“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.

1. My report card on innovation in
the NHS
A presentation to the
Derbyshire Innovation Partnership
6th February 2014
Helen Bevan
@HelenBevan

2. Definition of innovation
“Doing things differently and doing
different things”
Source: NHS Institute
@HelenBevan

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. 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. 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. 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. 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. 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. 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. 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. 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. Type of
innovation
Process
Service
Strategy
@HelenBevan
Potential
Current
contribution to prevalence in
transformational delivery of
change
innovation
Risk of nondelivery

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. 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. 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. 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. 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. 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. 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. @HelenBevan
Source : Kaiser Permanente Innovation Consultancy

21. Source: @NHSChangeDay
@HelenBevan

22. Source: @NHSChangeDay
@HelenBevan

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