Six Techniques for Creative Problem Solving

Consider these steps to help your colleagues and staff analyze and solve complex problems.

As organizations strive for ways to control health care spending, address the growing needs of an aging population, and respond to more informed and demanding patients, the need for creative problem solving and innovations has become critical to organizations and physician leaders.1

Physicians are often perceived to make important decisions in isolation of the team of stakeholders and lacking the business skills needed for creative solutions to complex institutional problems. However, there are techniques that physicians and physician leaders can use to foster creativity in problem solving.

Lateral thinking is a step-by-step method of creative thinking with prescribed techniques that can be used consciously. Key techniques that can be used for lateral thinking have been described in detail by Edward de Bono2 and us. Here are some other techniques that can facilitate lateral thinking.3

Shared Leadership

A sense of shared responsibility for the work and life of an organization, also called shared leadership, is critical for effective and efficient self-managing teams in the workplace. This structure does not diminish the need for skilled, effective team leaders, who function more as facilitators in team decision making.

This form of leadership structure utilizes the perspectives, skills and experiences of team members to the maximum and is often able to generate more creative ideas for problem solving than is a traditional leadership structure that less utilizes the talent of individual members of the team.

Shared leadership has been one of the methods used to enhance staff satisfaction in the Division of Preventive Medicine at Mayo Clinic.4 Mayo brought leadership representatives of all employee categories and work groups to work together toward a common vision.

The team members helped each other develop and execute the program goals, resulting in an atmosphere of shared ownership, where each leader used their experience and expertise to enhance employee satisfaction in areas outside their usual jurisdiction. This project resulted in enhancing staff satisfaction rates from one of the lowest in the institution to one of the highest in a matter of 18 months.

Systems Thinking

Peter Senge describes systems thinking as the "fifth discipline" since it serves to make the results of the other disciplines work together for business benefit.5 Systems thinking is based on the interrelationships of forces and seeing them as part of a one common process. It provides the platform to explore organizational issues as well as problem solving from a holistic perspective rather than from its individual parts.

For physicians who have been educated to focus on the individual responsibility to assist patients, simplistic analyses of complex problems come more naturally than systems thinking. As a result, problem solving can result in solutions that affect other parts of the system with subsequent undesirable consequences.

Systems thinking is ideal for problems whose solutions are not obvious or simplistic and need to be examined as a whole, dynamic process. For example, cutting back on the investment in research in an academic organization can bring short-term cost savings, but also can significantly affect the long-term viability and credibility of the institution.

Cross-Fertilization

Using one's medical authority gained in one's specialty is necessary, but not sufficient to lead organizations. Additional understanding and training in systems thinking from other service industries can significantly enhance creativity in the health care environment.

The creation of cross-functional teams such as idea innovation networks,6 idea centers, idea task forces7 and skunk works8 are all aimed at encouraging interaction between individuals with different perspectives and experiences.

One significant venture succeeded because of successful cross-fertilization in our institution. In cases of ruptured chordae of the mitral valve, the standard procedure is open-heart surgery to replace the damaged chordae.

With the increasing availability of minimally invasive techniques, Giovanni Speziali MD, decided to explore a technique to do minimally invasive chordae replacement in 2004.

Through a collaboration with inhouse mechanical and electrical engineers, machinists, designers, cardiac surgeons, cardiologists, ultrasound and surgical technicians, the team was able to develop an appropriate device for the same. This device was successfully used in animals, then patients, became patented and commercialized.

Brainstorming

Brainstorming is typically done to elucidate a variety of perspectives in developing several possible solutions. Successful brainstorming techniques include gathering people familiar with the problem, careful definition of the problem, suspension of judgment, creation of a safe environment for participants to express ideas and build progressively on ideas generated.

After many ideas are generated, an affinity analysis process is used to combine similar ideas. Participants then vote on the most reasonable ideas and work to further refine the top three to six ideas.9

Other methods like TRIZ and mind-mapping aim to create structured brainstorming. TRIZ, for example, creates an algorithmic approach to the invention of new systems, and the refinement of old systems.10

A mind map, on the other hand, utilizes a diagram to represent words, ideas, tasks, or other items linked to and arranged radially around a central key word or idea. This kind of tool can be used to generate, visualize, structure, and classify ideas, and as an aid in study, organization, problem solving, decision making, and writing.11

Root Cause Analysis

Although typically described in the quality improvement literature, the concept of cause and effect analysis (e.g., Ishikawa's root cause analysis) can be useful for a physician leader for the analysis of systems solutions that did not work or went wrong. It is based on the belief that problems are best solved by attempting to correct or eliminate root causes, as opposed to addressing the obvious symptoms. By directing corrective measures at root causes, it is hoped that the likelihood of problem recurrence will be minimized.12

The root cause analysis method involves asking "why?" in reference to the initial event and repeating it again four more times in response to each answer. Each repetition of the question can uncover a deeper level of contributing causes.

