Richard Gleave on healthcare innovation

When we think about innovation, a bio-engineering project or the latest whizzy computer gadgetry probably comes to mind.

The San Francisco Bay Area is rightly proud of the role of Silicon Valley as the world's leading centre for IT innovation, but it also promotes itself as the heart of cutting edge biomedical research. So it is not surprising that Kaiser Permanente, as the area's largest healthcare provider, decided to create a centre for innovation.

The Sidney Garfield Innovation Center is named after the visionary doctor instrumental in creating the Kaiser healthcare system. It has some impressive equipment - on my visit I saw home monitoring instruments for people with chronic conditions which linked into a video consultation with their doctor, and a computerised simulation training system which built on the technology used to prepare soldiers for war in Iraq and Afghanistan.

It was the low-tech innovations that impressed me most, though. Through its learning from an international design consultancy called IDEO, the centre is using human-centred techniques to redesign care processes. Although cutting edge computer programs and equipment are important, piloting and testing the procedures clinical staff use to treat patients can lead to important improvements in clinical care.

Kaiser Permanente's innovation consultancy has developed a structured methodology to generate possible solutions to a problem. The company has cheap, quick prototypes of the best ideas, which it rigorously tests in the lab before trying them out in a controlled pilot in a working environment. The tested innovations are then handed over to the service under an agreed regime that sets the expectations for local implementation.

I saw a project to reduce medication errors. These are a major problem: in the US they contribute to 7,000 deaths a year, while the cost to the NHS is an estimated£2bn.

Using a cardboard mock-up of a drug preparation room, nurses with scissors, tape and empty boxes experimented with room layouts to design one that would minimise the scope for errors in preparing the drugs trolley.

A team looked at the drugs round and concluded that a big problem was patients and other staff disturbing the nurse when medication was being administered. The solution was to identify the nurse clearly: a badge was too small to be noticed, while a fluorescent jacket was not popular among staff, so they settled on a sash.

A similar culture exists in Geisinger Health System in Pennsylvania, which combines multidisciplinary collaboration with targets for implementation. It has created a dedicated innovation team with board-level leadership that is proud of its service redesign projects.

High Quality Care for All proposes an ambitious framework to stimulate innovation, and the challenge is to use this to install new equipment and to implement new models of care.