A case study on addressing challenges in healthcare delivery in Mid and South Essex through implementing a unified innovation programme and embedding a frontline innovation culture.
Themes: Culture, Partnership Working
Case study summary
Mid and South Essex NHS Foundation Trust have led work to develop a unified local innovation ecosystem and innovation culture, to encourage new ideas, support organisational development, and support innovators to collaborate and build on local needs and assets.
What was the problem or opportunity?
The trust set out an ambition for innovation in 2017, and a strategy and vision for innovation was developed and embedded in the Mid & South Essex Health and Care Partnership (HCP) 5-year Strategy and delivery plan.
The HCP which comprises key NHS and Local Authority organisations covering the Mid & South Essex area which draws in external expertise through two local Academic Health Science Networks (AHSNs) to encourage innovation and collaboration, build on local needs and assets and supporting innovators to improve outcomes in the area. Since 2018 with no initial budget for the programme, they have developed a systemwide, unified Innovation Programme with clinical leadership, and dedicated project resource, supporting 24 Innovation Fellows, with inward investment of over £5.6m to date.
How did this support innovation adoption and spread?
In 2015, Mid & South Essex were identified as one of the most challenged health and care economies in England, with designation as one of NHS England’s ‘Success Regimes’. The challenges included:
- no clear route for staff to bring ideas forward
- limited awareness of who was testing what
- no safety net to support failure; and
- identifying the local need.
The NHS trusts in the area came together to form a group of trusts and pooled their resources to support transformation, improvement and change during 2016/7. Developing the shared approach and wanting to develop new models of care for the future that were clinically led and sustainable, the hospital group’s solutions included developing a unified Innovation Programme comprising the following:
- Starting with partnership – learning from others in the HCP and bringing in expertise from AHSNs, the Innovation Unit, local MedTech accelerators, and advice from test bed Care City in East London.
- Intentional leadership – developing a strategy and vision for innovation and embedding this in the partnership strategy and delivery plan.
- Incentivising innovation – by developing an agreement for working with industry, ensuring governance provides a safety net for innovation, and working as a partner in the Clinical Entrepreneur Programme to provide a safe test-bed environment for innovation.
- Aligning with other enabling functions – aligning priorities and developing relationships, and bringing together the innovation programme with key workforce and clinical services change programmes like outpatients, health inequalities and the Anchor Institution programme as well as MSE’s Strategy Unit evaluation and insight function, to promote collaboration.
- Building a pathway to support innovation – launching an innovation fellowship and encouraging staff to bring new ideas forward with a clear route for them.
- Challenges based on local needs – understanding the needs of local services and providing broad areas for innovators to focus on e.g. patient safety, supporting self-care.
- Providing wraparound support for innovators – including networking, mentoring, learning sessions and governance support often in very practical ways as well as slowly shifting cultural barriers.
How were patients and the public involved?
The Innovation Programme is co-produced with a full partnership which includes governors, the voluntary sector and patient partners. Patients and members of the public were part of all selection panels for the Innovation Fellowship. Local community engagement partners help to prioritise system resources to impactful innovation, relevant to community needs.
What were the results?
In developing an environment that encourages innovation, MSE are seeing significant skills transfers and idea generation between staff and Innovation Fellows. This is seeding major change and influencing the ambition and decision-making of the organisation. People across the HCP have begun to ask if MSE has an innovation fellow who can find a solution, rather than looking for fully formed ideas.
Three distinctive features have driven an approach to innovation that is both evolutionary and revolutionary, delivering impact for the Mid and South Essex system:
- innovation focuses on locally identified need, encouraging bottom-up change and seeing innovation as a team endeavour, that builds organisational capacity, rather than a way to develop individual talent
- the innovation pathway leads to a unique asset-based innovation fellowship; and
- clear leadership and light-touch support provide innovators with safe space.
Mid and South Essex has seen tremendous impact from innovation including a 286% rate of increase in research and innovation. There was also £3.6m worth of R&D funding over the last 8 months in 2021. This has been enriched further with successful funding applications and joint appointments with start-ups in 2021 and 2022. Three apps developed, tested and evaluated in MSE (Shift partner, IBDoc and the Maternity Direct App) were finalists/highly commended in three different categories of the HSJ Value Awards 2021. MSE has also recently been celebrated for its innovative approach to outpatient care in a partnership with e-Consult. The impact of these innovations has been substantial locally:
- 79% of the users of the Maternity Direct app which has been in use in 3 maternity units since 2019 have said it prevented them needing to access other services.
- Using the IBDoc has increased the engagement from both the patients and the clinical team, and the speed of the results makes a big impact in decision making, personalised care and self-management.
- Shift Partner a staff shift booking app has been converted to a market ready product sold to other Trusts with a profit share agreement, and over 100 primary care locations.
What were the learning points?
MSE FT committed “to make innovation a strategic objective, building on the strength of our group and partnership.” Emphasis was placed on both taking advantage of opportunities to innovate by connecting entrepreneurs with services, as well as supporting MSE staff to innovate. Aligning incentives with enabling functions provided a safety net for innovators without unnecessary complexity. Early efforts focused on developing relationships and alignment of priorities to enable quality improvement and organisational development. Cross pollination and collaboration helped other local programmes. A bottom up understanding of local needs and an acknowledgement that staff were already creating their own workarounds to existing problems, was also important.
Key points of learning included the importance of the following elements of the programme:
- developing a vision and strategy for innovation which builds clearly onto broader strategies
- developing a case for change that describes both the future you want to create and why things need to change
- establishing key priorities which have aligned time and resources with a dedicated innovation budget
- running a staged selection process to ensure innovations that are supported have merit and are aligned to key priorities, with a balance of early stage ideas and more developed innovations
- building an innovation function that can run these processes, nurtures communities of practice (innovators) and communities of engagement (potential adopters), providing toolkits, sourcing funding, measuring impact and sharing learning.
This fellowship has been evaluated by the MSE Strategy Unit as well as the evaluation of a number of the individual products. An innovation impact evaluation framework was also developed, as MSE is a learning system and keen to be driven by evidence.
A key learning point for MSE has been the importance of innovators spending time in services and alongside teams – having this access was a core aspect of the Fellowship and helped to increase uptake of trails and tests of new ideas, as well as ensuring they were targeted to service needs.
Another valuable learning point for MSE has been the similarity in values and skills between industry and the NHS, and this has evolved into a Ways of Working with industry approach in MSE which helps reduce stigma and barriers to helping NHS and non-NHS partners solve problems together.
Executive sponsorship and a clear approach to testing and evaluation which is separate from investment decisions and procurement has been vital in MSE to move at pace and be clear about commitments and boundaries on all sides. However, being nimble with procurement approaches is useful when the opportunity to collaborate arises, or products are market-ready and there is an aligned service need. To enable this MSE has developed a dynamic purchasing system for working with smaller enterprises and entrepreneurs.
Next steps and sustainability
The MSE innovation Fellowship has just closed for its third intake, with the highest number of applications ever, so this continues with a focus on health inequality, children, and young people’s mental health, and supporting the health and care workforce. MSE is also the hub site for the new AAC-led Clinical Entrepreneur InSites Programme, working to adopt a similar approach to MSE Innovation in 9 other sites across England.