We must embrace innovation, not run from it, if the £22bn funding black hole is to be tackled head on, says Paul Kirkham

Paul Kirkham

Paul Kirkham

Not least in light of the recent revelation that the NHS in England has no convincing plan to plug a £22bn “black hole” in funding, the need for healthcare solutions that are both imaginative and cost-effective appears more pressing than ever. The answer may well lie in radical innovation, the general goal of which is to bring value by doing things differently.

It’s right to concede that radical innovation scares a lot of people, especially those tasked with holding the purse strings. The basic perception is that it entails uncertainty, which in turn is commonly associated with wasted effort and the frittering away of resources. This fear is in some ways justified – there is uncertainty – but it has to be overcome if genuine progress is to be made.

The need for healthcare solutions that are both imaginative and cost-effective appears more pressing than ever

New perspective

By way of illustration, consider the example of the NHS trust that embraced a novel concept proposed at a creative problem-solving session hosted by Nottingham University Business School. The idea came from one of the trust’s podiatrists, who described how renal patients, particularly those who are also diabetic, are at grave risk of losing their legs as a consequence of circulation issues or pressure sores.

Although substantial evidence highlights the advantages of preventive treatment, lack of mobility makes it difficult for these patients to attend clinics. Instead they require home visits, which, because of the amount of time spent on dialysis, are themselves hard to arrange. But what if dedicated renal podiatrists could see patients during dialysis, allowing more of them to receive in-clinic care?

Although substantial evidence highlights the advantages of preventive treatment, lack of mobility makes it difficult for renal patients to attend clinics

Senior managers present at the session agreed the proposal could be viable and promised to support it through commissioning routes. The new approach was up and running just a few months later and has since shown itself to be unusually capable of satisfying the “triple burden” of a patient-centred, cost-effective, high-quality service.

Inevitably, this rare success hasn’t gone unnoticed. With a view to suggesting something similar to their own managers, other dialysis providers and podiatry teams are now expressing their interest.

The new approach has shown itself to be unusually capable of satisfying the “triple burden” of a patient-centred, cost-effective, high-quality service.

Yet it’s vital to grasp that imitation alone would represent only a Pyrrhic victory for the cause of radical innovation. For the reality is that it’s not enough simply to adopt such a scheme: it’s necessary to comprehend the mindset that made it possible in the first place.

“Let’s do what they do” is a short-term philosophy; “How did they come up with that?” is a response much more conducive to a brighter future.

So how did they come up with it?

First and foremost, the trust was prepared to understand how creativity actually works. A “great idea” doesn’t miraculously appear from nowhere; it’s normally the result of lots of far lesser ideas being sifted and refined. The podiatrist’s proposal was one of 40 aired during the session, and the fact that the other 39 didn’t cut the mustard shouldn’t detract from their contribution to the creative process.

Relatedly, the trust was happy to give a voice to its frontline staff. It accepted that new ways of thinking can come from within – even from the “rank and file” – and that radical innovation isn’t the exclusive preserve of external forces. It was ready to grant its own employees an audience, to show faith in their input, to help rather than hinder and to tolerate the inevitable uncertainty we spoke about earlier.

A “great idea” doesn’t miraculously appear from nowhere; it’s normally the result of lots of far lesser ideas being sifted and refined.

Finally, the trust was willing to transcend the sort of set-in-stone, ever-inflexible metrics that frequently thwart potentially beneficial advances. It’s true that improvement is often impossible in the absence of a solid basis for comparison, but sometimes it’s worth remembering that there are things that really can’t be measured – or at least that what we’re measuring is liable to evolve and change before our very eyes. Pioneers are routinely short of relevant data, if only for the simple reason that they’re exploring uncharted territory, and in such instances it can pay to look beyond the spreadsheets.

Making innovation routine than novelty

It would be wonderful, of course, if the initiative at the heart of this story were to be widely adopted. After all, any innovation that brings about a shift from acute to preventive treatment deserves to flourish everywhere within the NHS.

But there’s an even more significant shift that demands equally pervasive recognition. It’s the shift from an organisational culture that revolves around the mistaken belief that innovation is invariably the stuff of genius, of visionaries, of “them”, to one that acknowledges that the habitually scattergun search for the elusive engine of change can afford to focus much closer to home. Many of the people best placed to save the NHS are already working within it: they just need the encouragement and the freedom to prove as much.

Paul Kirkham is a researcher in the field of entrepreneurial creativity with Nottingham University Business School and co-deviser of the Ingenuity problem-solving process taught to students at its Haydn Green Institute for Innovation and Entrepreneurship (HGIIE)