Innovation is at the heart of what we do as an organisation. Here two of our senior team – Kay Haughton, Director of Service Transformation and Nigel Harris, Director of Innovation and Growth – discuss innovation and our role in stimulating innovation in the health service.
In the context of health and care, what do you understand by the word innovation?
Nigel This is something we often get asked. It’s one of those questions that if you ask 10 people, you’ll probably end up getting 11 different answers. For me the key is about the application of ideas or technologies to achieve change.
Kay Innovation isn’t just about new devices or apps, it can also be about the application of a new pathway or new way of working. I would say our success in implementing the National Early Warning Score (see page 16) and the Emergency Department Safety Checklist (see box) across all NHS trusts in the West of England are good examples of innovation, because we were the first to achieve that level of coverage, and in doing something different at scale we made a significant impact on health outcomes.
Emergency Department (ED) Safety Checklist
The ED Safety Checklist was designed to address the shared challenge of ensuring patient safety during periods of crowding. It helps to standardise and improve the delivery of basic care in emergency departments, systemising the observations, tests and treatments that need to be completed in a certain order. It serves as an aide-memoire for busy staff, and any doctor, nurse, bank or agency staff can join the department and provide the right care by following the time-based framework of tasks.
The ED Safety Checklist was originally developed and tested by University Hospitals Bristol NHS Foundation Trust with support from the Health Foundation and the West of England AHSN through our Patient Safety Collaborative.
During your career which innovation has most impressed you?
Nigel The biggest innovation in my time has been in medical imaging. When I was at college the only way to look inside somebody’s head was through the use of isotopes. Then the use of computerised tomography (CT) scans and magnetic resonance imaging (MRI) revolutionised this. They are examples of a revolutionary technology being matched to an unmet need, and having a huge impact.
Kay For me it was robotic surgery. As an anaesthetic nurse I remember talking to conscious patients during neurosurgery so that surgeons could monitor any changes to their brain function. This level of precision would have been unthinkable when I was student nurse starting out, and seeing the impact it had at close range made a huge impression on me.
PINCER is a proven ‘Pharmacist-led INformation technology intervention for reducing Clinically important Errors’. It allows GPs to review patient records and identify patients who are being prescribed medicines that are commonly and consistently associated with medication errors. GPs can then take action to reduce the risk of these errors occurring.
It was originally developed by the PRIMIS team, part of the School of Medicine at the University of Nottingham. Since then it has been tested in GP practices across Wessex and during 2019 we shall be adopting the approach in the West of England.
What do you see as the role of technology in innovation?
Nigel This is a really interesting area. I see technology primarily as an enabler. We should always start with the problem we are trying to fix, and look for the technologies that might help.
Kay And technology doesn’t have to be employed to fix or cure physical issues. It could be used to overhaul systems in doctors surgeries like PINCER (see box above), or it could be a diagnostic tool.
Nigel What often doesn’t work so well are the examples we find of ‘technology push’ – somebody inventing a cool new gadget and then trying to find a use for it. It can sound exciting, but is normally far from ideal. It’s fundamentally better to start with the clinical need.
And do you think technology has a role to play in responding to workforce pressures in the NHS?
Kay Health is always going to be a human business. However, technology and innovation can certainly help to support the people working in healthcare.
Nigel Yes, I agree, this isn’t necessarily a technology challenge, it’s just a challenge, to which technology may, or may not, help provide the answer.
Kay So do you think I will eventually be able to have real consultations with my GP online with access to tools that allow diagnosis, not just a conversation?
Nigel Well that can already happen to an extent. Smartwatches can provide increasingly sophisticated biometric data – our phones have remarkable imaging and processing capabilities. But I know my clinical colleagues would say that there is no substitute for clinical acumen being applied face to face, when you can feel the pulse, feel the abdomen and asses the patient in person.
What do you think makes for a successful innovator?
