Innovation is a core theme for the next phase of NHS development. Innovation is about doing things differently or doing different things to achieve large gains in performance.

I have a concern that people might be interpreting the innovation messages in High Quality Care for All too narrowly - focusing on leading-edge clinical practice and technology. We can also significantly impact on the health and healthcare of our populations if we build more innovation into the ways we commission and deliver care.

At a time of economic downturn, we need innovation more than ever. Without it the inevitable pressure to contain costs can only be met by cutting services or forcing stretched staff to work even harder.

It is a myth that innovation largely comes from policy makers or very senior leaders. A study from Birmingham University's health services management centre across Commonwealth countries estimated 82 per cent of public sector innovations come from organisational staff. However, leaders set the tone and create the conditions where innovation can flourish or otherwise.

Most NHS change happens incrementally, even when we are seeking bigger improvements. But evidence tells us that if we do want to make step changes, we should consider adopting systematic processes.

A helpful five-step approach to service innovation is set out in the NHS Institute publication Making a Bigger Difference. There is also a special version for NHS commissioners, Commissioning to Make a Bigger Difference.

The contexts in which we use these approaches might be very different. For instance, a commissioner considering an innovative idea from a provider versus a clinical team reviewing its own improvement proposals. But the process and tools are largely the same.

We start by assessing an idea to see how much difference it might make across multiple dimensions of performance. Does it really represent a potential step change?

Next we consider context: how new or innovative is the idea compared with what is already going on?

The third step is to assess how big a process change it really is. How does it compare with the usual or past approach?

Next, we try to stretch our thinking to see whether we can add more innovative aspects that will make an even bigger difference, or even come up with alternative proposals.

The final step is to develop a summary statement of our assessment of the innovativeness of the idea compared with the typical practice.

This is the reality of what world class organisations that make world class step changes do. We are unlikely to achieve the breakthrough improvements we seek unless we systematise innovation processes. Even building some of these innovation assessment tools into our service redesign or commissioning processes can make a big difference.

What are we waiting for?