With a rebel yell, they cried “More, more, more”: A practical model to help the implementation of innovation

I have often thought about Billy Idol as I sat through meetings about transforming services and introducing new ways of working. Alongside the enthusiasm, passion and planning the capacity of busy health services to adopt innovation and identify available support is often overlooked. 

The NHS is poised for innovation, this is supported by the recent Innovation Ecosystem Programme which identified many recommendations including building skills, capabilities, and capacity in the NHS workforce. Despite extensive research, two challenges in implementing new ideas have endured. This blog, the first in our three-part series on supporting the adoption of innovation in complex adaptive health systems, emphasises the need to de-risk the introduction of innovation. We will explore the two enduring challenges faced as staff undertake the implementation of innovation and share an evidence-informed and practical model to mitigate these challenges. 

We understand that innovating whilst under the pressure of delivering patient care carries risk and practitioners need help to reduce that risk. The practical model shared within this blog serves as a useful tool to help deliver services efficiently under pressure. 

The ongoing pressure on staff to innovate stems from genuine factors such as the rising demand for health services, an aging population, and limited funding. Honest and open discussions about individuals’ capacity to innovate, adopt innovation, or indeed organisations to absorb new ways of working are required for every proposed innovation. Even the smallest new device or diagnostic tool can radically change or disrupt an established care pathway. Implementation activity should focus on the innovation’s impact rather than the perceived simplicity of the innovation. Implementation is ‘work in its own right’ and needs as much attention as the innovation itself. 

An interest side point here is whether NHS staff have a professional responsibility to engage with implementation activities to adopt innovation? The third principle of the NHS Constitution states the NHS will aspire to the highest standards of excellence and professionalism through its commitment to innovation and to the promotion, conduct and use of research to improve the current and future health of the population. However, most professional standards do not specifically mention innovation and in the General Medical Council's Good Medical Practice Guide, innovation is briefly mentioned as part of Domain 1 on sharing knowledge as fundamental to good practice, but it is not explicitly present. 

Either way, staff can grant themselves permission to invest time and identify capacity to track and address common evidence-based enablers and barriers to implementation. Amid significant patient care demands, it’s essential to dedicate effort to embrace innovation, preventing a scenario where care quality declines and innovations are not adopted. 

The second enduring challenge for researchers and clinical professionals is making sense of the landscape of available evidence for implementing innovation. At present, there are approximately 100 theories, models and frameworks to support how innovation is implemented into practice. 

Finding, choosing, and using information or tools to inform implementation can be hard. Issues such as limited access to information, insufficient capacity or a lack or readiness to engage with evidence, and a lack of usable guidance hinder the effective use of these tools for implementation – making it hard for a practitioner to pick up and run with an innovation. 

Health Innovation Wessex (HIW) teams have used their extensive innovation adoption experience and expertise to develop a practical model which can be used to support staff in implementing change and innovation into health systems. 

A detailed review of existing theories, models and frameworks was undertaken over 12 months, gathering a wide range of evidence-informed factors that influence adoption to inform the model. We regularly review our model to reflect changes in research evidence and improve its practical value. 

Central to the model is an early and detailed complexity assessment prior to the implementation of the innovation. This crucial phase, if not done well, can account for many reasons why innovation is not adopted, e.g. when adopters are not ready or the value proposition of the innovation is not easily understood. 

Framing is a key part of the process of adoption. If you consider that ‘value’ will mean different things to different people, you will need to adapt the way you tell the story of the innovation. The framing that you give the innovation will enable it to appeal to a broader (or more specific) audience. Remember that the story, value and benefits of the innovation won’t change, but you can choose to highlight certain parts depending on your audience. 

Another key part of the HIW model is about activities crucial for success. After the complexity assessment has been completed and the innovation appropriately framed, a range of plans for implementation, de-implementation, and sustaining the innovation are needed. The HIW guide that supports this model has a wide range of resources for staff facilitating change. These resources also help the reader to understand the research evidence influencing the HIW model. 

To avoid overburdening staff attempting to innovate, and ensure efficient implementation, it's essential to direct efforts effectively, avoiding time-consuming processes. 

In the words of Billy Idol, we need ‘more, more, more’ practical models and tools – that are born from research evidence – to help busy clinical professionals implement innovation quickly and with minimal disruption. 

If implemented efficiently, it can quickly determine whether to commission or decommission an innovation, enhancing the cycle of change and allowing for more innovations to be tested. 

Author: Andrew Sibley, Programme Manager, Health Innovation Wessex: andrew.sibley@hiwessex.net 

Interested in how our model can help your organisation to adopt innovation more efficiently and improve care? For an informal conversation, please contact Health Innovation Wessex at enquiries@hiwessex.net or message us via LinkedIn.