Against the Odds
Research ~ Successfully Scaling Innovation in the NHS
With The Health Foundation, London
To relieve the immense pressures in the health service, improve patient experience and outcomes, and save money, we need innovative approaches to benefit more people. But traditional approaches to scale and spread aren’t delivering the change we need. Our research looks at 10 stories of UK innovations that have scaled and built a rich picture of the factors that enable success.
10 case studies
of innovations that have spread in the NHS in recent years
8 key enablers
insights for successful scaling that are relevant for both innovators and system leaders
“In this country, we have a proud record of invention, but we lag behind in systematic uptake even of our own inventions.” Lord Darzi
There are many pockets of innovation across the NHS; all delivering fantastic care in new and different ways, and achieving better outcomes for patients, staff and the taxpayer. Yet there is frustration across the healthcare system that few innovations fail to spread beyond their site of origin, and that even when they do, many struggle to reproduce the original outcomes and impact.
“Focusing only on incremental improvement won’t create the widespread change that’s needed in the NHS. We need more tried and tested innovations to reach more of those who could benefit from them.” David Albury
However, some innovations do spread, going from the marginal and cutting edge to routine practice. Our research with The Health Foundation explored 10 stories of successful scaling – uncovering insights from both innovators and those adopting and adapting the innovation in a new context.
We identified the shortlist of innovations through a public crowdsourcing campaign and an expert working group. They range from products, such as Implantable Cardioverter Defibrillators (ICDs) for preventing cardiac arrest, to new care models, like Rapid Assessment Intervention and Discharge (RAID), which provides liaison psychiatry support to patients in hospital. They took different routes to scale – from government led roll outs, in the case of Improving Access to Psychological Therapies (IAPT), to the clinician-led adoption of Florence, a telehealth system that uses SMS text messaging to collect patient observational data and offer real-time guidance to patients.
Delve into the case studies:
- Altogether Better Health Champions and Collaborative Practice
- Dose Adjustment for Normal Eating (DAFNE)
- Enhanced Recovery After Surgery (ERAS)
- Florence (Flo)
- High Sensitivity Troponin testing
- Implantable Cardioverter Defibrillators (ICDs)
- Improving Access to Psychological Therapies (IAPT)
- Macmillan Cancer Nurse Specialists
- Rapid Access Intervention and Discharge (RAID)
- Schwartz Rounds UK
KEY ENABLERS FOR SCALE
From these ten stories of scale, we identified eight key insights that describe the key enablers for scale both for those in pursuit of spread, such as innovators or those driving the scale of an innovation, and for those creating the conditions for spread, such as policy makers or grant funders.
CONSIDERATIONS FOR PRACTICE
There is no singular formula for the successful spread. But shining a light on some of the factors that support it can help us think more deeply about the different possible approaches and the wider system conditions needed to ensure transformative change reaches more patients.
The report poses a set of considerations about what should be done to change the way innovations are supported to spread and scale across the NHS. In particular, we argue that system leaders and policymakers need to understand and respond to the following:
- The ‘adopters’ of innovation need greater recognition and support. The current system primarily rewards innovators, but those taking up innovations often need time, space and resources to implement and adapt an innovation in their own setting.
- It needs to be easier for innovators to set up dedicated organisations or groups to drive scaling. Scaling innovation can be a full-time job for an individual, and difficult to do alongside frontline delivery. Often dedicated organisations are needed to consciously and strategically drive scaling efforts, including when innovators ‘spin out’ from the NHS, and innovators may need support to set them up.
- System leaders need to take more holistic and sophisticated approaches to scaling. Targets and tariffs are not a magic bullet for scaling; while they can help, they don’t create the intrinsic and sustained commitment required to replicate new ideas at scale. System leaders need to use different approaches, including articulating national and local healthcare priorities in ways that create strategic opportunities for innovators, and using commissioning frameworks to enable rather than hinder, the sustainable spread of innovations.
You can read about the considerations in the report here.
SUPPORTING YOUR SCALING EFFORTS
If you have questions about the research, or are interested in talking further about what its implications mean in your context and how Innovation Unit could help, get in touch with David Albury at firstname.lastname@example.org