Defining and refining success: innovation in the NHS

In our new report last week on the spread of new innovations in the NHS, we identified four key themes that innovators, potential adopters and policy-makers should keep in mind to achieve scale and spread across the health service. Here co-author Rachel Hutchings focuses on the first of those – defining and refining success.

Blog post

Published: 12/03/2020

While it may not always feel like it, in most of our interactions with health care services we benefit from the spread of past innovations. This perhaps could be a previously novel drug, device, app or even a way of working that was introduced to improve clinical outcomes, efficiency or patient experience.

Such spread continues to be a priority, with the NHS Long Term Plan committing to “speed[ing] up the path from innovation to business-as-usual”.

For our new report – commissioned by the NHS Innovation Accelerator – we took stock of relevant literature and identified the practical steps that eight innovators took to achieve scale and spread across the health service. We included a range of commercial and non-commercial innovations in our research, including patient-facing apps, new models of care and mobile technologies.

Key themes for consideration

  • Defining and refining success
  • Identifying and understanding the market
  • Adapting and evolving
  • Generating and disseminating evidence

As the report says, while there are rarely single or simple solutions, we suggest that innovators, potential adopters and national policy-makers should be mindful of four related areas (see the adjacent box). In this blog, we focus on the first of those – defining and refining success.

Is universal coverage always the ultimate goal?

Our work suggests that before embarking on a journey of innovation adoption, scale and spread, understanding what it means to be successful – for innovators, adopting organisations and the NHS as a whole – is a crucial first step. Across our case studies, innovators defined success in numerous ways, often changing over time.

For some, success was not only about the number of sites (‘breadth’), but also about increasing their work with existing adopters (‘depth’). Others had broader ambitions, such as achieving a particular policy change or social mission.

It might sometimes be beneficial for an innovation to be adopted by the NHS as a whole to, for instance, benefit from greater economies of scale and consistency of care. The Long Term Plan even flags ambitions around “reducing variation” in access to innovations, and conversations about how far particular innovations should be ‘mandated’ across the health service are a live topic.

However, comprehensive coverage may not always be realistic or desirable for the NHS. Certainly, national bodies’ views of success must acknowledge the potentially wide-ranging goals and ambitions not only of the innovator but, importantly, across the local adopting organisations who may, for instance, have quite different financial positions, service challenges and recent experience of adopting technology.

Continually reassessing their views of success was also important for innovators. Remaining mission or values-driven was seen as vital for innovators to stay faithful to their organisational goals, and guided their scaling strategy (for example, the partners they were willing to work with). These parameters for defining and refining success seem similarly appropriate for NHS bodies when they are considering whether and how to adopt innovation.

Aligning aims and remaining authentic

Being clear on their views of success and how their innovation addressed the NHS’s priorities was essential for innovators. This meant remaining flexible and being able to adapt to the particular needs of adopting organisations.  

Rather than being seen as a solution looking for a problem, innovators need to have a clear understanding of what they are trying to achieve and the evidence base that supports it. From an NHS perspective, it also underlines the importance that local and national bodies clearly articulate their needs.

For some innovators, the way in which their innovation was being used was important. For example, where an innovation had been shown to be effective as a tool for early intervention, being used by adopting organisations as a ‘last resort’ in the particular pathway was not a success for the innovator. And it probably should have not been deemed a success for the NHS either.

Rather, policy-makers need an approach that recognises the importance of aligning innovation to the most pressing priorities facing the NHS at the moment.

Measuring success and achieving sustainability

As a result, how success is measured is also important. Innovators and adopting organisations within the NHS were clear that solely measuring things such as the number of sites using an innovation was not necessarily an accurate way of assessing how well it is being used, or even if it is being used at all.

Adopting an innovation is not just a one-off event and requires continued monitoring and likely ongoing support. Achieving lasting change and becoming sustainable was therefore central, and innovators reflected that just focusing on expanding to more sites would not have enabled this. To this end, innovators will likely have to provide support to adopting organisations for implementation (particularly if this involved digital transformation).

National policies and programmes must also continue to recognise the importance of measuring success in a variety of ways in order to capture this.

Embracing opportunities

Innovators will admit that, in hindsight, it is easy to underestimate the time it takes to embed an innovation across the NHS in a sustainable way. Perseverance is crucial. But, despite the challenges, the NHS was considered to be a “fertile” place for innovation, offering a vast array of opportunities alongside supportive policies and national programmes that encourage scale and spread.

What’s clear, however, is that for innovation to flourish, there needs to be a closer look at what it actually means to succeed – for innovators and for the NHS as a whole.

Suggested citation

Hutchings R (2020) "Defining and refining success: innovation in the NHS”, Nuffield Trust comment.