Innovating health services successfully will require staff at all levels of healthcare organisations to create a culture in which innovation can thrive, say Lynne Maher and Mark Mugglestone.

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In the December report Innovation Health and Wealth David Nicholson says “Searching for and applying innovative approaches to delivering healthcare must be an integral part of the way the NHS does business”.

In fact, innovation is a feature of all recent health policy documents and many local health organisations and communities have specific strategies for innovation.

Despite this high level of interest, along with a plethora of methods and tools, the NHS is still failing to reap many of the benefits of innovation. Efforts to diffuse or spread innovations in health care seem to move at the same slow pace and have the same mixed results that other improvement efforts have had in the past.

This situation will not change unless leaders at all levels within the health system explicitly address the culture that is needed to support innovation.

Many research studies have focused on the characteristics of highly innovative organisations and support the conclusion that organisational culture is a major factor affecting the speed and frequency of innovation.

These studies have also identified that leaders have a disproportionately large effect on the cultures of organisations and systems. The behaviour of leaders and the way they lead the organisation impacts directly on staff and creates the conditions that can either help innovation to flourish or hinder its progression within an organisation.

So how can leaders really understand how supported the staff in their organisation actually feel?

Following a comprehensive review, the NHS Institute for Innovation and Improvement has identified seven dimensions of culture that characterise innovative organisations:

Dimensions of innovation culture

  • Risk taking
  • Resources
  • Knowledge
  • Goals
  • Rewards and recognition
  • Tools and methods
  • Relationships

Risk taking is about establishing an organisational climate where people feel free to try out new ideas by judging any risks appropriately. Leaders in innovative organisations demonstrate that they are more interested in learning from failure than in punishing it.

The resources dimension might immediately be considered as being within the domain of finance; in this context it considers resources in the broadest sense. The climate for innovation is enhanced if people know that they have the “resource” of authority and autonomy to act on innovative ideas, as well as time - along with some financial resource - to support the new work.

Broad-based knowledge is the fuel for innovation. We create better conditions for innovation when information, from both within and outside the organisation or system, is widely gathered, easily accessible, rapidly transmitted, and honestly communicated.

Contrary to what some may believe, the literature shows that having clearly defined goals actually supports innovation. Organisational and system leaders should signal that innovation is highly desirable by setting aspirational goals around specific organisational priorities and challenging teams to find ways to meet these goals.

Rewarding innovative behaviour is important as it demonstrates that innovation is taken seriously. It is important to think about how behaviour can be rewarded, rather than just rewarding the results of innovation. To be really innovative there has to be an element of well-considered risk taking and potential failure. If only the results of successful initiatives are rewarded then the danger is that staff will “play it too safe”. The best rewards are those that appeal to one’s intrinsic and individualised motivation.

In high-performing organisations innovation isn’t left to chance; rather, it is the product of the deliberate application of practical tools and processes. Leaders need to consider how they build capability - and capacity in appropriate methods, including creative thinking, idea management and implementation.

The relationships dimension refers to the patterns of interaction in the organisation or system. Innovative ideas therefore are rarely the product of a lone genius; environments where staff are routinely exposed to a range of different approaches and thinking from a selection of different people with different backgrounds and points of view can be a significant support for innovation.

We have used these seven dimensions to form a framework which leaders can use as a diagnostic tool in order to better understand how staff feel about the culture for innovation within their organisation. The assessment tool is an online survey that can be deployed across a whole organisation or an individual directorate. 

The Culture for Innovation tool (along with the associated guides) is a useful starting point for senior leaders who understand that they need to ensure a supportive culture for staff if the benefits of innovation are to be realised within organisations.

Case Study: Avon and Wiltshire Mental Health Partnership Trust

Avon and Wiltshire Mental Health Trust (AWP) is a significant provider of secondary and specialist mental health services to a population of 1.6 million people. The trust delivers services at over 90 sites within six local authority areas. 

AWP named innovation as one of the key strategies to support the delivery of trust strategic objectives and launched its first Innovation Strategy in March 2011.

To measure the impact of the Innovation Strategy, the NHS Institute’s Culture for Innovation Survey was adopted as part of a suite of innovation metrics. With support from the communications team, the survey was widely publicised through trust publications, log-in screens and direct requests to professional groups.

Overall, the results from the survey resonated with those of the staff survey and demonstrated a desire from staff to feel they are making a difference. Looking in detail at the results - both positive and negative - really helped us to understand what needed to be done to support and empower staff to innovate.

In the past year we have been developing a range of initiatives to better channel the innovative talent of staff, service users, members and partners to support the trust’s objectives.

Creativity training has been developed, giving staff skills that support new ways of thinking about challenges. More resources in the shape of time, money and expertise have been released to support staff and encourage them to develop their ideas for quality improvement.

Using the popular ‘Dragons’ Den’ format, we have tested out ideas against specific criteria: feasibility, sustainability, and likelihood of improving quality and enabling recovery. 

February 2012 sees the launch of the Making a Difference Hall of Fame, which recognises the creative talent and commitment of colleagues (clinical and non-clinical) and shares best practice throughout a large, dispersed organisation.

The Culture for Innovation Survey was an ideal tool for capturing the prevailing attitude towards innovation from a cross-section of staff. Additionally, it served to raise the profile of innovation throughout the organisation and create interest in the newly launched Innovation Strategy.

The survey will be repeated in March 2012 to measure whether the implementation of innovation infrastructure has influenced the culture within the organisation.

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