BLOG: 10 factors for successfully systemising innovation and improvement

The South West Academic Health Science Network (South West AHSN) is working closely with local Integrated Care Systems (ICSs) to understand what enables innovation and improvement in a health and care system. 

Here Dan Lyus, Director of Partnerships for the South West Academic Health Science Network (South West AHSN), describes the 10 factors gleaned from our work that suggest how ICSs can effectively integrate innovation and improvement into their design.  

Legislation that has recently come into being around health and social care integration places a responsibility on Integrated Care Systems (ICSs) to ensure research, improvement and innovation (RII) are prioritised in their systems. So how do ICSs, which currently exist as systems of partners, design into their new system approaches to RII that have historically been conducted in silo?  

Through collaborative field research with Integrated Care Systems in the South West, alongside detailed desk research with national ICSs, we’ve been able to piece together an evidence base to support the integration of RII into an emerging system: our ten factors for successfully systemising innovation and improvement.  

A starter for ten   

Our work to understand the factors needed for systemizing innovation and improvement is rooted in a 2018 report by The Health Foundation, The spread challenge. The report highlighted the challenges of adopting innovation in health and care systems, and the need for new approaches to programme development to support the spread of innovation.  

A subsequent fund set up by The Health Foundation for innovation hubs across the country led us to support our three local ICSs, Devon, Cornwall and Somerset, to bid for support. Our work together fuelled our understanding of the barriers and enablers to adoption of innovation in their systems.  

Then, with the outbreak of COVID-19 in early 2020 and our subsequent work to support our three local systems through the changes that ensued, came our understanding and proposal of the eight conditions needed for rapid change in health and care.  

In parallel our understanding of system need was embellished by insights from our work with Devon Sustainability and Transformation Partnership on the Think 111 campaign and with NHS Nightingale Hospital Exeter.  

Collectively these pieces of work emphasised to us that you need certain factors in place to be able to adopt innovation and scale it across a system. So, when we were approached by Devon ICS as part of their development work, to identify UK-wide approaches to integrating innovation and improvement into ICS design, we stepped forward. We were keen to utilise a strong foundation of knowledge about systemisation of innovation, built on a deep, practical process. Through our ensuing collaboration we built on our historic work with The Health Foundation and our system partners, validating our theories about the ten factors it takes for successful use of innovation and improvement in ICS design.  

The top ten

The following ten factors we suggest an ICS needs to successfully integrate innovation and improvement into their design.   

• Provide corporate-level leadership to develop and implement service transformation practices. Invest in programme management, analysis, evaluation and learning skills for innovation and improvement projects. Coach and develop leaders with the soft skills to implement innovation and improvement at pace, systemically, in context. 
• Motivate and support teams to connect, co-design and co-produce. Allow space and promote the value of exploratory conversations that build shared purpose and identify shared challenges. Promote/enable a continuous improvement culture, developing an internal network of staff who freely champion improvement and implementation approaches across traditional boundaries.  
• Invest in those who can be called upon to support improvement and implementation. Building from the improvement expertise in the system, invest to develop a systemic capability in improvement practice. A commonality of methodological approaches to improvement and innovation are more likely to support wider cultural change. 
• Identify and frame the challenge: matching innovation with un-met need. Learn to love the problems – continuously gather information to deepen the understanding of the problems. Assess potential impact of action on a thorough review of the capability and capacity in the system as well as the evidence of the fit of the intervention to the problem. 
• Cultivate and access an innovation pipeline. Harness the wider innovation ecosystem capability of the research and clinical community. Develop an innovation pipeline able to routinely and continuously scan, classify, test, select and adapt innovations. 
• Support prioritisation to enable delivery of innovative practice. In the short term, prioritise the adoption and spread of available innovations that will confer near-immediate benefit. Medium to long term – prioritise innovation and improvement projects that offer ‘high leverage’ for the changes you are seeking. 
• Routinely gather insight from service users, and co-design. Define the role of user insight in decision making, at design, delivery and strategic level. Ensure those who will be impacted by innovations/interventions are actively engaged as equal contributors in research/co-production. 
• Test and Learn. Create and curate mechanisms and approaches (tests of change, peer networks, huddles and learning logs) that support excitement for and ultimately a healthy addiction to continuous learning so that improvements to methods occurs iteratively. Maintain/build the awareness, will and skill levels necessary for the challenges ahead – sharing learning/impact stories. 
• Design and integrate enabling evaluation plans. Set specific, timebound, measurable aims and select meaningful and measurable indicators of the change the system needs. Continuously learn, monitor and support progress through the integration of analysis and evaluation into delivery. 
• Apply insight to increase the impact of the innovation and improvement ecosystem. Review your innovation ecosystem to identify where your next set of investments will return the biggest benefit. Support knowledge transfer and dissemination of improvement and implementation practice across wide areas – creating strong bridges between research and improvement networks/systems to attract resources to the ecosystem. 

Ten together  

If you work in the health and care system, some of these 10 factors may be highly familiar to you. Perhaps you already perform them or are working towards them.  

To others of you, some of these factors will seem sensible, but the pressures of day-to-day service provision will mean they don’t or can’t take place. Take test and learn, for example. The idea of experimentation and a safe environment in which to do so is ideal, but there can be limited freedom to do it.  

When we published our eight conditions for rapid change in health and care, our partners and peers asked us which condition is the most important. The answer? None more so than the other – they’re equally important and need to operate in tandem to create change.  

Naturally, we expect the same question here. You can implement any of the ten factors individually, but it is the combination of all ten that is important. In a complex health and care system, the presence of these ten will create significant leverage potential.  

This is down to connection. For example, if you don’t have corporate-level leadership which creates a culture in which it’s deemed OK to fail, then testing and learning will fall flat. Or if you don’t identify and frame the challenge by continuously gather information to deepen understanding of the problems, it will be challenging to develop an innovation pipeline with the innovations needed to respond to your system’s needs. 

So pursuing all 10 factors in combination should give ICSs the best chance of success in achieving the degree of change necessary to effectively adopt innovation and improvement at the scale and pace they want.  

What now? 

ICSs were placed on a statutory footing from the beginning of July 2022. In the South West we have been working with the leaders of our three ICSs since late 2021 to co-design a framework that can enable the effective deployment of these 10 conditions. 

This framework is now coming together. Our intention is that as we start to run live tests through the framework – and share the learning from these tests within and across ICSs – it will support our region to engage in a learning system approach to research, innovation and improvement. This could offer significant change potential and accelerate the adoption of innovation in our rural and coastal communities (read our blog on the importance of place and context in spreading innovation here). 

We look forward to sharing more insights with you as we progress our work to explore the systemisation of innovation and improvement. Until then, why not learn more about how the South West AHSN is supporting the local health and care system to build capability to enable innovation and improvement to thrive, or read about examples of our work in our latest Annual Review 2021-22.  

We are always keen to hear from our partners and peers working across health, care and innovation. If you’d like to explore the 10 factors in more detail – or you have an idea or opportunity of your own you’d like to explore – please get in touch. Together we can create the conditions needed to improve the health and wellbeing of those living across our region.