The NHS needs to welcome in radical new thinking because it needs both innovation and incremental improvement, say Axel Heitmueller and Richard Taunt

What’s the difference between improvement and innovation? Pedantry aside, should we care?

There is some seasonality in the NHS’s use of these terms. Right now it is improvement season – the new NHS England Sustainable Improvement Team and NHS Improvement were both established in the last year – like mushrooms in autumn. A while back it was innovation season. Unlike seasons though, there doesn’t seem to be a clear law of nature governing the naming convention of NHS organisations.

Perhaps it’s all in the name? Well, it turns out it’s not. Academic Health Science Networks are not just academic. The new NHS England Sustainable Improvement Team is not just about improvement but includes elements of innovation.

This is not surprising given that it swallowed up NHS Improving Quality, itself born of the NHS Institute for Innovation and Improvement. Evidently, there is a growing graveyard of euthanised innovation infrastructure. However, all this does is confuse.

Real meaning

If you seek clarity on what improvement means, visit Unipart Expert Practices, Unipart’s consulting arm. Unipart has spent 25 years developing and embedding a culture of continuous improvement in its operations. It empowers staff to solve problems at their own level – developing their ability to tackle and solve problems every day. However, the company also constantly seeks innovative solutions to stay ahead of the competition.

Improvement is incremental change, continually improving a process over time, and innovation is a step change, finding a new way of doing what you did before

To demonstrate how effective this combined approach can be, the graphic below shows improvement over time within a picking process in one of Unipart’s distribution centres. It is crucial for Unipart to deliver the right product first time; any picking errors can lead to a customer receiving an order late or at the wrong location, holding up their operations.


Number of individual picking errors per week

Number of individual picking errors per week

During the first phase of activity, you can see that through solving problems regularly at a local level, picking errors gradually reduced over time. Following the implementation of innovative technology, there was then a rapid step change improvement in performance.

Once the process was embedded, continuous problem solving helped to improve the process further. Through a combination of  innovation and daily improvement activity, they achieved a significant improvement in performance over time, to the benefit of the staff operating the process and their customers.

This example helps to explain the difference in terms: improvement being incremental change, continually improving a process over time, and innovation being a step change, finding a new way of doing what you did before.

However, incremental improvement and innovation are not distinct worlds, but part of a range of means to an end of improved quality of health and care. Using “improvement” to only refer to incremental change is misleading. It can also compartmentalise “improvement” into the job of the “improvement team”, rather than being a core part of everybody’s job.

So let’s reclaim improvement for its real meaning, as Batalden and Davidoff put it, the “combined and unceasing efforts of everyone to make the changes that will lead to better patient outcomes, better system performance and better professional development.” This applies to both incremental improvements and new innovations.

The importance of the right learning culture has rightly been prioritised in the world of incremental improvement, and it is also of fundamental importance to “contextual” innovation – the introduction of new processes to a setting. It is unlikely Unipart could have simply introduced barcode readers in the absence of a firmly established incremental improvement culture in their organisation.

However, this culture needs to be complemented by a deliberate focus on creating eco-systems within organisations which support staff to scout for innovations. We are currently not doing this systematically. Instead we reward local re-invention that gets academic acclaim but will not transform the NHS.

At Imperial College Health Partners and the UK Improvement Alliance, we are seeking to embrace the commonalities between improvement and innovation for mutual learning. We’ve started with encouraging the stealing of ideas, which is the only way to accelerate the dissemination of both incremental improvements and innovations in the NHS. In particular, at ICHP we have created a capability programme for executives and frontline staff which is starting to bear fruit. Come and steal it.

But what if you can’t steal because the desired change is yet to be developed? Modern life surrounds us with “conceptual” innovations, with Uber being the current poster child, and it’s here the NHS needs to welcome in radical new thinking, whether from within NHS structures or outside.

Too often we get stuck in the trap of pitting innovation and incremental improvement against each other. The NHS needs both, and each needs the other. Time to put aside the differences and focus more on what we have in common.

Dr Axel Heitmueller is managing director, Imperial College Health Partners; and Richard Taunt is director, UK Improvement Alliance