Team versus Individual Creativity

Team creativity is different than individual creativity. For example, a team of creative individuals may not be a creative team if individual creativity is stifled by nonsupportive decision making and problem-solving processes. The same point applies to creative team leaders: having a creative leader does not ensure a creative team, unless the leader implements processes that support team creativity. The preceding vignette illustrates the quandary of many creative individuals in teamwork settings. Mr. Jackson’s individual creativity was stifled by team processes that did not invite participation and the widespread sharing of ideas. Team leader Dr. Pierce pre-empted creative suggestions by announcing that he strongly supported Ms. Zasky’s preference for one option. Dr. Pierce actually may be a quite creative person, but, even if he is, his creativity was not enough to elicit a high level of team creativity.

Teams that would benefit from greater creativity should strive to improve creativity in both individual members and in team processes. In one study of hospital leadership teams, researchers found that both innovative individuals and innovative team processes predicted the overall level of innovation on the team, reporting that the quality of the innovation (radicalness, magnitude, and novelty) is more related to individual member characteristics, while the overall level of innovation is more related to team processes, such as participation and commitment to team goals (West and Anderson, 1996). Both individual and team-level creativity are important. A team with processes that are “creative-friendly” still depends on individuals to come up with the ideas that then are processed by the team. And, as the introductory vignette illustrates, teams with creative individuals need support through appropriate leadership, team processes, and norms.

Potential for Creativity in Individuals and Teams

All individuals (and teams) have the potential to be creative and innovative. Novel and useful ideas are not the purview of a select few individuals or teams. This recognition is important in stimulating creativity, since many individuals label themselves as noncreative and behave in accordance with that self-fulfilling prophecy. Some observers go so far as to suggest that there is only one major difference between people who exhibit creative tendencies and those who do not: people with creative behaviors regard themselves as creative (Quinn et al, 2011, p. 289).

There are some personality traits that make creative thinking more likely or more natural. For example, the personality trait of openness has been linked to creativity (King et al, 1996). Openness is an indicator of imagination, originality, aesthetic sensitivity, attentiveness to inner feelings, preference for variety, and intellectual curiosity (McCrae and John, 1992). But regardless of personality, behaviors that enhance creativity can be stimulated, learned, and increased. Among those individual behaviors are questioning, observing others, experimenting, and networking. All of these behaviors encourage individuals to stretch their minds and make connections across seemingly unrelated questions, problems, or ideas. Associations across seemingly unrelated ideas are the basis of creativity (Dyer et al, 2009). Other experts urge individuals to develop outward interests, to diversify their searches for solutions to problems, to practice creativity, and to be adaptable—willing to drop their preset ideas and engage new ones (Boynton et al, 2011). Again, the point is that creativity is a competence that can be learned by individuals. Individual creativity requires hard work and a strong knowledge base; it does not happen by luck or chance. The empirical evidence on creative achievement concludes that individuals have not been able to make generally recognized creative contributions to a domain unless they have mastered the relevant knowledge and skills in the course of a long preparatory period (Ericsson and Lehmann, 1999, p. 706).

Creative Realism

There is rarely, if ever, a need for teams to pursue creativity just for the sake of it. Novelty that derives from nonconformity, lack of discipline, blind rejection of what already exists, and simply letting oneself go has been referred to as pseudocreativity or quasicreativity (Cropley, 2006, p. 392). As noted earlier, creativity is linked to innovation, where innovations are the implementation of creativity in the form of useful new products or services. Creative individuals and teams may generate hundreds of ideas to solve a problem, while only one (or none) may emerge as an innovation. Most organizations establish boundaries on the performance-enhancing expression of creativity—sometimes overtly and sometimes by implication. Without those boundaries, creativity can be a burden rather than a value-add to team performance. If ideas are completely unconnected to current realities and knowledge, they are not implementable. Thompson (2003, p. 97) and others describe the optimal level of creativity as creative realism. Teams should strive for creativity that generates original but realistic ideas. In contrast, creative idealism is the generation of highly original but highly unrealistic ideas.

Types of Thinking

Three contrasts in the way that people and groups of people process information are useful in understanding the nature of creativity: critical versus creative thinking, divergent versus convergent thinking, and exploration versus exploitation.

Critical versus Creative Thinking

Critical thinking is the cognitive search for one answer to a problem through logical thinking and mathematical processes. It traditionally is emphasized in Western cultures, and it anchors most of the sciences that underlie the healthcare disciplines. Creative thinking begins with the same one problem, but generates numerous possible solutions (de Bono, 1970).