Nigel I think there are a number of factors, from a willingness to listen and collaborate (and use tools like hyvr – see page 21) and continually refine and focus their proposition (see HIP on page 14). Ultimately though, one characteristic that nearly all the successful innovators share is persistence; a single-minded drive to pursue their idea until they find a solution.
Kay That sounds like Andrew Bastawrous who presented at our EXPO event at UWE last year. He designed a smart phone app that can perform retinal screening in developing countries – a cost-effective solution to delivering eye care for people who don’t live near eye health facilities or can’t access treatment. They were even innovative by using of a piece of string to place patients the correct distance from the phone to enable scanning.
But as we said before, it’s not all about technology. Take Karen Luyt at University Hospital Bristol. PReCePT (see box below) was such a simple concept, but she was the one that grasped it, gathered evidence and then worked with us to spread it. It was based on NICE guidance that hadn’t been implemented. It goes to show that just because something is evidence based, it doesn’t mean it will automatically be carried out. Finding a way, creating a pathway takes imagination and persistence – just as Andrew and Karen have shown.
PReCePT started life as a West of England project five years ago. Today it is a national programme and a powerful example of how we, as part of the AHSN Network, can rapidly put evidence into practice to improve healthcare for the nation. Through PReCePT, women going into early labour under 30 weeks are offered magnesium sulphate, which helps to protect their babies’ brains. As a result fewer babies are likely to develop cerebral palsy, improving quality of life for both preterm babies and their families.
What do you think are some of the challenges we have in front of us?
Nigel As humans, particularly in the medical profession, we are inherently cautious and it takes quite a bit to encourage us to try something new, even as individuals, let alone in something as complex as rolling out a new clinical pathway. Overcoming that barrier is one of the key skills of any innovator working in this area.
Kay I think we need to find ways to move further into the prevention space, be that genomics or independent blood sugar monitoring – enabling people to understand what challenges they face and helping them to deal with them, to reduce the demand on clinicians.
Nigel Yes, but we have to consider that behaviour change doesn’t always follow from access to information. People don’t necessarily change behaviour now to avoid a potential problem in five or 10 years’ time. It can also be harder to demonstrate return on investment for innovations in the prevention space.
That is a fundamental challenge: how do we find money for an intervention that requires investment now, but will yield a saving in a few years’ time? There is some interesting work going on in a few pockets where outcomes are being commissioned, not just activity.
What is our role as an AHSN in helping our members, innovators and the wider community explore what can be achieved?
Nigel For me, a central part of our role is around culture and helping our members do things differently. We are working with them to find ways to innovate, to deliver the health and social care we all want to see.
Kay But we have to recognise that some healthcare organisations just don’t have the workforce capacity to do this currently, so this is a pressing need. Technology has progressed, but the stress people work under is creating a different workplace environment.
Nigel Yes, it feels that sometimes there are unrealistic expectations of what individuals can deliver. If we are to get the best out of people we have to create space for compassion, and time to think about doing things differently to allow for innovation.
Kay I agree that it’s important to look at civility and kindness at work, not just productivity. We must never forget we are working with people, both staff and patients, and we have to consider how they respond to change. The success we’ve had in the quality improvement area has been about helping to change mindsets. I think we can learn from this and apply that learning to help our members develop and adopt innovation. It’s something we are looking to develop over the coming year through our Innovation Academy
Working with innovators, to help them understand the NHS and how their ideas and products might be adopted is a key part of what we do. Another, sometimes overlooked, aspect of our work is helping the health and care system understand, foster and adopt innovation. To bring a new level of focus to this work we are developing an Innovation Academy.
The aims of the Academy will be to develop the understanding of innovation within our member institutions; to help innovation be seen as part of everybody’s business. We have learnt from our successful Quality Improvement Academy that ongoing training and support and the fostering of an active network can contribute to a significant cultural shift. Helping our members build a vibrant innovation culture is our next ambition.
Read more in our Innovating Together magazine – a look back at the work of the West of England AHSN in the year 2018-19, and a look ahead to some the work we have planned.Download it here as a PDF or read it below via Issuu.