@HelenBevan

My report card on innovation in the NHS

A presentation to the Derbyshire Innovation Partnership

6th February 2014

Helen Bevan

@HelenBevan

Definition of innovation

“Doing things differently and doing different things”

Source: NHS Institute

@HelenBevan

Some key questions

• What kinds of innovation should I be thinking about?• Which kinds of innovations are most likely to deliver

our goals for patients and the public?• What are the risks around different kinds of

innovation?

@HelenBevan

Types of innovation• Process innovation• Service innovation• Strategy innovation

Source: Kathryn Baker http://www.au.af.mil/au/awc/awcgate/doe/benchmark/ch14.pdf

Source of image:Allywatch.com

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Process innovations

• Patients booking their own appointments online• Reinventing the triage process in Emergency Department• Home delivery of patient prescriptions• Redesigning the job application process within recruitment

and selection• Smartphone technology to monitor chronic disease• Daily ward huddles to replace the weekly multidisciplinary

team meeting• Patient education before surgery as part of enhances

recoverySource: Sheffield Service Improvement Team

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Kinds of service innovation

Parker H Making the shift: a review of NHS experience. Health Services Management Centre and NHS Institute for Innovation and Improvement http://www.bhamlive3.bham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/2006/Making-the-Shift.pdf

Integration

Segmentation

Simplification

Substitution

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Substitution: providing higher value, lower cost care for patients/service users through

• location substitution: substituting high tech clinical environments for community based settings

• skills substitution: enhancing the skills of specific groups of staff to undertake roles previously undertaken by those with a higher skill level, for instance enabling nurses to prescribe drugs, a role that was previously only carried out by doctors

• technological substitution: maximising the use of new technologies in the service. Includes channel shift by which organisations seek to encourage their service users to access or interact with services via channels other than those to which they are accustomed. A typical channel shift is moving from face to face or phone interaction to self-service online

• clinical substitution: moving from a medical care model to community care or family or self care model

• organisational substitution: looking at a wider range of providers to those who have traditionally delivered NHS care, for instance voluntary and community groups and social enterprises.

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Service innovations• Delivery specialist services in the home e.g. Intravenous

chemotherapy, care for heart failure, parenteral nutrition• Introducing hyperacute stroke services across a city• Radical redesign of the pathway for people with

dementia• Virtual wards post specialist diagnosis• Transformation from “assess to discharge”(traditional

hospital model) to “discharge to assess” (active recovery at home)

• Directorate level standardisation of care across all departments and care-giving teams

Source: Sheffield Service Improvement Team

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Strategy innovation

“the question today is not whether you can reengineer your processes; the question is whether you can reinvent the entire industry model”

Gary Hamel

Source of image:Inovationmanagement.se

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Strategic innovations• Shifting power: patients, carers, families and communities as

co-creators and producers of health• Transforming the paradigm of urgent and emergency care

across the community• “Theranostic” (integration of therapeutics and diagnostics to

deliver personalised medicine)• GPs responsible for overall care of frail older people

(including social care)• Quality improvement regarded as important a topic as clinical

education in clinical schools

Source: Sheffield Service Improvement Team

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Discussion

• Which kinds of innovation are most important to deliver the improvements we seek for patients and the public at scale?

• Which kinds of innovation are most prevalent?

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Type of innovation

Potential contribution to transformational change

Current prevalence in delivery of innovation

Risk of non-delivery

Process

Service

Strategy

@HelenBevan

Type of innovation

Potential contribution to transformational change

Current prevalence in delivery of innovation

Risk of non-delivery

Process Lowest High Lowest

Service Higher Lower Higher

Strategy Highest Lowest Highest

@HelenBevan

My report card• Increasingly an ambition for strategic innovation

but reality of innovation practice mostly at process innovation level

• Conflict or misalignment between leadership aspiration and front line reality

• Frequent lack of theory of change - multiple process innovations don’t add up to strategy innovation

Source of image: talentmagnet.com

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How to align the different levels of innovation

1. Seek to match our level of ambition for change with the methods and mindsets for innovation that give us the best chance for delivering our goals

2. Create a “roadmap” to guide innovation practice3. Build shared purpose for strategy innovation on a

big scale4. Always review and celebrate all attempts at

innovating to make a difference, whatever the level of innovation

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Matching our mindset/innovations to our level

of ambition

Source: adapted by Helen Bevan from Brooks and Bate (1994)

1st order 2nd order

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Ambitions for change

@HelenBevan

Matching our mindset/innovations to our level

of ambition

Planned incremental(small scale change)

1st order 2nd order

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Ambitions for change

Source: adapted by Helen Bevan from Brooks and Bate (1994)

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@HelenBevan

Matching our mindset/innovations to our level

of ambition

Underachievement of goals for large

scale change

1st order 2nd order

2nd o

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r1

st o

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Ambitions for change

Source: adapted by Helen Bevan from Brooks and Bate (1994)

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@HelenBevan

Matching our mindset/innovations to our level

of ambition

Planned incremental(small scale change)

Underachievement of goals for large

scale change

Achievement but more limited in

scope or scale than potential suggests

Achievement of goals for large scale

change

1st order 2nd order

2nd o

rde

r1

st o

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Ambitions for change

Source: adapted by Helen Bevan from Brooks and Bate (1994)

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@HelenBevan Source : Kaiser Permanente Innovation Consultancy

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Source: @NHSChangeDay

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Source: @NHSChangeDay

Permissionlessinnovation!

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is the new normal!

“By questioning existing ideas, by opening new fields for action, change

agents actually help organisations survive and adapt to the 21st Century.”

Céline SchillingerImage by neilperkin.typepad.com