The Hayes, Batalden and Goldmann piece is an important contribution to the debate about what exactly is practice improvement. Most practice improvement thinking is anchored in the 'innovation' paradigm, and this paradigm is predominantly 'gadget thinking'. Others' solutions are to be adopted here because they produce great outcomes elsewhere. Except now we have to figure out how we can get the gadget to work. Few commentators have been game to shift towards acknowledging that care practices are now too complex for 'gadget thinking'. Hayes and colleagues are an exception. They propose that frontline professionals themselves need to become smarter at 'co-designing' solutions that suit their unique contexts and practices. Here, we are not talking about adopting new gadgets from elsewhere. We care talking about people who will - and who have the skill to - take inspiration from the smartness that may be invested in whatever gadget or improvement initiative, and apply this smartness to their own workpractices. Indeed, these professionals may not even need inspiration to come from elsewhere: they may well be motivated by issues arising in their own work, and decide to redesign their practices.But to date, we have not focused on what this ability to co-design care practices consists in. We expect frontline professionals to somehow know how to co-design practice, and know how to be smart about what they do andwhat they should do. And yet, their training has not skilled them in practice design. We nevertheless expect them to readily (re)design the organisational dimensions of their work. Usually, such designs fall prey to people's espoused ideas and pre-existing assumptions about how things work and should work. Often there are worrying gaps between what people know and what they (think they) do. Put differently, smartness, in the sense of learning about how to manage complex situations and improve complex practices, is rare.Smartness cannot be expected to exist or arise in situations where there are no resources available for professionals to learn about (or 'make explicit') the complexities of their own day-to-day work. Smartness must be nurtured.The way par excellence to achieve this is professionals, just as do top-end athletes, studying their own performances. In sport, video-ing one's game for transforming good performances into excellent ones is now not just common but also indispensable. This is about capitalising on and building on existing strengths. By analogy, video-ing in situ practice andusing the resulting footage to reflect on the work is central to enhancingsmartness at work. This is what Katherine Carroll and Jessica Mesman and colleagues have referred to as 'exnovation'. Of course, many excuses and objections are raised to auto-observation, themost common ones of which are privacy, the Hawthorne effect, and subpoenable evidence. But these concerns are over-stated, and they trade areal need and opportunity for improvement and smartness off against maintaining the status quo. Without auto-observation, existing habits and routines will go on unquestioned. Work can only become harder, as the onlysolutions to improvement will remain gadget-based. Smartness, by contrast,starts from where we are, and explores where we can go.
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