Crisis Thinking Outside Our Traditional Boxes

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

The current COVID-19 virus presents unprecedented challenges to the healthcare delivery system. Albert Einstein once noted that ” The significant problems we face cannot be solved at the same level of thinking we were at when we created them.” This really rings true during this time of crisis. It has never been more important to think outside our traditional boxes. Many thought leaders are now urging that there has never been a better time to put design thinking to work for us. The goal of design thinking is to remove our normal patterns of thinking and search for creative out of the box solutions. The steps in the process include the following:

Empathize– focus on understanding human-centered challenges
Define– articulate the challenge intended to solve
Ideate– brainstorm potential solutions
Prototype– develop model solutions to test
Test– iteratively analyze solutions to continuously improve the design

The potential lack of ventilators and critical care beds is an excellent challenge to consider. WHO has projected that around 6% of those who contract COVID-19 may need ventilator support. The exact numbers of hospital ventilators are not known but even a moderate outbreak could create severe shortages. Without a plan in place, heart wrenching decisions may need to be made about who is placed on a ventilator.

Now is the time, design thinkers would begin to ideate. Where outside traditional hospital settings could you look for ventilators? Some will be in the national emergency stockpile but this may still not be enough. What about the nation’s Long Term Acute Care hospitals? Although, they traditionally do long-term ventilation – a prototype might be a collaboration to work with an LTAC to share resources. Another source are outpatient surgical centers. There are almost 10,000 outpatient surgical centers in the US. Most are equipped with ventilators. What if these ACSs were temporarily converted to surge ICU beds utilizing ACS staff including anesthesia staff familiar with ventilator management. It is estimated that most ASCs have five ventilators.

The time to look at new model approaches is now. As you move through this leadership crisis, the following are five key strategic ideas to consider:

1. Ask yourself whether your issue or challenge can best be solved using a traditional approach – if not, then it is time to be innovative in your thinking.

Not every issue or challenge requires out of the box thinking. Many problems can be effectively solved using a more conventional approach. But sometimes to achieve more effective outcomes, innovative thinking is required.

2. Consider the problem from an entirely different vantage point.

When we are willing to examine a problem from an entirely different vantage point, our thinking can become more creative. Asking ourselves what is really needed here becomes important. To think outside the box, you need to ask “Is there another way to think about this or other partners that could be brought in to help?”

3. Seek ideas and input from others.

Seeking the opinions of others can help in the creative thinking process. As a nurse leader, you can improve your out of the box thinking if you seek ideas from individuals outside of your own profession – ask pharmacists for their opinions, your perioperative staff who manage acute patients and your central supply staff. This is not the time to be territorial. Ask yourself how things are being done in other industries. What ideas can be applied to this situation.

4. Identify at least three different approaches to solving a problem with at least one approach being outside the mainstream of how you would usually manage a challenge.

Challenge yourself to identify at least three different approaches to solving a problem. Getting out of the box means sticking with the problem longer, and looking at it from various sides. This requires a willingness to take new perspectives to your day-to-day work. In the box thinkers often believe that every problem needs only one solution; therefore, finding more than one possible solution is a waste of time.

5. Never dismiss a possible solution on the basis that it can’t be done. Consider everything. Go through every possibility until you know for a fact it can or cannot be done.

Challenging your own assumptions can be the most difficult part of out of the box thinking. Just because something has always been one way, doesn’t mean that it has to continue to be that way. When someone challenges an idea – keep asking why, why and why.

Out-of-the-box thinking requires an openness to new ways of seeing the world and a willingness to explore. It means considering other innovative options as the nurse leader in our case situation was able to do while recognizing that new ideas need nurturing and support. Even great creative people can become in-the-box thinkers when they stop trying. As nurse leaders, we need to nurture our ability to think outside the box at this time of crisis.

Read Rose Sherman’s new book – The Nurse Leader Coach: Become the Boss No One Wants to Leave