Innovating for improved healthcare: Sociotechnical and innovation systems perspectives and lessons from the NHS

Abstract

Healthcare systems with limited resources face rising demand pressures. Healthcare decision-makers increasingly recognise the potential of innovation to help respond to this challenge and to support high-quality care. However, comprehensive and actionable evidence on how to realise this potential is lacking. We adopt sociotechnical systems and innovation systems theoretical perspectives to examine conditions that can support and sustain innovating healthcare systems. We use primary data focussing on England (with 670 contributions over time) and triangulate findings against globally-relevant literature. We discuss the complexity of factors influencing an innovating healthcare system’s ability to support the development and uptake of innovations and share practical learning about changes in policy, culture, and behaviour that could support system improvement. Three themes are examined in detail: skills, capabilities, and leadership; motivations and accountabilities; and collaboration and coordination. We also contribute to advancing applications of sociotechnical systems thinking to major societal transformation challenges.

The ELIAS framework: A prescription for innovation and change

“…Nevertheless, there are occasions when disruptive innovations demonstrate major gains in effectiveness and efficiency for patients and providers. 7,[13][14][15][16] Innovations are accepted and diffused if they can demonstrate relative advantage over previous practice; there is a fit between the innovation and current culture; the benefits can be easily tried and observed under local contexts, and there are organizational networks for spreading the innovation. [13][14][15]17,18 A learning organization can be described as one that continuously creates, acquires, and routinizes knowledge and modifies its behaviour to reflect the new knowledge.…”

“…The characteristics of a learning and innovation culture are outlined in Table 1. 3,9,[11][12][13][14][15][16][17][18][19][20] The ELIAS performance management framework…”

“…[23][24][25][26][27] Disconfirmation of the processes and activities designed to achieve the outcomes of programs and services being assessed is an important step in the framework. [10][11][12][13][14][15][16][28][29][30] This leads to a search for solutions and innovations and then testing them within the organization's context to improve performance (contextualization). This process is an important source of learning and innovation.…”

“…The search for and testing of solutions generates knowledge, learning, and innovation that is reflected in modified processes or new innovations. 8,10,14,19,20…”

“…15,[30][31][32][33] In addition, people charged with performing the new tasks must feel a sense of efficacy in their capability to successfully perform them. 14,19,30,31,33 Management can enhance this perception by providing the necessary training, resources, and support for performing the new behaviors for successful implementation of the innovation. It is also important for management to show those who will be affected by the change that they will benefit directly and indirectly from it.…”