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For an innovation to reach its full potential impact, clinicians, providers, commissioners and patients must decide to adopt it.
This means changing behaviour from the status quo and potentially stopping previous practice. Persuading decision makers to take a risk on a new innovation, and simply to make the time to consider it within the whirlwind of their busy day jobs, is a challenge.
So, what’s needed to help someone decide to adopt an innovation?
Evidence is critical – albeit not sufficient on its own. Taking a risk on something new requires data that reassures and convinces. But the role of evidence to support the scaling of an innovation is not a simple one.
For every Randomised Controlled Trial (RCT) that has created buy-in, there are examples of personal patient stories unlocking commitment, as well as hard data that has failed to mobilise any change. Innovators often plough a huge amount of resource into evaluation and evidence production, but it does not always translate into meaningful change.
In this challenging context, NHS Innovation Accelerator (NIA) Fellows are working hard to scale their innovations. And they’re having great success. Since the NIA launched in July 2015, 469 additional NHS commissioners and providers have adopted NIA innovations.
Innovations that NIA Fellows are scaling are diverse. Some are technical devices that improve existing practice, like PneuX Pneumonia Prevention System. Others offer care that was not previously available, like Sleepio’s digital sleep improvement programme.
Depending on the nature of the innovation, Fellows face different ‘evidence thresholds’ from the key decision makers they work with. The more an innovation differs from existing practice, the more complicated its theory of change, the more components it encompasses and the more invasive; the greater the volume of evidence that is typically required by decision makers to reassure them that adopting the innovation does not entail unwarranted risk.
Despite this variation, there is much in common as to what Fellows are learning about how to develop and use evidence effectively.
Fellows’ experiences offer three key insights…
Evidence is a tool that helps people decide to invest public money and/or time in adopting an innovation. Every decision requires the weighing up of significant opportunity costs when time and money resources are extremely limited and demands are high.
When considered in this light, it’s clear that the way innovators develop and deploy evidence must be grounded in the context within which decision makers for their innovation operate.
What is the greatest problem the decision maker is trying to solve? What is their local context, and how does this relate to national issues? What do they need to know? What might their concerns be? What level of risk will they be carrying?
With these questions in mind, an innovator can deploy the most relevant information from their evidence toolkit to respond to the decision maker’s most important questions and priorities.
Often we talk of the need for quality evidence, perhaps marked by an ‘independent’ evaluation, giving a stamp of approval. But the quality of evidence for mobilising action comes through how compelling the evidence is, as well as how rigorous.
For example, Mark Campbell, Associate Director at NICE, in a recent presentation to NIA Fellows, talked about the ‘wow’ factor, whereby adopters may consider lowering the evidence threshold when the theory of change and narrative around an innovation’s impact are highly persuasive.
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.
Often, the responsibility for producing evidence that proves an innovation’s impact is given to innovators. In fact, collecting evidence must be a shared endeavour between adopters and those scaling an innovation – both can benefit from being able to articulate the work and its impact.
Finally, if evidence must be personal and compelling, an innovator’s best intel’ is those that have already adopted it. Working with them to consider retrospectively what their biggest challenges were, what they would have found most persuasive about what they now know the innovation has to offer, and why they would recommend the innovation to others, helps innovators to understand what the most powerful messages are for future potential adopters.
It’s clear that evidence plays a critical role in scaling innovation, and that evidence alone is not enough – how evidence is gathered, presented and communicated is key.