why won't my innovation spread - nhs england · • how benefits were achieved, not just what...
TRANSCRIPT
@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
@robertvarnam #Expo18NHS
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’
@robertvarnam #Expo18NHS
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%).
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Common challenges
Innovators Innovations Packaging Spread Adoption
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Common challenges
Innovators Innovations Packaging Spread Adoption
Whacky … Too brainy …
Too creative … Too hard working
very impressive, but it’s just not me…
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Common challenges
Innovators Innovations Packaging Spread Adoption
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.
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Common challenges
Innovators Innovations Packaging Spread Adoption
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?
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Common challenges
Innovators Innovations Packaging Spread Adoption
‘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!
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Common challenges
Innovators Innovations Packaging Spread Adoption
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.
@robertvarnam #Expo18NHS@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Common challenges
Innovators Innovations Packaging Spread Adoption
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
@robertvarnam #Expo18NHS@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Common challenges
Innovators Innovations Packaging Spread Adoption
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
@robertvarnam #Expo18NHS
Innovations from practices throughout around
England that release time and improve care.
bit.ly/gpcapacityforum
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
@robertvarnam #Expo18NHS
Innovations from practices throughout around
England that release time and improve care.
bit.ly/gpcapacityforum
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
bit.ly/gpcapacityforum
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
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Features of our approach
Innovators Innovations Packaging Spread Adoption
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Features of our approach
Innovators Innovations Packaging Spread Adoption
• 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?
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Features of our approach
Innovators Innovations Packaging Spread Adoption
• 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?
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Features of our approach
Innovators Innovations Packaging Spread Adoption
• “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
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Features of our approach
Innovators Innovations Packaging Spread Adoption
• 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
@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW Features of our approach
Innovators Innovations Packaging Spread Adoption
• 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
@robertvarnam #Expo18NHS
bit.ly/gpcapacityforum
@robertvarnam #Expo18NHS@robertvarnam #Expo18NHS
GENERAL PRACTICE
FORWARD VIEW
Innovators Innovations Packaging Spread Adoption
Beyond ‘diffusion’ of innovation
• @robertvarnam
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