The NHS Long Term Plan has a clear emphasis on innovation for patient benefit, and highlights that the challenge ahead of us is adoption and spread, reports Dr Amanda Begley, national director of the NHS Innovation Accelerator. Here she gives real-world learning and insight into the problems and ways of overcoming them.
We know that there are a complex set of challenges to innovation uptake in the NHS, which means that realising the potential outcomes of new technologies and models of care can be delayed and patchy across the country.
There are however, pioneering individuals and NHS organisations working incredibly hard to adopt innovation. In doing so, they are driving enormous benefits: better outcomes for patients, more equitable access, cost-effective integration of care and resources around the needs of their patients and populations.
Research recently published by the NHS Innovation Accelerator - an NHS England initiative delivered in partnership with the AHSN Network - shines a light on some of these NHS ‘adopter’ sites, capturing their learning and insights as to how they’ve successfully implemented innovations supported by this national accelerator.
Nine case studies were selected, representing a breadth of innovation types (digital, devices, models of care), a range of adopters (commissioners and providers), and sites that were geographically dispersed. The research was guided by existing theoretical perspectives on innovation adoption, which informed the interviews and analysis. Three common findings were identified: adoption journey, adoption network and adoption tasks.
1. Adoption journey
From initial awareness of an innovation through to it being sustainably implemented, the adoption journey tends to be iterative and non-linear. Think of it like a lock and key. The innovation starts out as an uncut key which becomes embedded over time in the lock through a process of mutual shaping, negotiation and adaption. The lock refers to the unique organisational context of the site adopting the innovation. Push and pull factors play an important role at various points within the adoption journey. Push factors relate to the innovator and innovation, eg adaptability, availability to support the NHS site, flexibility of training offered to staff. Pull factors relate to the adopter site, eg recognising a need, awareness of the innovation, having key individuals motivated to drive improvements.
2. Adoption network
The adoption network illustrates what’s already well recognised in research and practice - the role of champions. Rather than one lone champion, a network of multiple champions is needed, who are operating inside and around the adopting organisation. You might describe these champions as working like an orchestra, undertaking tasks individually and collectively to really improve the fit between the innovation and the adopting context. Our research revealed a common set of traits for these champions. All were reflective of their current practice and sought opportunities for driving improvement, all had the ability and confidence to act outside of their immediate role and responsibilities, and all were well connected within their local networks.
3. Adoption tasks
The third finding related to the common tasks that were replicated time and again across the case studies. These included a process of getting to know the innovation, building the local case for adoption, adopting the innovation for the organisational context (the lock and key analogy highlighted previously), and working through how it could be embedded and sustained.
Throughout this process we saw constant trialling - within different services, at different points along a care pathway - with real thought as to the data collection to support and engage different audiences.
There are key recommendations from the research:
- The adoption of innovation is incredibly complex and challenging. There isn’t a blueprint to follow: adoption requires innovative thinking. As such, we must find ways to better applaud and celebrate NHS staff and organisations who take the risks and invest the time necessary to adopt innovation for patient benefit. They should be recognised for their resilience, commitment and tenacity.
- There is a huge amount of evidence-base and theory to draw upon. We need to ensure that we draw on this to guide our adoption strategies.
- We need to think how we best capture and share learning across adopter sites and networks. Historically, we’ve tended to try to make adoption sound easy to encourage participation. This is arguably counter-productive as a few people try, fail and then engagement drops off.
We need to be open about the complexity of adoption, draw on the evidence-base, and be prepared for a lot of trialling and adaptation. Delivering the benefits of innovation for patients and the NHS requires a partnership between users and innovators; one which is built for the long-term and involves multiple champions.
Dr Amanda Begley is national director for the NHS Innovation Accelerator (NIA). Follow the NIA on Twitter @NHSAccelerator