Innovating is an evolutionary process with trials and errors - bit it is vital in financially hard times, says Becky Malby

Why innovation means survival in the NHS

Why innovation means survival in the NHS

Why innovation means survival in the NHS

Continuing with “the way we do things round here” just isn’t good enough for the NHS in 21st century. Right now the solution to the financial squeeze is to innovate your way out of it. Innovation means survival.

Recognising when to pull the plug on something is far harder than getting started

But what is innovation and how do we encourage its growth? The Centre for Innovation in Health Management has tried to answer these questions in Innovation and Public Services: insights from evolution.

People in public services have a great history of inventing new ways of delivering them. But these improvements often fail to spread. The report offers a way of understanding why this happens and ways forward.

Innovation is an evolutionary process - not a eureka moment. There is no search for “best”, but a series of small changes and improvements which constitute “better”. Progress is not inevitable and there are many blind alleys and failures.

Innovation as an evolutionary process requires constant interaction between three elements:

  • a means of generating new possibilities
  • a means of amplifying useful adaptations
  • a means of eliminating adaptations that are no longer useful.

To evolve, living systems require mechanisms to generate variety. It is widely assumed that the people working in public service organisations need stimulation to come up with new ideas. We suggest that when managers listen they discover a wealth of new possibilities.

Generating new possibilities comes from allowing people to experiment. However, the dominant NHS approach to improving quality - the standardisation of care - militates against this. One of the unintended consequences of standardising services has been to reduce variation and the capacity for innovation.

The main ingredients for generating new ways of doing things are time and space for dialogue among people who may not usually communicate together.

In public services a great source of energy for change is the dissatisfaction felt by staff about how they are expected to work, despite their ambition for their services.

Managers can harness this dissatisfaction by holding meetings at which staff discuss things they are not happy about and come up with ideas for solving these problems.

Another great source of dissatisfaction is patients. Health service professionals can work with patients to co-design services.

But how do you get the time and space to make this happen? Meetings not tied to agendas are useful, as are regular reviews of practice where a team meets to identify dissatisfaction as well as pride in a good service.

Pull and push models

Once you have generated your innovative idea what do you do with it?

An innovation may improve efficiency or allow a service to be provided at a lower cost, but it does not necessarily attract funding - indeed it might require funding cuts elsewhere to pay for it.

Innovations need to be amplified. The commonly held model about the spread of innovation in public services is a “push” model of amplification, where effort goes into disseminating the results of demonstration projects and best practice.

Instead, we propose a pull model, with strivers rather than drivers, who focus on ensuring the organisation is ready for innovation.

The pull model allows organisations to build their own capacity for innovation. They enable people to extend their horizons, pick up ideas, open their eyes, become exposed to different ways of thinking and steal ideas with pride.

Celebrating and rewarding innovative ideas is important, as is recognising the value of small improvements - small changes lead to great developments.

Understand failure

Evolution eliminates processes that do not work well. In a market driven environment poorly selling products fail. But in the public sector how do we decide what and when to eliminate?

Recognising when to pull the plug on something is far harder than getting started. But there are ways to make disinvestment in the public sector easier. One is to expect failure.

The fear of failure is present in many organisations but ones which promote learning recognise that poor results do not necessarily mean failure.

This means a culture that can “tell the story” in ways which recognise that contributing to an innovation that goes nowhere can be just as important as contributing to one that thrives.

Another way to make disinvestment easier is to ensure that evidence is gathered and that evaluation is designed as a way of deciding whether to disinvest. Do we evaluate the wrong things?

If we only evaluate what is new it is likely to be very hard to disinvest. It is important to evaluate services in the context of other services.

There is no shortage of good ideas in the NHS. What we need is leadership as persistence - trying and trying over and over to get it right, and rigour in our practice of asserting what works.

Innovation lies in every single member of NHS staff - we just need to unleash it.

Innovative tips

  • Value the process of innovation as much as the output - innovation inevitably means some ideas fail - that is part of the deal. If there is a fear of failure, no ideas will be allowed to fail
  • Stop stopping it - paying lip-service and doing nothing is the most common way of inhibiting innovation
  • Instigate rapid prototyping to replace long, drawn-out pilot projects. Quick implementation, quick and good enough evaluation and quick amplification or de-selection
  • Scrutinise practices: the NHS can be good at adding in new ways of working but not at taking out things that don’t work - or even knowing if they work or not.
  • Work from investment portfolios where there is comparative evaluation of investment and disinvestment