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Fresh eyes
NHS England and NHS Improvement
Fresh eyes
What is it?
We naturally view situations using our own personal perspective and experience.
However, to get radical new ideas and ways of working, it is important to look at things
from perspectives that are different from our own. A ‘fresh pair of eyes’ brings a new
perspective to a situation when you may feel that all the options being suggested are just
variations on what happens already.
The fresh eyes tool is based on these principles. It helps to generate new ideas by getting
you to view a situation from very different perspectives.
When to use it
If you feel you have tried to make something work better but there has been little real
improvement, you could try the fresh eyes approach. A different perspective or a fresh
attitude will generate a range of ideas for solving long term problems that you and your
team may have been battling with.
How to use it
1. Define the problem or issue.
2. Randomly select alternative viewpoints and view the problem from that new
perspective. Ask the following questions:
• What would be important to them here?
• What aspect of the topic would they focus on?
• What ideas and approaches might they have?
Viewpoints could include people from all walks of life: politicians, parents, comedians,
children, retired people, teachers, etc.
3. Reflect on what has been generated and think about how these ideas could be
adapted for use in your situation. If there is a particularly useful concept, you might want
to carry out a brainstorming session focusing on that concept to explore it further.
It can be helpful to ask ‘why?’ five times (see Root cause analysis using five whys) for
example?
• Why do we have to come to this place?
• Why do we have to wait?
• Why do we have to have this done?
• Why do we need to see lots of different people?
• Why do we have to see this person again?
Quality, Service Improvement and Redesign Tools: Fresh eyes
TIPS
The whole process may only take an hour of your time: 30–40 minutes to gather
all the ideas and 20 minutes to decide what to do next. You should aim to use
at least four or five different perspectives and record the combined results so
that you can review the ideas later.
If you are really struggling to see how a particular viewpoint would link to your
issue after giving everyone a chance, just move on to a different perspective.
It will help if you are able to give some examples of how different perspectives
can be applied to common healthcare issues so that people can see how the
tool works. These can be used as warm-up exercises.
For example, ask the group to look at the issue of increasing the take up of flu
vaccinations and consider it through the perspective of a fast food chain. How
would a fast food chain run a flu vaccination service? Undoubtedly the idea of a
‘drive through’ will come up and although people may laugh, this approach is
common place in some countries now.
The list of different fresh eye perspectives can be added to, changed or
modified. You could set the group a warm-up task of identifying a list of
different job roles and then use these in the session. Try not to censor the
choice of perspectives, some will work better than others but all are valid. Even
if you can’t see an immediate connection, others probably will.
When you have identified some of the challenges, you can also use the simple
rules tool to help make the changes.
Examples
John is once again waiting for 3–4 hours in the orthopaedic follow up clinic. He thinks he
should have an x-ray but no one has given him a form. Last time he waited to see the
doctor, who then wrote the form for the x-ray, after which he had to queue again to see
the doctor. John can now book his outpatient appointment, but no matter what is done,
waiting times always seem to be the same.
Look at this issue through the eyes of a child, who might ask:
• Why do we have to come to this place?
• Why do we have to wait?
• Why do we have to have the test?
• Why do we have to see the doctor again?
Quality, Service Improvement and Redesign Tools: Fresh eyes
By looking at this issue through fresh eyes, we might ask ‘How would a supermarket
manager reduce waiting at checkouts during peak times?’ Subsequently, we might think
of the following approaches:
• Encourage internet shopping with home delivery.
• Have flexible opening times.
• Open smaller stores close to where people work so that people can drop in on their
way home from work.
This encourages us to make lateral connections we might not otherwise have made. In
the healthcare context we could consider:
• Do all follow ups have to be face-to-face or could we telephone patients?
• Can we run follow-up clinics at different times to reduce demand?
• Can we form partnerships or agree protocols with our local GP practices to assess
the viability of patients being followed up elsewhere?
• Can we plan the process so that it runs more smoothly?
What next?
• Review all the ideas – try using Six Thinking Hats® as a refining tool.
• Run several small scale tests to learn more and see what works in practice (PDSA).
• Share the findings.
• Implement the best ideas.
Other useful tools and techniques that can help you
• Brainstorming
• Simple rules
• Thinking creatively to solve problems
Alternatives
There are two alternatives to the description of fresh eyes:
• Invite others to discuss your challenges from outside your usual contacts, eg invite a
local factory manager and others to see how they would solve the problems, perhaps
run a workshop with members of the local community.
• Use the ‘fresh eyes’ of new members of staff – ask them: does anything strike as
processes that can be improved? What would you do differently? What have you
learnt from other organisations that could help us here?
Quality, Service Improvement and Redesign Tools: Fresh eyes
