A Project, a Pilot and a Plan: Promoting a Culture of Innovation

"What is innovation?" "How do we operationalize the term?" "How do we create a culture of innovation?" Richard Conroy (National Institutes of Health), David Howell (Assistant Secretary for Preparedness and Response), Michael Arsenault, Elisa Gladstone, Narayanan Valappil and I [(Health Resources and Services Administration (HRSA)] became teammates when we chose to address the topic of innovation for the HRSA Senior Leader Fellowship Program. As participants in the program, we spent the first few months of 2014 grappling with these questions.

Defining Innovation: Framing the Project

The 12-month leadership development program, in its inaugural year, was open primarily to HRSA staff, with several slots allocated to all other HHS Operating and Staff divisions. The main components of the program included on-site training, reading assignments, coaching, mentoring, an executive speaker series, and an action learning/group project. Our action learning project addressed the seemingly nebulous question, "How can an organization like HRSA engage staff at all levels to think critically and creatively about ways to meet the agency's mission?" From January through June 2014 we set out to learn everything we could about innovation. We conducted a literature review and talked with senior leaders within HRSA, across the federal government, and in the private sector. Everyone generously shared their thoughts on innovation, its definition, key drivers and barriers, challenges, risks, and strategies for measuring the value of innovation, as well as lessons learned and pitfalls to avoid. All interviewees agreed that defining innovation is a critical first step in trying to make a difference-or shift an organization's culture. We understood culture to be an organization's values and guiding principles related to how it does business and interacts with employees and customers. Culture is comprised of actions as well as beliefs and perceptions. So, after much deliberation, our working definition of innovation was the process of mission-driven improvement, adaptation or development of a product, system or service to deliver better results.

Operationalizing Innovation: Starting with a Pilot

We spent last summer working to identify the best strategies to make innovation part of the agency's DNA and motivate staff at all levels. Shifting the culture of an organization can take years, and we only had six months by that point. We also recognized that creating a culture of innovation involves both what we think and what we do. So, our approach was two-pronged: not only develop a pilot project and subsequent evaluation, but also outline a blueprint for how the agency could shift its culture-at the team and/or division level; across offices and within HRSA bureaus. Our pilot project took place in the Healthcare Systems Bureau (HSB). The bureau can be considered a microcosm of HRSA. There are five divisions, encompassing 11 programs with individual missions that all loosely fall under the rubric of healthcare infrastructure. The programs have very few natural connections. For example, the Division of Transplantation has very little in common with the Poison Control Program, and the National Hansen's Disease Program has very little to do with the National Vaccine Injury Compensation Program. Like HRSA, the approximately 90 bureau staff are dispersed in other regions of the country and even within the Parklawn building. HSB had made efforts in the past to engage staff, but senior staff felt there was still room for improvement and engaged us to develop the pilot. Working closely with senior staff, we launched the pilot: a new initiative, called Having a Say in the Bureau. The goal identified by senior staff was to enhance employee engagement as well as improve communication across the bureau's divisions. We piloted the first component of this initiative - an ideation session called IdeaStorm. First, we conducted a one-day moderated session including seven HSB staff from across the bureau's divisions and geographic locations. The intent of the session was to identify and prototype ideas for enhancing employee interactions. These staff then evaluated their discussion and experience. To ensure that everyone in the bureau was able to contribute, we then emailed the IdeaStorm-generated ideas to everyone in the bureau to solicit additional suggestions. Finally, we asked everyone to vote on their favorite ideas. The event and voting process were well-received, with 87% of votes cast by Parklawn and 13% of votes from Baton Rouge staff, respectively. The top three ideas selected were social events (51%); a bureau newsletter (33%); and a staff retreat (29%). Seventy-one percent of IdeaStorm participants felt the process helped stimulate ideas that would enhance communication within HSB, and 57% strongly agreed the activity made them feel engaged. The top three ideas were shared with all bureau staff at a holiday party in December 2014, and implementation has begun. To date, the bureau, with support from senior staff, has implemented multiple ideas, including HSB coffee breaks and Thursday TED talks; initiated a newsletter; and begun planning a retreat.

Characteristics of an Innovative Culture

We debriefed about our pilot project, and found that all our work at that point- the literature review, 23 interviews with senior leaders in the public and private sectors and the pilot-solidified that innovative cultures typically possess the following characteristics:

• change is welcome;
• leadership demonstrates support;
• diversity is valued;
• thoughtful risk is rewarded;
• follow through on decisions/commitments is expected;
• failure is seen as a learning opportunity;
• knowledge and ideas are shared freely;
• recognition is encouraged, and trust is fostered;
• development opportunities are available to all staff; and
• time and resources are devoted to innovation.

Creating a Culture of Innovation: The Blueprint

We had identified common characteristics of innovative organizations, but we also recognized that drafting a prescriptive strategy seemed to go against the fundamental aspects of an innovative culture. There were, however, some general principles that emerged:

• understand risk is an essential part of any process;
• set aside time to listen and learn;
• create an atmosphere of transparency, open dialogue and trust;
• engage and acknowledge all employees;
• step out of the comfort zone;
• determine the approach to innovation, and take action.

An organization must identify its own needs, resources, and other key factors in order to develop or select activities or initiatives that have the greatest potential impact. So, we chose to develop some basic guidance and resources that could be tailored to assist the agency in engaging employees at all levels within HRSA. Generally, organizations that understand the importance of innovation and successfully shift the culture consider their overall approach to fostering innovation and think differently about day-to-day interactions. The blueprint highlighted six organizational philosophies or approaches to innovation: laboratory, facilitator, advisor, technology build-out, liaison and sponsored. We also compiled 33 ideas successfully implemented by public and private sector organizations, understanding that in reality the possibilities are endless. We then graphed these ideas based on the potential level of resources required and risks involved versus the likely impact. And, to show the likely short-term and long-term outputs and outcomes, we created a logic model. This project provided a wonderful opportunity to see the diversity of innovative projects going on across the federal government and to better understand the role we can all play in creating a culture of innovation. We gratefully acknowledge the time and support of everyone who participated in our project. We are especially thankful for the wisdom and support of our HRSA executive sponsors, Sabrina Matoff-Stepp and Bethany Applebaum. For more information on the team's work, please contact Michael Arsenault at marsenault(AT)hrsa.gov.