Opinion Piece: Combinatorial innovation and collaboration: the key to successfully embedding new technologies in the NHS?

John Craig, Chief Executive of Care City Test Bed, highlights the successes of ‘combinatorial innovation’ and why collaboration is king when it comes to embedding new technologies and services into whole systems and pathways.

You cannot admit to many people that you are obsessed with public sector innovation before one tells you, ‘it’s a contradiction in terms’. I am always ready for them. From the eradication of smallpox to the creation of the internet to the moon landings, all the greatest innovations are public sector innovations.

But, the truth is, it is not that simple. All the great innovations like these really came from collaborations that crossed every sector of society. To do our best work, humanity has to work together.

Engaging in real-world testing

In the discourse about health innovation, there has been a related shift in emphasis this year, from ‘push’ to ‘pull’.

From the Nuffield Trust to The King’s Fund to The Health Foundation, researchers have argued that supporting innovation is less about helping innovators to make even smarter, glitzier pitches and a bit more about helping hard-pressed leaders and clinicians to work with them.

At the very least, customers need time to engage with complex products, but there is more to it than that. A focus on integrated care – and of course efficiency – means that products and services are judged as much by their fit with wider systems as their stand-alone performance. Innovators’ expertise has to stretch beyond their offering to implications for workforce development, governance and system change. For clinicians, more than ever, adoption is a creative act (and a time-consuming one!). Few innovations worth having will be ‘plug-and-play’. As a result, innovators need to engage in ‘real-world testing’, to ensure they deeply understand adoption and benefits realisation.

Combinatorial innovation

At Care City, our NHS England/Office for Life Sciences Test Bed has absolutely emphasised this kind of collaboration between people from different sectors. The result – at its best – has been what NHS England call ‘combinatorial innovation’ – translating ideas and gadgets that are brilliant in their own right into whole systems and pathways that deliver better outcomes and experiences and lower costs. As I am fond of saying, in most cases in our programme, the clinicians have done more innovating than the ‘innovators’.

Interestingly, Fellows on the NHS Innovation Accelerator (NIA) have benefited from this approach most of all. AliveCor worked with us – and with Barts Health, Waltham Forest CCG and the North-East London Local Pharmaceutical Committee – to develop a new kind of AF pathway. We placed Alivecor’s Kardia Mobile in twenty community pharmacies, enabling rapid referral directly to Barts, remote screening and a one-stop AF clinic within a fortnight to confirm diagnosis and begin anti-coagulation. We are now working with the Provider Alliance for Barking & Dagenham, Havering and Redbridge to learn from this work, transforming the AF pathway across our locality.

Similarly, HealthUnlocked worked with us to embed their capability within primary care, working with GPs to develop a social prescribing plug-in for EMIS, which generates personalised social prescriptions quickly and easily. Thirteen practices have issued 800 social prescriptions over the last six months, the system is being scaled across Barking & Dagenham and conversations with other boroughs continue.

Reflections on success

I have two reflections on these success stories. First, Oscar Wilde said: ‘If one could only teach the English how to talk, and the Irish how to listen, society here would be quite civilized’. This may also be true of innovators and clinicians. What really impressed us about Alivecor and HealthUnlocked is that they were never ‘pitching’ – they spent time and energy listening to their customers to better understand their products potential, and the listening paid off.

Second, if we are moving past the ‘private sector good, public sector bad’ phase of thinking about health innovation. We can acknowledge that – where problems do exist in our health and care system – they are hard, complex problems, and the bar one must clear to really make a difference to them is a high one, and even then it will require sustained, collaborative effort. In that context, a programme of the quality of the NIA is important for clinicians and leaders, in identifying people with whom it will genuinely be a delight to collaborate.

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