1. Challenges Facing Innovation Researchers in Public
Sector Services: Consumption, Production, and
Measurement.
… A Postcard from the UK
Paul Windrum
Keynote Presentation
RESER Conference
11th
September 2015
Copenhagen
2. Issues and Challenges
Consumption & Production
Invention and first application
What is the role of citizens/consumers in innovation?
What are the implications of user-led and social
innovation for established understandings of services
innovation, e.g. ‘co-production’?
New avenues of research:
Service Design
Expertise and the scope of citizens’ involvement
3. Issues and Challenges
Consumption & Production
Diffusion
•Why do so few service innovations diffuse?
•Are these more context specific (compared to
manufactured goods)?
•How are we to bridge research on local
implementation with our traditional models of
diffusion?
•What is the role of organisations (public-private-third
sector innovation networks) for diffusion?
•What is the role of standards for diffusion?
•Role of professions in driving / inhibiting diffusion?
4. Issues and Challenges
Measurement
The measurement of the ‘how’ (process) as well as the
‘by how much’ (impact) of service innovations?
What kind of process changes are important for
implementation? How do we measure these?
Are we reaching the limitations of CIS applications,
particularly for public sector / NGO(social) innovation?
How do we develop metrics on implementation?
7. Organising the Discussion
1.Use the Windrum and García-Goñi (2008) framework
to organise my thoughts…
2.Refer to practical examples in ongoing / recent
research by myself and by colleagues at the Centre for
Health Innovation, Leadership & Learning (CHILL) at
Nottingham University, and international research
projects on health innovations.
8. Consumption and Production
Increasingly moving way from a definition of services
as being consumed at the point of use, to a definition
in which consumption and production are tied.
•User-led innovation (von Hippel)
•Social innovation
Examples:
•German teams organising camps for Syrian refugees
ask refugees for ideas on how to improve conditions.
•Community micro-financing
•Von Hippel’s discussion of open source software
development
10. Consumption and Production
Implications of user-led innovation hypothesis for
existing concepts within the services innovation
literature?
Let us consider the co-production concept.
13. Consumption and Production
Co-production
Fuch’s examples:
•Self-service in retailing.
•Health care - Competences of patients with respect to
describing symptoms directly affect the doctor’s ability
to arrive at the correct diagnosis and, hence, the correct
prescription.
14. Case Study
Piggly Wiggly: First Self-Serve
Grocery
Piggly Wiggly opened 6th
September
1916 at 79 Jefferson Avenue, Memphis.
Clarence Saunders’ innovations to
improve efficiency and cost/price:
• shopping baskets for self-service
• checkout stand
• price marking every item in the shop
http://www.pigglywiggly.com/about-us
15. Several clerks were replaced by one, (self) service
was quicker, and prices lower.
Took advantage of the increase in branded tinned
goods.
Also incorporated early advances in business
machines to automate and replace labour – e.g.
cash tills.
16.
17.
18.
19.
20.
21.
22. Consumption and Production
Notice here how the activity of the customer is
carefully designed by the producer:
•How the customer moves around the store
•How they interact with the items (stacked shelves)
•How they interact in new ways with staff (at check-out
point)
•How the staff worker interacts with the customer – via
a cash till, standing at a check-out.
23. Consumption and Production
Public sector organisations have also been applying the
same principles applied with equally remarkable effect.
Through websites (an enabler), the customer-producer
relationship is being redesigned:
24. Consumption and Production
•Electronic prescriptions.
Patients use on-line systems for repeat prescriptions.
Cuts out admin work of receptionists, and paper costs.
Also opportunity to shift the workload of
checking/monitoring from GPs to pharmacists.
25. Consumption and Production
•Patients self-booking appointment systems
Dramatically reduced admin work.
Lowers ‘DNA’ (non-attendance) rates, which are a
large inefficiency.
29. Consumption and Production
Services Design
A new avenue of research for service scholars.
Services design as the services equivalent to R&D
engineering in manufacturing?
Paul Stoneman’s discussion of ‘design services’ sector
[2010 book ‘Soft Innovation. Economics, Product
Aesthetics, and The Creative Industries’].
Also some work by Bruce Tether on architecture.
30. Consumption and Production
Research agenda – to build a bridge to recent work by
design scholars (specialist sub-discipline).
