If anyone needs a reason to innovate in the NHS, then they need look no further than the Francis Report into the deaths at Mid Staffordshire. This was published this February and painted a picture of a health service under pressure, constrained by money and targets and managed by people out of touch with the frontline. In the advent of one of the largest healthcare scandals in recent memory, there is a real focus on both improving the standards of care and about driving clinical innovation.
The culture change Francis asked for in order to make sure that patients never went through this again, was enabling fresh ideas from the ground up to be actually put into practice.
So what stops this from happening?
Nurse First recently surveyed NHS clinicians find out what were the major barriers stopping local innovation. We also wanted to know what had worked in order to help others create sustainable local innovation. We were really surprised that the top answer was not money in either case.
The most important factors that helped create clinical innovation (in order) were:
• The attitude of senior and middle managers in their organisation
• Being given skills and knowledge around in innovation
• Being given protected time for innovation
• Being given access to senior managers in their organisation
Access to start up funding was mentioned but was not even in the top 5 factors that actually helped people create innovation.
We were surprised by these findings as we had expected to find money the main issue. Yet in reality it may be liberating because anyone really wanting to create an innovative and safe organisation in the NHS doesn’t have to worry about money first and foremost but should focus on changing the attitudes of management and giving staff the skills and knowledge to put their ideas into practice. If an organisation wants to create more clinical innovation, the answers are less about finance and more about attitude and access of its management team, combined with skills, knowledge and time to encourage innovation.
The issue of getting access to senior managers was a theme that emerged elsewhere in the study. Our survey found that 38% of clinicians found it difficult or impossible to meet their own Chief Executive and some people may find this surprising. One of the things we ask participants on our innovation programme to do is get a meeting with their Chief Executive. This turns out to be a very interesting indicator of the culture within healthcare organisations. In some cases we have seen staff being threatened with disciplinary action simply for trying to contact and meet their own Chief Executive. In these cases Chief Executives were often completely unaware of the gatekeepers in their own organisations who prevent them from talking to frontline staff.
We know that we cannot keep delivering healthcare in the way we have been doing it for decades, pouring more and more money into hospitals and ignoring the demographic time bombs around diabetes, heart disease and dementia. We also know that innovation in healthcare is much more likely to come from the clinical staff who provide care and the management challenge going forward is how to help these innovative ideas flourish and help make them sustainable and scale quickly across the whole NHS.