NHS managers are pivotal to adopting the latest breakthroughs, explain John Hutton and Colin Callow
Innovation has been a constant factor in the NHS’s development, but it has only recently become a major element of health policy. The 2007 Cooksey report into healthcare research highlighted its strengths and weaknesses and development in the UK and focused on two major gaps in the process of turning scientific ideas into products that benefit patients.
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The first is between scientific advances and new product development. Britain has a strong scientific sector, but has been less successful in practically applying new scientific ideas.
The second is the delay in adopting new products. When new products do emerge from scientific advances, the NHS is slow to adopt them compared with other countries’ health services.
At a time of restricted funding, the NHS cannot afford delays to adopting proven innovations if service quality and productivity is to be improved. This has placed technology innovation directly on the management agenda.
In the past, many NHS managers have seen technology innovation as separate from mainstream activities, associating it with clinicians pushing for funding for new drugs and equipment, and seeing it as a “problem” in the context of managing limited resources.
A York University study for the NHS Technology Adoption Centre and NHS Institute for Innovation and Improvement bear out this view. Drawing on literature and a survey of more than 50 senior NHS managers in provider and purchaser organisations, a picture emerged suggesting significant improvements are required in managing the innovation adoption process.
There is either a lack of formal processes through which to make decisions about adopting new technologies or a failure to effectively make use of such processes. Poor communication channels make it difficult for clinicians to navigate these processes and gain support for innovative approaches. Where there is evidence to support adoption, the knowledge management skills are not always available to analyse and apply it.
Even when a new approach is agreed, clear implementation plans are not always developed, so the full benefits of the approach may not be realised.
There has been much discussion of the need for an “innovative culture” in the NHS. Academic Chris Ham and colleagues put forward 10 ways in which strategic health authorities could encourage innovative thinking. Innovation tsar Jim Easton offered NHS managers four key points.
Rigid organisational structures are often blamed for inhibiting innovation, with decentralised decision structures advocated to encourage original thinking.
However, it became clear from the survey that direct managerial intervention is required to move from a decision to adopt, through planned diffusion, to mainstream and routine use across an organisation or health economy.
A major effort is needed to make organisations more open to adopting proven new methods, rather than generating new ideas per se. Once this is recognised, there are many solutions within the senior management control.
The managers in the York study had a significant understanding of the issues and all suggested changes they wished to make within their organisations to improve innovation adoption.
The most important were:
- formal decision making processes;
- prioritising adoption based on evidence;
- implementation plans;
- improved communication;
- realigned financial incentives.
The last point is particularly important, as parallel changes in managing NHS organisations provide opportunities to improve the incentives for technology innovation. Where clinicians and managers have a shared appreciation and understanding of the financial context of service delivery, appropriate adoption of new approaches can be managed alongside the decommissioning of superseded activities.
By establishing a cycle of evidence based prioritisation, adoption and implementation, managers can be pivotal to the quality, innovation, productivity and prevention agenda. Radical new ideas will continue to emerge, but in the short term, capturing the benefits of proven and innovative technologies cannot be delayed any longer.