What is Creativity?

Part of the issue surrounding creativity is that many people are not sure what it is- they think its something to do with art, or only for gifted and talented people.

The reality is that we all have a creative side, we all have imaginations, we can all ask ourselves "what if...".

So in truth, we can all be creative.

The next issue is that people sometimes think they need to be taught how to be creative, that years at art school or university are required.

The reality is that no education is required to be creative at all. Children possess innate creativity which our education system has previously tried to beat out of them. Current education methods are focussed on development of creativity, encouraging the questioning environment and association of ideas which is the hallmark of creativity.

So- now you know what it is- why not try it?

Just look around you now and select two objects, any two. Now mentally link the two objects, what have you "created"? I'm sitting at a desk in a shared office environment. It has loads of objects cluttering the surface.

The cleaner has left a bottle of cleaning solution, on my right hand side and there is a stapler on my left.

Ok- so cleaning spray, stapler- what have we got?

A spray for cleaning your desk equipment? Staples that smell? A stapler that releases a scent onto the paper?

Three ideas in less than a second.

Now next time you are in a clinical area and have the luxury of a minute spare, just relax and try the same game. Granted its unlikely you will come up with the bagless vacuum cleaner, but you never know.  

Why do we do what we do, when we can be so much more?

I know it sounds like a lyric from Gerry and the Pacemakers but I was thinking about motivation this week.

Daniel Pink in his excellent book "Drive" outlines some of the science behind motivation and draws some lessons for how we manage and motivate. I must admit his work did resonate with some facets of how medicine is currently configured.

No medic starts out with the ambition of being mediocre, avaricious or dangerous, yet some of us become exactly that. Extrapolating the theories outlined in Drive in to the current NHS it would seem that many doctors, regardless of area of practice, are being subjected to rewards based on action which saps their intrinsic drive, their willingness to just be the best they can be, and replaces it with a financial focus on activity.

I would argue that this applies equally to GPs in carrying out QOF and hospital doctors in warning of "destabilisation" if activity levels change in outpatients.

How then can we take the lessons of "Drive" and apply them to the NHS?
Developing a payment mechanism that remunerates fairly without some form of performance measurement is pure fantasy in our current structures.
If however we were able to reward systems that perform well, with all parties in each health economy receiving some benefit for their innovation, economies and creativity, then we might find ourselves in a virtuous circle.

This circle would see patients, primary and secondary care all looking out for each other, offering challenge to unhelpful behaviour and being part of a system that strives for excellence, driven by the intrinsic motivation in each of us.


Simply put-the reward is being the right thing, not doing the right thing.

Transforming the Horse and Cart

Part of the problem in healthcare is that we don’t actively seek transformational change. We focus on being better, being safer and just working darn harder to get results. Unfortunately building a better horse and cart has inherent limitations.

Sport illustrates this quite nicely, the high jump in the early days of the Olympics was a standing jump, which became a scissor jump after a run up. Of course performance increased, and thanks to occasional falls a mat was introduced to prevent injury.

Things went on for a while with slightly better results every four years but then, the straddle jump evolved and results improved dramatically. Now everybody did the straddle jump and things were slightly improving every four years, it seemed that the straddle jump was the best way of doing it, period-until Dick Fosbury came along that is.

Once again a transformation occurred which changed the game with a quantum leap.

Of course now the NHS faces a major pressure to survive, and surprise surprise we’re squeezing efficiency out of the current systems, getting that better horse and cart. Even the potentially transformative shift to Clinical Commissioning Groups looks like it will be focussed on better pathways, again that horse and cart.

So what should the transformation be? Who is the Dick Fosbury of our NHS. I don’t know, it could be you or me. The solution is not going to come to those of us who are equine focussed in mentality. The solution will come from people who are not afraid to question the status quo, and ask the question “why not?”

What kind of bike do you ride?

