Really breaking through the innovation barrier in health care

At the Health Foundation we’ve been supporting teams to test their innovations for over five years through our Shine programmes and, now, through our new Innovating for Improvement programme. We are starting to see the benefits that can be reaped from a small amount of support as many innovations spread not just in the UK, but some internationally.

However, our focus has been to support people once they have come up with the innovation. We haven’t supported people to innovate. This is what they do at Kaiser Permanente’s Garfield Innovation Center in the US, and I went along to visit on a recent trip to the US.

The Center – named after Sidney Garfield, the physician co-founder of Kaiser Permanente (KP) – is located on what looks a bit like an industrial estate on the outskirts of Oakland, California. Entering the building, it struck me as a very anonymous space. But as Chris McCarthy (the director of the Innovation Learning Network) showed me round, it quickly became apparent that the anonymity actually allowed the space to become anything. Inside, the large warehouse was segmented into different testing spaces: theatres, clinics, people’s homes and space to become anything anyone wanted to help with their innovating.

The Centre supports team to innovate in three respects:

• Providing access to people who have expertise in innovation through two teams. One supports clinical teams to apply human-centered design approaches to a problem they are grappling with. The other proactively searches out new technologies and considers how they can be applied to improve health care.
• Offering a space in which teams can test out new equipment or workflow processes, often starting with cardboard prototypes of clinical units that get designed, tested and re-designed until eventually a fully working prototype is produced.
• Using methods for testing ideas to establish whether they are genuinely an innovative alternative to the status quo.

Walking around the Centre I saw examples of all of these approaches in play.

A theatre space had just been used to test new lighting systems. Operating on pumpkins, surgeons tried different models and positioning to work out the optimal deign. Having done this, it will be standard for all new or upgraded KP hospitals.

Workflow processes for premature babies had been designed and tested using a cardboard mock-up of a special care baby unit, to optimise staff deployment and family privacy.

Technology was being tested as part of a programme called ‘Care Anywhere’, from looking at how to optimise care in clinics and in people’s homes, to amazing futuristic pods that would be placed in shopping centres and stations. People concerned about a health issue could enter and hook up to a health professional remotely. It felt like the walk-in centre idea turned inside out – the health care professionals all located together in one place and the pods placed throughout the community.

For me a slightly more unnerving innovation being tested was the idea of using driverless cars to go and collect people who were having their vital signs monitored and starting to show abnormal readings. Once in the car, the person would be able to speak to a health professional remotely and have a series of tests carried out using devices in the car.

And there was much more...

But the striking impression I was left with was how seriously they took innovation and they worked to some exacting principles:

• Innovation was seen as a specific step in the process of a project, not an exercise in end-to-end project management. This meant that the Centre could work with hundreds of teams each year and not be burdened with the ongoing management of the work.
• The central team was staffed with people with the skills to support innovation – designers, engineers, ethnographers. These individuals were able to bring distinct thinking to the clinical teams and weren’t constrained with pre-conceived ideas of how things have to be done.
• The Centre uses defined methods and techniques to help people imagine how things could be different, to notice things as they really are and to find alternative approaches of achieving the same goals.
• Coming up with ideas that will improve things for staff is considered to be a requisite for any innovation, so they talk in terms of human-centred design rather than patient-centred design. Unless it is better for both patients and staff, an idea is unlikely to get adopted; this honours all the humans in the system.
• When it comes to spreading process innovations, they use the concept of minimum specifications that focus on what needs to be done, rather than how it should be achieved. This gives scope for any necessary local adaptation without losing fidelity with the original design.

Some three years ago, the predecessor of NHS Improving Quality started to create a similar facility in England, but that went by the wayside with the last restructuring. Some trusts have started to develop innovation spaces in their own organisations. But I have yet to see anything as systematic as the Garfield Centre in applying method to innovation. If we are going to get break through thinking in how we deliver care then something along these lines feels to be a necessity, rather than a ‘nice to have’.

Jo is Director of Strategy at the Health Foundation, www.twitter.com/JoBibbyTHF