As opposed to this kind of retrospective analysis of events, the failure mode effect analysis (FMEA) offers a systematic method to identify potential failures, effects and risks within a process with the intent of preventing problems before they occur.

This requires careful analysis of the current process at a fairly detailed level, using input from individuals who are experienced in the day-to-day practical operations. Regardless of the technique used, a focus away from individual blame to systems issues is likely to lead others to embrace a just culture that assertively seeks out errors as opportunities for improvement, rather than as personal failures.13

Prototyping

As physician leaders aim to solve complex problems in their institutions, prototyping or pilot testing solutions prior to large-scale implementation becomes critical. By comparing the ideas generated in the first phase to the requirements of the solution developed separately, fanciful ideas can be extracted, and the design of a feasible solution comes forth to allow a prototype to be constructed.

The analysis aspect allows the specific evaluation of experiment results and includes evaluation of characteristics necessary for success of the innovation, including usability, financial value, manufacturability, FMEA for safety, maintenance and repair, and lifetime failure projections. In addition, the innovation or change should be evaluated to see if it has applicability in other parts of the organization.1

For example, prior to the implementation of medication reconciliation across our institution, the proposed set of interventions was tested in several pilot hospital floors with subsequent technology enhancements and process changes prior to institution- wide implementation.14

Prathibha Varkey, MD, MPH, MHPE, MBA, is professor of medicine and health policy/management at Yale University, president/CEO of the Northeast Medical Group and senior vice president of Yale New Haven Health in Connecticut, and adjunct professor of medicine and preventive medicine at Mayo Clinic in Minnesota.

James S. Hernandez, MD, MS, is an associate professor of laboratory medicine and pathology at the Mayo Clinic College of Medicine in Arizona.

Nina Schwenk, MD, is v__ice president of integration and consultant/general internal medicine for Mayo Clinic in Minnesota.

This article was originally published by the American Association for Physician Leadership in 2009.

REFERENCES

1. Varkey P, Horne A, Bennet KE. Innovation in Healthcare: A Primer. American Journal of Medical Quality 23(5):382-8, Sept-Oct. 2008.

2. de Bono E. Creativity and quality. Qual Manag Health Care. 2(3):1-4, Spring 1994.

3. Basic introduction to mindmapping. https://www.mind-mapping.org/index.php?title=Basic_introduction_to_mindmapping .

4. Sweitzer SC, Silver MP. Learning from unexpected events: a root cause analysis training program. J Healthc Qual. 27(5):11-9, Sep-Oct 2005

5. Marx D. Patient Safety and the Just Culture: A Primer for Healthcare Executives. Trustees of Columbia University in the City of New York., 2001

6. Varkey P, Resar R. Medication Reconciliation Implementation in an Academic Center. American Journal of Medical Quality 21(5):293-5, Sept/Oct 2006.

7. Hernandez JS and Varkey P. Vertical vs. Lateral Thinking. Physician Executive, 34(3):26-8, May-June 2008.

8. Varkey P, Karlapudi S, Hensrud D. The Impact of a Quality Improvement Program on Employee Satisfaction in an Academic Setting. American Journal of Medical Quality 23(3):215-21, May-Jun 2008.

9. Senge PM. The Fifth Discipline, the Art and Practice of the Learning Organization. Doubleday, New York, NY., 1990.

10. Hage J, Hollingsworth R. A strategy for analysis of idea innovation networks and institutions. Organization Studies. 21(5), 2000.

11. Price C. How to foster innovation in your hospital. Hospitals. 65(13)FB46-FB48, July 5, 1991.

12. Essentials HB. Managing Creativity and Innovation Boston: Harvard Business School Press

13. O'Connor K, Brown PB. The Map of Innovation 1st ed: New York, NY Crown Business; 2003.

14. What Is Triz. The TRIZ Journal. https://triz-journal.com/what-is-triz/ .