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NHS England and NHS Improvement
Leading the Spread and Adoption of
Innovation and Improvement:
A Practical Guide
Diane Ketley
30 November 2021
Please introduce yourself in the chat box
Say:
• Who you are
• Where you are today
Any questions?
Add to chat box, will be answered today or in a follow up blog
Recording and slides will be available
Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide
Chat Flurry
What are you curious
to learn about
today?
Image Pixabay
The Horizons team
https://horizonsnhs.com/
Horizons Colleagues Today
Rupal Johal
Laura Yearsley
Ani Majothi
What Does Spread And Adoption Mean To You?
Spread – replicating an
innovation or improvement
across multiple locations.
In practice the terms spread and
scaling blur together, and are
often used interchangeably
Adoption – to put something new
into practice that has been used
elsewhere
See Glossary in the Guide
Chat Flurry
What are you curious
to learn about
today?
Image Pixabay
https://www.england.nhs.uk
/spread-and-adoption/
How to Use The Guide
The Guide
What is it?
A set of NHS England and Improvement webpages offering practical guidance,
resources and knowledge synthesis on how to enable the spread and adoption of
innovation and improvement.
6 sections - Mindset, 7 principles, systems convening, tools and support, case studies,
resources
Who for?
Aimed at system leaders, local to national, in all health and care sectors particularly
leaders of large-scale change and those with responsibility and interest in increasing
the adoption of innovation in practice
When?
Published September 2021
Why?
The Reality of Spread and Adoption
“Isolated islands of
improvement effect”
(lack of spread and
adoption)
Developing the Guide
Acknowledge a new
mindset is needed
Build on experience,
knowledge, publications
View through lenses
of complexity science
+ social science
+ implementation
science
https://www.bmj.com/content/3
65/bmj.l2068.full
Tested and developed with staff
Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide
Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide
15 |
15 |
7 Interconnected Principles For Spread and
Adoption
16 |
SPREAD
and
ADOPTION
The
Individual
Adopter
Focus
Networks
Benefit
Complexity
Learning
Leadership
7 Interconnected Principles For Spread and Adoption
Spread and adoption in health
and care is a complex activity
An enabling leadership
style is needed
The perspective of the
individual is pivotal
Focus on the
benefit rather than
innovation
Support adopters
to have a sense of
agency and feel
energised
Build communities,
energising and
connecting
individuals
Develop a habit of
learning, sharing and
seeking knowledge
7 interconnected principles
Complexity
Spread in health and care is a complex activity occurring
across a system
• Complexity around innovation, the process of spread, the
context of spread
• Health and care is a complex adaptive system
• Match complexity of the approach to spread with
complexity of the situation
Complexity
Source: Adapted from Glouberman, S., and Zimmerman, B.
(2002)
19 |
“Complexity thinking adds a real-world, multi-
dimensional appreciation of the system…but it
does not make it easier to effect change; in fact
the opposite is true.
Even though this makes our ambitions to
improve healthcare infuriatingly more difficult,
we must grapple with the world we actually
inhabit, not the one we wish we did”
Braithwaite, Churruca, Long et al BMC Medicine 2018
We Need To Choose Complexity
What Do We Need To Focus On To Embrace Complexity?
