When it comes to innovation in healthcare tech dominates the agenda, but innovation is broader than just tech and simple things like how we construct a message can create outsized impact.  For better or worse innovation is now synonymous with tech and so we find ourselves in a cycle of peaks and troughs where we hear that the next new technology is going to solve all our problems but before we know it suddenly we’re doomed by this very same tech! We spend so much time and effort on the new and shiny with little thought on how hard it is to get something new to actually be used and how to support organisations to be changable and adaptable. Often it’s the people that can make or break whether an innovation gets used and its the people that we don’t spend enough time on.

Change fatigue

One of the major barriers to adoption of a new technology or a new process is the uncertainty it creates in people - job change anxiety which can quickly lead to reluctance and even fear. Change translates to uncertainty on the impact on a person; do they do less of what they love and more of the things they hate? As an employer there’s the prospect of difficult decisions, challenging conversations, and disappointing a valued member of the team.

Using an innovation whether it’s a new technology or a service change means that it will inevitably impact roles and responsibilities. It can feel like there are never ending initiatives for change in the NHS and many people within healthcare systems have had bad experiences from past iniatives - insufficient training, poorly functioning systems or being left with more to do. It wouldn’t be surprising if staff were starting to feel change fatigue! It is easy to see how anxiety can exist at multiple levels and creates inertia to change. However, healthcare systems need to continue to change and adapt as demographics and health challenges shift, new tools become available and patients expectations change.

Uncertainty and anxiety is not inevitable and could be mitigated to improve how organisations adapt and use innovations that address the needs of the healthcare organisation, staff and the local population. Transparency, flexibility and co-development of processes to enable role evolution could help to move past some of this inertia for change. In the NHS and other healthcare systems this could be the perfect time to build the foundations for adaptability and change within the healthcare system.

All change...again!

More recent changes to the English NHS have been driven through the Five Year Forward View and GP Forward View, and are now continuing with NHS Long Term Plan. These documents outline the planned changes to the NHS in England but many changes are not unique to England. They indicate a move towards the integration of health and care across primary, secondary and tertiary care, a change to network based care, larger collaborative (or multi-site) primary care providers as well as a focus on digital. There are also significant shortages in clinical staff leading to  more diverse professions entering health and care in a multitude of ways. These professions include familiar and unfamiliar roles e.g. link workers, pharmacists, paramedics, physios, and physician associates. In addition to this we have record numbers of clinicians retiring potentially creating a loss of organisational knowledge.

Larger organisations, networks, new types of professions and shared pools of staff creates an opportunity to develop career paths with succession planning in a way that hasn’t really been possible before. Career paths and succession planning can mean creating a static set path for staff development comprising of skill sets and responsibilities for each role and the expectations related to increasing seniority. This gives a member of staff transparency on how they can progress their career if they want to but also codifies each role and stifles change - each role is well defined, and can be less versatile and more specific.

Foundations for adaptability

Instead of creating specific roles consisting of specific activities and set career paths healthcare organisations could broaden the approach to instead consider pools (or teams) of roles with delegated responsibilities and requisite outcomes. Grouping staff into pools of expertise instead of by job title means the roles themselves become less well defined but more flexible - focusing on outcomes and responsibilities not activity. This means organisations (or networks) are now able to support teams of staff with similar responsibilities. Teams who can co-develop approaches to improve outcomes that are within their responsibilities. This gives the organisation and clinical teams incentives and reassurance that having an agile and adaptable approach to care delivery is also a continuous development opportunity. Teams are empowered to co-create and control activities to that keep the role responsibilities the same but use new tools and approaches to do more of what they enjoy, less of what they dislike and improve outcomes. This becomes an investment into the people and the community that form an essential part of the healthcare system.

In an environment where there’s high expectations and demands on people within the healthcare system there’s ongoing focus on resilience. Can changing how we think about roles and responsibilities provide more opportunities for people to be in control to make change happen - boosting morale, reducing pressure and improving care. Integrated care, networks and multi disciplinary teams provide us with an opportunity to fundamentally rethink healthcare organisation structures, roles and responsibilities. This could help care provision to become agile and embrace change establishing the foundation for a healthcare system that’s flexible, adaptable and can evolve.


[My thanks to Dr Neil Modha and team at Thistlemoor Medical Centre in Peterborough who inspired this post. Dr Modha and his colleagues are doing amazing things to support the staff to progress and develop within the practice environment in ways that help the staff to develop in areas they are passionate about while improving on the care provided.]

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