Catalysing health information technology innovation in the National Health Service

Introduction

Innovation strategy is now high on political agendas globally as part of efforts to drive economic development, maintain international competitiveness and address existing global challenges. ¹ Healthcare presents a particularly fruitful area for such activity and there continue to be major international investments in innovations in health information technology. This is particularly timely in light of the recently published Wachter review setting the future direction for health information technology strategy in the NHS. ²

However, UK healthcare is still lagging behind many other economically developed countries and industries in terms of digital innovation.^3,4 This is, at least in part, due to the divide between NHS providers and innovators. While healthcare has no shortage of ‘pain points’ and an increasing array of technological solutions are becoming available daily, more concerted efforts, identifying which problems are most pressing and which solutions are most promising in what context, are urgently needed. In attempting to explore how information technology innovation in the UK can be catalysed, we here discuss three key lines of investigation that, we believe, can help to address this issue.

Systematically investigating the factors that contribute to ‘successful’ innovations

Identifying social and technical facilitators associated with ‘successful’ digital innovations (e.g. effective leadership and usability) is an important means to promote transferability of solutions across contexts and help design systems that are accepted by users and useful for organisations. These efforts should be guided by critical reflection, including an assessment of what factors make an innovation ‘successful’ to which group of stakeholders and how best to learn from ‘failure’. There are, for instance, many examples of organisational initiatives that were retrospectively judged as ‘successful’ or ‘unsuccessful’ without considering more subtle/indirect implications of innovation efforts (e.g. capacity development). These are often best conceptualised as a process whereby learning from perceived ‘failures’ is instrumental in developing new solutions – if, for example, technology does not address a clinical problem, this may help to identify which features can do so. This learning process can be accelerated by encouraging bottom-up innovations (i.e. those that stem from real-world problems experienced by frontline healthcare workers), experiences in international settings who are likely to face similar problems and other industries that have developed workable innovations within their respective settings. Such efforts should also involve examining unanticipated consequences of particular applications (e.g. effects on workloads) and how these could be anticipated/mitigated in advance. Major funders are increasingly recognising the importance of these issues, including for example, the Commonwealth Fund’s International Health Policy and Practice Innovations program, which focuses on exploring how healthcare innovations may be transferred across countries and how lessons learned may be most effectively disseminated.

Identifying which innovations have the potential to scale across the NHS

There is also a need to examine factors that determine the likelihood of an innovation scaling-up and diffusing across healthcare settings and systems. This may involve retrospectively investigating the most ‘successful’ innovations in more detail and explore how they have evolved and diffused over time and space. Drawing on existing theoretical work in other sectors may be beneficial in this respect. For example, the Multi-Level Model can help to identify emerging technologies as niches and explore which factors make a niche technology become mainstream. ⁵

Work surrounding the scaling of innovations will also require collaboration across sectors and international settings, as innovations now rarely remain within the constraints of geographical borders but get adapted and/or improved to suit local settings. A good example of activity in this domain is the World Innovation Summit for Health, which has a particular interest in how innovations can scale through global research partnerships.

Fostering socio-political environments that promote innovation in health information technology

Innovation climates are instrumental in promoting innovative activity and outputs. ⁶ These can consist of a range of structural and functional factors that should be part and parcel of efforts to catalyse digital innovation. Structural means to facilitate the creation of innovative environments include the development of facilities that encourage interdisciplinary collaboration and promote acceleration of the most promising ideas. International innovation hubs and labs such as the Harvard iLab and the Centre for Global eHealth Innovation are good examples and also often include simulation facilities that create safe spaces for trying out new technologies and ways of working. Similarly, the Stanford Clinical Excellence Research Center facilitates the creation of innovative care designs through promoting collaboration between researchers from medicine, engineering, social sciences and business sectors. Functional efforts may include the creation of organisational or wider incentives (e.g. tax incentives and rewards for innovators) organisational initiatives to stimulate ideas (e.g. hackathons, sandpit events), and the establishment of new roles that help to create environments that allow innovation to flourish (e.g. chief innovation officers and innovation fellowships).

Conclusions

Digital innovation will be instrumental in driving forward health and wealth agendas in the UK and globally. Of particular concern is that the UK is in need of concerted efforts in this area in order to help channel the very substantial funding the NHS now faces. Future work should be characterised by the NHS systematically identifying the features of ‘successful’ innovations, assessing their transferability and scalability, and by creating innovative environments that promote scalable solutions. ⁷ Such work should also involve targeted cataloguing of current ‘pain points’ and developing innovations that help to address these. We have provided a starting point as to how strategic approaches to catalysing digital innovation may be conceptualised and hope that this will help to stimulate debate surrounding this important area.