Moving Beyond Iteration to Innovation: An Adaptive Leadership Approach for Health Care Leaders

Whether you're leading a health authority, running a regulatory college, or directing a school filled with future health care professionals, you're often caught between the relentless pressure for innovation and the very real constraints of professional standards, patient safety, and regulatory requirements. I see this tension in every strategic planning session I facilitate.

"I know we need to innovate, but..." This is how many conversations start when I work with health care leaders. 

And you know what? That hesitation is completely valid. Here's why:

• Professional cultures prioritize stability and proven approaches
• Patient safety and quality standards require careful validation
• Regulatory frameworks can seem to reward iteration over innovation
• Resource constraints make experimentation feel risky
• Multiple stakeholder interests need careful balancing

When asked to explain the difference between iteration and innovation, I frequently use a well-known piece of technology to make the point. Iteration is the difference between the iPhone 13 and iPhone 14. Innovation is the release of the iPhone.

The challenge often isn't that health care leaders don't want to innovate - it's that the path to meaningful innovation isn't always clear. 

This is where Ronald Heifetz and Marty Linsky's Adaptive Leadership framework becomes incredibly valuable. Not because it offers quick fixes (it doesn't) but because it helps us understand why moving beyond iteration is so challenging and what we can do about it.

The Technical Trap

Here's a truth that might sting a bit: Many health care professionals are masters of technical solutions. They excel at making existing processes better, safer, and more efficient. Need to reduce wait times? We'll optimize scheduling. Want to improve staff and faculty satisfaction? We'll enhance communication protocols. These important improvements should be explored, but they're iterations of existing approaches.

Today's health care challenges - from the mental health crisis to equitable access to care - aren't just technical problems waiting for technical solutions. They're adaptive challenges requiring fundamental shifts in how we think and operate.

Getting to the Balcony

Heifetz and Linsky talk about "getting on the balcony" - stepping back to see the bigger picture. In health care, this means asking uncomfortable questions:

• Are we solving the right problems or just getting better at managing symptoms?
• Do our improvement efforts challenge fundamental assumptions?
• Are we innovating our processes but maintaining outdated paradigms?

Time for a quick reality check: When was the last time you spent a full day thinking about where your organization needs to be in five years, not just next quarter? If you're like most leaders I work with, finding that time feels impossible. But innovation doesn't happen in the margins of our calendars.

The Adaptive Challenge of Innovation

Moving from iteration to innovation in health care is itself an adaptive challenge. It requires:

1. Distinguishing Technical from Adaptive Work

• Technical: Implementing a new EMR system
• Adaptive: Reimagining how technology changes the provider-patient relationship

2. Managing Loss

• Acknowledging that innovation means some cherished practices must change
• Supporting teams through the discomfort of new approaches

3. Orchestrating Conflict

• Creating safe spaces for challenging traditional approaches
• Seeing resistance as a resource for learning instead of a threat

Practical Steps Forward

So, how do you actually do this? Here's where the rubber meets the road:

Create Innovation Zones: Set aside protected spaces - both physical and metaphorical - where different rules apply. Maybe it's a pilot project that operates under modified protocols, or a "skunkworks" team that questions basic assumptions about care delivery.

Reframe the Risk Conversation: Instead of asking "What might go wrong if we try this?" start asking "What opportunities are we missing by not trying?" This isn't about being reckless - it's about balancing the risks of action against the risks of inaction.

Build Learning Systems: Innovation requires rapid learning cycles. Create structures that:

• Capture insights from failed attempts
• Share learning across departments and disciplines
• Celebrate intelligent failures
• Scale successful experiments thoughtfully

Engage the Resistance: Here's something counter-intuitive: Your biggest critics might be your best innovation allies. Why? Because their resistance often highlights important considerations you need to address. Instead of trying to overcome resistance, engage with it:

• Listen to concerns with genuine curiosity
• Incorporate valid critiques into your innovation process
• Use pushback to refine and strengthen new approaches

The Leadership Work

As a leader, your job isn't to have all the innovation answers. It's to:

1. Create the Conditions

• Build psychological safety for experimentation
• Protect innovation initiatives from "business as usual" pressures
• Align incentives with innovative thinking

2. Model the Behavior

• Show vulnerability in not knowing all answers
• Demonstrate comfort with controlled experiments
• Share lessons from failures openly

3. Maintain Productive Tension

• Keep enough pressure for change without overwhelming the system
• Balance short-term performance with long-term transformation

The Time Factor

One of the biggest barriers to innovation is the tyranny of the urgent. Everyone agrees innovation is important, but today's crisis always seems more pressing. 

Here's the hard truth: If you don't make time for innovation now, you'll be forced to make time for crisis management later.

Start small, but start now. Block out two hours next week for ‘balcony time.’ Identify one process that's ripe for reimagining, not just refinement. Find one team willing to experiment with a new approach.

Remember the Power of Questions

Innovation often starts with better questions. Instead of asking "How can we do this better?" try:

• What would this look like if we started from scratch?
• What assumptions are we treating as unchangeable?
• What would our patients/students/registrants design if they were in charge?

Moving Forward

The path from iteration to innovation isn't a straight line. It's more like sailing - you tack back and forth, adjusting to conditions while keeping your destination in sight. Your role is to be the captain who maintains course while empowering the crew to explore new routes.

Time to Raise Your Sails

You have more power to drive innovation than you might think. Starting today, you can begin creating the conditions for transformation while honoring the essential stability that health care requires. The future of Canadian health care depends on leaders like you who are willing to look beyond the horizon while keeping both feet firmly planted in today's realities. Remember: every transformative innovation in health care started with someone asking, "What if we tried something different?" Let that someone be you.