(1) Navigating the system 

Companies producing a new product or service are often grounded in innovative practices. However, health and social care systems are historically not designed to create value through innovation. Indeed, many would argue they were not even designed as a whole system. Instead, they have come together as separate entities, merging and growing over time. It is therefore unsurprising that it may be difficult to develop ideas and products and then test their full potential. However, an increasing number of resources offer advice, explanations and ways in for potential innovators and innovation partners.  

Our Achieving Innovation Directory allows you to easily navigate this ecosystem. It compiles all relevant organisations in one place and detailing how each can help you, no matter what stage you have reached on your innovation journey. 

(2) Spread 

Innovation is easier if it is simple, focused on one department or institution, and can be funded from that department’s budget. You need a more strategic approach if your goal is to spread innovation beyond one setting and deliver benefits on a greater scale. 

Our ‘Achieving Innovation in Health and Social Care Review’ highlights research that describes how to create the conditions required for successful spread. As part of this, three different factors must be accounted for: 


Referring to how much of a system is affected by the change caused by innovation. If implemented, will it impact multiple departments, institutions, or even sectors? Changing established patient pathways to accommodate innovation may be difficult and needs to be accounted for. 

Deep changes:

Focusing on paradigm shifts and changes in assumptions or behaviour. This is if innovation relies on shifting professional methods of practice. Effective leadership to help deliver this is essential – driving it through existing regional service networks, teaching, and research activities. 

Large changes:

Involving many people. New networks and groups may need establishing when there are large changes involving different identity groups. This is important because many innovators have found value in bringing disciplines and teams together to train, learn and problem solve in a collaborative and diverse learning environment. 

(3) Top-down versus bottom-up 

Care systems, in particular healthcare systems, can find innovation difficult because they are accustomed to a top-down system of command and control. This is driven by desire to reduce cost and avoid risk, but which sometimes has an opposite effect. Costs are increased by overlaying successive orders from the top onto already existing systems, and risk is increased by loss of local ownership. When applied to innovation, top-down approaches undermine the potential for front line professionals and patients to experiment and change the status quo. Over time, they erode trust, pace, and energy. 

Therefore, many of the ‘Rules for Stifling innovation’ proposed by Professor Trisha Greenhalgh in her editorial in the ‘Achieving Innovation in Health and Social Care Review’ are recognisable in management systems and policy approaches. To their credit, health and social care services in Wales have recognised the need for change and many of the new approaches are discussed in Life Sciences Hub Wales’ Achieving Innovation blogs.  These developments aim to change the climate for innovation: reducing delays and encouraging people to take the lead on the front line. 

(4) Strategic priorities 

Health and social care’s business systems were not designed as innovation pathways. Money and managerial responsibilities are allocated to functions or departments (so, not aligned with value seen from a patient’s perspective) and accountability for performance is often judged by process measurements which are similarly based on functions. Moreover, standards and specifications are relatively static, with little space for experimentation. This emphasis on governance and accountability has created risk aversion and reinforced the status quo. 

Governments across the UK have recognised these deficiencies and introduced ways to prioritise and fast track strategic priorities. This might be seen as introducing a lightning rod to achieve rapid change while the underlying system is still slow, but it is a pragmatic approach. Miles Burrows discussed Genomics England in his blog as an initiative delivering unusual pace and clarity of purpose. Here, Government priorities were linked with investment and a dedicated development pathway to minimise delay and encourage entrepreneurship. The lesson is clear: while prevailing business systems may not be innovation driven, innovators are advised to align to clear strategic priorities with this focus. 

(5) The innovation habit 

It is easier for any clinician or manager to change practice if they work in an organisation where innovation is encouraged as an everyday habit. In his blog, Dr Chris Subbe described his frustrating experience in getting small but lifesaving changes to spread. Less persistent clinicians might well have given up.  

Individual local authorities, health boards and trusts are at different stages of embedding innovation into their workflows. Consequently, it’s more likely to flourish in some places. Research confirms that the important features of organisations lie within the eight challenges of quality improvement cited in the Achieving Innovation in Health and Social Care Review.  

But what do they look like in practice? Examples include the presence of a clear innovation strategy in the organisation, a centre or resource at the heart of how the place runs, internal courses and resources that support innovators, a sense that clinician and innovation champions are ‘plugged into’ working processes and have corporate support, and a track record of innovation and change. 

These features may be visible when talking to individual clinicians or found within public-facing documents. If you have a choice of organisations to work with, pick one that is purposefully developing the innovation habit. 

(6) Culture 

Innovation prospers within specific culture, underpinned by certain behaviours. Leadership can encourage these by consistently reinforcing these changes. In other words, culture can be deliberately affected by purposeful leadership action. Therefore, it is important to be clear what we mean by the difference between the ‘right’ and ‘wrong’ type of culture for facilitating innovation. 

The good news is that we know from published evidence what changes to make, how to make them, and their effects. The ‘Achieving Innovation in Health and Social Care Review’ described how healthcare organisations can use the QUASER tool to assess current attributes, select behaviours and systems to deliver desirable change, and create a change plan. 

(7) Fashion in terminology 

To an outsider, the rate at which health and social care coins new terms and champions new causes may seems unnecessary and confusing. This also places valuable and useful concepts in competition. 

A more balanced approach selects theories and models according to how relevant they are to the situation. Both the Achieving Innovation Review in Health and Social Care and John Boulton’s blog makes clear that transformation, innovation and improvement are not opposed to one another but necessary parts of a whole. An organisation wanting to transform must be competent at managing its business, improving its systems and introducing innovations.  

There is a similar clash of terms around outcome measures. Again, it is useful to understand overlap and similarities. The Parliamentary Review spoke about the Quadruple Aim. Here, all services should be judged against their ability to improve individual experience of care, improve population health, reduce per capita cost of care, and improve the experience of delivering care. Value-Based Health Care (VBHC) is a different approach that seeks to achieve “outcomes that matter to the patient in relation to the costs of delivering care”. 

However, these two concepts distinctly overlap. Both approaches aim to encourage service providers to look beyond activity measures and performance to form an understanding of the value of services to individuals and the population, and whether they best use resources. 

(8) Once for Wales 

The term ‘Once for Wales’ describes a desire to achieve common architecture and interoperability between systems and sectors across Wales.  

However, there is a danger the term is applied too widely and discourages innovation. If it is taken to mean that an innovation developed in one place should be copied everywhere else, it can result in chaos and apathy. Solutions will be overlayed regardless of need, meaning that local control is lost.  

In summary, if “Once for Wales” is applied as a principle as originally intended then it will strengthen the ability of local systems to test and adapt solutions from other settings. Applied wrongly, it can reinforce a top-down culture and a simplistic and counterproductive view of care systems. 

Life Sciences Hub Wales is committed to supporting multidisciplinary stakeholders making Wales the place of choice for health, care and wellbeing innovation. Our Achieving Innovation work has enabled us to better understand how we can help you deliver this. Explore our continually evolving resource now.