Why It's So Important: In order to identify areas of potential transformation, hospitals conduct a "deep dive"—an in-depth and lengthy brainstorm session—that involves exploring methods of improving bedside care in medical surgical units. The deep dive engages frontline staff, physicians and hospital leaders in an in-depth understanding of the core work processes in medical surgical care.
The "deep dive" process was first initiated by IDEO, a respected process design firm. For three days in August 2003, a group of nursing and health care experts participated in a deep dive process at three Boston hospitals—storytelling, identifying design challenges, brainstorming, reenacting scenarios and developing prototyping exercises.
Recognizing that devoting three days and countless person-hours at every hospital would be cost-prohibitive, IHI and RWJF, with the assistance of IDEO, coined the term "snorkel"—a facilitated shortened version of the "deep dive." Hospitals continue to conduct "snorkels" with multidisciplinary frontline teams to generate transformative ideas for testing.
Tips to consider for conducting a "deep dive" and/or "snorkel:"
This effective method involves multidisciplinary frontline teams in work redesign and innovation.
1. Convene a mixed group of clinical and nonclinical team members, along with representatives of related departments and management staff, for a half-day session targeted toward innovation related to a specific theme.
Tip: Consider including patients in a brainstorm session to understand what improvements they want to see and to better understand what changes they want most.
2. A "deep dive" session is recommended when first implementing the program to allow teams to fully engage in brainstorming new ways to improve quality.
- A "deep dive" should be at least three hours to allow time to fully explore new ideas and allow more time to consider different options and tests of change. Some sites schedule half-day or full-day sessions to allow for extensive brainstorming.
- Snorkels should be conducted on a regular basis following a "deep dive." Many sites have weekly and/or monthly snorkels typically lasting an hour to provide opportunities for shorter brainstorm sessions.
Tip: Several hospitals recommend convening three-hour "deep dive" brainstorming sessions every six months with new team members.
3. Build a "deep dive" or "snorkel" agenda that includes storytelling exercises where select representatives discuss specific process-related work challenges or focus on design themes.
- Pick one or two topics at a time to discuss and focus on what staff is worried about the most. Ask questions like: "What is your biggest pet peeve? What are you worried about most? What areas could we most improve?"
4. Brainstorm ideas for potential changes that could improve the processes being discussed.
5. List all ideas on Post-ItTM notes and place on a board for the team to view. By posting all ideas generated, team members may refine, expand or generate new ones.
Tip: Things to aim for in a brainstorm include:
- Wild ideas are great
- Generate hundreds of ideas
- Defer judgment until later
- Be visual: draw pictures
- Build on ideas of others
- Stay focused on topic (“how might we…” scenarios).
6. Vote on which changes can be tested. Set priorities for which tests to conduct first.
8. Identify team to lead test, inform staff and develop time line.
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