4th February 2019

On exnovation

I attended an excellent meeting in OLVG Hospital, Amsterdam recently. It was a convention of healthcare practitioners with an interest in LfE and safety-II. Delegates shared some presentations on LfE implementation and some related topics, including Appreciative Inquiry and joy in work. It was a stimulating and inspiring day, and as I reflected on what I had learnt, I became aware of a stream of thought about LfE and related endeavours: there is no single way to “do” LfE, Safety-II, appreciative inquiry or “joy”.  None of them is a panacea, and none should be ‘done’ in isolation. But they share a common thread of positivity: a kind of positivity that naturally emerges in a deficit-based culture. This type of positivity is not a highly energetic, celebratory force (although, I’m sure that sort of positivity has its place); it is a calming, warming, appreciative, nurturing sort of “everyday” positivity.

This thought has been with me for a while, just out of reach. But it started to take shape during the seminar while I listened to a lecture on exnovation, by Professor Mesman.

I first came across the term exnovation when I read Hollnagel’s “Safety-I to Safety-II”. It was listed, along with Appreciative Inquiry, as a methodology which may be used to facilitate safety-II. I confess that I never found the time to investigate further, and so I was pleased to find myself listening to a lecture on the subject.

I learned that exnovation is, in some respects, opposite to innovation. Where innovation may be considered to be the creation of novel improvements; exnovation is the process of improvements based on understanding current solutions within a system; many of which we don’t see because we take then for granted. Exnovation is a process to help us see what is right in front of us.

Exposing (or unmasking) these solutions, for the purpose of improvement, is the business of exnovation. Prof Mesman demonstrated how this can be done with in situ video ethnography. In other words – filming daily activities and then reviewing and analysing these videos in order to understand what is working.  The beauty of this approach is that the “solutions” or “recommendations” already exist and can be shared more widely.

Reports from the LfE initiative often focus on “everyday” excellence, and therefore, the potential to collaborate with the process of exnovation is worth further exploration. A vital part of exnovation is the recognition of something which works, and this is also the business of LfE. In both LfE and exnovation, the recognition of something good comes from the staff who are actually doing the work. This makes the process highly valid and relevant.

I returned to work inspired to see if I could turn my appreciative eye to some everyday excellence: something apparently mundane which I could learn from, or could share with colleagues. Whilst I was bemoaning the length of our ICU ward rounds, I noticed that a colleague routinely delegates certain tasks to team members during a ward round. This simple act saves vital time, minimises stress and inspires team members to engage with the round. Such a simple act is typical “everyday excellence” and I immediately adopted into it my practice.

Have you seen everyday excellence recently? Try actively looking for it, by watching your colleagues go about their work; and you might be pleasantly surprised about how much you learn.  Feel free to share examples (or other comments) below.


Thoughts on “On exnovation

  1. Thanks Adrian – very enlightening, and a suitable procrastination from the work I actually have to do today!

    Struck by your example of picking up a practice change from a colleague and adopting it into your practice in real time.

    Have started to pick up some of what I guess are exnovations from submissions to our reporting system where I work – I got these through very brief (5-10mins on the shop floor in the ED) appreciative inquiries with the staff members involved.

    An example is an episode of treating a paediatric ED patient with autism, where the learning points seemed to focus around anticipation of the child’s needs, early pick-up from the waiting room, and treating the establishment of rapport as an end in itself, rather than merely a bridge to what the staff member ‘needs’ to accomplish (ECG, cannulation etc), much like what a play specialist would do.

    It would be nice to have a way of ‘measuring’ whether displaying this learning to the rest of the staff group actually changes their practice – if there’s something I should read where this has been published please let me know!


  2. Hi Adrian.
    Nice to know about this new term ‘Exnovation’. I would like to share a simple example that my colleague ODP displayed on a routine working day. We have new Anaesthetic machines and monitors with very long cables. The cables always frustrate you when you are transferring patient from Anaesthetic room to theatre or to recovery. We complain about it daily but had not found any solution. My ODp yesterday made a ‘Glove ribbon’ to tie these cables and it solved the problem instantly. When given the credit my humble ODP said he just imitated what he saw the ITU nurses doing!

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