This week I attended the Reform conference on health innovation, which got me thinking about the different ways that people interpret ‘innovation’. At the Health Foundation, the innovation we promote is in how health services are organised, managed and delivered. It seems that much discussion about innovation in healthcare focuses on new technologies, but innovative behavioural change is essential if their promised benefits are to be fully realised.
Let’s take access to GP records as an example. About 60% of GP practices in England already have the technology in place to allow patients online access to their records. But despite the government’s decision that all NHS patients should have this access by 2015, very few practices have seized the opportunity.
We have funded a project, myRecord, which is exploring how to support general practice in making records accessible. And having the technology in place is merely the starting point.
The myRecord team is learning how important it is to clearly explain the benefits of this new technology in order to convince practices of the need to change how they work. Also it’s essential that all practice staff (clinical and non-clinical, such as receptionists) and patients are encouraged and supported to adopt such innovations.
But innovation is not only about new technology-led developments. The challenge is as much about embedding known best practice in one area into routine care everywhere.
One example is our Safer Patients Initiative. During the programme we discovered that achieving organisation-wide change was extremely challenging – if something is new to a particular clinical team they will see it as a threatening innovation, even if it is routine elsewhere in the same institution. Implementing such changes across the whole of a hospital requires deliberative processes of local testing and adaptation. We also learnt the crucial importance of measurement and just how badly the NHS seems to do this.
On the subject of measurement, this week we published a fascinating study, Lining Up, into the problems associated with the spread and adoption of proven organisational innovations and the role played by measurement.
The study looks at how intensive care units in the UK have implemented Matching Michigan, a nationally organised infection control programme. Matching Michigan was designed to replicate the highly successful Michigan Keystone programme, which had shown impressive results in reducing central line infections in American intensive care units.
The study shows that the units involved collected data on infection rates in very different ways, implying that comparison across units was almost meaningless. In the past, such differences have been attributed to staff gaming to meet performance targets. But Lining Up provides a different explanation…
Measurement in the practice setting was shown to be a social process. Interpreting guidance on counting infections was seen to be heavily influenced by the standard working practices of each of the units. Our research found that the cultural context for an improvement initiative is profoundly influential.
Lastly, when considering how to deliver innovation in the NHS, I think it’s vital that we don’t forget the role of patients. We are working with the renal team in Yorkshire and the Humber to provide patients with kidney disease the option to undertake self-dialysis on a medical unit and support them to do so. Changing practice in this way demands new behaviours and skills from both patients and health professionals (see previous blog posts ‘No more groundhog days’ and ‘In patients’ own words’).
Of course, this innovative way of undertaking dialysis has to be sensitive to each individual patient and take account of their whole life – their confidence, motivation and well-being. One patient was diagnosed with breast cancer while she was learning to needle herself. Understandably it was too much to cope with at once, so she paused her training. With support from the clinical team she felt able to start again a few weeks later. This flexibility is vital in introducing innovative approaches to care.
So, to sum up, when introducing successful innovations in the care process we need to remember three key things: resist the temptation to believe technology alone is the answer, pay special attention to measurement, and to engage patients from the start. We must be able to confidently address all three if we are to progress in innovating in the way we know we must, to ensure a sustainable future for the NHS.
Stephen is Chief Executive of the Health Foundation, www.twitter.com/THFstephen