Making change succeed

It’s no secret that it is hard to create change in healthcare systems and the NHS is not unique in this [1,2]. We see almost all of the effort going into the development of an innovation without considering how to address the challenges of implementation and absorption.

System wide initiatives led by governmental bodies struggle to have broad usage as much as solutions marketed direct to practices, hospitals or tertiary centres. To drive system change incentives like contracts and funding are often used to persuade innovation uptake. In reality the letter of the contract is adhered to - an innovation is made available (implemented) but not used in everyday care (absorbed). This approach increases availability but still suffers from low usage and so has low impact. Furthermore incentivising through contracts and payments means measuring progress against metrics, the result is to optimise on the metrics not the use and impact. This potentially increases activity, decreasing capacity and having no actual impact on patient care. Technologies and process changes that are not backed at a system level have even less levers to incentivise absorption of innovation.

The last mile is perhaps the most important

The human elements of innovation need just as much time and effort to develop as the technology side and the human elements are the ones that decide whether the innovation gets used or not. The awareness, engagement and buy-in are often overlooked in importance and vastly underestimated in the amount of time, money and effort that is needed. Health and care systems are complex with a variety of people and expertise including public, patient, carer, clinicians, healthcare professionals, commissioners to name a few.

Looking at healthcare innovation we see that healthcare systems have a “last mile” problem. That is after all the effort designing, developing and creating we struggle to complete the last part of the journey - getting new approaches absorbed into everyday care and so in use to improve health and care. An underappreciated challenge is the culture change to win hearts and minds of patients, clinicians and healthcare professionals.

Humans!

Often an innovation has several users (e.g. patients, carers, doctors, nurses, mangers) each with different needs. By communicating with patients, carers and clinical teams from the outset the design and interface can be developed to address the patient, carer and clinical needs while being intuitive. We also establish listening and conversation channels so we can collectively develop an understanding of the trade offs that are being made. This is also a good time to start understanding the concerns and value of the innovation for patients, carers and clinical teams. The information lcan then be used to address the concerns and highlight the value. But also the purchaser and commissioner are different from the users and each other, they all have differing priorities. So the needs of these must be included when considering how an innovation will be made available.

This might sound like additional work (and more cost) but there are opportunities also. The patients and carers we work with may wish to become advocates for change. We often discuss peer to peer communications and neglect the power of the patient voice. Through engagement with patients and carers we can support system change and introduce platforms of innovation but we need to take the time and effort from the beginning to do this.

Clinicians and healthcare professionals are not effectively engaged despite being responsible for making the change happen if they don’t believe in it, then it won’t happen. There will be specific clinical and healthcare professional concerns that need to be addressed, ranging from personal (e.g. job change) to professional (e.g. risk, ethical practice). Many concerns will have already been considered and compensated for but the message often doesn't reach substantial numbers of the clinical team who have their heads down delivering care. With understanding and opportunity to contribute we can create a more receptive environment to improving healthcare with new tools, approaches and technologies.

Through engagement we win hearts and minds which means addressing concerns, making improvements and creating a receptive environment which can support innovation which supports patients, clinicians and healthcare professionals while mitigating negative side effects. This takes time and effort in our constant drive to reinvent and innovate we need to acknowledge the importance of people in making change succeed. Currently systems are running at near full capacity with their head down focusing on care delivery. When times are hard the instinct is to draw back and lock down but we need to support time to look up and engage if we want innovation in healthcare to be more rapid.

All or nothing

Whether it’s a digital front door, diagnostic or pathway we need to consider a number of key factors to support implementation and absorption of an innovation into everyday care so it makes an improvement for patients and carers.

The design of an innovation facilitated through co-creation means that an innovation addresses a need and accounts for our expectations and values.

Capacity within the implementation site means there’s time to absorb an innovation which may mean changing processes, de-commissioning duplicating functions and training staff.

Robust evaluation and impact measures displayed transparently captures the risks and benefits. They also help decision makers understand if the innovation would address a need they have.

Education creates an understanding of the innovation to inform of the capability, bounds and use. It provides the tools to change processes to adjust and optimise care provision around the new innovation.

Finally we need to achieve buy-in with conversation and continuous engagement. With patient, clinical and healthcare professionals as advocates to help develop wider understanding of why the innovation, with the compromises, is the best way forward for the team, patients and carers.

Not one of these alone will solve health system adoption but without them all the adoption of innovations will continue to struggle. We need to put just as much effort into the people as we do in developing the new shiny solutions.