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On the power of spontaneous collisions: preserving culture and effectiveness in the pandemic
  1. James K Stoller
  1. Education, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr James K Stoller, Education, Cleveland Clinic, Cleveland, OH 44195, USA; STOLLEJ{at}


In the pivot to virtual interaction imposed by the coronavirus pandemic, some benefits have been realised, for example, time savings from avoiding commuting, the efficiency of back-to-back virtual meetings, needing to dress only from the waist up for work and so on. Yet, we also experience significant loss when our interactions are largely confined to being virtual. Specifically, spontaneous interactions between colleagues, what might be called ‘collisions,’ and their benefits are lost. Such collisions occur, for example, when we bump into a colleague while walking to or from a meeting and so on. These collisions are the nexus for maintaining connectivity between colleagues and can be a forum for creative exchanges that may lead to innovation and enhanced organisational effectiveness. Citing the experience of ‘bootlegging’ of time as a feature of organisations that thrive on innovation, this commentary discusses the value of spontaneous collisions in the healthcare environment. Given the persistence of virtual interaction throughout the pandemic and likely, to at least some extent thereafter, countermeasures to preserve spontaneous interaction in a virtual world and to maintain connectivity among colleagues are proposed. Awareness of the threats posed by a fully virtual experience and of these countermeasures are useful leadership attributes.

  • performance
  • clinical leadership
  • management

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The COVID-19 pandemic has mandated new practices: mask-wearing, handwashing and social distancing. At the same time, born by a primal human need to connect with one another, the world’s collective response to staying apart has been to be apart together…virtually. ‘Zooming’ has entered our vocabulary; in overuse, we develop ‘zoom fatigue.’

We connect virtually for many purposes—to do work, where zoom huddles have largely replaced live team meetings; to connect with friends and loved ones; to play games with one another, and so on. And our virtual lives have revealed some clear advantages to these virtual practices: averting commuting; cleaner air; the flexibility of working from home; the option of dressing from the waist up only; and the efficiency of a virtual schedule that moves uninterruptedly from one prescheduled virtual meeting to another, eliminating the ‘chaff’ of needing to travel between live meetings. But is it chaff?

Just as there are advantages to our virtual lives, so too have there been casualties. Our interactions are confined to the sterility of the ‘Hollywood Squares’ tiles of a virtual platform; we miss the connectivity that comes from shaking hands and hugging; we miss the chit chat with work colleagues that bookends live meetings, when people are coming together or dissembling. Indeed, we miss spontaneous meetings among colleagues—what some have called human ‘collisions’,1 2 a big casualty of our virtual pandemic lives.

Spontaneous meetings are both nice to have and are critical to organisational success. In a pre-pandemic life, we would see a colleague at a meeting and catch up afterwards before everyone scattered, we would bump into someone while walking through the workplace and arrange in passing to meet for coffee. These collisions are the nexus of human connectivity. But the impact of collisions between us is far greater. The ‘nice to have’ spontaneous collision is actually a ‘must have’. Spontaneous collisions are actually a crucible for enhanced organisational effectiveness and innovation.

Collaboration and teamwork underlie great human accomplishments in all spheres and encouraging spontaneous collisions and collaborations have often been part of highly successful organisational strategies. Consider ‘bootlegging’ at 3M. Since 1948, with the goal to spur innovation through spontaneous collisions, 3M implemented its bootlegging policy by which 15% of the employee’s time is sanctioned—and encouraged—to be spent outside of one’s primary work locus.3 The very name for the activity—‘bootlegging’—connotes the stealth of hidden benefit, just as Civil War bootlegger soldiers snuck bottles of alcohol into the barracks in their pant legs. Collisions between colleagues during bootlegging have spawned key innovations in innovation-dependent companies like 3M.