Do you ride a bike? What kind of cyclist are you? If you ride a bike you know what I mean, generally there are two tribes, the roadies and the MTBers. Although the are different demographic features of the two groups, certainly different appearances and features in the various bits of mechanics they employ in their leisure pursuits, I would like to suggest that there is a more fundamental difference in the way you think in the two pursuits. As a Roadie the Tarmac is endless, your body settles in to the rhythm, the pace line, the drafting and, odd pot hole aside, the Zen. The mental quiet, conversation and interaction in the group is the reward and in many cases reason to be a roadie.
MTBers on the other hand are always physically interacting with the bike, the terrain, the changing challenge, conversation is impossible especially on the "gnarly bits". The impact is that MTBers focus on the here and now, no chance to think beyond the next rock, dip or bend.
Neither group is superior to the other, no one is wrong or right. They are just very different in how the same activity is performed and the thought processes which the activity requires and generates in it's performance.
Medicine is like that, we have at the moment two tribes, the generalists and the specialists, each performing and to a certain extent thinking in different ways. 
Neither is "better" than the other and both are required to deliver a functional healthcare system. 
My issue at point is that there are a group of cyclists who are happy to wear Lycra, ride the road, accept the zen of the racing bike on a Sunday morning. Those same cyclists will have been out on the Saturday morning attacking the trails, making the jumps and wearing the baggy shorts of the MTBers. 
Where are those who straddle both primary and secondary care? The GPWSI is one breed, but the Consultant with interest in primary care is not yet on the map.
Should it be? Isn't there a piece missing from the landscape? Perhaps consultants in intermediate care are the closest we have at present but their value needs to be recognised and we all need to recognise the beauty inherent in each others craft. 

Trust me I'm a Doctor!

A key part of being a leader is to be trusted by those we lead. many of us think that trust is something which has to be earned, takes time and either happens or not. 
Oddly enough I used to think that until I came across an article in Harvard Business Review which outlines the factors on which trust can be built. Of the ten or so listed there are three which are entirely dependant on the individual who needs to develop trust in someone else. The remaining factors are all able to be influenced by the person who wants to be trusted. 
These factors include obvious features such as consistency of action, perceived risk, having similar goals and ambitions, as well as some less obvious factors. If someone asks you to trust them you need to know they actually care about you, not in a romantic way but in a benevolent way, considering your interests as pat of their value set. 
Our emerging clinical leaders in primary care will need followers who trust them to lead. These leaders need to be able to communicate, be predictable, be capable, care for their colleagues, be transparent in their goals and strategy and build on the common agenda of all clinicians. 
There is obviously a significant trust gap within primary care, small practices, GP providers and self aggrandising leaders will all contribute to the trust gap. However that gap is nothing in comparison to the gap in trust between secondary and primary care.

What's the game?

Do you ever ask yourself why you are doing what you are doing?

Do you ever think that there must be a better way of doing things?

Do you then decide that sometime in the future you'll need to think about it?

You do!- Fantastic, you are normal, i.e. average.

Most of us do question our decisions in clinical practice, it's right that we should. But how often does this reflection prompt you to do more than justification in a post hoc kind of way?

The next time you feel that there must be a better way of doing the task, handling the patient or dealing with a problem just stop. Take a mental snapshot of the scenario, and later that day instead of wasting 30 minutes watching the latest Scrubs episode just sit and think about what the problem really was, not just the immediate task, but how did that task come about what really was the underlying reason that events transpired in the way they did. Ask the why, until you reach answers outside of the need to demonstrate some CPD or reading of a particular research paper.

You will not always get answers to your questions, but at least you will really start to understand the problem.

What's it all about?

Clinical Creativity seeks to unlock the additional potential within every clinician.

Granted there are some absolute truths in medicine, those complete certainties that evidence based medicine tells us we can believe in without fear of contradiction. However the rest of the time clinicians are left to "work it out for themselves" to use their creativity in finding solutions that work, for them and their patients.

Clinical creativity offers solutions and examples in formats that are not evidence based, but reality based. These lessons are not gold standard evidence but stories or techniques of the real world, through which we all can learn.