Highlights the role of the designer as
•a technology interpreter and practical translator of
users’ needs – they create new, unmet needs
[B. Lawson, 2006. How Designers Think: The Design Process
Demystified]
•integrating design, engineering and marketing
functions in the new product development process
[H. Perks et al. 2005. Journal of Product Innovation Management]
31. Consumption and Production
More recently,
•Design as a driver for innovation
[R. Verganti, 2009. Design Driven Innovation: Changing The Rules
of Competition By Radically Innovating What Things Mean]
•‘Design thinking’ as a means of structuring strategic
product development – holistic ‘integrator’
[T. Brown, 2008. Harvard Business Review]
34. Consumption and Production
Redesigning hospitals
•Work sponsored by the UK design council in 2000.
•New UK guidelines: a minimum distance of 2.7m
between the centres of adjacent beds and 3.7m2 of clear
space around each bed, excluding space for storage,
hand hygiene and worktops.
[Scottish Health Facilities Note 30. Infection control in the built environment:
design and planning. NHS Scotland, January 2002.]
[Ward layouts with single rooms and space for flexibility. NHS Estates,
February 2005.]
36. Consumption and Production
Redesigning hospitals
•To improve flow of people and ‘paper’ around the
hospital.
Space and circulation modelling of patients, and staff to
staff interaction.
•In A&E, key points are corridors and entrances.
Redesigning these improves the flow around the rest of
the building.
37. Consumption and Production
Ergonomics
Ergonomics is a specialist knowledge field in design.
•Ways in which a physical artefact interacts with the
human body, and with the environment in which the
artefact/human is expected to move and operate.
•‘Design for effective use’, explicitly takes account of
the user's physical and psychological capabilities and
limitations.
•Of particular importance here are the size, shape,
weight and configuration of the artefact, and how
appropriate these are for the task.
38. Consumption and Production
Ergonomics
In medicine the specialist area = occupational therapist
e.g. They do assessment of your house following an
operation that affects your mobility
They do the evaluation of how you operate your
computer, your desk and chair etc.
39. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
Prompted by Maureen McKelvey’s observation.
‘Everyone talks today about patient involvement in
health innovations. But when we actually look at the
innovations, the patient disappears’.
40. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
Traditional versus Patient-centred medicine.
Traditional, biomedical relationship - the professional
is the expert and takes a leading position in the
conversation. Uses closed-ended questions and gives
directives at end of consultation.
Patient is expected to ‘comply’ with directions given.
41. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
Traditional versus Patient-centred medicine.
Patient is placed at the centre of the patient-centred
approach and the patient-doctor interaction.
This presupposes patients’ experiences and
understanding.
43. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
So why does the ‘patient disappear’ in the invention of
new health services?
Even in the development of patient-centred health
services?
Example: type 2 diabetes education programmes.
The first tested programme was the ‘Düsseldorf
model’, developed by German diabetologists.
44. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
Useful to build a bridge with recent work on expertise
in science and medicine.
Today, I’ll consider the work of Harry Collins…
45. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
Simplified Table of Expertises
(Collins & Evans 2005 Rethinking Expertise)
1. UBIQUITOUS EXPERTISES: Acquired through growing up in society.
e.g. Natural language, social skills (interaction),
reading & writing, knowing where to find information
2. DEGREE OF
SPECIALISM
UBIQUITOUS TACIT
KNOLWEDGE
SPECIALIST TACIT
KNOLWEDGE
Beer-mat
knowledge
Popular
Understanding
Primary
source
knowledge
Interactional
Expertise
Contributory
Expertise
46. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
So let’s address Maureen’s observation….
Where can we expect patients to be on Collins’ ‘Table
of Expertises’?
47. Consumption and Production
Health care was one of Fuch’s co-production examples:
‘Competences of patients with respect to describing
symptoms directly affect the doctor’s ability to arrive at
the correct diagnosis and, hence, the correct
prescription.’
49. Consumption and Production
Jane Hayes & Martin Scurr (2015) Doctors Dissected
“Stomach ache and headache are amongst the most
frequently presented conditions and with headaches I
usually decide in the first 30 seconds if it is a headache
that requires further investigation… The patient
inevitably will think they might have a brain tumour, so
taking a history and an examination is reassuring,
although only one percent of brain tumours present
with a headache”.
51. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
•Over time, they will develop ‘experience expertise’ in
‘living with the condition – perhaps develop primary
source knowledge.
1. UBIQUITOUS EXPERTISES: Acquired through growing up in society.
e.g. Natural language, social skills (interaction),
reading & writing, knowing where to find information
2. DEGREE OF
SPECIALISM
UBIQUITOUS TACIT
KNOLWEDGE
SPECIALIST TACIT
KNOLWEDGE
Beer-mat
knowledge
Popular
Understanding
Primary
source
knowledge
Interactional
Expertise
Contributory
Expertise
52. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
•But, very unlikely to acquire specialist medial
training, to access specialist networks of diabeticians
etc.
1. UBIQUITOUS EXPERTISES: Acquired through growing up in society.
e.g. Natural language, social skills (interaction),
reading & writing, knowing where to find information
2. DEGREE OF
SPECIALISM
UBIQUITOUS TACIT
KNOLWEDGE
SPECIALIST TACIT
KNOLWEDGE
Beer-mat
knowledge
Popular
Understanding
Primary
source
knowledge
Interactional
Expertise
Contributory
Expertise?
54. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
•Representative Organisations
These third sector - voluntary, community and social
enterprise (VCSE) organisations have
•the ‘interactional expertise’
•funds to commission
•political and other network connections to influence
health policy and regulation
[Windrum (2014) Third sector organizations and the co-production of health
innovations’, Management Decision].
55. Innovation Country Category Third Sector Central Role
Diabetes Education UK Intangible service Yes Yes
Capacity Planning UK Organizational
/Process
No
Health school for illness prevention Denmark Intangible service No
Public-private network for elderly care
innovations
Denmark Network Yes Yes
IT risk adjustment software tool Spain Technology
mediated service
No
Social network site for health professionals Spain Network Yes Yes
Handheld defibrillators Austria Network &
Technology
mediated service
Yes Yes
Virtual reality rehabilitation therapies France Technology
mediated service
No
Supersonic imaging France Technology
mediated service
No
Public-private partnership for research France Organizational
/Process
No
57. Consumption and Production
Expertise & Citizens’ Involvement in
Invention
Can Representative Organisations be used to
organise citizen/patient inputs?
NHS Hartlepool and Stockton-on-Tees CCG – using
third sector providers to ‘recruit’ patients who then
assist in new service co-design.
58. Diffusion
•Why do so few social innovations in public sector fail
to diffuse?
[Note: de Jong and von Hippel’s paper in current RP: ‘Market
failure in the diffusion of consumer-developed innovations:
Patterns in Finland’]
59. Diffusion
Sir David Cooksey. A review of UK health research
funding. HM Treasury report 2006.
Identifies two gaps in research pathways that affect
translation of biomedical science to healthcare:
1.Translation of basic and clinical research into ideas
and products
2.Implementation into clinical practice - innovations,
evidence-based interventions & new ways of working
often struggle to make an impact on frontline practice
60. Diffusion
Theory problem
Our (contagion) diffusion models assume that diffusion
occurs through individual interaction
•spill-over effects due to use (Stoneman)
•information (Bas)
•social structure (Rogers).
61. Diffusion
Theory problem
We know from many studies in hospitals, that evidence
base is not a sufficient condition for implementation.
So what are the key factors affecting implementation?
Lars Fuglsang’s (2010) paper has a nice way of
framing this question – ‘ad hoc adjustment’.
“adjusting the protocol to unforeseen events” and
“creating structures by means of events”
[Also Gallouj & Weinstein 1997; Toivonen, Touminen & Brax 2007]
62. Diffusion
Role of Medical Professions
‘Occupational professionalism’ is an alternative, to
both the market and to public bureaucracy, for the
organisation of work and the delivery of services
(McClelland, 1990; Evetts, 2006).
63. Diffusion
Role of Medical Professions
Emphasis is on autonomy and the self-regulation of
work by the profession, with professionals best placed
to act in the best interests of their clients.
Emphasis is on autonomy and the self-regulation of
work by the profession, with professionals best placed
to act in the best interests of their clients.
