HealthManagement, Volume 19 - Issue 6, 2019


Summary: It should be the responsibility of leadership to promote a culture for innovation by questioning established cultures and liberating narrow mindsets.

It is a harder to come to grips with organisational culture as opposed to, say, strategy or structure. This is because culture is a set of shared values, beliefs and assumptions which strongly influence behaviours, norms and the ways people interact. It is trickier to measure and monitor culture than it is to define objectives and resources or map out processes and organisation charts. Culture, as many a failed change agenda will bear witness to, can place huge obstacles to innovation.

Culture is determined by context, legacy and leadership. Context, represents the external influences on culture and the realities of the environment in which an organisation is operating – sector, profession, country, competition, regulation, etc. Legacy is the history of the organisation and how it has been doing business in the past. Context and legacy are, therefore, givens. Which leaves leadership as the only factor which can look to the future and actively change culture.

Two very simple, real-world cases illustrate the need for leaders to take on change responsibilities.

Going Dutch in Healthcare

Earlier this year, The Economist (2019) published an interesting article focused on why Dutch hospitals have a significantly lower incidence of superbugs – antibiotic-resistant microbes and a number of dangerous viruses - than most other European countries.

This is simply because, in the Netherlands, health professionals wash their hands better. Washing hands is something all hospital staff are trained to do. But frequency and thoroughness vary a lot, and this is what makes the difference. To actually get hospital professionals to wash their hands better and more often, it is important to prioritise reducing infection and to share statistics of the hugely positive outcomes of such practice. Less easy is allocating more money to cleansing products and making staff accountable for hand cleanliness. The hardest part of all is getting senior specialists to accept that a junior nurse might be strictly monitoring their hygiene (a key to success in the Dutch case).

You might ask how innovative the idea of washing your hands more frequently is for health specialists. Innovation is not always 'the next big thing.' A product, a service, a strategy, a business model, a process or a work practice is innovative if it is new to the workplace and if it brings value.

We Can’t Change, or Can We?

About five years ago, I spent a day with senior health professionals of the public sector of a European country. To start off, I got an unsolicited earful of why any kind of creative change was impossible because they did not have budgets for innovation. After four hours of imagining possible improvements at hospital level, they came up with a scheme that needed no budget, and would save a projected few million euros if implemented. They had simply figured out smarter ways of organising and allocating beds. They agreed this could be implemented in a few weeks and they set off to do it.

Why was the culture so stubborn, so negative and so resistant to change to begin with in this case? Why will other hospitals not rush to take on Dutch hygiene habits any time soon? The above examples show that seemingly small changes often encounter the barrier of human mindsets.

How then might leaders liberate those limiting thoughts which exist only in people’s minds (the public sector case) and how might they take action to change habits so as to deliver new value (the Dutch case).

Leadership Tips for Developing a Culture for Innovation

Fortunately, we have many documented cases of good and fast culture change in organisations. To share new values, new beliefs and new assumptions and to engage in new behaviours is a responsibility best undertaken consciously and as a priority by an organisation’s leaders. As usual, actions speak louder than words.

Tip #1

Promote New Ideas

This is both a top-down and a bottom-up responsibility. An innovative company loves new ideas. Innovation will thrive only when everyone recognises that it is a key value. Leaders in the top team must continuously design new strategies and business models. All people must be expected to bring forth and implement new ideas in ways that are compatible with the new strategies. Leaders must create forums such as innovation teams and idea sessions and offer idea-time and incentives for value-adding ideas. Of course, leaders must also be enthusiastically receptive to novelties proposed by their team.

Tip #2

Promote Freedom at Work

Creative ideas can come from very restrictive circumstances but they truly thrive with more rather than less freedom. Leaders should shift from simple delegation to empowerment, inviting people to create their own jobs around agreed expected outcomes. They should promote open debate or new ideas. Everyone need not always agree with their boss.

Tip #3

Generate Engagement in the Organisation

Engagement is the unwritten contract between organisation and employee to help each other grow. People will more generously offer their creativity when the organisation offers good training and personal development opportunities and when leaders strive continuously to achieve and sustain high levels of trust.

Tip #4

Ensure Everyone Takes Risks

Innovation is practically impossible without risk, but this does not mean licensing recklessness. A zero-risk policy is vital under some circumstances, especially those where the failure can be very costly, but leaders would do well to recognise that most situations are not like this. Leaders should carefully consider risks and accept, even encourage, mistakes and not let failure be career-limiting. Making risk-taking acceptable is an invitation for leaders and people to take responsibility for their actions as they try out new things and to truly learn from experience.

Tip #5

Cultivate a Propensity to Change

Change is not easy and organisational change is best implemented when there is plenty of willingness for change at a personal level. Begin with the leaders’ real efforts to change themselves. Recognise that people have different propensities to change. But do take action to place people in situations of change. Do not comfort people with the thought that when a change happens it’s all over. Make sure they realise there will be more and more change. That way, the culture of the organisation gets used to navigating new, as yet unexplored, territories. This is the essence of innovation.

Key Points

  • An established culture can place huge obstacles on innovation.
  • Innovation is any product, service, strategy or business model that brings added value to the workplace.
  • Even small changes to a system can be vulnerable to human mindsets. It's important for leaders to liberate these limiting thoughts.
  • To develop a culture for innovation, leaders must work to promote new ideas and freedom, generate engagement, encourage risk taking and cultivate a propensity to change.

To buy a copy of Dimis Michaelides’ book, The Art of Innovation – Integrating Creativity in Organizations, hailed as “a must-read for 21st century CEOs,” email: [email protected]


The Economist (2019) Why Dutch hospitals are so good at beating superbugs. Available from