Helen Bevan looks at how healthcare leaders can deliver better services using existing resources, by examining processes, services and strategies

IV drip with money inside

IV drip with money inside

IV drip with money inside

In an era where healthcare finances are so constrained, the need to develop an effective innovation strategy is a no-brainer. We face clear choices as healthcare commissioners and providers. We can seek to contain costs by restricting services, or requiring often overstretched staff to work even harder.

‘The future health and care system will need a combination of strategy, service and process innovations’

The alternative approach involves thinking differently, often in a radical manner, about the way that services can be delivered within available resources and taking action to design and deliver services in different ways.

But what kinds of innovation should healthcare leaders be adopting to give us the best chance of delivering our transformational goals? It’s helpful to differentiate between three kinds of innovation in health and care:

  • process innovations;
  • service innovations; and
  • strategy innovations.

Process innovations

Process innovations are the most common type of innovation in healthcare. They involve reducing or eliminating unwarranted variation and activities that do not add value from an existing process.

They tend to be narrower in scope than service innovations, focusing on a discrete part of, or contribution to, a wider service, typically without changing the nature of the overall service or patient pathway or requiring a different paradigm about care.

Service innovations

Service innovations seek to improve or transform an offering for an entire service or pathway of care for a specific group of patients, usually covering multiple processes. More than a decade ago, I worked with colleagues from Birmingham University’s Health Services Management Centre, on a project called Making the Shift (to primary and community based services). We created a typology for service innovations that is still the best one that I have seen anywhere and I continue to use to this day.  

Service innovations bring more risk than process innovations because they are more complex and innovations are more likely to cross existing departmental or organisational boundaries. However, the quality and productivity gains of service innovations are typically more significant than those of process innovations.

Strategy innovation

Strategy innovation means thinking in an entirely new way about the basis on which the organisation, system or industry operates. Most organisational innovation is at process and service level, but these innovations may lack the pervasiveness to deliver change at the scale or pace required.

Strategy innovation is relevant when the demographic, financial or technological challenges that we face can’t be met without abandoning the prevailing management model and rethinking the system.

It offers the greatest opportunity to deliver large scale change but it is also the highest risk of all three levels of innovation. It requires a fundamental shift in mindset; key people are likely to lose power and influence as the organisation moves to the new arrangements and the kinds of change programmes that result from strategy innovations are big and complex. Many change initiatives based on strategy innovation fail to deliver their objectives.

Examples of process, service and strategy innovations
Process innovationsService innovationsStrategic innovations
  • Patients booking their own appointments online
  • Reinventing the triage process in the emergency department
  • Home delivery of patient prescriptions
  • Redesigning the job application process within recruitment and selection
  • Smartphone technology to monitor chronic disease
  • Daily ward huddles to replace the weekly multidisciplinary team meeting
  • Patient education before surgery as part of enhanced recovery
  • Delivering specialist services in the home, eg: intravenous chemotherapy, care for heart failure and parenteral nutrition
  • Introducing hyperacute stroke services across a city
  • Radical redesign of the pathway for people with dementia
  • Virtual wards post specialist diagnosis
  • Transformation from “assess to discharge” (traditional hospital model) to “discharge to assess” (active recovery at home)
  • Directorate level standardisation of care across all departments and care giving teams
  • Shifting power to patients, carers, families and communities as co-creators and producers of health
  • Transforming the paradigm of urgent and emergency care across the community
  • “Theranostics” (integration of therapeutics and diagnostics to deliver personalised medicine)
  • GPs responsible for overall care of frail older people (including social care)
  • Quality improvement regarded as important as clinical education in clinical schools

Source: Sheffield Service Improvement Team

Three-way process

So what should we do to align the different levels of innovation? Seek to match our level of ambition for change with methods and mindsets for innovation that give us the best chance for delivering our goals.

The organisations I see doing this most effectively recognise that innovation is a structured and disciplined process, the product of the deliberate use of practical tools. They have adopted evidence based, people centred design methodologies and invested in design capability.

Leaders in these organisations work very hard to build shared purpose for innovation among those who create a compelling narrative for change that unites people around the cause. They prioritise making the time for strategy innovation and act as deliberate role models in its execution. They measure the outcomes of strategy innovation efforts and take the following steps:

  • Create a “roadmap” to guide innovation practice. In my experience, leaders are more likely to be successful in their innovation efforts if they design and work with a “roadmap”: an explicit model or theory that hypothesises how they will deliver large scale change through strategy innovation. The roadmap helps align and connect activities at all three levels of innovation and enables frontline staff delivering process and service innovation to make sense of how their activities fit into the bigger picture of strategy innovation. It reduces the risk of ambitions for strategy innovation being translated into the operational reality of service and process innovation.
  • Build shared purpose for strategy innovation on a big scale. People will own what they co-produce. That means engaging those who will define the benefits of the innovation, those who are going to make it happen and those it will affect to be part of the innovation design effort. The wider the engagement and the broader the perspective, the less risk that the change effort will unintentionally converge into incremental process innovation. This means inviting patients, carers, staff, partners in the wider community, leaders from other care organisations and other industries to be part in our innovation processes.
  • Always review and celebrate all attempts at innovating to make a difference, whatever the level of innovation. Do this regardless of the results, because it means that people are more likely to attempt more innovation in the future.

The future health and care system will need a combination of strategy, service and process innovations to deliver its quality and productivity challenges.

On one hand, innovation in the current NHS context has to deliver more than small scale process changes. On the other, if we just concentrate on large dramatic changes there is a risk that we will miss the incremental impact of multiple small changes at the frontline of care.

Case studies: Innovation strategies

Southern Health NHS Foundation Trust

Southern Health is one of the largest community based NHS trusts in England, providing community health, mental health, learning disability and social care services. It has a staff of 9,000 working across 150 sites, spanning five counties across the south of England.  Southern Health has adopted a transformational “spectrum of care” strategy (innovation) for frail older people, based on a paradigm shift from reactive care to proactive, patient-led services that promote independence. This has required Southern Health to develop radical new ways of working with its partners in primary, social and acute care, involving joined up care pathways and sharing of resources. Service and process innovations flow from this strategic innovation at Southern Health. For instance, Southern Health doctors working within GP localities to accelerate and shape integration with other community health and care services is an example of service innovation; whereas, GP Directory of Service app to enable easier navigation of Southern Health services would be considered a process innovation.

Jönköping County Council, Sweden

Jönköping County Council is a health and care system in southern Sweden with responsibility to provide healthcare and dental services for the 340,000 residents within Jönköping County. 

Qulturum is a centre for learning and innovation within Jönköping County Council that supports the transformation of care. The main focus of the centre is on facilitating improvement in the areas of patient involvement, prevention, cooperation, clinical improvement, safety, coaching teams and designing healthcare services. One of the strategy innovations for which Qulturum is best known is the Esther Network.

This network is made of caregivers, clinicians, patients, and families who work to promote and improve complex care. Esther is a symbolic patient with complex care needs who requires the coordination between hospital, primary care, home care, and community care. Esther symbolises radical patient/service user orientation as the patients’ needs are put above anything else.  It is about creating a bond between patients and healthcare providers and creating new levels of patient satisfaction. The Esther network is a strategy innovation because it has fundamentally changed the perspective from which the patients’ process of care is viewed and has transformed the nature of improvement work in Jönköping.

Helen Bevan is chief transformation officer for NHS Horizons, a new team for radical thinking about large scale change that has been established by NHS Improving Quality. All views in this article are her own.

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