One of the things I love about twitter is the way that random tweets can spark a thought process that leads us to look at things with an alternative eye and challenges the hitherto underutilised recesses of my mind.
The other day I noticed that Clare Gerada, Chair of the Royal College of General Practitioners tweeted ‘Can someone give me a clear definition of innovation in the NHS’?
I then had the luxury of a three hour train journey to Liverpool to contemplate this conundrum. Two diametrically opposite quotations sprang to mind. The first by Bill Gates 'Never before in history has innovation offered promise of so much to so many in so short a time' celebrates newness and change in all its glory. The second, by Coco Chanel 'Innovation! One cannot be forever innovating. I want to create classics' honours the tried and tested.
Of course both of these quotes are applicable to the NHS in the 21st Century and maybe an appropriate combination of the old and the new is the Utopian vision we should aspire to achieve. Innovation in any context can be the excuse for a multitude of sins or a cacophony of excellence, but here is my personal view of where innovation should sit within the context of an NHS struggling with reform.
Innovation should NOT be…
The new buzz word! Yes the irony does not escape me. I have recently written a piece in Health Insurance magazine pleading for providers to stop using the ‘I’ word unless they really are coming up with something new. Whether it’s products, services, care pathways or medical techniques, please don’t say they are innovative unless they really are. The rehash and repackaging of old ideas achieves little and can cost much.
Change for change’s sake: Secretary of State for Health (whoever you are) please note. Change, such as radical restructure, rebranding or even just changing titles, must comply with measurable governance and provide a real opportunity for improvement. Change should not have a political expediency or be created on the basis of a need for heightened publicity.
Re-inventing the wheel: Same job, different title. Same function, different department. GP commissioners and disbanding PCT’s. Enough said.
Innovation in the NHS SHOULD be:Ways of working smarter: Needed at all stages of service delivery. This is innovation in the improved outcomes sense of the word– streamlining, service improvement, efficient pathway mapping, resource planning and possibly most important of all – robust leadership.
Looking at sustainable means of funding care: The public purse is not like the fabled magic rice bowl that refills on demand. Public private partnerships, patient contribution, increased taxation, improved use of voluntary resources – all must be considered to meet growing cost of healthcare.
Creating a system to not only educate the public but to generate changes in behaviour: The western world seems to be on a path of self-destruction with unbelievably unhealthy habits, from smoking to drinking, over indulgence and lack of exercise. Changing this self-harming way of life would not only be innovative, it would prolong healthy life and save the NHS billions.
Research and Development: Whether this is funded by commercial enterprise, charities or academic institutions – the unimaginable has already been achieved through innovation within the NHS and through strategic partnerships. Reform and cost cutting must not be allowed to halt this progress.
A crystal clear definition of innovation in the NHS? Not possible. But I can have a stab at defining the golden rule that should apply to all such innovation. It works for clinical research, and applies to basic management techniques, service redesign and lean consulting. What is the true cost of a planned innovation (in financial and human terms) and what is the potential, measurable benefit? Is there sufficient evidence or theory to justify the risk associated with the innovation (clinical, emotional, physical or fiscal). If these questions produce unsatisfactory answers then you should only proceed, if at all, with caution.
And one last quotation – accredited to ‘anon’ perhaps provides the closest to crystal clear I can manage..
‘Innovation is not the same as reform.’