Most healthcare professionals exhibit strong critical thinking ability. They are rewarded in the extensive educational process of their professions largely for critical rather than creative thinking.

Problem solving by teams requires both creative and critical thinking, and creative thinking tends to be underemphasized. In healthcare interprofessional teams, creative thinking often needs to be expanded relative to critical thinking.

Convergent versus Divergent Thinking

The contrast between convergent and divergent thinking conveys similar messages. Convergent thinking means narrowing down alternatives quickly and logically, in the search for one right answer or solution (Cropley, 2006). It assumes that there is one right answer or solution. Convergent thinking leads to a single-best answer, with no or little ambiguity.

Divergent thinking involves producing multiple or alternative answers. It requires making unexpected combinations, recognizing links among remote ideas and themes, and transforming information into unexpected forms. Convergent thinking generates orthodoxy, while divergent thinking generates variability (Cropley, 2006).

Researchers have found that individuals are better than teams at divergent thinking, while teams are better than individuals at convergent thinking. The finding is counterintuitive to many individuals (Thompson, 2003). Teams do less well at divergent thinking because of the social pressures for conformity—members want to be approved of by other members. Individuals are more removed from the pressure to conform when they are left alone. Therefore, a collection of separate individuals can generate a larger quantity of creative ideas than a team of the same individuals. (In addition, several other social processes detract from the team’s productivity on the creativity dimension, as discussed below in relation to brainstorming.) Teams do better at convergent thinking than individuals, however, because more minds are focused on the search and logic required to find an answer.

Experts argue that teams need both divergent and convergent thinking—typically sequenced with divergent thinking first, followed by convergent thinking. Convergent thinking is required to make the ideas generated by divergent thinking more fact based and reality based. Convergent thinking helps teams recognize promising solutions, see limits, be aware of weaknesses, and weigh feasibility of ideas.

Exploration versus Exploitation

Exploration versus exploitation provides another useful dichotomy in thinking about individual and team creativity. Exploration involves searching for new possibilities through experimentation, discovery, and innovation. Exploitation involves refining and extending existing products and services. Exploration, then, requires more creativity.

Organizational scientist James March noted that in general organizations have a tendency to focus on the exploitation of known alternatives rather than the exploration of unknown ones. Such organizations increase the reliability of organizational performance more than the average level of performance (March, 1991, p. 85). Organizations that focus too much on exploitation are likely to find themselves “trapped in suboptimal stable equilibria” (March, 1991, p. 71). The equilibria are suboptimal if the environment of the organization (for example, its customer base, technologies, or competition) is changing in ways that require the organization to produce different goods and services rather than becoming more reliable at producing existing goods and services. The dilemma can be summarized as the need to balance short-term efficiency with long-term effectiveness in a changing environment.

Like organizations, many teams focus on exploitation because its returns are positive, proximate, and predictable, while exploration is risky and its returns often are negative. Consider the trend toward patient-centered care over the past 2 decades or so. Healthcare organizations and teams face decisions about whether to continue doing business as usual or to introduce innovations such as e-mail communication with patients. Exploration of the new space of patient-centered care creates team learning, both positive and negative. In settings where competition and technology and patient expectations are driving the shift to patient-centered care, such learning through exploration is critical to the long-term success of healthcare organizations and teams. One interesting implication of the tendency to exploit rather than explore, noted by March (1991, p. 86), is that rapid socialization of new members may hurt the team, as the development of knowledge may depend on maintaining an influx of the naïve and ignorant. For purposes of team learning, relatively slow socialization of new members, as well as moderate turnover in membership, is preferred.

In summary, there are arguments for improving exploration, divergent thinking, and creative thinking in virtually all teams. All are paths to improved creativity. Yet too much exploration, divergent thinking, and creative thinking has dangers of its own, so a balance must be maintained.

There are specific practices that teams can employ to improve creativity in their work. We classify these into: (1) practices that embed creativity in team culture, and (2) tools that improve team creativity.

BUILDING A TEAM CULTURE OF CREATIVITY

Elk Valley Rehabilitation Hospital is a leader in its region on measures of quality and service. That was not always the case, as the hospital drastically improved patient satisfaction and recovery times (following mistakes or errors) over the past decade.

The Quality Council of the hospital was a major reason for the hospital’s improvement in quality outcomes. The Council had originated and driven the idea of team-based care, for example. Not all of the Council’s ideas worked, but several of them, like team-based care, did.

Meetings of the Quality Council were fast-paced and engaging. The Council chair, physiatrist Gary Kopek, MD, really enjoyed pushing the envelope on innovation. He always brought a light bulb (encased in a plastic cube) to the meetings, as a symbol of his commitment to innovation.

