Accelerating the adoption of innovation in the NHS
Spreading innovation in the NHS is as much about fostering collaboration and building relationships as it is about designing new interventions and launching new technologies.
Scaling up the adoption of new interventions and technologies in the NHS has always been something of a challenge.
But a review of approaches used by the Academic Health Science Network (AHSN) shines a light on the best ways to effect change, while demonstrating the complexity of stimulating wide-spread adoption among NHS trusts and organisations.
Presented at this year’s NHS Confederation Conference, the study found that long-term collaboration, relationship building, and tailoring approaches to local organisations were the keys to moving new interventions from the drawing board into routine practice.
What are AHSNs?
Professor Gary Ford, chief executive officer of the Oxford AHSN, explained that the network had been established by NHS England in 2013 to increase the spread of innovation so as to improve health and generate economic growth.
“We are unique organisations in that we sit between the NHS, academia, local authorities, the third sector, and industry to create the right conditions to facilitate change across the whole of the health and social care system,” he said.
“Our main focus is improving outcomes for patients by getting more rapid uptake of advances in life science technology and service reorganisation.”
Each of the organisations that make up the network has developed its own ways of working, he explained. The review, carried out between January and November 2020, sought to understand the range of approaches used, and capture views on how best to address the traditional challenges of innovation adoption in the NHS.
Andrew Sibley, valuation programme manager at Wessex AHSN, said the exploratory study included all 15 ASHNs and spoke to 143 of their around 600 staff.
“A key message was that AHSNs support spread by responding adaptively to complex environments through a flexible range of methods,” he said.
While the approaches used were varied, including the model for improvement and the NASS (non-adoption, abandonment, scale-up, spread, sustainability) frameworks, no one methodology came out on top. Rather, flexibility was the common denominator of success.
“This reflects the inherent complexity of spread work and the huge diversity of activities that AHSNs are involved in – there are hundreds of innovations across the whole network.
“Successful spread is often changeable, resource intensive, and always, even in the case of nationally organised programmes, requires localising to the place it finally lands,” he said.
Even where innovations consist of “intrinsically simple devices”, the people they serve and the pathways they fall into are anything but.
Projects requiring “significant pathway change”, for example, can take six months to a year to implement and this kind of work requires long-term collaboration with multiple stakeholders at all levels.
“I can’t emphasise enough how important relationships are to the to the process of spread – that came through very strongly as a key enabler,” said Sibley.
“Even simple innovations have a long reach – to different staff, units, wards, and services – so broad engagement can be a very successful way to ensure sustainability.”
In addition, innovations need to be aligned to local priorities, organisational cultures, and even characters, all of which will vary widely.
As part of the review, researchers carried out an in-depth study of how the different AHSNs approached the implementation of Transfers of Care Around Medicines (TCAM).
TCAM, Sibley explained, is a digital platform that enables hospital trusts and community pharmacies to share patient information safely and securely.
Analysis of the ASHN staff responses identified two factors that were critical to the success of rollout, which was defined as 50% or more uptake of the system in the network’s catchment area.
“Where the ASHNs did not delay their start to the national programme and where they employed a senior, local pharmacist to lead the adoption work, they were very successful.
“The converse was true for those who did delay and did not have senior pharmacist support,” said Sibley, highlighting the important role of clinical champions.
Spreading best practice
Sarah Robens, Evaluation Lead at the South West AHSN, reiterated that innovation spread worked best when methodologies were “aligned to existing knowledge approaches and processes”.
Learnings from the review, she went on, have implications for the wider health and social care community working to accelerate the adoption of innovation.
“Innovations are only useful if they are able to be effectively adopted or spread. Therefore, making the ‘work’ of spread and adoption visible and increasing its profile as important work would support all innovation activity,” she said.
“We need to continue the development of shared learning across the AHSNs, including a repository of learning across the AHSN Network, containing insights and evidence from existing and new approaches to spread and adoption from within the AHSN and elsewhere.”
She also recommended further exploration of the approaches used, and how best to tailor them.
“Organisations, leaders, and staff have tacit knowledge, explicit ways of working, and preferences for undertaking the spread and adoption of innovation.
“Making them more visible will increase learning, avoid clashes of approaches, and increase accountability,” said Robens.
Ultimately, the review alludes to, when it comes to spreading innovation, we need whole-system collaboration.
About the author
Amanda Barrell is a freelance health and medical education journalist, editor and copywriter. She has worked on projects for pharma, charities and agencies, and has written extensively for patients, healthcare professionals and the general public.