Many of us have been to a strategic planning retreat, or a blue-sky visioning meeting, where the unofficial blessing to “think outside the box” is given to get the creative juices flowing. The idea being that we need to break free from the box’s constraints to find a creative solution. Often in those same meetings, the bold and creative ideas that we had hoped for are quashed by the very realization that there are constraints like time, resources, and processes that can limit the work.
Today, innovation is mostly seen as a progressive and advantageous process that changemakers introduce. Throughout history, innovators have been considered rule-breaking heretics and revolutionaries. Inventors have been met with skepticism and ridicule for significant, modern advances that have changed humankind, such as aviation, light bulbs, personal computers, and vaccines. Since changing the dogma continues to be difficult to overcome today, thinking of the box as positive and embracing the constraints is a little scary.
What if we have been thinking about it backwards and the limitations that we overcome actually promote more creative thinking and innovative processes? Perhaps creative innovation derives from thinking inside the box.
In rehabilitative medicine, constraint therapy is used for patients who have experienced a stroke by limiting movements of the less-affected arm with a sling or mitt for 90% of their waking hours. This intensively induces the use of the more-affected arm.
A number of highly respected neuroimaging studies have found that constraint therapy can produce cortical reorganization of the brain involved in the innervation of movement of the more affected limb. In essence, the constraint leads to rewiring of the brain. This is a prominent example of how applying constraints on your brain can cause it to work differently. So, can constraints influence creativity?
Another study, which examined how thinking about scarcity or abundance influences how people use their resources, found that people simply have no incentive to use what's available to them in novel ways. Yet, when people face scarcity, they give themselves the freedom to use resources in less conventional ways because they have to. The situation demands a mental license that would otherwise remain untapped. If constraints can lead to creative thinking, can creative constraint – or thinking inside the box – be applied to educational innovation?
Time Box
We all have experienced the time box. There are only so many hours in a day, week, or year. For many of us, deadline drives inspiration, and we produce because we have to. When a project or a grant is due, we meet the deadline. This is the essence of a hack-a-thon, a time-constraint creative process derived from the tech industry. With outside-the-box thinking, anything is possible, and people explore divergent ideas endlessly. Whereas thinking inside the box during a hack-a-thon, with a single day or two to produce an app, creativity becomes laser focused. In dental education, the academic calendar, and our desire to advance our teachings and expand our learner’s knowledge in the same amount of time – can drive creativity.
Resources Box
All of us are familiar with the resources box, which decides factors like our limited space, capacity on our team, and financial resources. The concept of doing something innovative with the limited resources you have is the basis behind many popular cooking shows, where participants create innovative dishes from limited resources and time. Having limited resources is the contemporary reality of how academic health systems operate. Embracing this box could lead to the most creative ways to decrease the cost of professional degree education.
Systems Box
The systems box is the framework, structures, and processes our universities use to manage our missions. Many of us are familiar with the National Institutes of Health’s grant formats and page limits, as well as the Commission on Dental Accreditation reporting structures. In addition, UC San Francisco and other academic health systems have adopted the Lean management approach, first made popular by Toyota’s A3 thinking. With Lean, a change or improvement is addressed from root cause to plan on an A3-size paper. These systems force us to refine our creative output into a clear and concise approach.
The most successful creative people know that constraints don't limit their efforts. In fact, they give their minds the impetus to leap higher. People who invent new products or launch unconventional ideas are often inspired by their constraints. They are not limited by what they don't have or can't do. They leverage their limitations to even push themselves further. So, with the risk of being thought of as heretics or rule breakers, we should embrace creative constraint and have our teams think inside the box.
Michael S. Reddy, DMD, DMSc
Dean, UCSF School of Dentistry
Associate Vice Chancellor, Oral Health Affairs
