A recent policy reform by the Department of Health heralded a re-think on the way it promoted innovation and education for NHS staff.
The policy had three main planks: leadership, incentives and a responsive IT infrastructure. We have a number of “firsts” in these measures. For example, in relation to leadership, strategic health authorities will be mandated to produce an annual report on the progress of innovation across their patch, particularly in the areas of adoption and implementation of new ideas.
NHS organisations are bidding to become a health innovation and education cluster and separate funds will be made available for taking ideas to “product”. The product in this sense is any novel idea that aims to improve care, patient engagement, management of services or organisational development - in other words, innovation from all sections of the workforce.
The vision for the NHS expressed in High Quality Care for All has been seen as injecting fresh ambition in the ranks of senior managers in the NHS. The bind of targets has given (some) way to creating an environment in which patients - no matter where they live - get the best treatment available.
The terrain for innovation in the NHS is, however, quite complex and will increase in complexity as health innovation and education clusters come on the scene.
Any one NHS organisation may be directly involved with a number of innovation entities: the national innovation centre, the NHS Institute for Innovation and Improvement, academic health science centres, biomedical research centres, collaborations for leadership in applied health research and care and the closest structural sibling to a health innovation and education cluster, regional innovation intellectual property hubs.
The often cited “working in silos” springs to mind as new entities come into play and want to demonstrate their unique contribution and value. The need for integration and co-ordination for these bodies will be critical if real and lasting benefit is to reach the patient.
If policy and structures have been set out, what are the main processes by which to achieve successful implementation? In other words, what are the main enablers, constraints and characteristics in this complex terrain? Five key areas of the innovation terrain are:
- Workforce culture
- Hidden innovation
- Innovation development cycle
- Management processes
In relation to workforce culture, a significant majority of the 1.2 million staff (especially those in bands one to four) may think that it is not their job to innovate. Professional hierarchies abound in the NHS and innovation may be perceived as the responsibility of staff, to put it glibly, with research in their job title. Additionally, apart from the 1.2 million NHS staff, there are many thousands who work in the voluntary health sector that could make a significant contribution to the innovation agenda. Ask them what and how they would fix local problems and you might be pleasantly surprised at the degree of insight and motivation.
The Hidden Innovation report alerted policy makers to two central tenets, namely: that innovation frequently relies on collaborations between disciplines, across sectors and beyond regions, and innovation is often affected more by mainstream policies than by those aimed directly at innovation. There is a wealth of innovation activities not reflected in traditional indicators such as investments in formal R&D or patents awarded.
Too often, the NHS operating in “its own market” has failed to make the necessary links with the wider community (business, social care and enterprise, voluntary sectors). The findings from this report reinforce the view that we should look at new methods of stimulating and supporting innovative ideas.
The innovation unit at Nottingham University has emphasised that our efforts in an innovation development cycle have tended to focus on getting things to market (where potential is realised) rather than fully appraise the value and number of ideas at the outset.
The new innovation terrain should therefore seek out the largest number ideas from staff (intrapreneurship) and assess the quality /value from the outset. Greater emphasis should be on creative thinking, problem solving and effective decision making.
Management processes, specifically R&D and education, have tended to work to separate agendas with little co-ordination and integration. HIECs in principle will address this bifurcation of role and direction, and help to ensure that one feeds off or into the other. The principle sounds laudable but the actual practice will undoubtedly be dogged by traditional ways of working and professional allegiances.
The Innovation for a Healthier Future report identified that the NHS has an outstanding reputation in R&D (invention) but fails to make the necessary steps towards adoption and diffusion. The problem of scale has focused the minds and directed activities at the NHS Institute for Innovation and Improvement where the task of taking new developments to scale has resulted in a range of resources and applications.
Following an independent review of the innovation terrain, the Cambridge Institute has constructed a five point strategy for innovation development to help ensure that intrapreneurship flourishes in the NHS:
- Appoint an “ideas scout”.
- Create an “innovation commons”.
- Use state of the art innovation education practices from higher educational institutions.
- Pilot, appraise and score all ideas on an innovation scale.
- Close the innovation development cycle.
The task of an ideas scout is to flush out ideas across the spectrum of care services, to simplify and lower any transaction costs in the process of communicating such ideas. A scout will also promote innovation and the incentives available.
Staff would be informed as to a) an initial evaluation as to the value and/quality of their idea and b) the nature of a rapid pilot and c) what then happens by way of a development cycle.
An innovation scout would feed a synopsis of local ideas into an innovation commons. The commons would be at regional level which could then provide two important decisions a) checking to see if other regional innovation commons have logged such an idea and b) the extent of scale i.e. the likely potential and route to making significant change throughout the NHS.
Given the comments above in relation to working culture(s) in the NHS, it is imperative to consider instigating some form of access to educational resources in innovation. Many higher educational institutions are well advanced with respect to innovation (enterprise and entrepreneurship) education.
It is increasingly being accepted that such education moves beyond the teaching of facts to the focus of tacit knowledge i.e. know-how based on experience, understanding and insight. The NHS could learn a great deal from brokering and partnering with higher educational institutions on state of the art innovation education resource development. A first for NHS staff could be easy access and opportunity to a course in innovation skills.
As part of the idea development cycle, staff should be informed by the idea scout as to how the proposal will be assessed through piloting, appraisal and an innovation scale rating. In this way, staff would be given feedback to reinforce positive behaviours in the innovation process and information as to which areas of the idea could potentially be further developed.
If the findings from a rapid pilot are positive, the proposal then moves into a post-concept relevance stage. It is here that the ideas scout, using some of the tools developed by the NHS Institute for Innovation and Improvement, aims to close the innovation development cycle. It is here also that the necessary links are made with regional intellectual property hubs in relation to product development.
Current policy reform on innovation and education has the huge potential to make a direct impact on realising the aims of a High Quality Care for All to bring about the best care and treatment for all patients. The NHS needs to construct and execute a robust strategy to maximise ideas from staff and the related healthcare workforce. Staff have to be convinced of the need to challenge existing practice and be intrapreneurial; innovative behaviours need to be supported and reinforced.
Dr Chris Loughlan is director of Innovation at CiREM (Cambridge Institute for Research, Education and Management), www.cirem.co.uk