The story goes that Dr. Spencer Silver was trying to develop a strong adhesive but accidentally made a weak adhesive instead. Silver’s ‘solution without a problem’ came to fellow bootlegger, Art Fry’s attention in 1974 in a spontaneous collision, with the rejuvenated wisdom that the weak adhesive on a small piece of paper was a perfect way of marking places in church hymnals without having to dog-ear the pages. And so the Post-It Note was born—a huge commercial success for 3M. The process of driving spontaneous collisions has also fostered many other innovations—clear bandages, and painter’s tape to prevent paint bleed at 3M and, at Google, where the practice has been emulated in a 20% rule, innovations like Google Earth and Gmail have been ascribed to spontaneous collisions.

On a smaller but equally important scale, spontaneous collisions are critical in multidisciplinary organisations like hospitals, where collaboration across disciplines and roles is absolutely critical to producing optimal clinical outcomes. Hospital architects know this and design spaces that will foster such collisions. At the Cleveland Clinic, the horizontal quarter mile-long ‘Skyway’ that connects the outpatient Crile building with the hospital has just such an effect.2 By driving caregivers into a common horizontal conduit, the Skyway promotes collisions between caregivers from different disciplines caring for the same patient—between doctors and nurses, consultants from different specialties and disciplines, between attendings and trainees, and so on. The resultant, brief but unplanned encounters allow for key exchanges about updates and plans that would otherwise have required emails or phone calls, if they occurred at all in the blur of the clinical day. Just as collisions are key in innovation-dependent companies like 3M and Google, so too are they critical in complex, time-constrained settings like healthcare.

So given that collisions are critical but are threatened by our highly structured current virtual lives, how to foster spontaneous collisions in a pandemic virtual world? Here’s a list of options. Importantly, opportunities to increase spontaneous collisions should be broadly available in a healthcare organisations and their encouragement should by no means be confined to titled leaders. Certainly, encouraging such collisions can model the behaviour and endorse the practice; at the same time, collisions are arguably even more powerful when they emerge organically within the group.

One option to create collisions is to pick up the phone and call a colleague. On connecting, I preface the conversation with the query ‘Am I calling at a bad time?’ to acknowledge the addressee’s possible shock of receiving an unsolicited call in the pandemic and to allow for rescheduling if the call interferes with an ongoing activity, like a current Zoom meeting. Another option is to schedule an ‘agenda-less’ virtual meeting whose only goal is to connect and catch up. As a variation on this theme, both in the prepandemic time live and now during the pandemic virtually, ‘Chairman’s Lunches’ have been a mainstay practice in the Education Institute at Cleveland Clinic. Once a month, 10–12 colleagues in our institute are randomly invited to come together for an hour. The opening question ‘How many of you are looking at someone you don’t know?’ invariably prompts all hands to be raised, thereby inviting every member of the call to introduce him/herself to their colleagues. What is your story? How did you find your way to your current career in the Education Institute at Cleveland Clinic, what gives you joy in your work, and how might other colleagues collaborate with you? At the end of the call, everyone emerges with a richer human understanding of our colleagues and their lives. The familiarity begins to create a community of engaged colleagues and fosters what has been called ‘relational coordination’,4 the ‘coordination of work through relationships of shared goals, shared knowledge, and mutual respect’. In the context that Gittell and others have shown that relational coordination is associated with enhanced organisational outcomes—including in surgery,4 these ‘agenda-less’ virtual meetings produce more than ‘kumbaya’—they are part of the organisational glue that enhances effectiveness.

Another option that has been discussed in the context of virtual academic meetings is to build in frequent breaks. In discussing best practices for virtual meetings, Oeppen et al5 recommend organising 10 min breaks at least every 90 min during the meeting and at least a 20 min break after 3 hours of online interaction. In keeping with the theme of promoting spontaneous collisions, such breaks are not only intended to refresh the listener but also to allow open dialogue—spontaneous collisions, in fact—between meeting attendees.

Leading in a pandemic world is challenging and leaders need new and innovative practices for these times.6 Now more than ever, leaders must remember that ‘culture eats strategy for breakfast’7 and must know how to cultivate culture in order to unleash engagement and discretionary effort in their organisations.8 Fostering human connection through promoting spontaneous collisions that encourage trusting and meaningful relationships among colleagues is a key leadership practice—both during the pandemic and beyond.



  • Contributors The author is solely responsible for the entire content of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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