Share
At no other time in its history has the NHS needed innovation for service delivery as badly as it does now. Without innovation, the pressure to contain costs will only be met by cutting services or forcing overstretched staff to work even harder.
BUT, innovation won’t just happen, even if we give it a high strategic priority. There is one consistent message from innovative organisations globally.
Innovation is a structured and disciplined process. We are unlikely to achieve the breakthroughs we seek in quality and cost unless we “operationalise” innovation, building it into all aspects of our daily work. We have a highly creative NHS workforce, but too often that gets repressed. As David Nicholson describes it in his recent NHS Annual Report, the mindset is “we want to improve, but innovation is risky and failure will be punished”. Key tasks for NHS leaders in the next period include settingthe tone and creating the conditions where innovation can flourish and investing in systems and skills for innovation. Innovation practice must become part of the very DNA of the NHS.
That’s why we launched the pilot “Innovation Practitioner Programme” at the NHS Institute this week to build NHS innovation for improvement capability. It’s a small start with 20 people taking part from across the NHS - providers and commissioners, from clinical, operational and improvement leadership roles. Our view is the people who will make the most impact as innovation practitioners are those who already have a strong track record of delivering improvement. Innovation and improvement skills go together, yet few NHS improvement leaders have formal training in innovation processes.
.JPG)
Our 20 Innovation Practitioners took part in the first two days of an intensive training programme. They have been coached in models and frameworks for developing a culture of innovation and observation and insight skills. They have followed a systematic process for innovation, including ideas generation, prioritising and selecting ideas, prototyping (how to avoid costly mistakes by quickly assessing whether an idea is likely to work) and creative implementation. The entire process has been underpinned by a philosophy of “open innovation”, which means an approach to innovation that is not constrained by internal thinking, but that casts the net widely for new ideas from other organisations and systems. You can access some of the material that the Innovation Practitioners have been using by clicking here.
All of the participants will take an online examination in innovation practice methods later this month.
Innovation practice methods are only useful if they help to deliver better results for patients and populations. Therefore, each of the participants is undertaking a significant project to apply innovation practice in their own setting. Through the projects, the Innovation Practitioners are “thinking differently” about pre-hospital emergency care, orthopaedic services review, paediatric high-dependency care and patient discharge communication. They will be coached by our innovation practice experts as they implement their projects over the next six months. The Innovation Practitioners who pass the exam and are able to demonstrate use of the range of innovation methods and tangible outcomes in quality and cost will be accredited by the NHS Institute as NHS Innovation Practitioners.
.JPG)
This may seem like a tough process, yet let’s compare it to the learning process of clinical practitioners. Can you imagine a situation where someone with no formal clinical training or experience was allowed to practice unsupervised on patients? Yet that is the equivalent scenario that most people who are asked to lead innovation practice in the NHS face. They are expected to just work it out for themselves, or learn it on the job. We need to move to a situation where innovation and improvement practice is as well taught and supported as clinical practice. I would want you to be confident that any Innovation Practitioner was highly capable and experienced and could make a big difference very quickly.
Innovation practice is a key skill for NHS change agents to deliver quality improvement and cost reduction. Our team within the NHS Institute has been undertaking exploratory work to define the wider set of skills (including innovation practice) that we need to invest in to deliver the goals of the Next Stage Review and save costs at the same time. I will post my next blog on 13 July about this topic.
There are a number of areas that, as an NHS system, we need to invest seriously in, in order to save costs. Innovation practice for improvement comes pretty high up my list. We need to think about how we make this happen on an industrial scale, from 20 accredited NHS Innovation Practitioners to hundreds to thousands.
Have your say
You must sign in to make a comment.
From The NHS Change Agent
Helen Bevan is chief of service transformation at the NHS Institute for Innovation and Improvement.
