Achieving adoption and diffusion and where appropriate commercialisation of medical innovations can be a very challenging step in a highly complex process. The NHS Innovation Accelerator is achieving success in this important area and here Dr Amanda Begley, Director of the Programme, shares some early learning
Dr Amanda Begley
Since its launch in July 2015, the NHS Innovation Accelerator (NIA) has supported innovators to scale their high impact, evidence-based innovations to an additional 1,432 NHS sites across England and to raise £45m in external funding.
The NIA is an NHS England initiative, delivered in partnership with the country’s 15 Academic Health Science Networks (AHSNs) and hosted at UCLPartners. Created to support delivery of the Five Year Forward View, this national accelerator provides real-time practical insights on innovation scaling to inform national strategy, and in its first year - according to an independent evaluation - saved England’s health and care system over £12m.
The NIA’s unique dual focus offers personal development for individuals (or ‘Fellows’) with bespoke support to spread an innovation; recognising that both are critical to scaling in the NHS. To date, the NIA has supported 36 Fellows to spread 37 innovations - including digital, medtech, workforce and models of care - all of which have been through a rigorous selection process involving patients, clinicians, multiple government health agencies, NHS England, and AHSNs. Fellows come from a variety of backgrounds; some are practicing or former NHS clinicians, some work for SMEs or large corporates, some are academics or from third-sector organisations - one is even a former police officer! The one thing they all have in common is their dedication to spreading innovation for the benefit of patients and NHS staff, and for sharing their real-world insight with colleagues across the system.
So what have we learned about scaling innovation in the NHS?
We use a range of approaches to help Fellows develop their scaling strategies, including stakeholder panels, bespoke workshops, peer-to-peer sessions, mentorship, frameworks and tools. A key aim, through the partnership with AHSNs, is to enable NIA Fellows to engage with as many potential users as possible. To be successful in all phases of innovation development and scaling, the users’ perspectives - patients, clinicians, managers, payers - must always be foremost in an innovator’s mind.
The following framework incorporates some of the questions that potential users might ask themselves, and as such, highlights what entrepreneurs need to consider if they are to get CREDIT for their innovation.
Competition: How do I know this is the right solution?
It is essential to clearly communicate an innovation’s USP compared to existing practices and competitors (current and in the pipeline). Potential users need to be assured that they are selecting the right innovation. Being honest and thorough in the analysis of your competitors builds trust and saves potential users’ time.
Interestingly, we have found greater barriers to uptake if an innovation is the only solution on the market (e.g. Episcissors-60). Users prefer being offered a choice, and the NHS is often uncomfortable with backing a single (particularly commercial) solution. Where multiple innovations exist (e.g. mobile ECG devices, like AliveCor’s Kardia) there is already discussion and debate amongst potential users, creating more fertile ground for engagement.
Risk: What are the potential reputational, safety, clinical and financial risks?
Fellows need to consider how to de-risk an innovation, making it S.A.F.E.R for users to adopt their innovation.
This includes finding ways to Share risk; facilitating Adaption and adoption; gathering Followers and advocates; strengthening the Evidence base; and ensuring adherence to Regulatory requirements.
Expense: Is this innovation affordable and a good use of public funding?
NIA Fellows spend considerable time refining and evolving their business model – considering the cost of their innovation, who pays for it, where savings are realised and when. Innovations that deliver savings directly to the payer (rather than elsewhere in the system) and within a single financial year are, understandably, easier to sell, although also rarer to find.
A critical part of the NIA is to help Fellows develop a detailed understanding of the NHS payment and reimbursement system, and also to strengthen their economic case. NHS staff are highly cost conscious, so having an interactive budget impact model (eg: Imperial College Health Partners’ AF Budget Impact model) for an innovation can be influential, if the assumptions are evidence-based and key parameters can be localised.
Fellows also seek opportunities to reduce cost by further scaling their innovation. Management Systems International, for example, refer to three phases of evidence collection: efficacy, effectiveness and expansion. The latter is the stage at which you determine how to provide the solution on a larger scale, so testing out various adjustments to reduce the unit cost, simplifying the model, and adapting it for different contexts.
Disruption: How much change (time, effort, resource) will this innovation require?
Entrepreneurs need to consider the extent to which their innovation will disrupt existing practices, roles and relationships (particularly between patients and NHS staff). The degree of change required is often directly proportional to the number of people to be convinced before a decision will be taken to adopt an innovation. An innovation that crosses care settings and conditions is likely to face more challenges than a device which is to be implemented within a specified pathway.
Adoptability and spread frameworks (e.g. NASSS) can be extremely helpful in helping innovators to anticipate the challenges they are likely to face, and which need to be addressed within their scaling strategies.
Impact: Is the problem being addressed by this innovation and the expected benefit significant enough?
Communicating the impact of your innovation in a way that is compelling and relevant to patients and NHS staff is critical.
To be successful, this needs to include a clear articulation of the need or problem the innovation is addressing, alongside who benefits (quality and cost), how much and when. If the need or problem is unfamiliar (e.g. a rare disease or uncommon error), Fellows have had to concentrate efforts on amplifying the problem before engaging potential users with their innovative solution.
Furthermore, the power of stories and experiential evidence should not be underestimated when communicating the benefits of an innovation - this kind of evidence can mobilise people’s energy, enthusiasm and frustration into action.
Theory of change: Does the innovation make sense to me and can I communicate it to other users?
Finally, users need to understand the theory of change underpinning an innovation. Potential users tend to be more readily convinced if the inputs, activities and outputs for an innovation are simple and highly intuitive.
We have found that less evidence is required by decision-makers if the workings underpinning an innovation make logical sense. By contrast, Fellows with more complex innovations tend to spend more time testing and perfecting their communication materials and honing their evidence to ensure it clearly demonstrates the innovation’s theory of change.
Successful scaling requires innovators to be open-minded, with an enquiring mind, adaptability, humility and resilience. I am continually in awe of the NIA Fellows battling on, learning and adapting through the complexity of NHS decision-making, striving to make a difference for patients and the NHS.
I am equally inspired by the patients and NHS staff who take a risk on something new, which in the early phases of an innovation’s development must feel like a moderately informed leap of faith. It is the courage of users that brings us the trial sites and early adopters, and also informs Fellows how to scale further to improve and save more lives. Without close working with users and appreciation of their expertise and involvement, an innovation will never sustainably scale.
Find out more here about the NIA's fourth call for applications (the deadline is midnight on 24th October 2018): https://nhsaccelerator.com/apply/
NIA twitter: @nhsaccelerator
About the author
Dr Amanda Begley is UCLPartners Director of Innovation and Implementation & NIA National Director.