Guest editorial Thursday 18 June 2009: Mike Farrar on innovation

As the first Healthcare Innovation Expo opens today, this guest editorial from Mike Farrar, chief executive of NHS North West strategic health authority, discussest the importance of innovation.

The definition and the delivery of good healthcare are dynamic: they don’t stand still. What this means for the NHS is that innovation really matters - as Lord Darzi’s next-stage review and the duty to innovate in the NHS Constitution confirm.

In the context of a financial slowdown, as extensively discussed at last week’s NHS Confederation conference, the value of innovation becomes even greater.

Good at doing; bad at spreading?
It is suggested that the NHS tends to be good at innovation, but less good spreading innovation. One reason for this might be the NHS’s own structure – a national collection of hundreds of organisations, each with its own board. It might not be what you’d design as an innovation-spreading infrastructure.

Nor should we pretend that other big organisations necessarily find spreading innovation easy.

Both the NHS and the UK’s medical industry have good track records of innovation, in the biomedical field and in device development. Various award schemes highlight this on an annual basis.

Effectively spreading innovations: structure and context
Spreading innovation is crucial to making it effective. One aspect of spreading innovation effectively is about structure; another is about context.

In NHS North West, our work on clinical quality and outcomes has had impact because we’ve been able to get every trust in the region doing it. So the structural role of a third party organisation – in this example, the SHA - can be important to spread of innovation.

Leaders need to promote a culture that understands the value of innovation, and where ‘not invented here’ isn’t an acceptable reason for failing to try things.

At a local level, this could be about a trust’s management being facilitative: identifying their creative and innovative people; understanding and quickly latching on to their innovations; and creating the conditions and incentives to support the adoption.

The importance of scale
‘Scaling’ and ‘industrialising’ innovation are important. As the NHS is shifting the balance of power from the central to the local, we have to get the right balance of central and local involvement.

A degree of central influence is needed to pick up, invest in and advance the cause of a good new idea. We can’t assume that a more localised NHS will inevitably be more innovative – we might get more new ideas and inventions, but struggle with spreading them.

Sometimes, context is crucial to spreading an innovation. When Kettering developed the ‘See And Treat’ approach to A&E triage (where unlike traditional triage, the most senior A&E clinician sees patients as the first filter), it was effective innovation because the most experienced staff knew what treatment was needed; could take decisions; and allocated the work very effectively. But the context of the 4-hour maximum A&E waiting time target made every trust want to know about how to do A&E more efficiently.

So ‘See And Treat’ spread quickly.

Creative approaches
A creative approach towards innovation could pay dividends. One approach could be to use the new national innovation funds to pay people bursaries, incentives or subsidies towards implementation costs to take up best practice.

Another option might be to use the money as match funding for venture capitalists – who have lots of experience on how to take good ideas and get them into rapid uptake, so that the NHS benefits.

The Harvard academic Clayton Christensen’s work on disruptive innovation suggests that it can be hard for organisations with already-successful business models had to make the business case to innovate. Christensen cites the big US motor manufacturers (Ford, Chrysler and GM), whose business models made high profits on gas-guzzling cars. Oil price rises and environmental concerns moved market share to companies who made smaller, cheaper, less gas-guzzling cars, such as Toyota.

If a traditional business model locks an organisation into a way of producing and working, then perhaps big acute trusts will look to the third sector, or to semi-independent directorates or teams who are not locked into the overall acute business model of seeking income to cover the fixed costs.

The NHS is currently considering what PCTs will do with their community services. If the chosen solution is to create (at arms’ length) something that looks and works like an NHS trust, that locks them into the traditional business model, and an opportunity to innovate could be lost.

Other options include allowing more vertical integration of NHS organisations – perhaps led by primary care or by the third sector lead.