Intimate Innovation

In June 2013, I worked with some colleagues, the Health Foundation and 80 staff and patients from hospitals in England – we wanted to get to grips with the idea of return-on-investment. We were working in the Wallace Space – where they attend to every detail, care for you as you think.

We were inspired by several impulses and observations:

• we know that carers – in the front line, so to speak – are making decisions all the time about return-on-investment (whether to care like this, or like that; whether to use this treatment or that; this therapy or that); yet they outsource decisions about ‘money’ to accountants and financial analysts, who set the parameters for resource allocations
• we know that senior managers and boards of directors have developed abstractions – like metrics and targets – to act as proxies for the conflict of deciding how to care
• we know we make private decisions about return on investment (every decision involves this), but public discourse on how-to-choose hurts too much – so we ‘outsource’ what we need to face to so-called ‘faceless bureaucrats’

So, we tried to act on this knowledge. We designed some activity in which

• we used freefall writing to get at what we each thought and felt we were trying to do that was good
• we shared this verbatim together and noticed similarities and differences
• we grouped these together
• we invited Dr Mikey Dunne (a medical ethicist from Ethox) to act as observer and provocateur

So, we explored how what we value links to what we decide to do; how what we value links to what we invest, and what we understand by ‘return’. Some, fascinating things became visible:

• we valued differences, but we found it very hard to make use of them
• we became aware of gaps between our assumptions; we thought we agreed on our values, but we were ill-equipped to test this
• we saw that the limits of agreement with others about what we valued was a limit on collaboration; that there would be points at which our ‘stand’ presented a limit to sharing – a limit to making use of our differences

So, the spread and adoption of innovation is in part a question of values.