Today the Council was welcoming new member Casey Wilhoit, MHA. Ms. Wilhoit was administrator of the facility’s transitional care unit, which she had transformed from a drab and depressing wing with a demoralized staff into a national trend-setter. The Council had expanded its membership to make room for Ms. Wilhoit. Dr. Kopek welcomed her warmly, noting that “You were selected because you aren’t afraid to try new ideas. We want you to keep that up, whether we use your ideas or not. We like to think we’re a really creative bunch and that we’re responsible for the excellent quality outcomes that Elk Valley has enjoyed. We work hard to learn what works and what doesn’t work. If you don’t find that to be the case, let us know. We need some new blood—we don’t want to rest on our laurels.”

Today’s topic was “what can we learn from the turnaround of our transitional care unit.” Ms. Wilhoit looked forward to sharing her learning and to contributing new ideas to other areas of Elk Valley Rehabilitation Hospital.

How does creativity become embedded in the culture—the way we do things around here—of a team, as it apparently was for the Elk Valley Rehabilitation Hospital Quality Council? Organizational psychologist Michael West (2012, p. 168) provides a series of concrete steps for teams, beginning with setting a goal of creativity and selecting the right mix of members. Subsequent steps test the seriousness of the commitment to creativity through the hard work of changing team processes and norms to support creativity. The steps are listed in Table 10–1, with some modification and supplementation.

Specify Realistic Creativity as a Team Goal

Countering the self-fulfilling prophecy that “we are not creative” is as important at the team level as it is at the level of the individual member. Achieving creativity as a team characteristic requires a conscious commitment to creativity or innovation as a team goal as well as norms and policies to support creativity. Team leaders are particularly important in this step. It is also important to establish that creativity is not easy to achieve, and that creativity has boundaries—it has to be realistic. In the vignette above, Quality Council leader Dr. Kopek states the team’s commitment to maintaining excellent quality outcomes and claims that the team is creative and works hard. He links the team’s creativity to measurable outcomes, all consistent with achieving realistic creativity as a team outcome.

Select for and Encourage Diversity

Diversity of perspective is a key to creativity at the team level. Indeed, this is one reason that interprofessional care is effective—by definition, diverse perspectives populate any interprofessional team. At the stage of selecting team members, this is a crucial design issue for teams that need creativity in order to perform well. Research finds that teams with diverse members in terms of background and perspective outperform teams with homogeneous members when teams perform tasks requiring creative problem solving and innovation. They generate more arguments, apply more strategies, detect more novel solutions, and integrate multiple perspectives (Thompson, 2003, p. 102). The opportunity to appoint members with diverse perspectives and creative styles generally falls to team sponsors and leaders, although team leaders and team members can lobby for creativity as a criterion for new members as well. Team sponsors in organizations searching for innovation in clinical processes are well served by seeking more creative participants as team leaders and members. In the Quality Council vignette, team leader Dr. Kopek sought out new member Ms. Wilhoit because of her reputation for innovation.

Earlier we noted the argument that slower socialization of new members, and moderate levels of turnover, help reinforce creativity in teams. Thompson (2003, p. 105) refers to cognitive arthritis which develops in teams that stay together for a long time without any change in membership. Researchers have found a negative relationship between repeat collaboration and creativity (Thompson, 2011, p. 225). The more that team members do the same task together, the more routinized the team performance becomes. This explains why low turnover can make the performance of a team better in one way—its errors are fewer. Highly stable teams are likely to be more reliable in the performance of their regular tasks, but less creative. New members in a team shake up the routine. And when new members enter a team, they not only bring a new perspective. They also can motivate existing members to revisit their own ideas and behaviors. In the vignette, Dr. Kopek hopes that Ms. Wilhoit will add some new blood to the team, perhaps to counter the possibility of cognitive arthritis.

Build Support for Creativity in Team Activities and Processes

After creativity is set as a team goal and an appropriate mix of individuals is on the team, the work of sustaining creativity in team activities and processes begins. Participation as a team norm is particularly important to creativity. People who have influence, interact frequently, and share information are more likely to invest themselves in team outcomes and offer ideas for new and improved ways of working. Leaders who require that ideas flow through them (a hub-and-spoke communication model) may feel threatened if ideas come from others on the team. In such settings, members will learn to self-censor their ideas, creating a collusive pattern in which leaders solicit input but do not receive any (Dye and Garman, 2006, p. 178). Another barrier to full participation is the tendency of physicians or other professionals with higher relative power or status to dominate discussions, thus repressing others’ contributions, as noted in Chapter 9.

