Jonathon Gray is Chief Executive of the South West Academic Health Science Network
Christmas is a great time for reflection, a pause for breath as we contemplate our achievements through the past year and prepare for the challenges ahead. Sometimes I look at a piece of work, and marvel at how ‘magical’ it appears to be. The aim is inspiring and audacious, yet somehow achieved. One of our areas of focus for 2018 will be how we share great ideas and innovations better around the South West and the NHS nationally.
We have no shortage of creativity and wonderful new ideas. The literature and our conferences are bursting with many examples of small-scale improvements. But publications, conference presentations and posting on websites are weak hypotheses for wider implementation. My suggestion is that we have much to contribute, but also much to learn from the developing field of the science of large-scale change.
Work like the 100,000 Lives Campaign (Institute for Healthcare Improvement), the 1,000 Lives campaign (Wales) and many more initiatives do look ‘magical’, but you and I know that the reality is different: they were meticulously planned, involved gruelling, long hours of work from many incredible people, often on top of their busy day jobs. Crucially they had a clear aim, a logic which we tend to put into a ‘driver diagram’, and a methodology for small-scale change testing.
Stepping back for a moment and reflecting on work in different systems around the world, I have observed a number of blocks to the spread of new ideas and innovations:
- The status quo or ‘how we always do things’ tends to be all-consuming and denies us the space to think or work on transformation.
- Acute, urgent issues can overwhelm us and prevent us addressing the important issues that slowly draw ever closer.
- Isolation: the loneliness that often comes with this sort of improvement work.
- The loss of a sense of the bigger picture. Often we focus our attention on just one part of the system and not the whole.
- People become fearful after failures, and it’s understandable that fear of further attempts is a significant barrier.
In the summer, I visited Rome for the first time. A wonderful city, where the past sits alongside the present. Two thousand years ago, Rome sat at the centre of a huge empire, criss-crossed by 55,000 miles of incredible well-made roads. As I walked around Rome, the centre of that empire, I reflected on how they had not just invented so much, but how had they engineered the spread of ideas across their system? Architecture, sanitation, aqueducts, cement, libraries and of course their famous baths and roads.
It turns out those baths and roads are pretty fundamental to the success they achieved, as were the deliberate settling of soldiers across the empire, the prizing of knowledge and ideas, and the joy they took in debate. The Romans teach us the importance of creating the right climate for change, the infrastructure, and great enthusiasm not just for creativity and invention, but the systematic transfer of knowledge.
We know that traditional approaches – meetings, committees, consensus and broadcasting of information – are unlikely to be successful. Instead we need to build an ‘incident command’ culture that is fast-paced, agile and adaptable in real time. Looking at other industries and sectors, there are over 100 approaches that could be applied to large-scale change initiatives. Which is the right one for any given innovation or improvement? Well that takes us deeper into the science, which we will explore in subsequent blogs.
Let’s be clear: it is no longer good enough to come up with the ideas – the majority of current attention, thought and funding goes into the creative end of the process. Not enough resource goes into the implementation and sharing to ‘Make It So’*. My definition of innovation, borrowed from industry, is ‘ideas into action’. To get that action, we need to successfully spread those ideas.
It turns out achieving large-scale take-up of innovation is not ‘magic’, it’s disciplined, structured, practised hard work. But when it works, perhaps it does feel like magic.
*As well as learning from the Romans, I sometimes wonder what we can learn from another ‘republic’: the fictional future as portrayed in Star Trek! I hope you enjoy this festive diversion.