Scaling innovation: a collective endeavour

blog | 27 Apr 2018

How can healthcare leaders create cultures in which innovative solutions can scale up? Sarah Dew, Project Lead at Innovation Unit, explores what needs to change.

Clinicians, entrepreneurs and managers across the country are developing innovative new ways to tackle the challenges they face in delivering quality healthcare to patients – whether that be developing a new solution in-house, or working with external partners to provide care in a different and better way.

But often these successful innovations struggle to spread next door, let alone to other places in the country, where clinicians and managers are puzzling to find answers to similar challenges and where more patients would benefit. Helping scale and spread solutions that work is a moral imperative for healthcare leaders across the country, because as long as our best new ideas are stuck in single places, patients and practitioners across the country are losing out.


So, what can be done to create the conditions for new, evidence-based innovations to scale and spread in the NHS, and what role do leaders need to play?

Traditionally, the role of spreading innovative practice has been characterised as one played by a singular charismatic champion.

But spreading innovation is a collective endeavour, not simply a communication challenge that is solved by a lone individual extolling the virtues of their idea from the rooftops. Leaving behind the status quo requires many individuals and teams to change, and to make a collaborative effort to adopt new behaviours and practices.

Healthcare leaders play an important role in creating cultures that encourage innovation – cultures where new ideas are not just born, but can grow and scale, and into which great ideas from elsewhere are adapted and adopted.

Taking an idea from elsewhere is hard work, no matter how good the innovation or its evidence base. As an adopter of an innovation, you need to demonstrate both tenacity and an ability to translate – being tenacious by holding true to the core elements of the original innovation that create impact, and translating other components to ensure the innovation fits your local context.


The cancer charity Macmillan understands the effort it takes to successfully adopt an innovation. By recognising and responding to the needs of adopters, it has successfully spread the Macmillan Cancer Nurse Specialist role across the country.

Macmillan offers up to three years of funding to partner organisations to support adoption, simultaneously pump-priming the new service, creating time to build it, and developing the case for integrating it into funding models and commissioning cycles.

Critically, much of the support offered by Macmillan to adopters is to counteract organisational norms, cultures or structures that make it difficult to adopt new ways of working. But not every successful innovation has an organisation behind it that can fund or deliver this level of support to adopters.


What should healthcare leaders do to create innovative cultures in their organisations, so that innovators themselves do not have to provide such extensive support for their innovation to scale?

Firstly, healthcare leaders need to prioritise the adoption of existing solutions from elsewhere at a strategic level, as much as growing new ones within.

They need to recognise the time and effort it takes for their staff to adopt and lead change, and create the space for them to do so. And the work of teams to adopt an innovation must be celebrated as much as those that develop new ideas are rewarded – those that do the latter currently receive an unfairly greater level of prestige.

When innovators need more flexibility and resource to scale their innovations than they are able to secure operating within the NHS, it needs to be easier for them to ‘spin out.’ They need access to support, advice and funds to create independent organisations that are dedicated to the scale and spread of their innovation.


Scaling innovation, and creating better, more equitable, more sustainable care, is a collective endeavour that too few are currently involved in – and leads to too few innovations succeeding beyond their home turf. Creating innovative organisations across the NHS that actively seek to adopt innovation and support their staff to do so can change this.

Our research with the Health Foundation, ‘Against the Odds,’ looks at 10 case studies of innovations that have scaled successfully in the NHS. It offers further insight as to how we can help more innovations to go to scale, such as by refocusing our attention on the role of evidence in building demand, and capitalising on national and local system priorities.

This article was first published by National Health Executive