Most of my work in health care has been in the US, but I have always been fascinated by universal health care and the NHS. And so I jumped at the opportunity earlier this year to work with the NHS on a Harvard Business School project studying the diffusion of innovation. We were lucky enough to meet with some of the most innovative trusts, CCGs and providers in the UK, and here are some highlights of what I took away…
Setting priorities locally. ‘Change is a threat when done unto me; change is an opportunity when done by me.’ This adage of a Harvard Business School professor resonates very well with the ‘not invented here’ syndrome which can prevent innovation spreading in the NHS.
For instance, Imperial College Health Partners told us about an effort to improve COPD care. It took months to obtain stakeholder buy-in because the Imperial-set priority was initially perceived as marketing, rather than a fundamental change to the care pathway. Change happened much more rapidly when the Academic Health Science Network got involved to set priorities in collaboration with their local stakeholders and the project then gained momentum. Setting priorities locally does risk letting ‘a thousand flowers bloom,’ but this can be mitigated by sharing learnings between localities with similar priorities.
Focusing innovation efforts. East London Foundation Trust’s Quality Improvement Programme exemplifies the power of focusing innovation efforts. In their first wave, they trained staff on quality improvement (QI) skills and allowed the staff to choose their own QI projects. This was a great way to motivate the front line and unleash their creativity – fantastic because it’s those who are delivering care who often understand the problems best and can come up with innovative solutions.
East London FT found, however, that their initial impact was low because the efforts were dispersed. In the next wave, they instead identified high priority projects and created teams across functions and specialties, allowing the QI Programme to create macro-level improvement.
This programme was especially inspiring because, like a lean startup, they rapidly experimented with how to apply QI, learned from what worked well and what didn’t in the first wave, and revised the second wave to be more effective. Moreover, I had previously thought that QI was limited to micro-level change, but this programme shows that macro-level improvements are achievable by carefully building teams that cut across the silos in health care organisations.
Co-designing with patients. In a management meeting at Newham Hospital, I was pleasantly surprised to see a patient join the conversation. As a diabetic, she helped design the Skype follow-up consultations, and her comments were eye-opening. For instance, we asked her if she had any concerns about privacy over Skype. Management typically thinks of privacy in terms of IT security to protect patient data; however, the patient interpreted privacy in a completely different, refreshing way.
She described how, in South Asian culture, there is a stigma against being seen as ill and going to hospital, and that Skype allowed her to have consultations in the privacy in her own home. This was an incredible insight, a consideration unlikely to have occurred with just clinicians and administrators around the table.
It was also powerful to see how the clinicians had changed their perspectives. Initially, they’d been sceptical of the initiative, thinking that in-person visits were superior to telemedicine. But they saw that patients were much more communicative in the comfort of their own homes, revealing more clinically important information through proactively asked questions, rather than passively answering a clinician’s questions.
Integrating health and social care. A goal of the NHS Five Year Forward View, integration is alive and kicking at the Bromley-by-Bow Centre in east London. Instead of just prescribing medications, GPs do ‘social prescribing’: they can prescribe over a thousand social services by ticking a box in an electronic patient record system. Once a patient is referred, they get a phone call from a ‘navigator’ – someone who then connects them to the relevant service. I was amazed not only by the strategy of the integration, but how it was seamlessly executed for clinicians and patients, making it easy for both parties to adopt.
But the success of the Bromley-by-Bow Centre is is also daunting – the Centre has been more than 10 years in the making, and depends on around 70 funding streams. Is it replicable? My hope is that shared budgets between health and social care proposed by the NHS Five Year Forward View will make it much easier to achieve similar integration elsewhere.
These examples were a great reminder of the wealth of talent in the NHS. With the ageing population and the looming NHS budget gap, the need for innovation and change is clear. We can make that change an opportunity rather than a threat by co-designing with local leadership, frontline staff, patients and the community.
Lisa is an MBA student at Harvard Business School, and an intern at Omada Health