When it comes to the NHS, particularly when there’s a general election on the horizon, we hear a lot of rhetoric. And a lot of that rhetoric is about innovation – the need to do things better.
Politicians are playing in a complex landscape of conflicting vested interests and short-termism in which some things are literally unsayable. For some innovation is a synonym for cuts, for others innovation is inseparable from the motive for profit. And so we hear a lot of words. But what we don’t hear enough of is examples of how innovation can happen in practice.
A pitch at a recent creative problem-solving session with a major NHS trust at Nottingham University Business School came from a podiatrist. She explained how kidney patients, especially those who are also diabetic, are at high risk of losing their legs.
These patients might suffer from circulation difficulties or develop pressure sores from swelling. Their kidney problems mean they don’t heal well, and sometimes numbness might even prevent them from realising what’s happening until it’s too late.
There’s considerable evidence of the advantages of preventive treatment, but mobility issues make it hard for patients to attend clinics. Instead they need home visits, which are themselves difficult to arrange because of the amount of time spent on dialysis – sometimes six hours a day for four or five days a week.
But what if dedicated renal podiatrists were allowed to see patients during dialysis?
First and foremost, this would deliver significant benefits to the patients themselves, more of whom could receive in-clinic treatment.
And as the session heard, the estimated cost of providing such treatment in the trust’s three dialysis units would be less than the cost of a single amputation.
The pitch was met with sustained applause. Senior management in the audience immediately confirmed the concept was feasible and pledged to support it through commissioning routes. The service was up and running just three months later.
Prevention in action
As envisaged, practitioners are now able to do their job more effectively and efficiently. A move from acute to preventive treatment has already been noticed.
But the most palpable change of all has been for the patients. For many a crucial aspect of day-to-day life has been completely transformed.
The hope originally expressed at the session was that the idea would be realistically affordable, allow staff and patients to interact in a safe environment and prove popular among those receiving treatment. It has ticked all of these boxes, so satisfying the “triple burden” at the heart of modern-day healthcare – achieving cost-effectiveness, attaining the highest standards and ensuring the patient experience is paramount.
Like most practical innovations, encouraging podiatrists to work with renal patients during dialysis might appear ridiculously straightforward in hindsight. To some it might even seem little more than common sense.
Yet nobody had thought of it before. It emerged from more than 40 ideas generated during the session. The basic concept of providing primary care in a secondary unit is, in the proposer’s own words, “a completely new way of working”, and one, I suggest, that wouldn’t have been identified from the top-down or from the outside-in. Ideas like this have to come from those who are most knowledgeable and concerned: frontline staff.
Searching out radical ideas
What does this story tell us? Above all, it tells us that radical innovation – bringing value by doing differently – is the result of producing lots of ideas and then selecting and developing the best ones. In times of austerity, in a climate in which the pressure to do more with less intensifies by the day, it would seem common sense to encourage such thinking.
And yet an enduring stumbling block to innovation in organisations both public and private is the conceit that good ideas are the products of outside forces, of others, of “them” – and that innovation is the preserve of special people, the “geniuses” or “creatives”.
Imagine a company has a staff of a thousand but only expects 50 of them to contribute to its innovation activity – say, by sitting on the board or working in the R&D department. That means 950 people, 95% of the workforce, contribute nothing.
This is both self-defeating and stunningly wasteful. In a large organisation, 95% of the workforce can easily run into the thousands. Were we to follow that model in the NHS we would be dismissing the input of more than 1.5m people – minds effectively wasted. And yet the human mind is our greatest resource. It’s readily available. It’s inexhaustible. It’s free at the point of use.
The point is that anyone might hit on an idea that has the potential to be a game-changer, but what she or he probably fears more than anything – and often, alas, with justification – is that those higher up the chain of command won’t show any interest. In short, everyone has ideas, but not everyone has a voice. What’s needed is a structure that allows those voices to be heard – the opportunity to spend some time with freedom and confidence to produce lots of ideas without regard to cuts or profits and bounce them around to identify the ones that genuinely bring value.
The most important lesson to learn from this story is that this particular initiative came out of a whole raft of ideas – 40 of them, 39 of which didn’t work. Being wrong more often than you’re right is the essence of creative thinking; unfortunately, it’s also the very antithesis of our education system, our career-development metrics and almost everything about target-driven culture.
If innovation is to mean something more than words, if anything like the creative potential of an organisation is to be realised, time must be found to build and encourage an environment in which the concept is properly understood and employees know there’s a mechanism whereby they can be heard, supported and, crucially, backed from the top. We need a participative culture that recognises that all of us know more than one of us.
Sadly, participative leadership isn’t the flavour of the month. Command and control is more the thing for an election season.
So is it possible for politicians to move beyond polemics? Probably not. It’s what they do. And so for most front-line healthcare professionals effective innovation – actually bringing value, not change for the sake of it – is something that goes on despite rather than because of the rhetoric.