Lynne Maher, Head of Innovation Practice, NHS Institute for Innovation and Improvement, looks at how the NHS embraces innovation
?I?m really pleased that we have the NHS, but my recent experience has infuriated me. When I got home after surgery, my outpatient appointment didn?t arrive until three weeks after my operation ? this wouldn?t have been a problem only I was told I needed to be seen two weeks after my operation! Changing the outpatient appointment was seemingly a simple task, but four hours later I was still being passed from pillar to post. First I got cross and then upset. It was only then the booking supervisor agreed to change it. I didn?t want it to be like this and now I feel awful. Why does it have to be like this??
Senior emergency nurse practitioner Jane Ingham and patient Joe Turner at the Productive Community Hospital test site in Chippenham
Although there are many examples of fantastic service delivery within the NHS, we know there can sometimes be frustrating experiences for patients and staff. How can the NHS transform these frustrations into delight for the services it provides? Innovation could be the next step in our improvement journey.
There?s no doubt that innovation is one of the buzzwords of the 21st century. As the financial crisis rolls on, the need to ?innovate? is becoming an increasing priority in boardrooms across the country. In the health service, the Next Stage Review sets out our specific innovation challenge, ?to focus relentlessly on improving the quality of care patients receive?, ?to seek to harness innovation? and to ?create partnerships that empower patients?. The Next Stage Review clearly sets out an ambition to increase the level of innovation within the NHS.
HOW TO IMPROVE THROUGH INNOVATION
How does an organisation as big and as complex as the NHS continue to offer high-quality, effective and safe healthcare to a wide demographic of people across different regions, while still effectively managing resources? Today?s health leadership challenge requires us to think differently about delivery of care so we provide it in an effective way that meets the needs of our patients and carers. The mindset of today won?t deliver the care we need for tomorrow. It is only through fresh thinking and doing things differently that we will meet the challenges that the NHS faces.
Thinking differently often involves looking outside of our traditional mindset, and one way to do this is to make connections through networks and with other industries. This is a technique employed by many industries and one promoted by the NHS Institute through Thinking Differently, a book of tools and techniques to support the transformation of health services.
Though a series of lateral-thinking techniques, including ?Fresh Eyes? and ?Mental Benchmarking?, it encourages health staff to make connections with organisations and industries outside of the traditional health domain. It is at these interfaces of new people and new systems that creative connections are made and new ideas are often born. Some of these ideas may be commonplace in other industries, but are new and can have a significant positive impact when applied in a healthcare context.
?The best innovators aren?t lone geniuses. They?re people who can take an idea that?s obvious in one context and apply it in not-so-obvious ways to a different context.?
Harvard Business Review.
The NHS Institute actively promotes two approaches that have led to innovations in health care services. The first approach is the creation of networks where people can bounce ideas off each other within a safe and supportive environment through which new ideas thrive. The second is to actively look outside of health systems to seek ideas from other organisations that might be applied to healthcare. These have both yielded new ideas to improve healthcare services.
Having ideas is the start of the innovation process. It is only through successful application of those ideas that innovation can happen. Three NHS Institute programmes that have demonstrated the successful application of new ideas are: The Productive Series, Experience Based Design and the NHS Live network.
THE PRODUCTIVE SERIES: IDEAS INTO REALITY
The Productive Ward (part of the Productive Series) is a prime example of successful service innovation that drew on ideas from other industries and translated those to fit within the context of healthcare. It is a programme designed to release more time for nurses to use on direct care for their patients. The development of the programme has drawn from the principles of Lean and Six Sigma, two methods that are commonly used within manufacturing industries. Both methods rely on the empowerment of front-line workers to lead the improvement effort.
Our research suggested that ward nurses in acute settings spent an average of just 40% of their time on direct patient care, yet if you asked nurses why they choose this profession they would say it is about spending time with patients and providing them with high-quality care. The Productive Ward is an innovative programme that has enabled nurses to do just that. Improving workflow and patient flow through clinical pathways, taking out wasteful activities that do not add any value for patients, eliminating defects and variations in care that could cause harm to patients and empowering front-line staff to improve care delivery are all critical if we are to deliver high-quality health services.
With support from an expert team, staff implement the programme on their own wards. Working through a series of modules, staff are able to identify where there is variation in the care they provide, where time is wasted on tasks not directly related to patients and where poor flow impedes rather than supports effective processes. The team then work together to identify, test and implement solutions which fundamentally change the way their work is organised.
The programme has been a great success, enabling wards to increase the amount of time nurses spend on patient care. Results in some trusts have delivered a reduction in handover times by a third, reduction in medicine round times by 63% and even a reduction in meal wastage rates from 7% to 1%. Such is the programme?s success, that now over 80% of trusts within England have already signed up to the programme, and there is significant international interest.
Liz Ward, nurse and Productive Ward ex-case manager at Barnsley Hospital, with patient Douglas Senior
ADOPTION, ADAPTATION AND SPREAD
For innovations to have maximum impact, it?s important that they are spread and adopted throughout the health system. This is a challenge faced by healthcare systems globally. Such is the power and impact of The Productive Ward that the principles and tools have been translated into other areas, forming a series of programmes now taken up across the NHS.
Each programme has taken the basic concepts, tools and techniques that have been proven to work and adapted them for use in different clinical areas:
Another interesting adaptation of the techniques has resulted in The Productive Leader ? a programme for NHS Leadership teams that are using the same techniques to filter out time-wasting activities and free up time to make the decisions that really matter. Some teams report that they have released up to seven hours a week by improving e-mail and meeting practices.
The Productive Improvement Agent is a new application being developed to train NHS staff to become experts in applying these techniques across their organisations. The Productive Improvement Agent is currently in concept phase, but takes the productive methodology yet another step further for the benefit of the NHS.
EXPERIENCE BASED DESIGN
Another example of using approaches from other industries is Experience Based Design (EBD). Taken from the world of service design, this approach uses actual patient experiences, through narrative, film, diaries and storyboards, to help understand better the services provided for patients. Then patients and staff together, through co-design, create the new care pathway. The impact of this work has included improvements to patient safety, timeliness of care, dignity, streamlining processes and moral support for both patients and staff. In one hospital alone, over 40 changes were made to a single service. Staff and patients alike have enjoyed the impact of Experience Based Design.
Developing networks for professionals to share solutions to common problems is a massive step to driving rapid improvements across a large healthcare service. The NHS Institute provides leadership and support to NHS Live, a national learning network of projects from across England open to all NHS staff.
Recent statistics show a real increase in the number of great new ideas coming from the NHS frontline workers. Figures from NHS Live show a 75% increase since 2006 in the number of frontline staff who have had ideas and want to work together to make them happen. This reinforces the value of providing a safe and supportive environment through which new ideas thrive. NHS Live has created the context which enables a vibrant and active network of frontline staff who work together to share their current challenges, new ideas and potential solutions. These are then tested and applied through local projects across the NHS.
At this time of economic uncertainty, it is more important than ever to recognise the value and unlock the creativity of our workforce. We believe it is the innovators on the front line that have the power in their hands to improve the level of patient care across the NHS. Leadership teams also have a critical role to play in creating the culture and supportive environment within which frontline staff can identify new and effective solutions to some of their greatest challenges. Leaders can remove barriers, and support their teams to take risks when appropriate, they can also provide resources (time is often considered more important than money), and reward and celebrate efforts to improve health services for both patients and staff.
THE FUTURE OF THE NHS
If we are to rise to the challenge of transforming healthcare and continually improving patient care, we must make innovation an essential part of what we do. Knowing that creative new approaches to healthcare come from giving a voice to staff and patients, the challenge is now to ensure these people have the tools and space to take their ideas forward. We believe that the NHS Institute?s tools and networks offer the solution for innovation.
For more information, contact:
Head of Innovation Practice
NHS Institute for Innovation and Improvement
University of Warwick Campus
Tel: 0800 555 550
Added the 25 August 2009 in category Innovation UK Vol5-1