Some organisations, especially those that have been around for a while, struggle with innovation. The reason is often quite simple: they’re so good at doing what they’ve always done that they have no inclination to change. Over time trial-and-error has been replaced by tried-and-tested. And so they carry on until transformation is forced on them from the outside rather than from within.
Even upon realising the choice is to innovate or die, these organisations assume a default position of attempting to get even better at what they do best. They build structures with rewards and sanctions to deliver continuous improvement. Ironically, this sort of incremental innovation can make them even more resistant to radical change and even more focused on short-term deliverables.
The trouble is that “doing better” sounds a lot less frightening than “doing differently”. Not least in the language of public service innovation, the latter is routinely interpreted against a backdrop of cost-cutting versus vested interests. That’s why we hear plenty of phrases like “more for less” and “not harder but smarter”.
What we hear precious little about is how innovation actually works. The following is a rare example from the NHS.
It’s not sexy or heartrending. It involves nothing new by way of drugs or surgery. It concerns only the ordinary business of day-by-day care and treatment. But it shows what can be achieved if an organisation takes the time to understand how radical innovation comes about and how, once embraced, it can deliver long-term and wide-ranging benefits.
A little over a year ago, at a creative-problem solving session hosted by Nottingham University Business School, a podiatrist took to the stage to describe the risk of renal patients losing their legs because of circulation issues or pressure sores. As she explained, preventive treatment is known to be highly beneficial but has traditionally been extremely hard to provide.
Lack of mobility makes it tricky for these patients to attend clinics. The amount of time they spend on dialysis also means home visits are challenging. So what about a novel approach, she suggested, whereby dedicated renal podiatrists could see patients during dialysis, allowing more of them to receive in-clinic care?
Although many truly effective innovations appear blindingly obvious with hindsight, no-one had thought of this before. It represented a completely new way of working. Sadly, the optimism of innovators who think “out of the box” too frequently comes a cropper when “business as usual” resumes a few months down the line.
It’s therefore particularly satisfying to report that this project has been a huge success. The pitch won the instant backing of senior managers, who backed the concept through commissioning routes, and the service was fully implemented within three months. It has improved savings, enhanced patient satisfaction and allowed staff to work more efficiently.
With the anticipated move from acute to preventive treatment already apparent, the team responsible has been able to collate a host of supporting data that makes a strong case for recommending all dialysis units across the UK follow this model of care.
This has to be great news. Imitation is the sincerest form of flattery and all that. And yet it’s worth pausing to examine how such a simple solution came about, because that’s the real lesson that needs to be learned here.
Although an outsider can see the benefits of a radical innovation, an insider can see the problems. In tandem, even though everyone might be able to discern the value, the price has to be accounted for somewhere.
This initiative concerned delivering community care in a secondary care unit in order to bring about savings in primary care. That meant disturbing an array of structures put in place to facilitate a “business as usual” culture.
The podiatrist’s initial argument was that the cost of providing such treatment in her trust’s three dialysis units could be offset against a single avoided amputation. Although this could be easily understood from an overall viewpoint, the costs would be incurred in one department, the benefits accrued in another and the treatment itself carried out in yet another.
Such cross-site collaboration demands careful explanation, which is why such an initiative couldn’t have come out of existing practice. It would most likely never have emerged from the top down or even the outside in. It had to come from front line staff, the people most knowledgeable and concerned.
Of course, front line staff working at 100% efficiency don’t have the time – never mind the incentive – to reflect on the potential advantages of radical innovation. So the first thing to do is to allow them the opportunity to think differently.
This means appreciating that the way to have good ideas is to have lots of ideas and discard the bad ones. You have to be willing to be wrong more often than you’re right. By way of illustration, the podiatrist’s proposal was one of 40 aired during the same session.
The would-be sources of feasible ideas also need an environment that promises them a hearing and, if appropriate, the necessary support. This can’t happen without a basic willingness to accept that everyone is capable of contributing to the cause of innovation.
It’s when these fundamentals are in place that the real work can begin. Building trust among the various parties involved is essential, because any innovation is under near-constant threat of being stifled by inertia. It’s easy for people who are already busy to do nothing, which is why a lot of good ideas fail – not because they’re tried and found wanting but because they’re never tried in the first place.
And even when they are tried, even when all the earlier hurdles have been overcome, there’s still uncertainty. This is a crucial point. Costs and benefits might change again and again. Metrics might become redundant. Such churn requires tolerance.
In the case of the podiatry innovation, for instance, the metric originally used to “sell” the idea – the price of an amputation – is no longer relevant. In a sense, the original problem has gone away. Yet the scope to bring value is undeniable, especially when NICE reports that the cost of diabetes and related complications amounts to 8% of the NHS’s annual budget and that a predicted rise could bankrupt the service.
Amid talk of a £22bn “black hole” in funding, it’s comforting to contemplate that the NHS’s elusive engine of change could turn out to be much closer to home than is customarily assumed. The story recounted here shows it’s perfectly possible to build structures that encourage, acknowledge and reward new ways of thinking among front line staff.
If good ideas can come from anywhere in an organisation, though, it’s vital to recognise that the culture that enables them to succeed can come only from the top. Managers have to make time for employees to think differently; they have to support the feasible ideas that emerge; and they have to tolerate the uncertainty that radical innovation inevitably brings.
This ideal is likely to become a widespread reality only if everyone learns to accept that radical innovation is always disruptive and, by extension, that existing practice might just be a hindrance. In other words, everyone – management included – has to be prepared to move out of their comfort zones. It sounds daunting, but it could be a game-changer.
Paul Kirkham is a researcher in the field of entrepreneurial creativity with Nottingham University Business School and co-deviser of the Ingenuity problem-solving process taught to students at its Haydn Green Institute for Innovation and Entrepreneurship (HGIIE).