Team members who are particularly creative may have little patience with helping other team members to understand how they arrived at their ideas. Creative members must recognize that as team members, they are responsible for bringing others along.

Support for creativity includes having a positive attitude toward problem solving. Creativity is fueled by the faith that solutions exist and can be discovered. An underlying current of optimism invites openness and participation. Challenges are viewed as opportunities for creative action rather than worries to resolve. This is related to the notion of psychological safety, mentioned in Chapter 6. It can be risky for team members to suggest new ways of working, and a nonthreatening and supportive environment is important.

One common mnemonic device for supporting participation and psychological safety is the practice of thinking or saying “yes, and…” rather than “yes, but…” when responding to the ideas of others. Teams can explicitly establish this practice as a norm in discussions that are in the idea-generation phase.

To fight routinization of team processes, review and reflection on team decision-making and problem-solving processes can be helpful. Having an outside facilitator observe meetings and monitor participation and encouragement can be useful for teams that find themselves stuck in a routine.

Improve the Base of Relevant Knowledge

As discussed above, creativity is more likely to emerge when it is informed by facts and knowledge about an issue. Thus we added this step to West’s suggestions for building a culture of creativity. Team members cannot be expected to be creative about things they know nothing about. Educational sessions to improve learning, share best practices, and explore how other teams are handling similar issues are useful. In the vignette above, Dr. Kopek’s effort to transfer some of Ms. Wilhoit’s knowledge from her experience in revitalizing the transition care unit to the Quality Council represents an improvement in the team’s knowledge base. Team members who connect with other experts by travel to conferences, study, and other means should transfer their relevant learning to the team.

Knowledge about many knotty healthcare issues can be gathered by studying positive deviants. Positive deviance is a change management methodology which begins by identifying the small minority of individuals or groups who are handling a problem extremely well—the positive deviants (Pascale et al, 2010). For example, suppose a quality improvement project team is searching for ways to improve hand washing compliance by clinicians. Relevant knowledge would include information on teams or units that have high compliance, and understanding whether the experience of those positive deviants can be transferred to one’s own setting.

Challenge the Team

As noted earlier, embracing creativity requires openness to new ideas, but not to any and every idea. This requires that openness be balanced with demanding criteria that are performance related. Otherwise, ideas go unchallenged, and there is little forward movement—anything goes. Teams that enjoy being creative can get caught up in the excitement of doing something new, for its own sake. Like most good practices, the pursuit of creativity can be taken too far.

Leaders need to set high standards for quantity and quality of creative ideas. Researchers have found increased idea generation when team members have information about other members’ activity levels, when performance standards are set high, and even when it is simply announced that members will see a list of all ideas at the end of the session (Thompson, 2003, p. 105).

As noted in Chapter 6, a safe team climate is not the same as a comfortable climate if team members respond to comfort by becoming complacent and giving less than their best efforts. Among teams of scientists, for example, research shows that innovation is high when the atmosphere within the team is warm, supportive, but intellectually demanding (West, 2012, p. 157). Mining creativity requires that teams progress to synthesizing and acting on new ideas, rather than letting them sit. This final step can be viewed as convergent thinking, after a period of divergent thinking—both are necessary. For this reason, members need to be prepared, that is, they need to know that their creative ideas will not always be used or implemented. Rejection of most ideas is an expected part of the pursuit of creative realism. This understanding encourages team members to keep generating ideas without the guarantee of adoption.

Stop Working

Another guideline is to devote formal team time to creativity. The advice to “stop working” is tongue-in-cheek; work to “stop” refers to the traditional view of work as critical thinking, convergent thinking, and exploitation as opposed to work that involves creative and divergent thinking and exploration. The formal delineation by the leader of a shift in thinking is sometimes helpful; for instance, “Why don’t we relax now and blue sky some possible solutions instead of critically assessing them.”

To the extent that fun and humor stimulate creativity, though, the “stop working” adage has some literal meaning. Humor and fun fuel creativity. Making sure that meetings and social activities are fun encourages a creative culture. A positive social climate contributes to the freedom that members need to be open without fear of embarrassment or sanction. In the preceding vignette, Dr. Kopek set the stage for fun by bringing his symbol of creativity—the encased light bulb—to Quality Council meetings.

Stop working also can mean turning to formal tools to stimulate creativity, such as those discussed below. While busy team members may be irritated to be spending precious time using formal methods, often use of the tools symbolizes a serious commitment to creativity development, as well as producing positive results.

