My report card on innovation in
the NHS
A presentation to the
Derbyshire Innovation Partnership
6th February 2014

Helen B...
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 ...
Types of innovation

• Process innovation
• Service innovation
• Strategy innovation
Source: Kathryn Baker
http://www.au.a...
Process innovations
• Patients booking their own appointments online
• Reinventing the triage process in Emergency Departm...
Kinds of service innovation
Integration
Simplification

Substitution

Segmentation
Parker H Making the shift: a review of ...
Substitution: providing higher value, lower cost care for
patients/service users through
• location substitution: substitu...
Service innovations
• Delivery specialist services in the home e.g. Intravenous
chemotherapy, care for heart failure, pare...
Strategy innovation
“the question today is not whether you can
reengineer your processes; the question is
whether you can ...
Strategic innovations
• Shifting power: patients, carers, families and communities as
co-creators and producers of health
...
Discussion
• Which kinds of innovation are most important
to deliver the improvements we seek for
patients and the public ...
Type of
innovation

Process

Service

Strategy
@HelenBevan

Potential
Current
contribution to prevalence in
transformation...
Type of
innovation

Risk of nondelivery

Process

Current
prevalence in
delivery of
transformational innovation
change
Low...
My report card
• Increasingly an ambition for strategic innovation
but reality of innovation practice mostly at
process in...
How to align the different levels of
innovation
1. Seek to match our level of ambition for change with
the methods and min...
Matching our mindset/innovations to our level
of ambition
Ambitions for change

1st order

2nd order

2nd order

Mindset/I...
Matching our mindset/innovations to our level
of ambition
Ambitions for change

1st order

2nd order

Planned incremental
...
Matching our mindset/innovations to our level
of ambition
Ambitions for change

1st order

2nd order

Underachievement
of ...
Matching our mindset/innovations to our level
of ambition
Ambitions for change

1st order
2nd order

Mindset/Innovations f...
@HelenBevan

Source : Kaiser Permanente Innovation Consultancy
Source: @NHSChangeDay

@HelenBevan
Source: @NHSChangeDay

@HelenBevan
is the new normal!

“By questioning existing ideas, by
opening new fields for action, change
agents actually help organisa...
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My report card on innovation in the NHS - Helen Bevan

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“My report card on innovation in the NHS”: this is a presentation that Helen Bevan of NHS Improving Quality made to members of the Derbyshire Innovation Partnership at their launch meeting on 6th February 2014.

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My report card on innovation in the NHS - Helen Bevan

  1. 1. My report card on innovation in the NHS A presentation to the Derbyshire Innovation Partnership 6th February 2014 Helen Bevan @HelenBevan
  2. 2. Definition of innovation “Doing things differently and doing different things” Source: NHS Institute @HelenBevan
  3. 3. 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
  4. 4. Types of innovation • Process innovation • Service innovation • Strategy innovation Source: Kathryn Baker http://www.au.af.mil/au/awc/awcgate/doe/benchmark/ch14.pdf @HelenBevan Source of image: Allywatch.com
  5. 5. 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 recovery Source: Sheffield Service Improvement Team @HelenBevan
  6. 6. Kinds of service innovation Integration Simplification Substitution Segmentation 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-socialsciences/social-policy/HSMC/publications/2006/Making-the-Shift.pdf @HelenBevan
  7. 7. 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
  8. 8. 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
  9. 9. 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 @HelenBevan Source of image: Inovationmanagement.se
  10. 10. 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
  11. 11. 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
  12. 12. Type of innovation Process Service Strategy @HelenBevan Potential Current contribution to prevalence in transformational delivery of change innovation Risk of nondelivery
  13. 13. Type of innovation Risk of nondelivery Process Current prevalence in delivery of transformational innovation change Lowest High Service Higher Lower Higher Strategy Highest Lowest Highest @HelenBevan Potential contribution to Lowest
  14. 14. 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 @HelenBevan Source of image: talentmagnet.com
  15. 15. 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 practice 3. Build shared purpose for strategy innovation on a big scale 4. Always review and celebrate all attempts at innovating to make a difference, whatever the level of innovation @HelenBevan
  16. 16. Matching our mindset/innovations to our level of ambition Ambitions for change 1st order 2nd order 2nd order Mindset/Innovations for change 1st order @HelenBevan Source: adapted by Helen Bevan from Brooks and Bate (1994)
  17. 17. Matching our mindset/innovations to our level of ambition Ambitions for change 1st order 2nd order Planned incremental (small scale change) 2nd order Mindset/Innovations for change 1st order @HelenBevan Source: adapted by Helen Bevan from Brooks and Bate (1994)
  18. 18. Matching our mindset/innovations to our level of ambition Ambitions for change 1st order 2nd order Underachievement of goals for large scale change 2nd order Mindset/Innovations for change 1st order @HelenBevan Source: adapted by Helen Bevan from Brooks and Bate (1994)
  19. 19. Matching our mindset/innovations to our level of ambition Ambitions for change 1st order 2nd order Mindset/Innovations for change 1st order @HelenBevan 2nd order 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 Source: adapted by Helen Bevan from Brooks and Bate (1994)
  20. 20. @HelenBevan Source : Kaiser Permanente Innovation Consultancy
  21. 21. Source: @NHSChangeDay @HelenBevan
  22. 22. Source: @NHSChangeDay @HelenBevan
  23. 23. 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 Schillinger @HelenBevan Image by neilperkin.typepad.com
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