A manual guide to healthcare innovation success

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Abstract

Background The UK has a well-developed healthcare research and clinical trial portfolio and has demonstrated significant activity over the years. However, research outcomes do not always translate into clinical practice change, despite research being most often driven by front line clinical leaders who are the professional experts of the clinical services and pathways. Similarly, healthcare innovation which involves the design of new services and products to meet healthcare needs or the improvement of existing services, is often initiated by front line clinical innovators, who are committed to finding solutions to common healthcare problems. But when it comes to innovation adoption, diffusion and implementation, there are often limited capabilities in the UK public healthcare system to turn ideas into sustainable improvements in clinical practice. Consequently, healthcare innovations often stall at the adoption stage and do not diffuse beyond a local hospital pilot stage.

Leadership within healthcare organizations is considered to be a key driver for all stages of innovation, from ideation to adoption, diffusion, implementation and innovation sustainability. The role of individual and organizational leadership in driving the different stages of innovation needs to be further explored and understood so that systems and frameworks are put in place to enable innovation success. In the current volatile, competitive and unpredictable external environment, healthcare organizations need to think and operate differently and more collaboratively, in order to improve outcomes at a population and system level, whilst delivering cost efficiencies. The introduction of Integrated Care Systems in April 2021 has already started to challenge the current status quo of the UK National Health Service. Innovation is high in the government healthcare agenda, evident from the publication of a new national strategy for innovation, the introduction of global digital exemplar and digital aspirant NHS Trusts, the launch of innovation accelerator and technology funds as well as other national initiatives to boost innovation.

The purpose of this manual is to provide a practical and strategic approach to initiating, implementing and diffusing innovation in the healthcare sector. This manual is the product of the researcher’s doctorate in business administration program. It defines the factors that enable innovation success in healthcare, with reference to all stages of innovation and with a particular focus on the role of clinical and organizational leadership in effecting innovation success.

The manual is aimed for doctor leaders, clinical innovators, researchers and strategists working across the public and private healthcare sectors. It is also relevant to healthcare executives, system leaders and commissioners. The manual provides practical guidance on how clinical leaders, healthcare managers and other stakeholders can apply leadership capabilities effectively at different stages of innovation, in order to enable innovation to move from ideation, to adoption, diffusion, implementation and be sustained long-term. The researcher does so by presenting three real life healthcare innovation processes, the interaction between innovation stakeholders, the challenges that innovators faced as well as the influence of internal and external stakeholders in the success and failure of those innovations.

Methods
The researcher reviewed the theories of innovation and leadership that exist in the literature and related the learnings of those with the real-life experiences from three contemporary healthcare innovation case studies. A combination of ethnographic observations of innovation processes and participant interviews, were all led by the researcher and healthcare leader in all the three case studies. The studies took place in two separate healthcare organizations, one being an acute NHS University Hospital in UK and the other being a UK and global based private healthcare organization. The researcher took different leadership roles within each innovation process, from a frontline clinical leader in case 1 (NHS digital innovation), to the executive medical director in case 2 (private healthcare transformation program) and the meso-level clinical director in case 3 (NHS transformation program). An in-depth interpretive case study approach which includes ethnography and interviewbased methods has been proposed as the optimal methodology when studying complex healthcare systems and in particular, the methods of innovation spread. The researcher used a realist evaluation approach which enables the evaluation of complex healthcare innovations with spread capabilities. The approach involves the understanding of what has worked or hasn’t worked, for whom, under what circumstances, the how and why it worked, by relating the clinical and organizational leadership capability with the innovation outcomes. Such a realist approach is appropriate, as research on healthcare innovation spread is an unmet need and questions around ‘what works’ and ‘what doesn’t work’ in healthcare innovation processes, are key to explore from a leadership perspective.

