It’s Sunday evening, and I’m in charge of bed time – if not in control. ‘I’m emptying the boat!’ says my 4-year old, using her milk cup to hurl as much water as she can from the bath to the floor. ‘Splash Daddy!’ says her little sister, squealing with joy as she joins in their combined efforts to make sure there is at least as much water out of the bath as there is in it.
‘Don’t be a copycat’ I tell her.
30 minutes later, I come downstairs to write this blog on spread, and wonder if there was anything to learn from that.
The spread of change and innovation is a complex social process, much studied and theorised. It’s also a very practical question which is crucial to improving the quality of care delivered by health services, and in ensuring their long-term sustainability.
In my first three months at the Health Foundation, I’ve learned about many of our projects that have made real improvements locally, recalling the Bill Clinton quote that ‘nearly every problem has been solved by someone, somewhere. The challenge of the 21st century is to find out what works and scale it up.’
In the English NHS, fragmentation of provision and the payment architecture may have unintentionally introduced additional barriers to spread: many autonomous providers operate at relatively small scale, each making their own purchasing decisions, each reinventing solutions to similar problems, and each being paid for their episode of activity rather than for improving and integrating a whole service around the needs of individuals. And regardless of the system context, even where there is agreement on what to do, there are the formidable challenges of replication of successful approaches to overcome.
Our August newsletter tells our grant holders’ stories of spreading their work in three different ways. Pathway, which provides health services for homeless people, has spun out of the NHS to become a charity; the PREVENTT trial, testing a new way of managing anaemia and blood transfusion in patients undergoing surgery, is now progressing through the NIHR Health Technology Assessment process; and the Scottish Patient Safety Programme is adopting the Breakthrough Series Collaborative Model to spread improvements in maternity care.
The Health Foundation has an active programme of new projects exploring these questions. We are currently putting over £7 million into supporting spread at the front line through our Scaling Up and Spreading Improvement programmes. We have recently opened our Behavioural Insights call, which seeks to support research that generates a better understanding of how to scale up effective behavioural interventions. And we have resources that can help now: our evidence scan on Spreading improvement ideas: Tips from empirical research, our practical guide on Using communications approaches to spread improvement and our new Communications in health care improvement toolkit.
We’re also currently planning three ways we might test and demonstrate new methods to support spread in 2016 and beyond. Firstly, we will commission a study into what has spread successfully from our portfolio (and what hasn’t) and try to understand the reasons why. Secondly, we will also look to learn from social innovation in sectors beyond health, such as the extraordinary growth in food banks that has been supported through a social franchise model – an approach that provides a centralised model with core elements that must be retained, and some that can be adapted to local context. And thirdly we will continue to develop our thinking to take account of the potential of organic spread in a more connected world, where ideas are shared and develop at pace through social and professional networks, whether offline or online. The ALS ice bucket challenge is one such example.
So as well as funding specific research and projects on spread, we’re also committed to building platforms that support the NHS to connect, mobilise, develop, and support people with improvement knowledge and skills. Our Q initiative, which we are currently co-designing with our first cohort of 250 participants, has great potential here.
We will always need new ideas to accelerate improvements in the quality of health care. But perhaps some of the greatest potential lies in the application of what we already know – maybe it’s not always bad to be a copycat.
Will Warburton is Director of Improvement at the Health Foundation. Follow him on twitter @will_warburton2
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