Tags
Camp Obama,
Richard Walton,
From control to commitment in the workplace,
Why David Sometimes Wins,
Marshall Ganz,
Don Berwick,
Next Stage Review,
Cost Reduction,
Quality Improvement,
"Thinking Differently" . Change Agents,
"Open Innovation",
Creative Implementation,
Prototyping,
Ideas Generation,
Culture of Innovation,
Innovation for Improvement,
NHS Annual Report,
Innovation,
six dimensions of quality,
Institute of Medicine
Readers' comments (10)
Helen Baxter | 7-Jul-2009 6:58 pm
Successful organisations have a process for identifying and selecting ideas to take forward. It is only through truly understanding a situation/challenge that you can gather insights which can help to identify areas of opportunity for improvement. In some work we have undertaken using experience to design better healthcare services, it isn't about asking the public what they want, it is through patient and staff stories that insights are gained about the 'touchpoints' of care - for example, it isn't that people are not given information, it is about how and when the information is accessed and whether it adds value to the pathway of care.
'Creative swiping' is a technique which is used by innovative organisations where they look at what other people/orgnaisations do and transfer to their industry - it's a good time for the NHS to use approaches, tools and techniques successfully used within other industries.
Unsuitable or offensive?
Paul Plsek | 8-Jul-2009 1:31 pm
I am pleased to see ‘innovation’ called out in the new focus on quality and productivity in the NHS. Studies across a variety of organisations, in both the commercial and public sectors, suggest that support for risk taking is one of the key factors that drives the rate of innovation in an organisation. I also agree with David Nicholson that the prevailing mindset on risk taking in the NHS needs modifying. We know from the studies that at least four sub-factors play a critical role in staff’s perception of whether or not it is safe to take a prudent risk with an innovative idea. Basically, it comes down to what leaders are seen saying and doing. First, we now know that talking about examples of risk taking begets more willingness for future risk taking. Second, speaking in a positive and celebratory way about the valuable lessons learned from what others would label a ‘failed’ innovation lowers staff’s anxiety about being punished for trying something a bit different. Third, word spreads quickly and has a positive effect when leaders go out of their way to make personal contact with, and provide emotional support to, teams and individuals who are trying innovative things. And finally, leaders need to be proactive in calling for a balanced assessment of the risk of trying a new approach; asking questions such as: “Can we just make a list please of the risks associated with staying with the status quo?” or “Is there really strong evidence to support the way we currently do things?”. Achieving the culture of prudent risk taking that Helen Bevan and David Nicholson advocate is not solely the product of new organisational structures, training programmes or policy documents; although these help. Rather, it will be the result mainly of what leaders at all levels say and do in the day-in and day-out life of NHS organisations.
Unsuitable or offensive?
bluebottle | 8-Jul-2009 3:36 pm
The NHS needs to embrace the philosophy behind ‘open innovation’. “Open innovation is a paradigm that assumes that firms can and should use external ideas as well as internal ideas, and internal and external paths to market, as the firms look to advance their technology” (from Chesbrough, H.W. (2003). Open Innovation: The new imperative for creating and profiting from technology. Boston: Harvard Business School Press, p. xxiv).
For the NHS we need to apply this kind of thinking to break down the barriers to innovation. It is not just relevant to learning and working with non NHS organisations, but also being more open to ideas that come from other bits of the NHS. This may be learning from an organisation based 200 miles away, or part of the NHS that happens to be based down the corridor. Changing the way that people view, use and implement ideas is as important for the NHS as considering how the money moves around. There is plenty of focus the money, isn’t it time we started focusing on ideas?
Unsuitable or offensive?
Kenneth Lownds | 9-Jul-2009 8:18 am
With the greatest respect to Helen Bevan and all of you who have added comments I find the NHS grossly behind the times when it comes to all of these subjects. Safety is first, unconditionally. When the NHS is delivering zero 'excess deaths' and harm to patients then you can move on to the 'cost of quality' and the saving from quality. All of these concepts have been well-understood in many safety-critical sectors for decades. The Stafford case demonstrates very clearly that 'institutionally' the NHS does not, even though many individuals and hospitals do and devote their lives to nothing else. Too many initiatives, too many definitions of 'lean'; time to deliver safety for your patients all day every day every night . 'Ken Lownds Cure the NHS, Stafford
Unsuitable or offensive?
stephen black | 10-Jul-2009 5:00 pm
I don't agree at all that the thing the NHS needs most is innovation in service delivery.