An enabling leadership style is needed
• Enable interactions between key people that transform
relationships leading to collective action
• Know when and where to bring people together [in an adaptive
space] to maximise connections across the system
• Create the environment for innovation development and spread
including by utilising peer leadership
• Build and enable continued support from key stakeholders
• Use knowledge of spread and change to strategically coordinate
innovation spread across the system
7 interconnected principles
Leadership
An enabling leadership style requires a mindset
shift such that
“my role is to think about how I can facilitate and
enable adaptation, emergence and change,
rather than directing people what to do”
Prof Mary Uhl-Bien
The perspective of the individual is pivotal
• Changing behaviours is hard, the more work routines affected,
the greater the spread and adoption challenge
• Consider the impact of the innovation on the individual
• Understand how to influence behaviour change and the
importance of motivation, engagement and providing a
supportive, safe setting
7 interconnected principles
The Individual
Focus on the benefit to the system rather than the innovation
• Focus on the ‘why’ rather than the ‘what’
• Take a system needs focus [to create a Pull] rather than an
innovation focus [the usual Push]
• Needs to significantly address a local strategic, agreed priority
• Each context is unique as is the benefit it may create and what
is needed for the innovation to be adopted, adapted and
routinely used in that setting
7 interconnected principles
Benefit
Benefit depends on your perspective
Image: Leigh Kendall, NHS Horizons
Increase focus on role of adopters to energise and spread
through commitment and agency
• How an innovation is developed influences spread and adoption,
early involvement increases commitment and ownership
• Maximise engagement and ownership to energise the adopter
community and spread via commitment [Pull] harnessing
individual and collective agency not via compliance [Push]
• Adaptation of complex innovation will be needed
7 interconnected principles
Adopter Focus
Networks build communities, energising and connecting individuals
• Spread and adoption depends on relationships so connectivity is
important
• Networks enable connections and relationship development ,
increasing communication, collaboration and the flow of
knowledge
• A broad range of networks and communities of practice exist all of
which can offer different opportunities
• Networks are important in the generation of and in the acceptance,
adoption and adaptation of the innovation in practice
7 interconnected principles
Networks
Build a learning system and habit of learning, sharing with and seeking
knowledge from others
• Developing a culture of continual learning means sharing, seeking
and using knowledge from experience and publications
• Seek learning – from own adaptation and adoption or from others’
experience
• Reflect on insights – what learning means for own practice and /or
for others’ practice
• Share learning – within your context and wider
7 interconnected principles
Learning
Remember…….. Sustainability
The challenge is not starting,
but continuing after the initial
enthusiasm has gone
Ovretveit (2003)
Spread and sustainability are
directly linked
Themes and Key Questions So Far
Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide
32 |
‘An enabling leadership activity working on sustainable change, across
challenging silos, in complex social landscapes, amid changing circumstances’
What is Systems Convening?
Handbook https://wenger-trayner.com/systems-convening/.
• Designs a plan
• Accountability within a
governance system
• Ensures that delivery
milestones are met
• Deals with risk and
ensures that barriers
are overcome
• Works with emergence
• Builds commitment to a
collective goal
• Builds relationships
• Seeks win/wins
• Makes sense of things for
adopters: the why?
• Enables spread across a
whole system
Interdependent
Complex
Independent
Complicated
PROGRAMME
MANAGEMENT
SYSTEMS
CONVENING
Working With Complexity Needs an Enabling
Leadership Style
Complex changes
require both
approaches to
work together
each bringing
valuable,
complementary
contributions to
enable spread
and adoption
Activities
not roles
34 |
Systems Convening is an Enabling Activity
• Matches approach to spread and adoption with
complexity of the situation
• Applies the 7 principles in practice to develop a bespoke
approach reflecting the specific context.
• Provides enabling activities delivered by a team or a
number of people
• Applicable to all levels of the system, with
interdependence between the levels
• Is a third complementary role, working alongside
innovators and adopters
• Systems convening is an emerging, and not until recently
well described, activity already in use in healthcare
Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide
A winning partnership: System Convening with Programme Management improves
patient experience
‘That’s what I do’: voluntary partnerships, complexity and an activity named system
convening’
A winning combination: programme management with system convening to develop
and spread the BASIC STEP tool in North West Ambulance Service (NWAS)
Spread, adoption and systems convening: the Welsh Ambulance Service Trust (WAST)
falls framework
Planning for spread and adoption from the start, the seven principles and system
convening in the successful Continuing Healthcare Improvement Collaborative
Spread and Adoption Case Studies
Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide
Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide
Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide
Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide
Further Themes and Key Questions
Ask and Offer
Ask
What in the Guide do you really like?
What else would you like included in the Guide?
What do you need to help you apply this Guide to your work?
Offer
Chance to win a session to help you apply this Guide to your work.
Send email to diane.ketley@nhs.net by 3/12/21
State how you have, or plan to, use this Guide to increase the spread and adoption of innovation
and improvement.
