Dr John Boulton, Director for NHS Quality Improvement and Patient Safety and Improvement Cymru, explores the importance of organisational culture and how we can integrate improvement and innovation.
Dr John Boulton
Director of NHS Quality Improvement and Patient Safety/Director Improvement Cymru
When aiming to improve health, care and wellbeing outcomes, innovation and improvement play an essential role. These areas of work are often perceived as separate fields by those working within the landscape, but they are really two sides of the same coin.
There are a multitude of definitions for both improvement and innovation. The Achieving Innovation in Health and Social Care report even dedicates a section to ensure that we have consistent definitions of such terminology. Put simply, improvement is always perceived as small incremental changes, whereas innovation is more focused on large system-level changes to health and social care. However, both are united by the overall goal of driving better efficiency and value within the health and social care.
Bridging innovation and improvement
I therefore believe we have real opportunity to link the two up and create a more integrated approach to both innovation and improvement. This is demonstrated through recent work where patient video consultations were implemented in response to Covid-19. Such digital tools are a fantastic innovation but underpinning this with an effective improvement programme allows us to design a reliable and effective system to maximise outcomes.
This also works in reverse. Take your typical improvement programmes in hospitals to improve patient care. These can truly be transformed for the better through applying innovative thinking, whether this is considering innovative technologies or practices.
It is also important to consider both innovation and improvement in evaluation and measurement of success. The Covid-19 pandemic saw a wide range of new practices and services implemented into our health and social care systems. However, while it is clear a lot of change has occurred, can we say that improvement has happened? This has not yet been documented or measured. Going back and considering whether such work constituted improvement and how that influenced innovation, and vice versa, will be important.
The culture of innovation and improvement
Effectively integrating both innovation and improvement is key, but they must also both be embedded into agile organisations. You can train thousands of individuals in improvement practices to provide them with a different lens of seeing and doing things. However, if these people then go back to risk-averse organisations that are hierarchical and slow to make decisions, then improvement can be stifled.
It can be even more difficult for implementing innovation. Large-scale transformation can be heavily hindered by bureaucratic organisations with slow decision-making processes. Proposals require executive approval, when practically they do not need such high-level authorisation. This eats up the time of both those sitting on the committees and those who prepare the papers for their approval.
Training people in innovation is also currently limited – providing the knowledge to turn an idea into a prototype is a skill some have naturally, but many more could have through training. It could also help people prepare and understand the frustration that is associated with innovations not reaching its intended audience. Even in an ideal innovation landscape, not all prototypes will be successful. Many try things once and get their fingers burnt, which makes them reticent to try again.
Training and support should also extend beyond how to develop an initial concept. Communicating your idea or product, while linking up to the correct networks to support this is essential. Right now, there is often a perception that the innovator needs to be solely responsible for taking the concept from a limited prototype to right through to international implementation.
Spread
Of course, it is also important to recognise that such global spread may not be appropriate for your innovation or improvement process. This is covered as a key topic in the Achieving Innovation in Health and Social Care report. It collates research demonstrating that an idea working in one place may not deliver benefits elsewhere. Innovation and improvement may be more effective through flexible translation, especially when hoping to embed this into complex organisations.
Different patient populations may necessitate different ways of working. In my own experience as a rheumatologist when I was tasked with spreading good practices, I needed to consider that my own colleagues may be undertaking equally good practices but with a patient that had different needs to my own.
Whether you consider innovation, improvement, or integrating both practices, all should be driven by leadership that creates that organisational culture and facilitates appropriate spread. Fostering this culture from the top down will allow us to enact transformation to support our health and social care systems, and critically, patient needs.
Life Sciences Hub Wales is developing an online resource to support how we can achieve innovation across health and social care.