As we reach the end of the NHS Innovation & Technology Tariff and Innovation & Technology Payment (ITT/P) 2018/19 programmes, South West Academic Health Science Network (SW AHSN) project manager Kim Morrissey shares five lessons learned from spreading the innovations in the South West.
The Innovation & Technology Tariff and Innovation and Technology Payment (ITT/P) are NHS England programmes, supported by Acaemic Health Science Networks (AHSNs) across the country, which aim to remove the financial barriers to the uptake of innovation in the NHS.
There are ten innovations between the two schemes, ranging from a digital platform to support people through rehab for chronic obstructive pulmonary disease, to devices which help secure peripherally-inserted central catheter lines and reduce infection rates.
In this blog, I share the insight gleaned from spreading all 10 of the ITT/P innovations, which I hope will prove useful for anyone embarking on a spread journey themselves.
1) There are ‘many ways to many’
As pointed out by Billions Institute change advisor Joe McCannon et al in the Stanford Social Innovation Review, there are ‘many ways to many’. This means there is no single method for spreading innovation because the circumstances in each setting vary. There are various models out there to choose from but I used a mixture of the Billion Institute’s Methods and tactics to raise awareness, build will and support behaviour change along with the ‘Beyond Adoption..’ framework and a systematic review carried out by primary care professor Trisha Greenhalgh et al. Although it’s not compulsory to use frameworks, working with the SW AHSN evaluation team to follow these helped me consider the methods that could be used to move our stakeholders from one behavioural stage to the next.
Methods and tactics to raise awareness, build will and support behaviour change – Billions Institute (view here).
2) Why are we doing this?
It’s easy to get to lost in the day-to-day job and forget who we are doing this for: patients and the healthcare staff who work hard to look after them.
The greatest reminder for me was visiting the frontline, something Joe McCannon – calls ‘getting out into the field’. There, I was able to see the challenges NHS staff face and the positive impact changes to health and care service models and innovation can make to patients and the healthcare system.
In 2018, I was lucky enough to join urologists from across England at Tiverton and District Hospital for a masterclass in UroLift – a surgical procedure for benign prostatic hyperplasia, a common and chronic condition where the enlarged prostate can make it difficult for a man to pass urine, that can be performed as a day case.
Getting into scrubs and going into theatre to observe Mr Malcolm Crundwell, urologist at Royal Devon and Exeter NHS Foundation Trust, perform the tissue sparing procedure on patients was an incredible experience …and not for the faint-hearted! The most rewarding element was being informed that the patients he had treated that morning were all up and walking around just a few hours after. This was quite something considering invasive alternatives mean patients have a long recovery period, preventing them from returning to work, driving, and going about their normal lives for several weeks!
3) People, people, people
The importance of relationships when spreading innovation shouldn’t be underestimated. Some of the most productive conversations I had on the ITT/P programmes happened as a result of existing relationships within our team and networks we had either built or were part of. This is sometimes referred to as ‘network surfing’ – using existing networks of key stakeholder groups to spread innovation.
We integrated Episcissors-60, angled scissors for episiotomies to reduce obstetric anal sphincter injuries during childbirth, into the SW AHSN’s existing maternity and neonatal local learning system – a series of quality improvement-based workshops. Not only did the existing network infrastructure make it more efficient for us, it also meant we were not having multiple different conversations with the same stakeholders and taking up their precious clinical time.
4) You don’t need to be an expert in everything
Each of the innovations were aimed at different specialities, meaning it was difficult to be an expert in all areas. I didn’t have any prior clinical experience, so having a dedicated SW AHSN clinical lead to support me when navigating the healthcare system was invaluable.
‘Extension Agents’ is a term Joe McCannon uses to describe people who travel from site to site across a geographic area to bring ideas, collect problems, and connect. On the ITT/P, I saw the ten companies distributing the innovations as extension agents. The suppliers routinely visited sites so having good relationships and regular contact with them was key to gathering intelligence and supporting any needs our sites had. I checked in with each company every fortnight to understand how their local conversations were evolving, and whether there was any help we could provide.
5) Test, learn, and adapt
Many of my ITP lead peers within the AHSN Network faced similar challenges, and although there wasn’t a single solution that worked for all of our regions, the shared learning and support from our network was extremely helpful. Our working group had regular calls and we shared resources via an online collaborative platform. This meant we were able to test out approaches that each other had taken, learn from these, and adapt accordingly for our own regions.
At the South West AHSN, we often use a quality improvement method known as PDSA (plan, do, study, act) for rapid tests of change. ‘Failing’ can sometimes be seen as a negative thing but models like PDSA help us to do so in a structured way and view it in a positive light.
The second ITP programme will launch in April 2019. For more information about the programme and innovations available please contact firstname.lastname@example.org.