Why won't my innovation spread

@robertvarnam #Expo18NHS@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW
Why won’t my innovation spread?
Practical lessons from 5 years in primary care
• Dr Robert Varnam
Clinical lead, primary care transformation
• Sustainable Improvement Team, NHS England
@robertvarnam
• robert.varnam@nhs.net

@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW

GENERAL PRACTICE
FORWARD VIEW
The problem of innovation spread
Balas, E. A., and S. A. Boren (2000)
…but this is probably an underestimate
for many innovations in healthcare
Westfall, Mold and Lyle (2007)
We can’t wait for ‘diffusion’

GENERAL PRACTICE
FORWARD VIEW
Our journey: general practice innovations
2013 Call to Action on General Practice: what would it take to spread
innovative ways of working?
2014 Prime Minister’s Challenge Fund on GP Access: how to improve
access and care in hard-pressed practices?
2016 10 High Impact Actions: suite of innovations to release time for care
General Practice Forward View: funding, workforce growth, innovation
Adoption support (‘Time for Care’)
Now Time for Care programme engaged with 178 CCGs (91%).

GENERAL PRACTICE
FORWARD VIEW
Common challenges
Innovators Innovations Packaging Spread Adoption

GENERAL PRACTICE
FORWARD VIEW
Common challenges
Whacky … Too brainy …
Too creative … Too hard working
very impressive, but it’s just not
me…

GENERAL PRACTICE
FORWARD VIEW
Common challenges
Relevance (to need / locality)
Fit with existing model
Credibility
Depth of change required
It’s different round here
Everything the NHS has asked of us in the past 20 years
has been more work. We just can’t do anything new.
You simply can’t achieve that much
I’m going to have to do what?!
That’s just not how things work.

GENERAL PRACTICE
FORWARD VIEW
Common challenges
Focus on what was achieved
… less on how
Reliance on single examples
Reliance on written formats
I don’t have time to read all that
People will say anything in a report
Of course, it would work in a place like that
How could I be expected to achieve that?

GENERAL PRACTICE
FORWARD VIEW
Common challenges
‘Diffusion’ is slow and random
Need to reach v large number of people
to achieve nationwide impact
Large number of potential channels
No single authority has universal
credibility
I’ve just discovered our
neighbouring practice solved this
years ago!

GENERAL PRACTICE
FORWARD VIEW
Common challenges
Limited capacity / headroom
Limited capabilities for improvement &
change leadership
Environment often not conducive
Just as we’re about to embed one thing,
the system asks us to do something else.
The hospital has a whole team
who do this kind of thing. I’ve just
got me on a Saturday afternoon.
I come across good sounding ideas all the time,
but it’s impossible to get anything done.

GENERAL PRACTICE
FORWARD VIEW
Common challenges
The ‘Time for Care’ programme
National programme to gather and spread actionable learning
about practical innovations that release staff capacity and
improve patient care, backed up by expert improvement
support to implement change.
www.england.nhs.uk/gpdp

GENERAL PRACTICE
FORWARD VIEW
Common challenges
The ‘Time for Care’ programme
www.england.nhs.uk/gpdp
Spread and adoption of innovation doesn’t “just happen”
Success involves multiple steps, beginning early
It’s active, sometimes technical and often about leadership

Innovations from practices throughout around
England that release time and improve care.
bit.ly/gpcapacityforum
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions

Innovations from practices throughout around
England that release time and improve care.
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
Progress so far…
• 91% of CCGs engaged in implementation support
programme
• Innovations featured in conferences, articles, awards
• Widely ‘appropriated’ and embedded by local / national
organisations
• Included in 2018/19 NHS Planning Guidance refresh

GENERAL PRACTICE
FORWARD VIEW
Features of our approach

GENERAL PRACTICE
FORWARD VIEW
• Systematic focus on ‘humanising’ original innovators
• Face-to-face / video presentationInformation about ‘how’
• Spotlight on ‘first followers’
Where has this been developed? By whom? With what support?

GENERAL PRACTICE
FORWARD VIEW
• Make it easier for people to do what they care about (pressures & values)
• Many are extensions/evolutions to existing models/processes
• Menu of options - something for everyone (different scale / speed / ambition)
• Grounded in established improvement science principles
Why should busy people stop what they’re doing to notice this?

GENERAL PRACTICE
FORWARD VIEW
• “Actionable learning”
• clear framing of why this is beneficial, relevant and achievable
• how benefits were achieved, not just what they were
• anticipate common questions or concerns
• Multiple formats
• short & long videos. Short & long case studies.
• summaries, FAQs, implementation guidance.
People want practical insights not just sales or congratulation

GENERAL PRACTICE
FORWARD VIEW
• Multichannel
• online forum, blogs, articles.
• national & regional conferences, local workshops … >8,000 attendees to date
• link with CPD
• Use of peers more than authorities
• Make it a movement – “we all own this” … spotlight local case studies
• Intimate link between spread and adoption support
People need to know about it AND think it’s credible

GENERAL PRACTICE
FORWARD VIEW
• Some teams will just do it alone
• Expert implementation support from Sustainable Improvement Team
• Funding for staff training and software licenses
• Capability building for improvement leadership
• Alignment of CCG support
Implementation is active, involving skills, tools and leadership … and costing money

GENERAL PRACTICE
FORWARD VIEW
Beyond ‘diffusion’ of innovation
• @robertvarnam
• robert.varnam@nhs.net
Spread and adoption of innovation doesn’t “just happen”
Success involves multiple steps, beginning early
It’s active, sometimes technical and often about leadership
bit.ly/rvbib-innovationprimer www.england.nhs.uk/gpdp

Why won't my innovation spread

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