A Bath-based trust has made it its mission to encourage, capture and develop innovation via a special panel, as Mark Tooley and colleagues explain

No one could doubt the importance of innovation in the NHS and the need to strive for better ways of doing things. It’s also a truism that staff in their day to day roles are often best placed to recognise where improvements could be made, and suggest smarter ways of working or small changes that could make a big difference to patient experience. But tapping these ideas and making them happen is another challenge.

In 2014, the Royal United Hospitals Bath Foundation Trust set up an innovation panel to encourage, capture and develop innovative ideas.

‘We’ve worked hard to make the innovation panel accessible to all our staff and to foster a supportive culture across our organisation’

Staff who have an idea for a new way of working that delivers a benefit for the organisation, but which needs support or resource to progress, are invited to put a bid to the innovation panel. The panel then assesses the application and can provide non-recurrent funding up to a maximum of £15,000, which can be used for staff time and/or resources to support their idea.

Chaired by Sarah Truelove, deputy chief executive and director of finance at RUH, the panel welcomes ideas including pilots of new or different uses of technology, schemes that require pump priming to change ways of working, short term pilots to test ideas and ways of working, as well as new product development.

“We are always looking for ways to improve patient experience,” explains Ms Truelove.

“We need to keep asking ourselves ‘How can we do this better?’ and to listen to and support our staff when they provide us with new ideas that can provide real benefits.

“We’ve worked hard to make the innovation panel accessible to all our staff and to foster a supportive culture across our organisation.

“The panel can also support the financial sustainability of the trust by providing another route for ideas to feed into the innovation part of the trust’s quality, innovation, prevention and productivity agenda.”

Applicants are asked to complete a two page application form that outlines how their proposal would offer an improvement on current ways of working, why it is innovative and what financial or practical support they would need, including accessing expertise from other teams.

Creative thinking

Applications are triaged by a small subset of panel members who provide support to the applicants to review and refine their bids prior to presenting to the panel.

The panel are often able to give approval on the day. Once approved, support is available to overcome obstacles that might hinder getting the project off the ground. Successful applicants are invited back to the panel to report on progress, and completed projects are analysed to determine if the innovation should be rolled out to other areas of the trust or embedded as business as usual.

‘It has allowed us to harness the creative thinking of our staff for the benefit of patients’

The panel has a varied membership. Clinical and non-clinical staff including consultants, nurses and ward managers sit alongside executive and non-executive representatives.

The panel also features rotating membership of staff from the local Academic Health Science Network, who provide an external peer review of the process, along with access to their network and expertise.

The panel has been running for almost two years and there is no sign of the stream of innovative ideas drying up.

“We feel the innovation panel has proved an excellent tool for further developing and supporting a culture of innovation at the RUH,” reflects Ms Truelove. “It has allowed us to harness the creative thinking of our staff for the benefit of patients.

“We have already hosted pop-up panels where staff are able to come along and pitch for funding of up to £500 on the spot and we’ve events planned for the future to ensure we don’t miss out on any great ideas.”

Professor Mark Tooley is a member of the innovation panel and research and development director at Royal United Hospitals Bath Foundation Trust. Sarah Cook is service improvement project lead and supports the running of the panel, along with Lisa Lewis, lead for transformation, women and children’s division, and Hester McLain, QIPP programme manager.

Case studies

The following three case studies are examples of projects that have been implemented as normal functions at RUH as a result of the innovation panel.

Case study 1: Combined hydrogen and methane breath testing

Prior to the trial of combined hydrogen and methane breath testing, patients who were suspected of having lactose malabsorption (LMA) and small intestinal bacterial overgrowth (SIBO) would be referred for a breath test, which tests for the presence of hydrogen on the breath. However, a proportion of patients produce methane instead of hydrogen, and these patients would go on to have further, more ‘invasive’ tests to diagnose or rule out LMA or SIBO.

The new machine, which tests both methane and hydrogen, has only recently been introduced in the UK. It has allowed the team to gather data about the proportion of patients who produce methane instead of hydrogen (which is not well researched and varies by geographical region), as well as improve the experience for patients who could have otherwise faced uncertainty about their diagnosis until further tests.

Case study 2: Psychology intervention in respiratory disease

Patients with chronic respiratory disease often have high levels of anxiety and depression, due in part to the disabling and frightening nature of breathlessness. This can lead to inappropriate use of emergency healthcare, resulting in unnecessary hospital admission and readmission.

The pilot was a success, with considerable positive feedback from patients. Early evaluation suggests that as well as an improvement in patient wellbeing, the intervention led to a reduction in follow up attendances and readmissions. The model is now being reviewed to identify a sustainable way forward that can scale across and benefit a wider proportion of hospital patients.

Case study 3: Portable resuscitaires for NICU

Before the trial, funded by the panel, preterm babies requiring stabilisation and term babies requiring resuscitation had their umbilical cords clamped and cut immediately after birth in order to take them to the resuscitation equipment (resuscitaire). By delaying cord clamping and keeping the baby close to the mother, iron status is improved, and in large randomised trials has proven to reduce neonatal interventions and length of stay in units. There is also evidence from animal studies that delaying the cord clamping stabilises the heart and lung function.

During the innovation trial, 98 per cent of the trial group received optimal cord clamping, and feedback from parents was very positive. On the basis of the trial two units were purchased and the rolling replacement programme of portable resuscitaires for all of the fixed resuscitaires is now in place.

The team are planning a regional networking event to inform interested trusts about the findings.