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How and why the NHS adopts innovation
Drawing upon this year’s NHS Long Term Plan, which underscored the critical need for innovation, Dr Amanda Begley, National Director of the NHS Innovation Accelerator, discusses ways healthcare professionals and innovators can work together to improve how the NHS adopts innovation
In the NHS Long Term Plan – published in January this year – it is said that ‘almost everything in this Plan is already being implemented successfully somewhere in the NHS.’ While innovation is regularly regarded as part of the solution to challenges facing the NHS, adoption of innovation is not easy. However, there are an increasing number of individuals and organisations successfully navigating the complex adoption journey and realising the benefits: better patient outcomes, improved cost effectiveness and savings, and more equitable access to care.
The NHS Innovation Accelerator (NIA) is an NHS England initiative delivered in partnership with England’s 15 Academic Health Science Networks and hosted at UCLPartners. Established to help deliver the Five Year Forward View, and more recently highlighted in the aforementioned NHS Long Term Plan, the national accelerator supports the uptake and spread of high impact, evidence-based innovations across England.
Since it launched in 2015, the NIA has supported 49 individuals (or ‘Fellows’) to spread 52 innovations – including digital, medtech, workforce and models of care – to over 2,030 NHS sites. To date, NIA innovations have raised over £84.3 millionin external funds, created over 390 new jobs and won 92 awards.
The NIA’s unique dual focus offers personal development for Fellows with bespoke support to spread an innovation, recognising that both are critical to scaling innovation in the NHS. To be selected to join the NIA, individuals and innovations undergo a rigorous assessment process including patients, clinicians, NHS England and AHSNs. Fellows come from a variety of backgrounds, ranging from practicing or former NHS clinicians, to academics, to individuals from small and large companies. What they have in common is a passion for spreading innovation to benefit patients and NHS staff, and for sharing their real-world insights with colleagues across the system.
Last year, the NIA conducted research to evaluate how decisions to adopt innovations are made within NHS organisations. The published analysis – Understanding how and why the NHS adopts innovation – captures the real-world insights and learnings of adopter organisations who have successfully implemented innovations supported by the NIA. It also identifies factors that facilitate adoption as well as the impact of adoption on an organisation.
It’s widely recognised that the journey to adoption is often not straight-forward: it is dynamic and non-linear, requiring flexibility between the adopter organisation and the innovator. Throughout the journey, a series of push and pull factors were identified as playing an important role at various points. Push factors, those that relate to the innovator and the innovation, include availability of the innovator to adopter sites, flexible training opportunities and the innovation’s interoperability with other systems. Pull factors relate to the adopter organisation and include an existing need for the solution, the capability to manage and coordinate the adoption process, and the opportunity to engage key decision makers and stakeholders.
The research highlighted a need for mutual adaption and iteration between the innovator and adopter. It was noted that there is a level of disruption to an organisation that occurs as it adopts an innovation. In turn, there is a level of disruption to the innovation. Described in terms of a lock and key, the innovation starts out as an uncut key and, through negotiation and mutual shaping along the journey, it is cut and embedded into the organisational context.
For healthcare professionals perhaps the most relevant learnings come from the analysis of the network of champions driving adoption. This ‘adoption network’ includes individuals from within and outside of the adopting organisations undertaking a set of critical adoption tasks.
Champions within adopter organisations
In some cases, a single internal champion is able to drive adoption of an innovation. In the research, this is depicted in a case study where a GP Practice Manager identified Lantum, a cloud-based tool used to fill empty slots in clinical rotas, to address the time-consuming challenge of finding locum GPs to fill shifts. He had the autonomy and budgetary control to procure the platform and quickly integrate it into practice.
Within larger organisations, and for innovations that directly impact on several different teams within an organisation, successful adoption can require multiple champions working together. In the case of DrDoctor, an online and SMS-based service for managing patient bookings, a collaboration of individuals drawn from multiple professional groups (clinical, operational, finance and IT) in the adopting hospital was established. This proved essential to navigating an adoption journey that met the needs of all stakeholders and delivered an innovation with relevance throughout the hospital.
Champions across organisations and sectors
In other cases, where the uptake of an innovation has implications outside of the adopter organisation, the adoption network needs to include internal and external champions. For example, when digital health leaders from the Lancashire and South Cumbria Change Programme (Integrated Care System) wanted to implement the health app portal ORCHA, the involvement of several organisations was necessary. To begin trialling the platform, the original adoption network was expanded to include champions from local GP practices, schools, and the Sustainability and Transformation Partnership’s (STP) Primary Care Digital Exemplar Programme.
Including a breadth of expertise and perspectives within the adopter network ensured that ORCHA was adopted as a practical solution for front line staff, was promoted at scale across the STP and became part of the wider digital transformation strategy. Additionally, close working between the NIA Fellow and champions within the adopter network led to the identification of new applications for ORCHA.
Finally, the research identified a list of ten tips for NHS sites to consider when planning to adopt an innovation. These are summarised below:
1 - Dedicate resources to engage the wide range of staff who will be involved in implementing the innovation.
2 - Understand what data and materials are available to support adoption.
3 - Review and free up the necessary organisational capabilities to engage with and implement the innovation.
4 - Explore the experiences of other organisations in adopting the innovation.
5 - Accept that the adoption process will be iterative, non-linear and uneven in progress.
6 - Plan for widespread engagement and training within the adoption network.
7 - Develop the local business case and plan for sustainability from the outset.
8 - Work with the innovator to co-develop an adoption roadmap that suits your specific organisational context and adopter network.
9 - Communicate often, clearly and openly.
10 - Be realistic about timescales and availability of resources to shape and implement the innovation.