why won't my innovation spread - nhs england · • how benefits were achieved, not just what...

@robertvarnam #Expo18NHS@robertvarnam #Expo18NHS

GENERAL PRACTICE

FORWARD VIEW

Why won’t my innovation spread?Practical lessons from 5 years in primary care

• Dr Robert VarnamClinical lead, primary care transformation

• Sustainable Improvement Team, NHS England

bit.ly/[email protected]@nhs.net

@robertvarnam #Expo18NHS

GENERAL PRACTICE

FORWARD VIEW


GENERAL PRACTICE

FORWARD VIEW The problem of innovation spread

Balas, E. A., and S. A. Boren (2000)

…but this is probably an underestimate

for many innovations in healthcare

Westfall, Mold and Lyle (2007)

We can’t wait for ‘diffusion’


GENERAL PRACTICE

FORWARD VIEW Our journey: general practice innovations

2013 Call to Action on General Practice: what would it take to spread

innovative ways of working?

2014 Prime Minister’s Challenge Fund on GP Access: how to improve

access and care in hard-pressed practices?

2016 10 High Impact Actions: suite of innovations to release time for care

General Practice Forward View: funding, workforce growth, innovation

Adoption support (‘Time for Care’)

Now Time for Care programme engaged with 178 CCGs (91%).


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FORWARD VIEW Common challenges

Innovators Innovations Packaging Spread Adoption


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Whacky … Too brainy …

Too creative … Too hard working

very impressive, but it’s just not me…


GENERAL PRACTICE



Relevance (to need / locality)

Fit with existing model

Credibility

Depth of change required

It’s different round here

Everything the NHS has asked of us in the past 20 years has been more work. We just can’t do anything new.

You simply can’t achieve that much

I’m going to have to do what?!

That’s just not how things work.


GENERAL PRACTICE



Focus on what was achieved

… less on how

Reliance on single examples

Reliance on written formatsI don’t have time to read all that

People will say anything in a report

Of course, it would work in a place like that

How could I be expected to achieve that?


GENERAL PRACTICE



‘Diffusion’ is slow and random

Need to reach v large number of people

to achieve nationwide impact

Large number of potential channels

No single authority has universal

credibility

I’ve just discovered our neighbouring practice solved this

years ago!


GENERAL PRACTICE



Limited capacity / headroom

Limited capabilities for improvement &

change leadership

Environment often not conducive

Just as we’re about to embed one thing, the system asks us to do something else.

The hospital has a whole team who do this kind of thing. I’ve just got me on a Saturday afternoon.

I come across good sounding ideas all the time, but it’s impossible to get anything done.


GENERAL PRACTICE



The ‘Time for Care’ programme

National programme to gather and spread actionable learning

about practical innovations that release staff capacity and

improve patient care, backed up by expert improvement

support to implement change.

www.england.nhs.uk/gpdp


GENERAL PRACTICE



The ‘Time for Care’ programme

www.england.nhs.uk/gpdp

Spread and adoption of innovation doesn’t “just happen”

Success involves multiple steps, beginning early

It’s active, sometimes technical and often about leadership


Innovations from practices throughout around

England that release time and improve care.

bit.ly/gpcapacityforum

GENERAL PRACTICE

FORWARD VIEW 10 High Impact Actions


Innovations from practices throughout around

England that release time and improve care.


GENERAL PRACTICE

FORWARD VIEW 10 High Impact Actions


Progress so far…

• 91% of CCGs engaged in implementation support

programme

• Innovations featured in conferences, articles, awards

• Widely ‘appropriated’ and embedded by local / national

organisations

• Included in 2018/19 NHS Planning Guidance refresh


GENERAL PRACTICE

FORWARD VIEW Features of our approach



GENERAL PRACTICE



• Systematic focus on ‘humanising’ original innovators

• Face-to-face / video presentationInformation about ‘how’

• Spotlight on ‘first followers’

Where has this been developed? By whom? With what support?


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• Make it easier for people to do what they care about (pressures & values)

• Many are extensions/evolutions to existing models/processes

• Menu of options - something for everyone (different scale / speed / ambition)

• Grounded in established improvement science principles

Why should busy people stop what they’re doing to notice this?


GENERAL PRACTICE



• “Actionable learning”

• clear framing of why this is beneficial, relevant and achievable• how benefits were achieved, not just what they were• anticipate common questions or concerns

• Multiple formats

• short & long videos. Short & long case studies. • summaries, FAQs, implementation guidance.

People want practical insights not just sales or congratulation


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• Multichannel

• online forum, blogs, articles. • national & regional conferences, local workshops … >8,000 attendees to date

• link with CPD

• Use of peers more than authorities

• Make it a movement – “we all own this” … spotlight local case studies

• Intimate link between spread and adoption support

People need to know about it AND think it’s credible


GENERAL PRACTICE



• Some teams will just do it alone

• Expert implementation support from Sustainable Improvement Team

• Funding for staff training and software licenses

• Capability building for improvement leadership

• Alignment of CCG support

Implementation is active, involving skills, tools and leadership … and costing money


GENERAL PRACTICE

FORWARD VIEW


Beyond ‘diffusion’ of innovation

• @robertvarnam

• [email protected]

Spread and adoption of innovation doesn’t “just happen”

Success involves multiple steps, beginning early

It’s active, sometimes technical and often about leadership

bit.ly/rvbib-innovationprimer www.england.nhs.uk/gpdp

why won't my innovation spread - nhs england · • how benefits were achieved, not just what...

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