PREST Institute of Innovation Research Innovation in the Public Sector Innovation in health and social services – results from the PUBLIN case studies

PRESTInstitute of Innovation Research

Innovation in the Public Sector

Innovation in health and social services – results from the PUBLIN

case studies

Paul Cunningham

(+ the PUBLIN Project Team)

PREST

University of Manchester



Introduction

• PUBLIN – comparison of innovation in public sector versus private sector

• Case study approach (11 ‘innovations’)• Perceptions and definition of innovation in

the public sector• A common analytical framework –

– Drivers– Facilitators– Barriers

• Findings & Lessons



Perception, definition & interpretation of innovation

• Concept of innovation accepted in national public sector context

• Definition works - “deliberate change of behaviour at the level of institutions that includes a new or improved service, process, technology, or administrative tool”

• Concept often applied in context of “change” “modernisation” and “problem solving”

• Concept is applied across all types of innovation (technological, yes, but also… process, organisational, etc.)



Study Teams & Case Studies

Social sector:– Ireland: (University College Cork)

• “The Pensions Retirements Savings Account”

– Israel (University of Haifa):• “Regional Resource Centres of Special Education”

– Lithuania (Mykolas Romeris University, Vilnius): • “Innovation in services for the elderly”

– Norway (NIFU STEP): • “Innovation in home-based services for the elderly”

– Slovakia (Comenius University, Bratislava):• “Residential care for the elderly”



Teams & Case Studies

Health sector:

– Ireland: (University College Cork) • “Innovation in the provision of home help services in the Southern

Health Board area.”– The Netherlands (University of Maastricht):

• “Development and implementation of clinical pathways in the psychiatric hospital Vijverdal.”

– Spain (University of Alcala):• “The adoption of innovations (Digital Radiology technology and Main

Ambulatory Surgery processes) in a public hospital in Spain.” – Sweden (VINNOVA):

• “Hospital-Managed Advanced Care of Children in their homes.”– United Kingdom (Manchester Metropolitan University):

• “Patient-Oriented Education Systems for Diabetes” – United Kingdom (The University of Manchester):

• “NHS Direct: An Innovation in Social Trust – Remote access to public healthcare and the health service”



Common issues in the public sector

• Demographics: an increasingly ageing population• Increase in chronic diseases & long-term conditions

• Integration of social groups into mainstream / decline of institutional care

• Patient empowerment / personalisation of services• Decline in public trust in expert opinion / emergence of

learned customers• Consumerisation• Privatisation and new public management

• Shortages of healthcare professionals / diversification of service providers



Analytical framework: Barriers and responses (1)

a. Size & complexity: i. phased introduction, pilots (UK1, SK)ii. local level implementation & push (UK, SK)iii. responsiveness to local conditions and needs (UK2)iv. thorough consultation with stakeholders (IE.s)

b. “Heritage and legacy” i. strong top-down drivers (UK1)ii. use of local “champions” (UK1)iii. engagement with stakeholders (UK1)iv. targeted removal of functional silos (NL)v. local problem solving and open remit, flexible culture

(SE, UK1 )vi. role of NGOs (SK, LI)



Barriers and responses (2)

c. Professional resistance i. integration with local systems / engagement of

stakeholders (IE.s, UK1)ii. large scale consultation (IE.s)iii. “agents of change” (SK, IL)iv. demonstration of benefits (ES, UK1)v. customer empowerment (UK1)vi. threat (!) (NO)

d. Risk aversioni. top-down driven (upward shift of responsibility) (NO, SK,

UK1)ii. piloted introduction (IL, SK, UK1)iii. strong quality control systems (UK1)iv. local level feedback loops (IL, SK, UK1)v. local responsiveness (UK1)




e. Public accountability and high profilei. ministerial responsibility (UK1)ii. local flexibility (UK2) iii. strong feedback mechanisms (UK1)iv. strong consultation and consensus (IE.s)

f. Unclear outcomes/need for consultation i. process of ex ante research, review and evaluation (ES,

IE.h, NO, SK, UK1)ii. ongoing consultation & feedback with stakeholders (IE.s,

UK1)iii. piloting (IL, SK, UK1)

g. Pace and scale of change – “innovation fatigue”i. rapid introduction (promotion of dynamic culture?) (NL,

UK1)




h. (Lack of) capacity for organisational learning?i. top down initiatives to promote general culture of

learning (UK1)ii. strong feedback loops & open remit (UK1, UK2, SK,

LI)iii. use of champions/entrepreneurs (SE, SK, LI)

i. Public/end-user resistancei. generally good uptake/high public acceptance (if

involved)… (IE.s, IL, LI, SE, SK, NL, NO, UK1) ii. …but better in some social groups than others (UK1,

UK2)iii. demonstration of benefits (ES)




j. Absence of resourcesi. acts as stimulus for change… (+/-SE, IE!!)

ii. ex ante demonstration of potential cost benefits (ES) or incentives (UK2)

k. Technical barriersi. development of clinical assessment software (UK1)

ii. lack of remote monitoring technology (SE)



Drivers & Facilitators (1)

a. Problem-orientated driveni. systemic crisis – multiple solutions required (IE.s, NO,

UK1, UK2)ii. specific problems (IL, LI, SK)iii. general efficiency or care needs (ES, IE.h, NL, SE)

b. Political pushi. high level endorsement/national impetus (IE.h, NL, SE,

UK1, UK2)

c. Strong culture of reviewi. use of ex ante consultation (IE.h, IE.s, UK1)ii. evaluation and monitoring, local & stakeholder feedback

(IL, NO, SE, UK1)iii. staff engagement (LI, SK)




d. Support mechanismsi. external agencies:

• workplace partnerships (IE.h)

• clinical pathway promotion (NL)

• NGOs (SK)

• Modernisation Agency (UK1)?

ii. funding (IE.h, NL, SE, UK1)

iii. input from key officials (SE)

iv. networking (IL, LI, NO, SK)




e. Capacity for innovationi. role of entrepreneurs/champions (all)ii. open remit – problem solving & stakeholder

engagement iii. further innovations, new applications & linkages with

complementary systems

f. Competition driversi. performance targets/pseudo-markets?ii. inter-organisational competition?iii. client satisfaction

g. Technological factorsi. new technology (ES, SE, UK1)



The nature of public sector innovation

• It involves interaction with the public

• It is complex (with multiple stakeholders, locales, contexts… and outcomes)

• It requires adjustments of relationships, norms and behaviour

• It is systemic – promotes/requires further innovation



Some lessons?

1. Pluralism of approaches

2. Openness to ideas

3. Ability to seize opportunities

4. Key role of champions / entrepreneurs

5. Teamwork & independent thinking



Some more lessons?

6. Engagement of stakeholders & ongoing dialogue

7. High degree of reflexivity

8. Demonstration of utility

9. Pilot process

10.Generate recognition and support

11.Retain momentum



End of Presentation

…thank you!…merci!…danke!

Documents

PREST Institute of Innovation Research Innovation in the Public Sector Innovation in health and social services – results from the PUBLIN case studies