F Art Collective, as quoted in Wallpaper magazine.