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It's not always clever but it must be big: why we need innovation


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Friday, 3 September 2010

It's not always clever but it must be big: why we need innovation

Innovation is often confused with invention. Invention is a minority pursuit. Only some of us can invent, but all of us can innovate.

Most descriptions of innovation feature invention, but recognise that on its own invention doesn�t get us very far. It�s what you do with the invention that counts, whether you can persuade other people to use it and how you make sure that everyone who might benefit has access to whatever it is. It is these later stages of innovation � usually termed adoption and diffusion -- that most concern the NHS and particularly the architects of the QIPP programme.

It is boring but still necessary to point out that the NHS does some things brilliantly, but usually on a small scale, in a minority of cases and in a handful of locations.

Scaling up the good stuff and driving out mediocrity has inspired countless policy initiatives and slogans. We have sought high quality care for all, made good great and worked towards being world-class commissioners � the objective always being fundamentally the same: to make best practice common practice.

Inventors do not need encouragement. They invent for the sake of invention, often creating solutions to problems that have not yet appeared or may never appear.

Innovations are not always clever or complicated. One of the greatest innovations in patient safety in recent years is the surgical checklist conceived by Dr Atul Gawande which is now used in hospitals all over the world.

Surgical teams use the checklist to verify the basic facts: Do we have the right patient? What procedure are we about to carry out? Does everyone on the team know their role? Is the patient on medication that might cause complications? Is there anything else we need to know?

The checklist prevents the sort of simple but potentially catastrophic error that can be made when routines become too familiar, such as amputating the wrong limb.

Dr Gawande can take the credit for the original idea, but also for understanding that implementation is more important than discovery. Had he kept it to himself, he might have saved a life or two. By encouraging the wider uptake of the checklist, it�s a reasonable assumption that thousands of lives will be saved.

Similarly, the dramatic fall in MRSA infections in the NHS can be attributed to implementation � the dull but important rear-end of innovation. The invention in this case was nothing more than a desire to improve hygiene procedures. MRSA is often spread by patients who acquire the infection in one setting and are admitted to another soon after. So a piecemeal approach would not have worked. The innovation was to make sure that everyone was following the procedures.

A couple of months ago, the Organisation for Economic Co-operation and Development (OECD) held an open forum, which concluded that innovation is critical to social and economic well-being. The OECD�s head of science, technology and innovation, Andrew Wyckoff, underlined the point that while R&D is important, it is only part of the picture.

Critical success factors for innovation are collaboration between different sectors and disciplines, and access to knowledge networks, he said.

Aneesh Chopra, the US chief technology officer and an assistant to President Obama, talked about the role of information technology and the critical importance of open access to data. It was striking that every example of innovation he gave was healthcare related.

His message in less than ten words: information is power, but only if you share it. The lesson for the NHS is just as simple. We don�t need to waste our energy coming up with more ideas. Somebody somewhere has had them already. We need to focus instead on taking what works elsewhere and making it work for us.