@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
@HelenBevan
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
@HelenBevan
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.
@HelenBevan
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
@HelenBevan
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
@HelenBevan
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
@HelenBevan
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?
@HelenBevan
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
@HelenBevan
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
@HelenBevan
Matching our mindset/innovations to our level
of ambition
Source: adapted by Helen Bevan from Brooks and Bate (1994)
1st order 2nd order
Min
dse
t/In
nova
tion
s fo
r ch
an
ge
2nd o
rde
r1
st o
rde
r
Ambitions for change
@HelenBevan
Matching our mindset/innovations to our level
of ambition
Planned incremental(small scale change)
1st order 2nd order
2nd o
rde
r1
st o
rde
r
Ambitions for change
Source: adapted by Helen Bevan from Brooks and Bate (1994)
Min
dse
t/In
nova
tion
s fo
r ch
an
ge
@HelenBevan
Matching our mindset/innovations to our level
of ambition
Underachievement of goals for large
scale change
1st order 2nd order
2nd o
rde
r1
st o
rde
r
Ambitions for change
Source: adapted by Helen Bevan from Brooks and Bate (1994)
Min
dse
t/In
nova
tion
s fo
r ch
an
ge
@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
rde
r
Ambitions for change
Source: adapted by Helen Bevan from Brooks and Bate (1994)
Min
dse
t/In
nova
tion
s fo
r ch
an
ge
@HelenBevan Source : Kaiser Permanente Innovation Consultancy
@HelenBevan
Source: @NHSChangeDay
@HelenBevan
Source: @NHSChangeDay
Permissionlessinnovation!
@HelenBevan
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
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