5 – Encouraging innovation

Clusters can play a key role in developing novel approaches to address local challenges, identifying successful projects for upscaling/ mainstreaming, and adapting or implementing prior learning from across Wales.

Developing innovative ideas                                                                           
Innovation involves development of “new or improved health policies, systems, products and technologies, and services and delivery methods that improve people's health, with a special focus on the needs of vulnerable populations” (WHO, 2016). The following resources offer insights into getting started and pitching cluster ideas in supportive environments:

• Innovation Programme for Health and Social Care (WG): Details TBC; draft logic model published for Innovation Strategy for Wales, Dec 2021 (here) aspires to deliver increased adoption of innovation; improved patient/ citizen outcomes; improved patient/ citizen experience; and improved resource efficiency.
• Caring to change: how compassionate leadership can stimulate innovation in health care (The King’s Fund, 2017): This paper looks at compassion—which involves attending, understanding, empathising and helping—as a core cultural value of the NHS and how compassionate leadership results in a working environment that encourages people to find new and improved ways of doing things.
• Open innovation in health: A guide to transforming healthcare through collaboration (NESTA, 2017): This guide explores examples of open innovation in the field of health from around the world. It analyses the ways that companies, governments, researchers and citizens are collaborating to improve the innovation process, from the way that problems are identified to how new products and services are created and then adopted by providers of healthcare.
• Crafting an elevator pitch (Mind Tools): An elevator pitch is a brief, persuasive speech that you use to spark interest in what your organization does. You can also use it to create interest in a project, idea or product—or in yourself.
• Creating a value proposition (Mind Tools): Communicating the benefits of your proposition simply and clearly.

Driver diagrams to support cluster innovation
Driver diagrams offer a tool to assist planning of improvement projects. They can:

• Provide clarity and structure for clinical teams, whose focus is operational delivery
• Be used to translate improvement goals/aims into a logical set of high level factors (primary drivers) that need to be influenced in order to achieve the agreed outcomes
• Detail the specific projects/activities that are needed to act on the higher level factors.

This structured approach assists the allocation of tasks to individuals or groups and provides an estimate of the skills and capacity to deliver the agreed actions. This also encourages the prioritisation of objectives where there are multiple competing expectations.

Primary and community services are complex and it can be challenging to deliver innovation in these settings. Driver diagrams can be used to gain clinical engagement (by communicating the project in logical sequence and with defined tasks) and to clarify what can reasonably be expected within the objectives of a small cluster team. Health boards may also develop innovation teams with skills and capacity to enhance local teams for identified priorities.

Tasks that cannot be accommodated should be added to local risk registers to provide a clear analysis of the unaddressed potential for improvement.

Professional collaboratives should be encouraged to generate improvement proposals as independent groups and across system boundaries. Pan-cluster planning groups (PCPGs) should establish systems to receive and consider these submissions, ensuring that improvement efforts are addressed to the agreed local priorities. An evaluation should be integral to all proposals and learning should be shared. A schedule of current projects should be maintained to monitor progress and ensure that cycles of change are completed.

Example driver diagrams include:

• IHC driver diagram examples (multiple), here
• Safe and reliable patient care, here
• Quality improvement work around COVID-19, here

Upscaling from pilot projects
Pilot projects serve to differentiate that which works from that which does not. Taking things that do work on a small scale to a larger scale (e.g. health board or all-Wales footprint) can be challenging; advice is contained with the following resources:

• Scaling up projects and initiatives for better health (WHO, 2016): Scaling up means expanding or replicating innovative pilot or small-scale projects to reach more people and/or broaden the effectiveness of an intervention.
• Bevan Exemplars Programme (Bevan Commission): Bevan Commission innovation programmes support and enable change makers to transform health and care services for all citizens in Wales and beyond.
• Against the odds: Successfully scaling innovation in the NHS (Innovation Unit, Undated): This report from the Innovation Unit and the Health Foundation calls for new approaches to scaling tried and tested health care innovations; it highlights the need to create the right conditions to spread these successfully across the NHS.
• Spreading and scaling up innovation and improvement (BMJ 2019;365:l2068): Disseminating innovation across the healthcare system is challenging but potentially achievable through different logics: mechanistic, ecological, and social.
• Effective strategies for scaling up evidence-based practices in primary care: a systematic review (Implementation Sci 2017;12:139): It is uncertain whether any strategies were effective as most studies focused more on patient/ provider outcomes and less on scaling-up process outcomes.
• A principled approach for scaling up primary care transformation in Alberta (University of Alberta, 2018): Address the early majority in terms that make sense to them; Help teams learn to distribute knowledge work activities and shift their mental models; Practice facilitation is essential; Focus incentive changes on removing barriers and obstructive incentives; and Focus on team-based, systems-based CDM as the initial target.

Learning from the Pacesetter Programme
Learning captured by the National Primary Care Pacesetter Programme critical appraisal (University of Birmingham, 2018) identified six transformation enablers. These enablers are recognised as key to successful transformation of health systems, both in the UK and internationally. Note that Pacesetters are superseded by the Strategic Programme for Primary Care Fund from April 2022:

• Facilitating: External facilitation is made available to general practices to provide additional capacity and expertise in undertaking transformation.
• Leading: Clinical and non-clinical leaders for the programme are identified within the practices and if relevant in local primary care networks and are given the time, support and space to reflect on the transformation process.
• Learning: Learning and development in relation to new skills is available, and there is opportunity to learn from the implementation process through structured reflection on emerging evidence.
• Engaging: Stakeholder engagement with patients, communities and wider clinical networks is embedded throughout with sufficient investment in associated infrastructure, capacity and skills.
• Funding: Transitional funding to enable continuation of existing activities whilst new approaches are introduced and free up capacity for clinical and non-clinical leaders.
• Evaluating: Robust evaluation to provide formative and summative insights against clear objectives and baselines.