Results
Our preliminary cyclical innovation model using data from the first two innovation case studies, represents the dynamic and complex process of innovation within complex healthcare organizations. It reveals that innovation is a continuous process within healthcare organizations and that leadership is essential across all stages of innovation. Healthcare organizations need to invest on innovation in terms of senior leadership, operational management and supportive resources (finance, commercial, technical). The ingredients for innovation success in our preliminary model included a flexible topdown and bottom-up leadership at different stages of innovation, early opinion leader engagement and knowledge mobilization, partnership creation (clinical networks), clinician incentivization and engagement, early evaluation of the innovation implementation benefits. Knowing about those ingredients of innovation, we proceeded to the study of the third innovation case study which helped enrich and refine our proposed innovation model. The unstable political, socio-economical and technological environment played a very important role in the innovation outcomes of case 3, unlike cases 1 and 2. A useful learning point in case 3 is the important role of the healthcare context and the power of commissioners within integrated care systems, as drivers of the overall vision for innovation within NHS organizations. A shift in culture from procurement solutions to more sustainable service solutions based on patient outcomes required strong commissioner leadership at a system level. 4 The three case studies have demonstrated that there are 8 key ingredients in making healthcare innovation a success, based on essential individual and organizational leadership behaviors. Those are summarized below and incorporated into our new model of leadership in innovation: 1. Integrated Care System (ICS) leadership: integrated care represents a shift in the mindset of commissioners in terms of putting long-term outcomes for patients and populations first before short-term organization outcomes. The need for strong leadership at system level and not just at organizational level is now stronger than ever. Close working between commissioners of healthcare services and the end users of services, primary and secondary care providers, the voluntary and private sectors, academia and the industry, is essential in order to agree on commissioning services that really matter to patients. Clinical leaders should take more active role in ICS leadership positions to be able to mobilize resources and drive healthcare innovation. 2. Early Key opinion leaders (KOLs) involvement: KOLs are the legitimate and respected clinical representatives and champions of innovation, who need to work together with top managers and commissioners to embed the clinical evidence for innovation into healthcare organizations. KOLs are the people who can mobilize knowledge within and across organizations as well as healthcare systems. They represent the agency that enables the voice of their peers and non-peer clinicians to be heard, they can influence their peers and non-peers and can catalyze the adoption, diffusion and implementation of innovation. 3. Meso-level clinical leaders working collaboratively with the operational management team can bridge the gap between executive sponsors, commissioners and front-line clinicians, acting as agents and facilitators of innovation. 4. Healthcare innovation adding societal value: innovation should benefit the society as a whole and not just individual patients, based on shared vision and goals that promote better population health. The benefits from innovation implementation can be financial or non-financial, the evaluation of those benefits should start early on in the innovation process and be used as vehicle for communication and championing innovation. 5. Clinician incentivization and engagement is critical in the innovation process in order for front-line clinicians to engage consistently throughout the process. A robust benefit analysis with a clear benefit evaluation and communication plan that starts early in the innovation process (ideation and adoption stage), can help sustain clinician interest and engagement. Matrix working in a multidisciplinary approach between clinicians, managers, executives within an organization and across clinical networks creates a sense of common purpose, removes the power conflict between clinical innovators and non-innovators and cultivates compassionate leadership. 6. Partnerships are essential throughout all stages of innovation. To be able to achieve this, internal and external partners may need to combine forces so that they offer a truly personalized care and patient experience. 7. Top-down directional support (ICS leaders, commissioners, executives with power to commission innovation) is essential in setting the common vision and purpose of any innovation and transformation strategy. This is particularly important in the early (ideation) and late stages (sustainability) of innovation. Without such executive support and investment on innovation, clinical innovators 5 often struggle to see their innovative ideas taking off, resulting in them becoming disillusioned or demotivated along the way. 8. A flexible top-down and bottom-up approach in leadership is needed at the diffusion and implementation stages of innovation, because those stages require significant clinician engagement and clinical agency for change (bottom-up) as well as executive investment and direction (top-down).

Summary The innovation model of the future for healthcare organizations, is a harmonious combination of top-down leadership and bottom-up agency aiming at transforming organizational processes and innovation behaviors in order to maximize innovation success. Clinicians, managers, commissioners, patients and the industry should work closely together to prioritize and work out innovative solutions to healthcare problems. Organizations and systems who embark into their innovation and transformation journeys will benefit from our model for leadership in innovation. Our model can help create the framework for maximizing innovation success within healthcare organizations.

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