Common misconceptions

One of the barriers to innovation in the health and social care sector is the range of views and myths about what innovation is, who should be doing it and how it should be done.

These lead to providers, regulators and national bodies not always acting in the best ways to promote innovation, and opportunities to improve care are missed. This section of the publication describes a few of the most common misconceptions that we have come across in our sector.

Only brand-new ideas count as innovation

Every day, across the health and social care system, people have new ideas about how to improve the care that they deliver. Innovation starts with these ideas, but we will only see a fraction of their potential benefits if we aren’t able to identify the best ones and spread them across the system.

Our sector – including regulators and national bodies as well as providers – can sometimes fall into the habit of celebrating the invention of new things and ignoring the hard and important work of selecting the best of what’s already out there, and then making it work for your service, staff and people.

We need to rebalance our view of innovation and pay more attention to adoption and spread to take full advantage of the best ideas and maximise the benefits for people who use health and social care services.

This means ensuring that there is an infrastructure for innovation that includes horizon scanning, provides the resources needed to implement and test innovations, supports good communication, and motivates the people who work in the sector to innovate.

Innovation is all about cutting edge technology

Innovation doesn’t have to be high-tech or complicated.

Simple technologies can be just as effective as cutting edge or sophisticated solutions - and are often much easier to implement.

For example, in 2017 CQC reported on The Haven care home in Colchester, which had introduced measures to reduce residents’ slips and falls. To do this, the care home analysed the patterns of residents’ falls, and bought glow in the dark door frames, foot-prints and toilet seats to prevent night time slips. After this simple intervention their falls rate reduced by 50% in the first four months of that year. They are not the inventors of glow in the dark equipment, but they made it work for their residents and made a big difference to their outcomes.

Even when we are talking about digital technology, getting the basics right is just as important to improving health outcomes and safety as implementing the latest technology.

Efficient and user-friendly sign-in arrangements for clinicians, or sharing people’s information easily with the right professionals, can deliver as much benefit to people who use services as the latest machine learning applications or precision medicine therapies.

Organisations should be promoting innovation at all levels and acknowledging that the best ideas often come from frontline teams.

A proven innovation can just be rolled out in a new setting and achieve the same outcomes

It is easy to think that the hard work is done once a new technology or service is developed and shown to work in one setting, and that when it is rolled out somewhere else it will result in the same outcomes – but it is often more complicated than that, even for innovations that seem relatively simple.

For example, the introduction of a surgical safety checklist was associated with reductions in mortality and complication rates in several organisations and countries, but these benefits weren’t reproduced everywhere it was implemented.

We often underestimate the importance of adapting innovations and taking account of local contextual factors.

When this has been looked at in detail, the scale of the challenge is clear: for example, the Sepsis Six clinical care bundle that focuses on six key rapid treatment tasks, was actually found to require some 48 interdependent steps for successful implementation. In another example, implementation of Practical Obstetric Multi-Professional Training (PROMPT), which was shown to halve the number of babies born starved of oxygen in Bristol, has not always achieved such dramatic outcome improvements elsewhere. One study suggests that the success of PROMPT is dependent on the underlying safety culture and attitudes at the adopting organisation. A recent report by the Social Care Institute for Excellence on scaling innovation in adult social care found that there were few reports of innovations that had scaled significantly in recent years, and that social care is an inherently difficult environment for innovating and scaling.

As these examples show, the fact that an innovation has worked elsewhere doesn’t reduce the importance of adapting and implementing it well. The principles set out in this publication are crucial to the success of an innovation, whether it is invented within an organisation or adopted from elsewhere.

Innovation is just for the biggest and best organisations

Innovation is not just the preserve of large organisations such as university hospitals. All health and social care providers should see innovation as an important way in which they can improve the care they deliver.

When NHS England and NHS Improvement visited acute NHS trusts that had quickly adopted four nationally-supported innovations, they found that the six key principles described in this publication applied across all types and size of hospital. A trust’s ability to innovate was not correlated with its financial position, CQC rating or the maturity of its local system. Instead, innovation was seen as a way of overcoming local challenges – for example, Royal Cornwall Hospitals NHS Trust sees digital innovation as a way of addressing the challenges of rurality.

Likewise, CQC’s research has shown that many small organisations are fantastic innovators. Several of the case studies in this publication (see page 19) highlight organisations that made substantial improvements through thinking creatively about how to achieve their mission to deliver better care from a tight budget.

In fact, large organisations can sometimes face additional challenges, as they have a range of support functions (such as HR, IT, legal and estates) that play a crucial role in delivering innovation and can be challenging to coordinate.

Leaders in large organisations need to ensure that innovators and people working in support functions work together effectively, and that opportunities and resources for innovation are communicated to all staff. Board-level support for innovation is vital for its success in large organisations. It is important that the board have the capabilities they need to set a vision for innovation, lead cultural changes and understand the opportunities and risks of new technology.

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