We already know dozens, if not scores, of ways to improve the quality and reduce the cost of running the NHS. Many of them could yield very large leaps in quality and efficiency at the same time. The trouble is we are failing to roll those ideas out across the service.
Lets not waste lots of effort inventing clever new ways to organise services. Instead why not seek the reasons why we avoid implementing known best practice?
The Don Berwick 100,000 lives campaign is a good illustration of what I mean. It didn't involve any clever new ways to run hospital wards. Mostly it consisted of better ways to shame hospitals into applying well know best practices that would reduce errors. If there was any innovation it was around finding good ways to expose how bad practice was and use the result to create a strong desire to improve.
Unsuitable or offensive?
muir gray | 12-Jul-2009 8:36 am
great to have helen's thoughts on innovation
the new clayton christensen's book is of great importance. It complements the book on Redefining Healthcare by Michael Porter and Elisabeth Teisberg and the drive to transform the NHS from a set of institutions to a set of systems for better value healthcare. One of the great insights is to call hospitals solution shops and to distinguish that function from that of systems for managing chronic disease. Health care is often described in terms of hospitals, health centres and payers but these are no more the core businesses of health care than factories and showrooms are the core businesses of Toyota. They focus on customers and types of car; a health service must focus on people with rheumatoid arthritis or epilepsy.
Muir Gray
www.muirgray.net
Unsuitable or offensive?
Karl Bates | 16-Jul-2009 10:54 am
The NHS has a great deal to learn from other industries, so I would support what Helen Baxter has said about creative swiping. This needs to be captured and rolled out with the relevant sponsorship from NHS leaders.
If the NHS continues to look more inward than outward, then innovation may not take hold as much as we want.
However, with continual targets and a blame-centric culture, we shouldn't be supprised at the amount of innovation in the system. Fortunately, some hospitals, PTCs and so forth have developed good examples of innovative cultures, which is reassuring in that it shows that achieving this is not impossible.
Overall, the main constraint to innovation is how it is perceived (i.e. viewed as a small optional part of our jobs if any, and not an expectation).
We need to embed the cultural styles of GE, Toyota and 3M, as they have achieved this by focusing on the customer; and supporting this strategy through a clear demonstrated leadership. However, NHS staff need an environment that fully supports this (from the polictical leaders downward), one where a Jack Welch (ex-CEO of GE) style is used rather than a Al Dunlap budget-cutting method in order achieve service viability.
I believe the capability for innovation exists already in the NHS, but currently is there a whole-system environment there to support it? (I'm not too sure about that...maybe I'm wrong).
Unsuitable or offensive?
Catherine Jones | 16-Jul-2009 7:58 pm
From personal experience I have found it most effective to focus on the relationship between safety, innovation and productivity.
Improving patient safety will reduce costs and this will be iterative. An example is the reduction in length of stay on intensive care units where ventilator acquired pneumonias and central line infections have been almost eliminated. Innovation helps staff redesign their systems of work so they become reliable in the care they deliver and aspire to. Many of the concepts of lean philosophy underpin the improvements required to eliminate harm. An example is that of standardisation of processes which deliver better outcomes and reduce waste in its many forms. Yes, safety is a priority and the route to safety requires innovation and improvement science. The result will be safe and less costly care. Kate Jones Head Safer Care. NHS Institute
Unsuitable or offensive?
Chris Jeffries | 26-Jul-2009 3:26 pm
We need to have more facilitators trained and developed in a consistent way. Each SHA has leadership programmes and a process for supporting management development. Building capacity and capability around service improvement ought to be part of the PCT and SHA Talent and leadership plans
Unsuitable or offensive?
thinkovation | 18-Aug-2009 8:36 pm
I am a proponent of management innovation and open innovation through the use of social media. I have gathered together some videos, tools and resources for everyone to access free of charge. I have also added discussion forums on NHS innovation topics. The blog can be found at http://thinkovation.ning.com/ please invite your colleagues to join in the debate...
Unsuitable or offensive?