26 October 2018

The spread challenge (and why invention is only half the story)

by John Illingworth, Head of Patient Safety, UCLPartners

John Illingworth shares his reflections on the unique challenges innovation adoption in healthcare can bring and describes how UCLPartners is taking a new approach which recognises the value of early adopters in this process when given sufficient support.

The challenge of spreading innovations is not new, nor is it unique to health care. When James Lancaster demonstrated in 1601 that citrus fruit in sailors’ diets prevented scurvy, it took until 1795 for the idea to be taken up by the British Navy.

But there is a related, and equally difficult, challenge that has received far less attention; that even when a health care innovation is taken up by another part of the system, it may not work as well as it did first time round.

This is particularly true for complex innovations that involve changes in clinical pathways or processes. Even innovations that seem relatively simple or discreet, like surgical checklists, can suffer from variable fortunes when attempts are made to spread them.

This issue was explored in a new report published by the Health Foundation that I co-authored. The report calls for greater recognition of the scale of the task faced by adopters of innovations, and for more resources to be given to support them – whether that means assistance with the upfront costs of adoption or by building their skills in improvement and measurement.

Whilst this would require additional investment, it would be an investment worth making. Through a series of case studies, we discovered that early adopters can play a valuable role, both in helping the innovator codify the core components of the innovation, and in demonstrating the degree of modifications that can be made to the innovation whilst still retaining its effectiveness.

In fact, our survey found that 81% of adopters of Health Foundation-funded innovations made adaptations to the innovation, with 94% of them saying these adaptations were necessary to make it work in their setting.

These findings challenge the traditional diffusion model of innovation, suggesting a more even division of labour between innovators and early adopters (or perhaps “co-innovators”), recognising the hard work, creativity and sometimes reinvention required to replicate the impact of an innovation in a new context.

We’ve incorporated these ideas into a UCLPartners pilot of the NHS Innovation Accelerator innovation RespiraSense, which is a device that enables continuous monitoring of respiratory rate to more quickly spot the signs of patient deterioration.

Working closely with the innovator, Myles Murray, we have selected four NHS hospitals that will provide a diverse range of contexts in which to test the innovation. We’ll then be able to evaluate its impact in a real-world context and understand the kinds of adaptations that need to be made to ensure its effectiveness.

Recognising the task faced by these early adopters, we will be providing hands-on support, not only with the technical aspects of using the device, but also with the improvement, process mapping and measurement skills required to implement it.

This is a hugely exciting project to be involved with, which we hope will bring benefits to everyone concerned: to the innovator, who will gain a deeper understanding of their innovation; to staff, who will be better equipped to identify deteriorating patients; and to patients themselves, who deserve the chance to have access to innovations that could improve their care and enhance their recovery.

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