Random draw and announcement w/c 6/12/21
Please type your answers in the chat box
• Guide at https://www.england.nhs.uk/spread-and-adoption/
• Horizons blogs, videos http://horizonsnhs.com/programmes-
of-work/spread-and-innovation/ incl. recording and slides from
this webinar
• Follow #NHSSpread, @DianeKetley
• Contact diane.ketley@nhs.net
Want to learn more?
#nhsspread

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Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide

  • 1. NHS England and NHS Improvement Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide Diane Ketley 30 November 2021
  • 2. Please introduce yourself in the chat box Say: • Who you are • Where you are today Any questions? Add to chat box, will be answered today or in a follow up blog Recording and slides will be available Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide
  • 3. Chat Flurry What are you curious to learn about today? Image Pixabay
  • 5. Horizons Colleagues Today Rupal Johal Laura Yearsley Ani Majothi
  • 6. What Does Spread And Adoption Mean To You? Spread – replicating an innovation or improvement across multiple locations. In practice the terms spread and scaling blur together, and are often used interchangeably Adoption – to put something new into practice that has been used elsewhere See Glossary in the Guide
  • 7. Chat Flurry What are you curious to learn about today? Image Pixabay
  • 9. How to Use The Guide
  • 10. The Guide What is it? A set of NHS England and Improvement webpages offering practical guidance, resources and knowledge synthesis on how to enable the spread and adoption of innovation and improvement. 6 sections - Mindset, 7 principles, systems convening, tools and support, case studies, resources Who for? Aimed at system leaders, local to national, in all health and care sectors particularly leaders of large-scale change and those with responsibility and interest in increasing the adoption of innovation in practice When? Published September 2021 Why?
  • 11. The Reality of Spread and Adoption “Isolated islands of improvement effect” (lack of spread and adoption)
  • 12. Developing the Guide Acknowledge a new mindset is needed Build on experience, knowledge, publications View through lenses of complexity science + social science + implementation science https://www.bmj.com/content/3 65/bmj.l2068.full Tested and developed with staff
  • 15. 15 | 15 | 7 Interconnected Principles For Spread and Adoption
  • 16. 16 | SPREAD and ADOPTION The Individual Adopter Focus Networks Benefit Complexity Learning Leadership 7 Interconnected Principles For Spread and Adoption Spread and adoption in health and care is a complex activity An enabling leadership style is needed The perspective of the individual is pivotal Focus on the benefit rather than innovation Support adopters to have a sense of agency and feel energised Build communities, energising and connecting individuals Develop a habit of learning, sharing and seeking knowledge
  • 17. 7 interconnected principles Complexity Spread in health and care is a complex activity occurring across a system • Complexity around innovation, the process of spread, the context of spread • Health and care is a complex adaptive system • Match complexity of the approach to spread with complexity of the situation
  • 18. Complexity Source: Adapted from Glouberman, S., and Zimmerman, B. (2002)
  • 19. 19 | “Complexity thinking adds a real-world, multi- dimensional appreciation of the system…but it does not make it easier to effect change; in fact the opposite is true. Even though this makes our ambitions to improve healthcare infuriatingly more difficult, we must grapple with the world we actually inhabit, not the one we wish we did” Braithwaite, Churruca, Long et al BMC Medicine 2018 We Need To Choose Complexity
  • 20. What Do We Need To Focus On To Embrace Complexity?