64. Diffusion
Role of Medical Professions
Professional values emphasise a shared identity based
on competencies (produced by education, training and
apprenticeship socialisation) and legal responsibility
(sometimes guaranteed by licensing).
65. Diffusion
Co-creation of Social Innovations and New
Professional Institutions: Diffusion of Patient-
Centred Diabetes Education in Austria
With Doris Schartinger & Justin Waring
The diffusion of this radical social innovation depends
on the co-creation of a new professional institution that
can challenge the established institution supporting the
‘traditional’ health model.
66. Diffusion
Co-creation of Social Innovations and New
Professional Institutions: Diffusion of Patient-
Centred Diabetes Education in Austria
With Doris Schartinger & Justin Waring
Everyday institutional work of patient-centred
diabetologists and nurses, e.g. training and governance,
create and sustain the norms and belief systems of the
new institution while simultaneously attacking
mechanisms of compliance to established institution.
67. Diffusion
Co-creation of Social Innovations and New
Professional Institutions: Diffusion of Patient-
Centred Diabetes Education in Austria
With Doris Schartinger & Justin Waring
A set of supporting organisations - FQSD-Ö and the
VÖD – needed to be created because the main
organisation (FDÖ,) was dominated by traditionalists.
68. Diffusion
Geography
Geographical distance, and the heterogeneous context
in which different parts of the same organisation
resides.
Local differences include patient conditions (urban vs.
countryside) (ethnic mix), socio-economic factors, and
ease of access to services.
69. Diffusion
The Exploitation of Space and Place by Local
Professionals: Reconfiguring Systemic Innovation in
Primary Health Care
with Stephen Timmons, Kirsi Hyytinen, Hannamaija Maatta,
Marja Toivonen,
‘Chronic Care Model’ (CCM) implementation in a
middle-sized city region in Finland.
70. Diffusion
The Exploitation of Space and Place by Local
Professionals: Reconfiguring Systemic Innovation in
Primary Health Care
with Stephen Timmons, Kirsi Hyytinen, Hannamaija Maatta,
Marja Toivonen,
What started out as a centralised, top-down
implementation shifted towards more differentiated
health service provision, with the localised expertise of
practitioners in organising and coordinating particular
responses to these localised needs.
71. Diffusion
Role of Standards
Evaluation research on the PM Challenge Fund for
Improved Access in Primary Care has highlighted
the importance of standards in the NHS.
These are important in ‘acting at a distance’ on the
everyday protocols used by medical practitioners.
73. Diffusion
Role of Standards
When combined with financial incentives, they are
particularly powerful.
The actors who work with policy makers to set
standards have a particularly powerful influence.
75. Louise Earl’s (2002) study of public and private orgs.
Based on Canadian 2000 Survey of Electronic
Commerce (550,903 private, 819 public sector orgs)
85% of public sector orgs had introduced significantly
improved technologies
Compared to 44% of private sector orgs.
80% of public sector orgs had undertaken significantly
improved organisations structures or management.
Compared to 38% of private orgs.
76. Antony Arundel and Hugo Hollander’s 2010 EU
Innobarometer survey of public sector innovation.
•Two-thirds of EU public administration institutions
introduced a new or significantly improved service in
the last 3 years.
•Likelihood of service innovation increased linearly
with the size of the institutions.
•17% are leading innovators(introducing one or more
service-related innovation ahead of other organisations
in the public sector).
•Leading innovators were typically large and national or
central organisations.
77. Past Research Indicates…
•Need to target surveys at appropriate managerial
level
•Issues around the definition of innovation
Same issues arise in surveys of private sector orgs (e.g. CIS) –
see Arundel and Huber (2013).
78. Past Research Indicates…
•Need to target surveys at appropriate managerial
level
•Issues around the definition of innovation
Same issues arise in surveys of private sector orgs (e.g. CIS) –
see Arundel and Huber (2013).
Q: Are we reaching the limit of what CIS can achieve?
79. Measuring Implementation: PMCF
There is evidence of new models of care and service delivery
being introduced without the required structures for testing,
monitoring, reporting or evaluation at a national level.
Over simplification and limited analysis of patients’ needs and
behaviour, which consequences for the appropriate allocation of
NHS resources.
Limited local evaluation capabilities within CCGs. This reduces
opportunities to assess the merits and relative performance of
different initiatives.
