The quality & productivity innovation challenge – getting over ourselves

As we face the challenge of driving for the next wave of quality improvement across the NHS in a formidably difficult financial environment, I cannot find anyone who doesn’t agree that innovation is a positive and critical element of the solution. We’re all innovators now.

The buzz around innovation in healthcare has been steadily increasing over the last few years

And yet our approach to innovation is paradoxical. Does our repeated commitment to provide the best in patient care lead to an unstoppable hunger to create new service models, or aggressively adapt and implement the innovation of others? Sadly I would say that overwhelmingly over our history the answer to this is a resounding “no”.

This is not to discount the many improvements in care that we have made together. But while individual innovators have done extraordinary things in their own service they have too often remained islands of excellence. Where service innovations have been spread it has rarely happened organically, but has often had to be forced out, against significant pushback, as an imposition against local freedoms. And many of these improvements cost us additional money which we simply will not have in the coming years.

So if we believe that we have to innovate and urgently spread innovation in order to meet the coming challenge we will have to face up to and change the cultural obstacles to this aim that we as a leadership community tolerate and even encourage.

I say culture because I don’t believe that the problem is lack of basic innovations or of information about those innovations.

Basic innovation abounds. Trust me: if you are appointed the national director of improvement and efficiency your inbox fills up with unsolicited emails all telling the same story - I’ve got a brilliant idea - I’ve shown it works - I can’t get people interested.

Information about innovation is also ubiquitous. I once met a spy. Actually an ex-spy who was now working in industry in counter-industrial espionage. He explained to me that this was a multi-million pound industry preventing organisations getting hold of information about processes that improve quality and reduced costs. At the time I was working with the Modernisation Agency and explained that we had a multi-million pound process trying to give such information away free. The problem is not information.

The buzz around innovation in healthcare has been steadily increasing over the last few years, and the commissioning and system management directorate at the Department of Health have developed a comprehensive programme to encourage greater uptake and application of innovation. All SHAs are now under a legal duty to promote innovation, which is being supported through the Innovation EXPO and the introduction of a new innovation fund and national innovation prizes, to stimulate research around areas of particular concern.

NICE has also successfully launched NHS Evidence, an online portal that provides people working across health and social care with the world’s best evidence and best practice at the touch of a button.

However, the scale of change required is unprecedented. We therefore need to be open to innovation which can only be achieved if we tackle the culture that inhibits the spread of innovation.

I would suggest four things that leaders can do to begin this change:

• Personally model a hunger for learning from the best, getting over our own egos to praise the great work done by others and asking them to share their learning. Nothing is more depressing to me than the whispered conversations that go on between leaders in an audience when one of their colleagues has been asked to share some piece of excellent practice with them. It is too often the opposite of positive recognition and hunger to learn.
• Learn locally as well as globally. I have no problem with some of the learning we are prepared to do from the best international systems - there are fantastic ideas out there. But we hugely under exploit the learning that is available to us in our own backyard. You are more likely to meet a group of NHS chief executives keen to learn in Boston Massachusetts than you are in Manchester or Newcastle and yet my experience is that there is as much to learn locally.
• Create and join networks that create innovation at scale. Whether it’s across a region or with like minded colleagues or organisations (and these are not mutually exclusive of course) pool knowledge and capability to accelerate change.
• Make sure that your clinical and managerial teams have the skills to innovate and spread innovation. We have learned a huge amount from the work of recent years on collaboratives for change, campaigns and social movement work, measurement and strong programme management. This learning is readily available to support the development of individuals and teams.

I recognise of course that we need to do those things at the centre that support such work. The cultural problem is as important to solve for us as it is in the local clinic. We have identified some and I welcome your continuing advice on what else we need to do. In addition to sponsoring good information, identifying excellence, ensuring organisations like the NHS Institute for Innovation and Improvement provide excellent support to skills development, trying to align incentives, supporting regions and networks in spreading innovation.

I am under no illusion that you will need to see us changing the way we work, not simply exhorting change from others.