  • 21. An enabling leadership style is needed • Enable interactions between key people that transform relationships leading to collective action • Know when and where to bring people together [in an adaptive space] to maximise connections across the system • Create the environment for innovation development and spread including by utilising peer leadership • Build and enable continued support from key stakeholders • Use knowledge of spread and change to strategically coordinate innovation spread across the system 7 interconnected principles Leadership
  • 22. An enabling leadership style requires a mindset shift such that “my role is to think about how I can facilitate and enable adaptation, emergence and change, rather than directing people what to do” Prof Mary Uhl-Bien
  • 23. The perspective of the individual is pivotal • Changing behaviours is hard, the more work routines affected, the greater the spread and adoption challenge • Consider the impact of the innovation on the individual • Understand how to influence behaviour change and the importance of motivation, engagement and providing a supportive, safe setting 7 interconnected principles The Individual
  • 24. Focus on the benefit to the system rather than the innovation • Focus on the ‘why’ rather than the ‘what’ • Take a system needs focus [to create a Pull] rather than an innovation focus [the usual Push] • Needs to significantly address a local strategic, agreed priority • Each context is unique as is the benefit it may create and what is needed for the innovation to be adopted, adapted and routinely used in that setting 7 interconnected principles Benefit
  • 25. Benefit depends on your perspective Image: Leigh Kendall, NHS Horizons
  • 26. Increase focus on role of adopters to energise and spread through commitment and agency • How an innovation is developed influences spread and adoption, early involvement increases commitment and ownership • Maximise engagement and ownership to energise the adopter community and spread via commitment [Pull] harnessing individual and collective agency not via compliance [Push] • Adaptation of complex innovation will be needed 7 interconnected principles Adopter Focus
  • 27. Networks build communities, energising and connecting individuals • Spread and adoption depends on relationships so connectivity is important • Networks enable connections and relationship development , increasing communication, collaboration and the flow of knowledge • A broad range of networks and communities of practice exist all of which can offer different opportunities • Networks are important in the generation of and in the acceptance, adoption and adaptation of the innovation in practice 7 interconnected principles Networks
  • 28. Build a learning system and habit of learning, sharing with and seeking knowledge from others • Developing a culture of continual learning means sharing, seeking and using knowledge from experience and publications • Seek learning – from own adaptation and adoption or from others’ experience • Reflect on insights – what learning means for own practice and /or for others’ practice • Share learning – within your context and wider 7 interconnected principles Learning
  • 29. Remember…….. Sustainability The challenge is not starting, but continuing after the initial enthusiasm has gone Ovretveit (2003) Spread and sustainability are directly linked
  • 30. Themes and Key Questions So Far
  • 32. 32 | ‘An enabling leadership activity working on sustainable change, across challenging silos, in complex social landscapes, amid changing circumstances’ What is Systems Convening? Handbook https://wenger-trayner.com/systems-convening/.
  • 33. • Designs a plan • Accountability within a governance system • Ensures that delivery milestones are met • Deals with risk and ensures that barriers are overcome • Works with emergence • Builds commitment to a collective goal • Builds relationships • Seeks win/wins • Makes sense of things for adopters: the why? • Enables spread across a whole system Interdependent Complex Independent Complicated PROGRAMME MANAGEMENT SYSTEMS CONVENING Working With Complexity Needs an Enabling Leadership Style Complex changes require both approaches to work together each bringing valuable, complementary contributions to enable spread and adoption Activities not roles
  • 34. 34 | Systems Convening is an Enabling Activity • Matches approach to spread and adoption with complexity of the situation • Applies the 7 principles in practice to develop a bespoke approach reflecting the specific context. • Provides enabling activities delivered by a team or a number of people • Applicable to all levels of the system, with interdependence between the levels • Is a third complementary role, working alongside innovators and adopters • Systems convening is an emerging, and not until recently well described, activity already in use in healthcare
  • 36. A winning partnership: System Convening with Programme Management improves patient experience ‘That’s what I do’: voluntary partnerships, complexity and an activity named system convening’ A winning combination: programme management with system convening to develop and spread the BASIC STEP tool in North West Ambulance Service (NWAS) Spread, adoption and systems convening: the Welsh Ambulance Service Trust (WAST) falls framework Planning for spread and adoption from the start, the seven principles and system convening in the successful Continuing Healthcare Improvement Collaborative Spread and Adoption Case Studies
  • 41. Further Themes and Key Questions
  • 42. Ask and Offer Ask What in the Guide do you really like? What else would you like included in the Guide? What do you need to help you apply this Guide to your work? Offer Chance to win a session to help you apply this Guide to your work. Send email to diane.ketley@nhs.net by 3/12/21 State how you have, or plan to, use this Guide to increase the spread and adoption of innovation and improvement. Random draw and announcement w/c 6/12/21 Please type your answers in the chat box
  • 43. • Guide at https://www.england.nhs.uk/spread-and-adoption/ • Horizons blogs, videos http://horizonsnhs.com/programmes- of-work/spread-and-innovation/ incl. recording and slides from this webinar • Follow #NHSSpread, @DianeKetley • Contact diane.ketley@nhs.net Want to learn more? #nhsspread