TOOLS TO SUPPORT TEAM CREATIVITY

The staff of Redborough Clinic, Wyndham Health Services, was restive. Wyndham Health Services was a large multispecialty group practice in a metropolitan setting crowded with other group practices competing for new patients. Statewide quality reporting statistics had been released earlier in the week, and Wyndham ranked in the lower quartile on diabetes care and several other measures of quality. Within the Wyndham organization, the Redborough Clinic had one of the lowest scores for diabetes care. Particularly troublesome was the distressingly low percentage of type 2 diabetes patients who had been tested in the past year to determine their hemoglobin A1c levels. National guidelines recommend that patients with type 2 diabetes have the test performed every 6-12 months.

Paul Pedersen, DO, an internist, was responsible for quality improvement in the Redborough Clinic. He called a meeting of staff who were most involved in diabetes care to discuss ways to improve performance as measured by adherence to the guideline recommendations. Attending the meeting in addition to Dr. Pederson were J. Stanley Wirth, MD, an endocrinologist; 2 general internists; 3 RNs; the Redborough Clinic administrator; and 2 clerks who helped patients with scheduling.

Dr. Pedersen opened the meeting with a request for ideas about improving compliance with the testing guideline. “The floor is open,” he announced. “Who has an idea?” Dr. Wirth immediately jumped in with his favorite suggestion, one he had been pushing for years. He recommended that patients’ insulin prescriptions would not be refilled if they had not had an A1c test done in the past year. A chorus of disagreement followed from one of the general internists and 2 of the RNs. They said that patients should not be deprived of insulin because it was not safe for the patients, and they speculated that patients whose refill requests were refused would simply go to another clinic. The other general internist then questioned the validity of the data used in the quality reporting program, and an RN sarcastically suggested they “move the clinic to a part of the town with a more educated population.” One of the RNs stated, “We have worse problems with getting diabetic patients to pay attention to their high blood pressure problems. Why aren’t we talking about those?” The 2 clerical staff members remained silent. The conversation was so chaotic that one of the RNs started to smile—although no one else knew why. After 15 minutes, Dr. Pedersen had heard enough. Saying “We’ll just have to try harder,” he asked 2 members of the team to meet to create a list of ideas for the whole team to consider at the next meeting. The team then moved on to discuss another disappointing aspect of its reported performance in treating patients with diabetes.

A plethora of tools and methods for improving creativity can be applied in team meetings and beyond. Following are a selection of several tools, with brainstorming and variations on brainstorming being the most prominent. Formal brainstorming is a tool that would have allowed Dr. Pedersen in the vignette efficiently to get more ideas on the table for improving the rate of hemoglobin A1c testing.

Brainstorming

Brainstorming is a focused discussion with systematic encouragement of creative thinking around an issue or question. Brainstorming enables widespread participation in discussions that are directed at innovation and creative problem solving. Formal brainstorming more systematically encourages group members to generate many ideas without worrying about whether they are good or bad ones. Approximations of brainstorming often are used informally in meetings when managers ask all participants for creative ideas about tackling a problem or pursuing an opportunity. Dr. Pedersen attempted to use informal brainstorming in the vignette above.

In organizations where participation in meetings typically is highly structured or routinized, formal brainstorming is an option for breaking the routine. Signs of routinized discussions include heightened predictability of the content of member contributions (for example, one member typically may suggest that the team will just have to work harder, as Dr. Pedersen did in the vignette) and a pattern of the same participants dominating discussions, with little participation from others. The lack of participation from the 2 clerical staff members in the vignette may be indicative of that sign of routinization.

Brainstorming as a formal method of generating ideas typically includes the following steps:

1. Introduce the question or issue and review guidelines for brainstorming, such as:

• All ideas are welcome

• No evaluation of ideas during the brainstorm

• The more ideas the better

• Do not worry about duplicate ideas

• Suspend judgment

• Be concise

• Include the unusual and strange (West, 2012, p. 167)

2. Display the central question or issue on a flipchart or elsewhere.

3. Offer a brief quiet period for team members to collect their thoughts and jot down ideas.

4. Ask for ideas and record them on a flipchart or elsewhere as they are offered. A separate recorder may perform this task. Do not accept comments that are evaluations of ideas. Use encouragement to invite more ideas.

5. Allow for lulls in activity; it is not uncommon for good ideas to emerge after periods of silence.

6. Offer one last chance for additional ideas, including ideas from the recorder. End the brainstorm.

7. To facilitate next steps, ask for clarification of ideas if needed, and number the ideas so that they can be referred to easily.

Table 10–2 displays an abbreviated summary of these steps.

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