Project 2.3 Work Organisation, Lifelong Learning and Employee-driven Innovation in the Health Sector

Project 2.3 Work Organisation, Lifelong Learning and Employee-driven Innovation in the Health Sector

Project Name: Project 2.3 Work Organisation, Lifelong Learning and Employee-driven Innovation in the Health Sector
Project Leader:
Alison Fuller, Susan Halford, Kate Lyle and Rebecca Taylor
Other Project Team Members:
Project 2.3 Work Organisation, Lifelong Learning and Employee-driven Innovation in the Health Sector

Project Details

Our research helps to understand how the latent capacity of the healthcare workforce can be turned into innovations that change people's lives.

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.

Research findings

Project publications:

Lyle, K., Fuller, A. and Halford, S. ‘Work organisation, lifelong learning and employee-driven innovation in the healthcare sector’, Employee-driven Innovation, LLAKES Research Seminar, 5 February 2014, UCL Institute of Education, London

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, 25-27 June 2014, University of Stirling, Scotland.

Fuller, A. 'Working and Learning for Innovation in Health care: New organisational forms and practices in Homeless Health', AERA, 16-20 April 2015, Chicago.

Fuller, A. 'Working and Learning for Healthcare Innovation: New ways of practising healthcare for homeless people', Researching Work and Learning (RWL), Dec 2015, Singapore.

Taylor, R., Fuller, A., Halford, S., Lyle, K. & Teglboorg, A. 'Organising Innovation in Healthcare: the creative practices of everyday bricoleurs', MedSoc Conference, 9-11 September 2015, University of York, York.

Taylor, R., Fuller, A., Halford. S, & Lyle, K. ‘Organizing Innovation in Healthcare: The Creative Practices of Everyday Bricoleurs’ Paper presented by co-author Rebecca Taylor at the British Sociological Association Annual Conference, 2016, Birmingham.

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. Human Resource Management, Innovation and Performance.

Fuller, A. 'The importance of a "cause": understanding professional working and learning for innovation in the Healthcare sector', LLAKES Research Seminar, 11 April 2017, UCL Institute of Education, London.

Fuller, A. 'Innovating for a cause, emergent processes in healthcare for homeless people', Ninth International Symposium on Process Organization Studies, June 2017, Kos, Greece.

Taylor, R. Fuller, A. Halford, S. Lyle, K. & Teglborg, A. 'Translating employee driven innovations in healthcare:  The creative practices of everyday bricoleurs' presented at 33rd EGOS Colloquiem, July 2017, Copenhagen - Sub-theme 68: Dynamics of Practices, Knowledge and Work in Healthcare Organizations.

Fuller, A. 'Organising for a Cause: The work and learning required to create innovative healthcare for disadvantaged groups', Keynote at 18th International Conference on Knowledge, Culture and Change in Organisations, March 2018, University of Konstanz, Germany.

Fuller, A., Halford, S., Lyle, K., Taylor, R. and Teglborg, A. (2018) Innovating for a cause: the work and learning required to create a new approach to healthcare for homeless people. Journal of Education and Work

Fuller, A., 'Employee-led innovation: a case study in healthcare for homeless people' presented at a Queens Nursing Institute Learning Event called 'Improving Health through innovation: better care for people experiencing homelessness', 27 April 2018, QNI, Bristol.

Fuller, A., Halford, S., Lyle, K., Taylor, R. and Teglborg, A. (2018) 'Innovating for a cause: The work and learning required to create a new approach to healthcare for homeless people' Paper presented by Alison Fuller at , 13-15 June 2018, Oslo, Norway.

Halford, S., Fuller, F., Lyle, K and Taylor, R. (2018) Organizing Health Inequalities?  Employee-Driven Innovation and the Transformation of Care. Sociological Research Online

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:

Photographs from the symposium are available at: 

We develiped a policy briefing based on the discussions from the symposium that details practical strategies to encourage, support and sustain change available here: