This project explores innovation and learning within the healthcare workforce. We are seeing increasing demands on healthcare provision in England & Wales, at a time when there is strong pressure to contain funding. Top-down measures to reform healthcare have not brought the expected gains in efficiency and it is now widely recognised that the most innovative and sustainable solutions may lie with the expertise and daily practice of employees and staff across the sector.
Despite this perceived role for the workforce, there is little evidence about where and how bottom-up innovation happens. We studied examples of employee driven innovation to understand the conditions that facilitate and impede innovation, focussing on three case studies in different areas of expertise, operating across primary and acute care and beyond in the third sector. This project used a qualitative methodology, focusing on participant observations and interviews with employees.
The research was supported by an Advisory Forum involving representatives from a range of policy, professional and practice organisations including: The Department of Health, the British Medical Association, The Nursing and Midwifery Council, The Royal College of Nursing, Skills for Health, General Medical Council, and Health Education England
Our study links to other projects being proposed in the ‘work strand’, particularly those on inter-professional learning in the creative and cultural sector, innovation in sectors) and on the youth labour market.
Lyle, K., Fuller, A. and Halford, S. ‘Work organisation, lifelong learning and employee-driven innovation in the healthcare sector’, Employee-driven Innovation Research Seminar, LLAKES, 5 February 2014
Fuller, A., Halford, S. and Lyle, K. ‘Achieving employee-driven innovation in the healthcare sector: new challenges for professional practice’, presentation to ProPel International Conference, University of Stirling, Scotland, 25-27 June 2014
Fuller, A. 'Working and Learning for Innovation in Health care: New organisational forms and practices in Homeless Health', AERA, Chicago, 16-20 April 2015
Fuller, A. 'Organising Innovation in Healthcare: the creative practices of everyday bricoleurs', MedSoc, University of York, 9-11 September 2015
Fuller, A. 'Working and Learning for Healthcare Innovation: New ways of practising healthcare for homeless people', Researching Work and Learning (RWL) Singapore Dec 2015
Fuller, A. 'The importance of a "cause": understanding professional working and learning for innovation in the Healthcare sector', LLAKES Research Seminar, 11 April 2017
Fuller, A. 'Innovating for a cause, emergent processes in healthcare for homeless people', Ninth International Symposium on Process Organization Studies , June 2017, (Kos, Greece)
Fuller, A. 'Translating employee driven innovations in healthcare: the creative practices of everyday bricoleurs,' 33rd EGOS Colloquiem July 2017 (Copenhagen)
Challenging the status quo: new structures and practices
Our case studies demonstrate the value of employee driven innovation: frontline healthcare professionals have a unique capacity to innovate in service delivery, grounded in their experiential understanding of both patient needs and the organisation and delivery of healthcare. However, we also saw how challenging it is for employees to translate their knowledge and insights into changes in organisational practice, especially within a large and highly regulated bureaucracy like the NHS. Initiatives often met internal resistance and staff faced difficulties in accessing the necessary resources to implement new ways of working. Some found they could only initiate and sustain innovation by operating at the edges of NHS organisational structures, or even by creating entirely new organisations, working practices and job roles. It is difficult to embed resources and managerial support for high quality innovations – even those with enormous potential to improve patient care and save money. Innovations are, by their very nature, new ways of working towards previously unachieved outcomes, yet they must conform to standardised regulatory and evaluative processes which prioritise metrics and criteria that do not capture the aims of these innovations.
Initiating and embedding innovation: harnessing workforce expertise
Our research findings suggest that employee driven innovation is initiated by distinctive groups of staff, who have identified a clear weakness in services for disadvantaged or vulnerable patient groups. It is often, but not always, doctors who have access to the necessary resources, and the power and expertise to mobilise them in support of their ‘cause’. However, these innovations were only embedded in practice because they were facilitated by a wider group of supportive colleagues, harnessing the skills of an extensive network of expertise and knowledge. If employee driven innovation is to change the NHS, then we need more thought and pro-active attention to how we can engage the expertise of the full range of clinical and non-clinical staff, and facilitate the development of integrated teams.
Employee Driven Innovation in Healthcare Symposium
On 9 June 2016 we held a symposium to present the results of our research and discuss the policy implications with leading experts and practitioners in the field. The event had a diverse audience with representatives from a range of NHS Trusts, commissioning groups, public bodies, and educational institutions, and featured two expert panels including:
Stephanie Aiken, Deputy Director of Nursing, Royal College of Nursing
Kath Checkland, Professor of Health Policy and Primary Care, University of Manchester
Dan Hopewell, Director of Knowledge and Innovation, Bromley By Bow Centre
Ian Wheeler, Head of Research and Evaluation, Skills for Health
Karen Deeny, Head of Staff Experience, NHS England
Ann Griffin, Academic Lead for Quality, UCL Medical School
Nigel Hewett, Medical Director, Pathway
Raj Jethwa, Head of Public Health and Healthcare Delivery, British Medical Association
The research briefing published for the event can be found here: http://bit.ly/IHC0606P.
Photographs from the symposium are available at: http://bit.ly/IHCPhotosGD.
We are currently developing a policy briefing based on the discussions from the symposium that will detail practical strategies to encourage, support and sustain change. The report will be posted here when available.
Fuller, A. (2016) 'Applying an Apprenticeship Approach to HRD: Why the concepts of occupation, identity, and the organisation of workplace learning still matter'. In Shipton, H. (2016) Human Resource Management, Innovation and Performance.