Scaling up innovation in the NHS requires action at multiple levels

Why do some health care innovations successfully go to scale while others fail to spread beyond their site of origin? And how can we ensure that many more spread successfully in future?

These questions, which are the focus of a new report published yesterday by the Innovation Unit and the Health Foundation, should be central to how we think about relieving the financial and operational pressures in the NHS, improving patients’ experience and outcomes, and reducing unwarranted variation.

Spread: Moving the debate forward

The spread of innovation in health care is often slow and laborious, and even when new ideas are taken up elsewhere, it proves harder to reproduce the original outcomes and impact. As Lord Darzi put it a decade ago, ‘In this country, we have a proud record of invention, but lag behind in systematic uptake even of our own inventions.’

Too often the NHS’s stock repertoire of approaches to uptake – disseminating evidence, supporting pilots, issuing top-down directives and creating financial incentives – prove insufficient to the task. Worse still, the debate itself is stuck, focused on the barriers to spread, rather than the enablers.

That’s why the Innovation Unit and the Health Foundation recently joined forces to investigate why some innovations buck the trend and, against the odds, do succeed in going to scale. We explored the stories of 10 innovations (products, pathways and models of care), identified through a crowdsourcing campaign, that have spread in the NHS in recent years, to see what they could teach us about how we might go about scaling innovations more effectively in future.

What did we learn?

Some of the insights challenge conventional wisdom. For example, despite all the focus on stimulating the supply of innovations, it is the approach to stimulating demand that is key to uptake. Stories and testimonies are a powerful complement to rigorous quantitative analysis in persuading others of the case for change. Ensuring successful uptake of innovation is often less of a technical challenge than a social one: seeking consensus on the problem to be tackled and on how the solution should be applied locally, and building and maintaining people’s commitment to change over time.

The report’s analysis also offers food for thought for policymakers and system leaders about what they might do differently to support spread.

Supporting the adopters of innovation

Firstly, while the current system primarily rewards innovation, there needs to be greater recognition and support for adopters of innovation too. It is tempting to think that once an innovation has been successfully demonstrated then the hard work has been done. But the reality is often very different. Those taking up an innovation often need time, space and resources to implement it, and to do the hard work of adapting the innovation to make it work in their own context.

Innovators and adopters will also often need to work together to develop the innovation and ‘codify’ its core features – something we saw with the development of the Rapid Assessment Interface and Discharge (RAID) liaison psychiatry model, a service supporting hospital patients who may have mental health problems, where the creation of the RAID Network brought adopters together to discuss how the model could be adapted to different contexts.

Resourcing spread appropriately

Secondly, it needs to be easier for innovators to set up dedicated organisations to drive the spread of an innovation. Scaling up new ideas across the health service can be a full-time job, and one that is difficult to do alongside front-line delivery.

In cases of successful spread there is often an organisation or group that has consciously and strategically driven it – something we saw, for example, in the way the Point of Care Foundation was set up to spread Schwartz Rounds, a structured approach to reflection for health care staff that aims to promote compassionate care. Such organisations can differ greatly in their structure and business model. Some find they fare better when they spin out from the NHS, like Phil O’Connell, who founded Simple Shared Healthcare to spread his telehealth platform Florence, which he found gave him greater flexibility to collaborate with partners.

Using a wider range of approaches

Thirdly, we need to take more holistic and sophisticated approaches to scaling innovation at the system level. Policy levers like targets and tariffs are not a magic bullet; certainly, they can generate interest and kick-start momentum for spread, but don’t by themselves create the intrinsic and sustained commitment that is often required. We saw this in the case of DAFNE, a patient education programme for people with type 1 diabetes, where the introduction of Quality and Outcomes Framework payments resulted in a rapid rise in referrals, but only a minor rise in those actually attending courses.

Instead, system leaders need to draw on a range of approaches. These could include:

• articulating national health care priorities in ways that create strategic opportunities for innovators
• ensuring that commissioning frameworks enable, rather than hinder, spread
• building the underlying capability of NHS organisations to learn and adopt new ideas.

Action at multiple levels

Ultimately, our research suggests there is no single approach to spread, and that improving how we replicate innovations at scale requires action on a range of fronts, at multiple levels of the system. But it is tantalising to think what improvements in patient outcomes and experience might be possible if we were to devote as much attention and resources to the process of adapting and applying what we already know as we do to the development of new ideas and technologies. 

Will Warburton (@willwarburtonHF) is Director of Improvement at the Health Foundation